joint pain
Introduction
Introduction to joint pain Joint pain is caused by the joint itself or systemic disease. Joint pain belongs to the natural damage and aging of articular cartilage. Cartilage is a substance that is arranged along the joints. It prevents the ends of the bones from rubbing against each other and allows the joints to move freely under the condition of full joint fluid. When people grow old, the cartilage of the human body is worn out, the bones are exposed, and the joints and joints of the fingers, knees, neck, etc. are painful, swollen, stiff (morning stiff) and squeaking when they are rubbed together. In addition, as the body ages, the body's ability to produce type II bone collagen (collagen) and glucose aminoglycans is also declining. Only by directly supplementing type II bone collagen (collagen) and calcium can it be continuously restored. Reconstruction, regeneration of articular cartilage tissue and pedicle tissue to prevent its degradation, maintain its integrity, and rebuild the bone essence so that the joints are no longer painful due to active friction. Common joint pain, where rheumatism is mostly migratory, and some have mild redness and swelling. If the treatment is not timely, it often invades the heart, and later develops into rheumatic heart disease. For rheumatoid, hands, wrists, The joints of the ankle and toe are the most affected. The joints are red, swollen, hot and painful. When they develop to the advanced stage, the joints are deformed and stiff until the serious obstacles. The age of onset is 20 to 45 years old, and women are 3 times higher than men. Anyone who has traumatic (twisting, frustrating, falling, hitting, touching, etc.) hits the joint, the skin of the light is red and swollen, and the severe one can cause ligament tear and joint. Dislocation or even fracture, rupture, this injury can bring severe joint pain to the injured, all systemic fever, infection or connective tissue disease, can affect, affect the joints, often cause joint and muscle pain. Rheumatic joint pain, have analgesic, swelling, and blood circulation. basic knowledge Proportion of disease: the incidence rate is 0.1%-0.2% Susceptible people: good for women aged 20 to 45 Mode of infection: non-infectious Complications: gout swelling
Cause
Cause of joint pain
Infectious arthritis (20%):
A variety of bacteria can cause infection by directly infecting and spreading the infection pathway through blood infection. The most common bacteria are Staphylococcus aureus, which accounts for about 25% of 50% streptococci. Others such as gonorrhea, pneumococcal meningococcus, Pseudomonas aeruginosa, and typhoid bacillus can also cause infection. Special infections include syphilis, Mycobacterium tuberculosis. Aspirin and so on. Caused by viral mycoplasma and fungal infections. It is rare to note that arthritic lesions are caused by the fact that some bacteria directly damage the tissue structure inside the joint and cause arthritis. In some cases, after bacteria or viruses invade the human body, bacterial toxins or broken bacteria can be used as specific antigens to cause sensitization to cause various allergic diseases. Such arthritis can not be cultured by joint exudate. The synovial membrane does show hyperemia, edema, inflammatory cell infiltration, and even the pathological examination of the synovial membrane, it is difficult to obtain specific lesions.
Metabolic joint disease (18%):
The most common form of metabolic joint disease is gouty arthritis. Uric acid is a product of sputum and nucleic acid decomposition. About 2/3 of uric acid is excreted by the kidney, and its discharge is related to the concentration of uric acid and the ability of renal tubules to secrete. Chinese adults daily uric acid excreted by the kidney is about 210mg, and the remaining l/3 is excreted by the digestive tract when endogenous uric acid is produced too much, exogenous uric acid is taken too much and uric acid excretion is reduced, so that the uric acid concentration in the blood Increased blood uric acid concentration above 476umol / L, urate can be deposited in the joint capsule, cartilage bone cancellous bone, kidney and subcutaneous tissue, causing tissue damage inflammatory changes and foreign body reaction, local urate deposition Many become tore. Calcium pyrophosphate deposits in the articular cartilage membrane calcification, also known as pseudo-gout, this family has a family genetic characteristics more common in the elderly, sebaceous calcium phosphate crystals can be detected in the joint fluid.
Ochronotic arthritis is an inherited metabolic disease. Due to the lack of urinary acid oxidase in the liver of patients, it cannot continue to oxidize and decompose urinary acid, so that a large amount of uric acid is excreted from the urine. It is deposited in various tissues and organs, and browning arthritis occurs.
