sacroiliac joint pain
Introduction
Introduction Ankle pain is a common clinical symptom of ankle joint tuberculosis. Ankle joint tuberculosis is rare in clinical practice, accounting for 8% of total body and joint tuberculosis. Early symptoms and X-ray signs are atypical, and there are many similarities with other diseases of the ankle joint, which are prone to misdiagnosis. Ankle joint tuberculosis, as a local manifestation of systemic tuberculosis infection, has gradually gained attention in recent years.
Cause
Cause
(1) Causes of the disease
The contaminated air of Mycobacterium tuberculosis infects the respiratory tract or digestive tract, and then causes bloody infection through blood circulation. Joint tuberculosis is divided into synovial and bone types.
(two) pathogenesis
The ankle joint is often severely damaged, the affected tibia is moved up, pathological dislocation occurs, female patients have more dislocation, and sometimes the pubic symphysis is dislocated, which may be related to the loosening of the female pelvis.
The joint lesions develop backwards, and the posterior joint capsule or humerus is worn through, so that the abscess gathers in the deep layer of the gluteus maximus. The lesion develops forward and will pierce the anterior joint capsule or tibia. The pus flows to the psoas muscle and the diaphragm, the muscle or the diaphragm is more common than the posterior, and occasionally flows to the groin or thigh. Break through the joint capsule below, the abscess along the sacral ligament or piriformis flow into the vicinity of the large trochanter, or separate abscess formation before or after, or communicate with each other. The abscess collapses outward to form the sinus. In some cases, the pus can be worn through the abdominal cavity or rectum.
Examine
an examination
Related inspection
Molybdenum target X-ray examination prone stretching test
First, clinical manifestations:
The incidence of this disease is generally slower than spinal tuberculosis, often found first abscess, pain and tenderness, but often due to abscess ulceration, pain relief and delay diagnosis. There is pain in the lower back and affected side. There may also be "sciatica" that transfers pain to the affected side of the buttocks and the lateral side of the femur. However, unlike the symptoms of lumbar disc herniation, it does not release to the calf and the foot, and there is no change in feeling. The pain is aggravated during exercise, such as turning over, sitting for a long time, going up and down the stairs, bending over, squatting, etc. When standing, the body generally leans toward the healthy side. I dare not dare to stride when walking. Supine pain is often felt in the supine position.
Second, the diagnosis:
The diagnosis is mainly based on the results of its clinical manifestations and auxiliary examinations, mainly X-ray examination.
During the examination, the anterior curvature of the spine, the extension of the back and the lateral curvature were limited, and there was local pain, but the activity was better when sitting. Straight leg raising test, the affected side is limited and there is local pain. Pain in the affected part when the humerus is squeezed or separated. There is tenderness in the affected part of the ankle joint, and there may be a cold abscess or sinus. Anal finger examination can sometimes touch local abscesses and tenderness.
X-ray examination is very important for early diagnosis. It is necessary to take the ankle joint and the oblique position (sagittal plane of the joint), and bone destruction, dead bone and cavity formation can be seen.
Diagnosis
Differential diagnosis
1. Ankylosing spondylitis:
Ankle joint tuberculosis can occur at any age, with unilateral morbidity, often occurring in the lower third of the ankle joint, while ankylosing spondylitis is common in young men, mostly bilateral symmetry, performance Irregularity of the joint space is narrowed or accompanied by osteopetal joints. The edge may have a small cystic defect. The lesion is easy to invade and the upper part of the ankle joint is often accompanied by blurred, narrow or disappearance of the lumbar facet joint.
2. Dense osteitis:
Bone type ankle joint tuberculosis occurs in the cancellous cane, which is a circular or elliptical localized destruction area, which can affect the ankle joint. Dense osteitis is more common in adult women, often symmetry violation of the ankle joint. The lower 2/3 part of the humerus appears as a triangular, crescent-shaped or pear-shaped dense shadow, and the trabecular fusion disappears without involving the joint.
3. Loss of bone caused by external pulsation of the external iliac artery:
Localized ankle joint tuberculosis in the proximal iliac artery area sometimes needs to be differentiated from bone destruction or loss caused by pulsation of the external iliac artery. Although the bone destruction area caused by the former is relatively limited, the bone destruction is extensive, and the edge of the destruction area is not Clear, no sclerosis, and long-term pulsation of the external iliac artery can cause obvious and deep depression of the lower edge of the humerus, and the edge of the depression can be seen clearly, without signs of hardening.
4. In addition, this disease also needs to pay attention to sputum strain, disc herniation, lumbar tuberculosis and hip inflammation, rheumatoid arthritis, septic arthritis and tumor identification. The symptoms, signs, abscesses, and sinus tracts of lumbosacral tuberculosis and ankle joint tuberculosis are similar, and they are easily confused. If both occur in the same patient, it is sometimes difficult to determine which lesion the abscess and sinus come from. Only by surgery or sinus angiography.
