Damage to the joints of the lower extremities is very common. Regardless of age, many people face a similar problem in everyday life. Some people have pain in their knees, and some suffer from diseases of the foot joints, primarily the metatarsophalangeal joints. Why this happens and how to get rid of unpleasant sensations are perhaps the main questions that concern patients.
The foot is an important element of the musculoskeletal system. Its main functional purpose is to maintain the vertical position of the body and ensure its movement. This section of the lower limb experiences serious static and dynamic loads, which the structural features of the foot allow it to withstand: strong ligaments and muscles, stable joints, developed soft tissues.
The metatarsophalangeal joints are formed by the heads of the metatarsal bones and proximal phalanges of the fingers. They have a spherical shape and are externally strengthened by several ligaments: plantar, collateral, deep transverse. Unlike similar joints of the upper extremities, the joints of the foot have a much smaller range of movements: the first metatarsophalangeal flexes and extends by 80 and 35 degrees, respectively, while in the remaining toes such movements are possible at an angle of 40 degrees.
To perform the functions assigned to it, the foot has a fairly strong and stable structure.
Considering the important role of the foot in human life, its damage becomes a significant obstacle to everyday and work activity. The compensatory capabilities of the articular apparatus are not at all limitless, therefore, under conditions of prolonged exposure to unfavorable factors, the joints are susceptible to pathological changes. The following factors contribute to this:
They lead to increased load on the metatarsophalangeal joints and incorrect biomechanics of the foot. But in addition to local factors, systemic disorders in the body play an important role, which are prerequisites for the development of arthritis and arthrosis:
Therefore, the problem of damage to the metatarsophalangeal joints is quite extensive, and finding out the cause of pain in the foot should be the main aspect of diagnostic measures. Taking into account the individual characteristics of the patient’s body, a thorough examination is required in order to differentiate inflammatory and degenerative-dystrophic changes in the joints, as the most common.
Metatarsophalangeal joints are more often damaged by a combination of local factors and systemic disorders in the body.
Among all foot diseases, arthritis and arthrosis are the most common. They have fundamental differences in the mechanism of development: the former are caused by inflammation, and the latter by degenerative and dystrophic processes in the cartilage and surrounding tissues. The clinical picture of these diseases is also characterized by certain features.
Arthritis occurs when infection directly enters the joint or due to systemic disorders in the body. In the first case, great importance is given to traumatic injuries, and in the second - endocrine, metabolic and immune factors.
Inflammation most often affects the joint capsule. But there are arthritis in which the pathological process extends to the underlying bone (for example, rheumatoid arthritis). The following symptoms are typical for inflammatory diseases:
This is observed in cases where the process is acute, and chronic arthritis is accompanied by less clear signs. In this case, not only the metatarsophalangeal joints are often affected, but also other joints, which indicates the systemic nature of the disease.
With gouty arthritis of the first metatarsophalangeal joint, pain occurs suddenly, more often at night and after dietary errors (fatty foods, alcohol). Due to inflammatory changes, movement of the thumb is very difficult, it is impossible to even step on the foot. Chronic gout is accompanied by the deposition of salts - urates - in the kidneys (nephropathy, urolithiasis) and under the skin in the form of tophi (above the joints, in the ear area).
If a rheumatoid process is suspected, then the joints of the hand are necessarily affected, morning stiffness is characteristic, and over time specific deformations appear (“swan neck”, “walrus fins”, “button loop”). In case of reactive arthritis, it is necessary to pay attention to the condition of symptoms from the respiratory system, eyes, intestines and genitourinary system:
If the metatarsophalangeal joint hurts, then you should think about the possibility of arthritis caused by local or systemic changes.
A slightly different situation arises with arthrosis of the 1st metatarsophalangeal joint. The nutrition of the cartilage is disrupted, which leads to its thinning, fiber disintegration and the appearance of cracks, which reduces elasticity and strength. Under these conditions, even the usual load becomes unbearable, and degenerative changes over time spread to the underlying bone, ligaments, tendons and muscles. Patients are concerned about the following symptoms:
Many people notice that an unpleasant bulge or “bone” has formed above the joint, which at first creates only aesthetic discomfort, and then difficulties when choosing shoes and while walking. In severe cases, the pain becomes almost constant, the joint becomes immobilized due to ankylosis, and the function of the big toe becomes significantly more difficult.
It is possible to suspect a pathological process in the joint clinically, but the diagnosis can only be confirmed with the help of additional examination. It consists of laboratory and instrumental methods, the results of which create the most complete picture of the disease. So, the following studies are recommended for patients with foot pain:
Based on the cause of the joint pathology, consultation with related specialists may be required: rheumatologist, orthopedic traumatologist, endocrinologist, infectious disease specialist.
The origin of the symptoms should be determined as early as possible, because the success of further treatment largely depends on timely diagnosis.
Regardless of how many joints are affected - one or several groups - the disease must be treated comprehensively. First of all, they influence the cause of the pathology and its development mechanism. And eliminating the symptoms comes second. The treatment plan is determined by the stage of the disease, the condition of the patient’s body and possible associated problems.
The use of medications is a necessary component of the treatment of arthritis and arthrosis. Modern drugs have a wide range of positive effects on various parts of the pathology, good safety and evidence base. But they are not without side effects and limitations, which are taken into account by the doctor when prescribing medication correction. Based on the causes and nature of the disease, the following medications are used:
Local signs of inflammation can also be reduced with the help of topical medications - ointment, gel, cream (Dolobene, Diklak, Fastum).
Any medications are used only with the permission of a doctor - in the recommended dosage and the required course.