Proliferative osteoarthritis (15%):
Hypertrophic arthritis (hypertrophicarthritis), also known as degenerative or senile arthritis, is also known as osteoarthritis or osteoarthrosis. But some are still accustomed to using proliferative arthritis. According to the presence or absence of local causes, the disease can be divided into primary and secondary.
1. The incidence of primary proliferative arthritis is often affected by age, heredity, constitution and metabolism. The age has two effects on the disease: one is the accumulation of cartilage wear during joint activities, and the other is the elderly. The content of the part of the cartilage matrix is reduced, the fiber component increases the toughness of the cartilage, and it is susceptible to mechanical damage and degenerative changes.
2. Secondary proliferative arthritis This type is more common in the clinic, often secondary to joint deformity, joint damage after joint inflammation. Congenital or acquired joint deformities, such as scoliosis and kyphosis, can cause four sides of the bone hyperplasia; knee varus * over skeletal joint disease, multiple skeletal dysplasia, exfoliative osteochondritis joint free body, half a month Plate injury, fracture of the cruciate ligament and intra-articular fractures are the causes of secondary lesions.
Structural disorders around the joints (10%):
Many joint pains are structures around the joints caused by structural damage around the joints, such as joint capsules, bursal muscles, muscle muscles, and connective tissue of the bile sheath fascia. They can cause inflammatory lesions themselves, and can also produce chronic diseases. Common injuries such as stenosis tenosynovitis, chronic bursitis, ligament strain, sphincter cyst, periarthritis of the shoulder, wrist tube syndrome, anti-extralateral epicondylitis, etc., these lesions can lead to joints pain.
Drug-induced joint disease (10%):
Joint and intramuscular pain can sometimes be caused or promoted by drugs.
1. Acute gout can be caused by oral diuretics (intramuscular injection of mercury sulphate, or by uric acid excretion drug (hydroxybenzene sulfonamide, phenyl sulfonone). Other sources of sterol have the same effect in early treatment. Treatment of radioactive phosphorus used in primary polycythemia, cytotoxic drugs for the treatment of chronic leukemia can promote acute gout attacks.
2. High-dose application of iron glucan: can make the symptoms of rheumatoid arthritis worse. Under normal circumstances, this medicine has different degrees of joint pain symptoms.
3. Repeated injection of corticosteroids in the joints: can cause destructive changes in articular cartilage, leading to joint pain.
4. In some rare cases, taking barbiturate can cause joint pain called barbiturate rheumatism.
5. Long-term application of corticosteroids in large doses can induce necrosis of the femoral head and cause myal joint pain. Long-term application of corticosteroids can cause joint pain called corticosteroid pseudorheumatic disease. It can be seen that there are many drugs that can cause joint pain. Therefore, when the cause of joint pain or arthritis is unknown, try to stop giving the patient any non-essential drugs.
Other arthritis (20%):
1. Endocrine aspect Because pituitary adenoma can cause chronic excessive secretion of growth hormone, the head, hand and foot bones of adults are enlarged, that is, acromegaly. Due to the thickening of the synovial membrane and the epiphysis, the joints may be exuded, and some patients may have intermittent joint pain, which is generally seen in the knuckle spine and knee joint. Hyperthyroidism, most of which is caused by hyperparathyroidism caused by parathyroid adenoma, which can be divided into three types:
1 bone-derived synovitis;
2 phosphate joint disease; caused by hypercalcemia;
3 Gout is the result of reduced uric acid secretion in the renal tubules. In short, endocrine diseases can cause joint disease.
2. Hematological hemophilic arthropathy is a rare case in the clinic. Hemophilia is a group of gender-related coagulopathy disorders, usually with A, B and C. Type A deficiency factor VII B lacks factor VIII, and type C lacks factor IX. Total A and B type accounts for about 90% of all hemophilia, both of which are transmitted by women. Half of the men suffer from this disease and half of the women are carriers. Therefore, when asking about such a family history of hemophilia, you should ask your brother and uncle whether or not the same patient's right to intra-articular hemorrhage can stimulate the synovial membrane to cause inflammatory reaction.
Swelling, pain. Acute lymphoid 50% of adults develop arthritis with lymphoblastic type, and arthritis can appear earlier than other symptoms. The affected joints are found in the lower extremities. The spine and knee joints are the most common. It is also seen that most of the joints of the marrow, ankle, shoulder, elbow and hand are severely painful.
3. Gastroenterology About 10% of patients with ulcerative colitis develop arthritis. Most of the joint diseases occur within a few years after the onset of colitis, while patients with a wide range of ulcers are more common. 10% of arthritis occurs in the intestines. Before the symptoms. Most of the knee and ankle involvement are asymmetrical, and they can also be migratory. Only 4% of Crohn's disease complicated with arthritis is associated with ulcerative colitis. Patients with chronic active hepatitis have a small number of joint pains, and most of the joint involvement is temporary and mild.
4. Dermatological psoriasis is a common disease, 10% of psoriasis joint disease, arthritis can occur in the face of psoriasis before the occurrence of multiple joints, hand small joints more common. There are three types of arthritis:
1 distal type 25% involving the distal interphalangeal joint;
2 Seronegative recessive type (65%) joint damage is clinically indistinguishable from rheumatoid arthritis;
3 deformation type (10%) can deform the joint and appear claw-like hands.
5. On the tumor side, the tumor at the joint site can cause joint pain first, the proximal end of the cavity bone, and the distal part of the femur is a tumor with good tumors, malignant tumors and tumor-like lesions. Cancer arthritis is caused by cancerous diseases such as bronchial cancer, prostate cancer and breast cancer. The clinical symptoms are similar to those of rheumatoid arthritis, but not cancerous at the bone and joint sites. Transfer.
6. Osteopathic joint pain Aseptic osteonecrosis is also known as ischemic osteonecrosis. This disease can be caused by many conditions, such as traumatic decompression sickness, radioactive injury, long-term use of certain drugs Gaucher disease, hemoglobin disease. Its pathogenesis is related to the anatomy of student mechanics and biophysics. Clinically, there are common femoral head bone marrow necrosis, bone marrow and bone marrow necrosis, bone marrow and bone marrow nodular bone marrow, and bone marrow necrosis can occur. Aseptic necrosis of adult femoral head is also more common. There are many factors, such as femoral neck fracture enough joint dislocation or trauma, high pressure, hyperlipidemia, alcoholism, coagulopathy, long-term use of corticosteroid J embolism, high uric acidemia, high snow disease More than 40 kinds of reports have been reported in cell anemia, arthritis, synovitis, etc. However, some are identified causes, while others are not completely determined. There are many factors that have been discovered but not yet recognized.
7. Intraosseous pressure and intraosseous pressure (intraosseous pressure), also known as intramedullary pressure (intramedullary pressure) or bone marrow pressure (bonmeropressure) refers to the mixed pressure of human blood flow in the marrow cavity. There are many studies on the intraosseous pressure of the knee joint and the intraosseous pressure of the femoral head, talus and talus. Many clinical data have proved that the intraosseous pressure is elevated, which affects the occurrence and development of the bone and joint lesions. Pain in joints can even lead to joint function disorders. There are also many studies demonstrating that increased intra-articular pressure can also lead to bone lesions, which leads to the corresponding factors of joint pain affecting intraosseous pressure: vascular occlusion, most scholars have shown that experimental occlusion of arteries or veins can cause intraosseous pressure. Changes in the nutrient arteries that are ligated or compressed can cause a decrease in intraosseous pressure. When the vein is ligated, the intraosseous pressure can be increased to confirm that the blood flow of the bone is closely related to the intraosseous pressure. After the femoral vein is blocked, the intraosseous pressure is rapidly increased. When the nutritional artery or the femoral artery is blocked, the intraosseous pressure is Significant decline. The comparison of intraosseous pressure and healthy side of the ischemic necrosis of the femoral skull showed that the intraosseous pressure of the former increased. It is believed that ischemic necrosis of the bone is the result of blood supply disorder caused by increased intraosseous pressure. Neurological factors Vasoactive drugs and the like are also factors that can not be ignored in the intraosseous pressure.
Prevention
Joint pain prevention
1. Strengthen exercise and enhance physical fitness
Regular participation in physical exercise, such as health gymnastics, practicing Qigong, Tai Chi, doing radio gymnastics, walking, etc., is of great benefit. Those who insist on physical exercise, the body is strong, the disease resistance is strong, and it is rarely sick. Its ability to resist wind, cold and dampness is much stronger than that of people who have not been physically trained.
2, to avoid wind, cold and damp invasion
Spring is the time when everything is germinated, and it is also a good season for rheumatoid arthritis. Therefore, to prevent cold, rain and damp, the joints should be kept warm, not wearing wet clothes, wet shoes, wet socks, etc. Summer heat, don't be greedy and exposed, drink cold drinks and so on. The autumn climate is dry, but the autumn wind is cool and the weather is getting cold. It is necessary to prevent the cold from invading. Winter winds are biting, and keeping warm is the most important thing.
3, pay attention to work and rest
Eating and drinking are common, and work and rest are the main measures for physical health. Clinically, some patients with rheumatoid arthritis are basically controlled, in the recovery period of the disease, often re-emphasized or relapsed due to fatigue, so work and rest should be combined, activities and rest should be moderate.
4, maintain a normal psychological state
Some patients are induced by the mental stimulation, excessive sorrow, depression, etc.; and after suffering from the disease, emotional fluctuations often make the condition worse. These all suggest that mental (or psychological) factors have a certain impact on the disease. Therefore, maintaining a normal state of mind is important to maintain the normal immune function of the body.
5, prevention and control of infection
Some rheumatoid arthritis develops after suffering from infectious diseases such as tonsillitis, pharyngitis, sinusitis, chronic cholecystitis, and dental caries. It is believed that this is caused by the human body's immune response to the pathogens of these infections. Therefore, it is also important to prevent infection and control infections in the body.
Rheumatoid arthritis is an allergic disease and is one of the main manifestations of rheumatic fever. Most of them are caused by acute fever and joint pain. The typical manifestations are mild or moderate fever, and multiple joint pains. The affected joints are mostly large joints such as knee, ankle, shoulder, elbow and wrist. The disease is often transferred from one joint to another. The lesions are red, swollen, burning, and severe. Some patients also have several joints at the same time. Atypical patients have only joint pain and no other inflammatory manifestations. Acute inflammation is common. Regressed in 2-4 weeks, leaving no sequelae, but often repeated attacks. If rheumatism affects the heart, then myocarditis can occur and even heart valve disease remains.
Common rheumatic diseases are: rheumatism, rheumatoid arthritis, rheumatic cold joint pain, rheumatism, rheumatoid, ankylosing spondylitis, osteoporosis, bone hyperplasia, proliferative arthritis, periarthritis of the shoulder, erythema Lupus, postpartum wind, intractable low back pain, sciatica, Sjogren's syndrome, etc.
6. In daily life, the precautions for rheumatism:
(1) The house to be inhabited should be ventilated and sunny, keeping the air fresh. Do not sleep on the concrete floor and tuyere.
(2) Washing should use warm water, wash your feet before going to bed, it is best to immerse your feet in traditional Chinese medicine to wash the soup, not only can promote the blood circulation of the lower extremities, but also can reduce swelling and pain, in addition to rheumatism.
(3) In the acute or acute stage of rheumatism, there are obvious redness, swelling, heat and pain. It is necessary to stay in bed for 2-3 weeks. Patients with kidney deficiency and lumbar spondylosis should avoid sex life.
(4) When the patient sweats more, he must dry it with a dry towel in time, and the clothes should be replaced in time after sweating to avoid being affected by wind and cold.
(5) Pay attention to keep warm, avoid wind, moisture, overwork and mental stimulation, and prevent colds to reduce the impact of natural factors on the disease.
(6) Patients with rheumatism should follow the doctor's advice on diet, and adjust their diet and taboos.
(7) Rheumatism can participate in some labor-saving daily labor after the disease is controlled, and adhere to physical exercise to enhance physical fitness and improve disease resistance.
(8) Rheumatism patients should maintain a good mental state, treat diseases correctly, and must not be anxious and anxious.
Complication
Joint pain complications Complications, gout swelling
Joint dysfunction.
Symptom
Joint pain symptoms common symptoms joint pain joint swelling
Main symptoms: joint pain is mainly caused by osteoarthritis, rheumatoid arthritis, joint trauma, septic arthritis, tuberculous arthritis and febrile diseases such as joint pain, redness, inflammation and activity, and limited function. . Light people affect activities and sleep due to pain, and severe cases seriously affect labor and life. The above-mentioned diseases causing joint pain, multiple violations, involvement or damage to the knees, marrow, shoulders, elbows, wrists, ankle joints, but also affect the joints of the fingers and toes, no matter which joint is involved, it brings pain to the patient. .
1. Traumatic joint pain: Acute traumatic joint pain often results in damaged joint pain, swelling and dysfunction after trauma. Chronic traumatic arthritis has a clear history of trauma, recurrent joint pain, often induced by excessive activity and weight-bearing and cold weather, and relieved after drug and physical therapy.
2. Septic arthritis: acute onset, systemic poisoning symptoms, early chills, chills and high fever, body temperature up to 39 ° C. The diseased joint is red and swollen. The deeper shoulder and hip joints are less red and swollen. Patients often feel persistent pain in the joints, severe functional disorders, and passive movements in all directions cause severe pain, and patients are often reluctant to move their limbs.
3. Tuberculous arthritis: more common in children and young adults. Negative major activities, multiple muscles and underdeveloped joints are prone to tuberculosis. The spine is the most common, followed by the hip and knee joints. Early symptoms and signs are not obvious. During the activity period, there are often fatigue and low fever, night sweats and loss of appetite. The diseased joints are swollen and painful, but the degree of pain is lighter than that of septic arthritis. Pain worsened after the event. Late joint deformity and dysfunction. If a sinus is formed next to the joint, cheese-like material is often seen to flow out.
4. Rheumatoid arthritis: a sharp onset. Often present after streptococcal infection, more common in the knee, ankle, shoulder and hip joints. The diseased joints are red, swollen and hot, and are migratory. The swelling time is short and disappears quickly. It often disappears within 1 to 6 weeks, leaving no joint stiffness and deformity.
5. Rheumatoid arthritis: more than one joint onset, the first pain in the interphalangeal joint. Following the swelling of the other interphalangeal joints and wrist joints. It can also involve the ankle, knee and hip joints, often symmetrical. The activity of the diseased joint is limited, and there is a sense of stiffness. It is called morning stiffness in the morning. May be accompanied by systemic fever. Muscle atrophy near the advanced lesion joint, articular cartilage hyperplasia and deformity.
6. Degenerative arthritis: Early manifestations of pain in the joints during walking, long standing, and weather changes, and relief after rest. If the affected joint is the metacarpophalangeal and interphalangeal joints, in addition to joint pain, the patient often feels stiff and swollen fingers, and the movement is inconvenient. If the lesion is in the knee joint, it is often accompanied by joint fluid, the skin temperature rises, and there is tenderness at the edge of the joint. In the late stage, the joint pain is aggravated, and it continues to radiate to the other side. The joint has a feeling of friction and there is a sound when it is active. Muscle contracture around the joint is often buckling deformity, and patients often have lameness.
7. Gout is often in drinking, tired or sorghum: after eating, the joints are severely painful, and the local skin is red and swollen. Patients often wake up at night. With the first metatarsophalangeal joint, the toe joint is more common. The ankle, hand, knee, wrist and elbow joints can also be affected. The lesion is self-limiting and sometimes resolves spontaneously within 1 to 2 weeks, but often relapses. In the advanced stage, joint deformity can occur, the skin is ruptured, and the heart is not cured. It often has a white cheese-like secretion.
Examine
Joint pain check
Physical examination
Joint pain should be thoroughly and carefully examined. First of all, it should be a diagnosis, observe whether there are red swelling and swelling in the joints, venous engorgement, sinus tract sinus, muscle atrophy, deformity, etc., combined with palpation, whether the sides are symmetrical, equal length, whether there is joint effusion such as knee joint The floating raft test is a common method of checking joint effusion. Gait is often also an important manifestation of joint disorders such as broken lines, duck gait, jumping gait and paralytic gait, squat gait, etc.; some joint lesions can have joint movements; joints Palpation is the examination of muscle contraction and joint mobility around the joint, and the comparison of limb measurements on both sides is also a part of the diagnosis. There are different special examination methods for different joints, and different examination methods have special significance for the diagnosis of diseases.
Laboratory inspection
Laboratory testing is an indispensable diagnostic step in the diagnosis of joint disease. There are many inspection items, and their clinical significance is different.
1. Rheumatoid factor (RE) is an antibody (autoantibody) that directly opposes natural or denatured gamma globulin. It appears as IgM, IgGIgA immunoglobulin and is specific for the adhesin of the crystallizable part of human IgG. There are many methods for examining rheumatoid factors, but the basic principles are the same. In addition to systemic lupus erythematosus, the positive rates of other joint diseases and joint lesions are lower (<50%), so this experiment is of great significance in differential diagnosis.
Positive rate of other diseases:
1 The positive rate of rheumatic fever and other collagen diseases According to Ziff's report, rheumatic fever is 20%, systemic lupus erythematosus is 23% for nodular arteritis, 21% for systemic sclerosis, and 12% for dermatomyositis. %.
2 The positive rate of non-rheumatic disease, according to Barffeld's report, infectious hepatitis is 20% for subacute endocarditis, 27% for syphilis, 11% for sarcoma, 11% for lenioma, and 4% for leukemia. Multiple myeloma was 4%.
3 The positive rate of ankylosing spondylitis is 10%-20%.
4 The positive rate in the normal population is about 4%.
2. The lupus erythematosus cell test is a phagocytic cell that has taken up denatured nucleoplasm. The phenomenon of lupus erythematosus is divided into two phases. The nuclear protein that appears in the first phase of the nucleus is altered by antinuclear factors. In the second phase, the phagocytosis of destroyed cells or dead cells is also the significance of lupus erythematosus. According to the careful treatment of the test, about 80% of patients with systemic lupus erythematosus can find lupus erythematosus cells. Chronic active hepatitis can be seen in 18% of patients with rheumatoid arthritis, and lupus erythematosus cells are sometimes seen in drug allergies, progressive systemic sclerosis, polyarteritis and dermatophytosis.
3. Erythrocyte sedimentation rate ESR is the simplest and most important means of detecting various rheumatic diseases and inflammatory diseases. ESR can be seen in acute rheumatic fever, acute infection, active tuberculosis rheumatoid arthritis, systemic lupus erythematosus , dermatomyositis malignant tumors and other diseases. Regular examination of erythrocyte sedimentation rate can help to infer the progression of the disease or gradually heal it. It can help in the identification of certain diseases.
4. Anti-streptolysin "O" test, such as anti-streptolysin "O" titer up to 500U or more, indicating that patients have recently infected with hemolytic streptococcus, commonly used to diagnose rheumatic fever must pay attention to, if there is hemolysis Hypercholesterolemia jaundice and serum contamination or bacterial infection can increase the anti-streptolysin "O".
5. C-reactive protein elevation in the blood of children's reactive proteins is often used to understand the activity of acute rheumatic fever and rheumatoid arthritis.
6. Anti-nuclear antibodies This test is often used for the diagnosis of connective tissue diseases, especially in systemic lupus erythematosus disease, the antibody titer and positive rate are the highest, and the diagnostic specificity is the strongest.
7. Immunoglobulin and complement This assay can be used to observe the status of immune function, and is helpful for the diagnosis of connective tissue diseases such as liver diseases, autoimmune diseases, chronic bacteria, viruses and parasitic infections, and tumors.
8. HLA-B27 can be detected by known HIA-B27, mixed with the lymphocytes of the testee, and then added with human complement. If the specific antiserum binds to the corresponding HLA antigen of the lymphocyte membrane, it can activate complement and cause cell membrane damage. . Damaged cell membranes can be identified by microscopic staining with reactive dyes. If more than 50% of the cells are stained, the lake cells are considered to be positive with the corresponding HIA-B27 antigen. HIA-B27 positive patients are most common in ankylosing spondylitis, with a positive rate of 86%-96%.
9. Uric acid uric acid is fully diffused throughout the body fluid, uric acid metabolism disorders, formation of hyperuricemia joint urate deposition, causing acute arthritis, that is, gout blood determination of blood uric acid, uric acid content.
10. The examination of synovial fluid firstly looks at the appearance, the normal joint fluid color is yellowish, clear and effective. According to its hyaluronic acid content, the concentration and degree of polymerization determine its partial stagnation protein test; adding acetic acid in normal or near normal synovial fluid can condense into a protein clot. Acute inflammatory joint fluid presents a sparse flocculent protein clot. White blood cells, degenerative joint disease, the number of white blood cells is (0~1) / L rheumatoid arthritis is (3-15) x109 mine, and even more. Rheumatoid factor; sometimes synovial fluid can be positive before a positive reaction to blood, which is helpful for diagnosis. If crystals appear, the crystals can be examined by polarized wet micromirrors.
Arthroscopy
Arthroscopy is a new surgical technique that has been shown to be advanced and accurate for the diagnosis and treatment of joint disorders. It has been widely used in the knee, shoulder, elbow, hip, ankle, and even wrists. Examination and treatment of joints and interphalangeal joints Arthroscopic techniques have little damage, and it is possible to directly observe the structural changes in the joints with the naked eye. It is more accurate than the imaging examination.
1 Early detection of injuries that can be treated by surgery.
2 Give the patient and the surgeon a basis for not requiring surgery.
3 As early as possible, it is possible to understand and study the possible small progress of certain lesions.
4 Arthroscopy can avoid unnecessary surgery and can change for a scheduled surgical procedure.
5 A diagnosis other than unexpected was determined.
Film degree exam
X-ray filming of joint diseases is one of the routine examination methods. It mainly looks at bone changes, especially bone tumors in joints, bone destruction deformity, joint exudate swelling, and has obvious diagnostic significance. CT and MRI are also new for detecting joint lesions. In addition to the bone imaging, the soft tissue structure of the cartilage in the joint can be visualized, and it has advanced features for the diagnosis of meniscus injury. This is a disadvantage that ordinary X-ray films cannot match. .
Diagnosis
Diagnosis of joint pain
Diagnostic criteria
Arthralgia is a subjective statement of the symptoms of joint pain reflected in each patient, and its actual meaning may vary. Sudden severe pain and long-term repeated pain may vary greatly in the extent of the disease. It is important to diagnose the pain at the joint site first by asking for a detailed history of the various features of the pain, including the onset of the disease, the nature of the pain, the onset of the symptoms, and the aggravating or mitigating factors.
1. The onset of joint pain is acute and chronic. Acute pain is seen in infectious inflammation, especially in septic arthritis, which begins with severe pain and swelling. Infectious arthritis such as Salmonella arthritis, meningococcal arthritis, and bacillus streptococcosis all begin with joint pain, followed by swelling or exudation. Metabolic joint disease has a rapid onset of gout, and sudden onset of severe pain/chronic pain is common.
In the case of degenerative joint disease, proliferative osteoarthrosis, osteonecrotic joint disease, idiopathic joint disease, nutritional joint disease, endocrine hematological joint disease, metabolic joint disease, joint tumor traumatic joint disease.
2. The nature of pain is generally not helpful for the diagnosis. It is painful when starting to stand. The pain is relieved or disappeared after a while. Most of the pains of degenerative osteoarthrosis are the meniscus injury or loose body in the knee joint. Resting pain is mostly caused by increased intraosseous pressure, and pain during exercise is mostly osteonecrotic joint disease.
3. Joint trauma Many joint pains are caused by joint trauma, damage to intra-articular cartilage, and ligament tear in intra-articular fractures. Joint capsule injury, intra-articular structural damage history of trauma is important for the diagnosis of joint pain.
4. Concomitant symptoms of infectious arthritis are often accompanied by symptoms of systemic poisoning, fever, headache and lack of appetite. Rheumatoid arthritis is often accompanied by carditis, chorea ring erythema, subcutaneous nodules. Psoriatic arthritis with skin lesions Gouty arthritis can have vascular disease, kidney urate stones. Hemophilic arthritis may have other parts of hemorrhagic acute leukemia joint involvement, common splenomegaly, hepatomegaly or lymphoid epilepsy. Gonorrhea arthritis may have gonorrhea urethritis, ulcerative conjunctival inflammatory joint disease such as conjunctivitis may have fever, anemia, intestinal discharge of blood and new fluid tuberculous arthritis may be associated with skin macules. Fever and myalgia. Rheumatoid arthritis can have muscle atrophy, osteoporosis, anemia, scleritis and other osteoarthritis can be associated with the distal interphalangeal joint Heberden nodules. Hyperparathyroidism is associated with hyperactive joints, and may have loss of appetite, vomiting and constipation, polyuria, fatigue, fatigue, and generalized osteoporosis.