In addition to medications, the treatment of inflammatory and degenerative diseases of the articular system cannot be done without physical methods. They allow you to activate blood flow, tissue trophism and reparative processes (healing) in both acute and chronic processes. The following procedures are widely used:
In case of purulent infectious arthritis, it should be remembered that the warming effect should be postponed until the acute inflammation is eliminated. Some concomitant conditions - skin diseases, tumors, cardiovascular pathology - are also a limitation for physiotherapy.
Among the non-drug methods, manual pressure on the joints is used - foot massage. Due to its comparative simplicity, this remedy is widely used not only in hospitals and clinics, but also by patients at home. You just need to learn the basic techniques of classical massage: stroking, rubbing, kneading, pressing. The course of such treatment is at least 10–15 procedures.
Therapeutic exercise is an extremely important component of the treatment of diseases of the musculoskeletal system. And diseases of the first joint of the foot cannot be avoided without it. First, passive movements are used, and after the pain syndrome is completely eliminated, you can move on to active exercises. But here too, you need to avoid excessive pressure or sudden jerks, so as not to provoke a return of symptoms. In any case, for effective therapy it is necessary to draw up an individual training program.
Properly organized therapeutic exercises create the prerequisites for restoring the motor function of the joints.
Arthritis or arthrosis of the metatarsophalangeal joint needs to reduce and properly distribute the load. This is achieved through the use of orthopedic devices:
An important aspect of this correction is the reduction of the patient’s weight, since this significantly reduces excess pressure on the foot and, accordingly, improves its function.
If conservative methods do not lead to the desired result, then surgery is considered. This is mainly necessary in advanced cases, when ankylosis develops in arthritis or severe osteophytes and stiffness in arthrosis develop. The following methods are used:
After surgery, immobilization of the joint with a plaster or splint and rehabilitation measures are necessary. Full recovery may require at least 2 months. But it’s still better not to let the situation get worse and get a good effect from conservative treatment. Then you can return to active life much earlier.
Surgical orthopedics - Surgery.su - 2008
Arthrosis is a degenerative disease of the joint, which manifests itself in the destruction of its cartilage tissue and inflammation of the soft tissues.
The most typical symptoms of arthrosis of the metatarsophalangeal joint are pain in the joint, some swelling, moderate redness and a slight increase in temperature in the joint area. Movement in the joint is usually painful and limited. This is manifested by the patient limping when walking.
Contributing factors for the development of arthrosis of the first metatarsophalangeal joint are:
The listed factors lead to deterioration of blood circulation in the first metatarsophalangeal joint, which leads to the development of arthrosis.
There are three stages of arthrosis of the first metatarsophalangeal joint:
The main method for diagnosing arthrosis of the first metatarsophalangeal joint is radiography. With arthrosis, changes are usually observed in the articular surface of the bones that form the joint: surface unevenness and narrowing of the joint space.
Treatment of arthrosis of the first metatarsophalangeal joint , as well as arthrosis of other joints, begins with conservative methods:
Nonsteroidal anti-inflammatory drugs help reduce inflammation and pain. These drugs include, for example, indomethacin, ibuprofen, ortofen, piroxicam and many others. Unfortunately, these drugs also have side effects, such as effects on the gastric mucosa. Therefore, they are contraindicated if the patient has gastritis or gastric ulcer.
Physiotherapeutic methods of treatment are successfully used:
If such methods of conservative therapy are ineffective, steroid drugs are injected into the joint. These include diprospan, kenalog, hydrocortisone. This method is very effective in eliminating inflammation and pain in the joint and soft tissues around the joint. In severe cases of arthrosis, when conservative treatment methods do not help, surgical intervention is used. Usually it consists of creating immobility in the joint - ankylosis. For prevention purposes, natural factors should also be used - children are recommended to walk barefoot on sand, mown grass, loose earth, or on a high-pile rug. Walking barefoot is also useful for adults, because such gymnastics strengthens muscles and improves blood circulation in the feet. Walking barefoot on asphalt and flat floors is harmful to your feet.
Arthrosis of the first metatarsophalangeal joint (hallux rigidus) is a degenerative disease characterized by the destruction of articular cartilage and deformation of the articular surfaces.
There are several classifications of arthrosis of the first metatarsophalangeal joint (Harttrup and Johnson, 1988; Barca, 1997; Easley, Davis et al., 1999, Coughlin MJ et al., 2003).
Depending on which of them is used, 3 or 4 stages of arthrosis are divided, not counting the pre-radiological stage (0).
First degree. It manifests itself as periodic pain after excessive exertion, and rapid fatigue.
Second degree. The pain syndrome is more pronounced. There is a limitation in dorsal flexion (extension) of the first finger. Radiographs reveal subchondral sclerosis, flattening of the articular surfaces, and narrowing of the joint space.
Third degree. The pain becomes constant and bothers me even at rest. Dorsal flexion of the finger is absent, plantar flexion is limited. Joint deformity appears. Radiographs reveal bone growths and severe deformation of the articular surfaces.
Fourth degree. All of the above symptoms become more pronounced, noticeable deformation appears, and the pain syndrome can become unbearable. In some cases, complete immobilization of the joint develops.
Used in the initial stages of the disease.
For grades I and II of arthrosis, the following is performed:
For III–IV degrees of arthrosis:
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Foot diseases are one of the most common pathologies in the world. In one form or another, they can be identified in 70–85% of adults, but many of them do not consider themselves sick: protruding bone in the area of the big toes (this is how arthrosis of the metatarsal joint manifests itself) is often perceived by people as the norm - age-related changes that cannot be avoided .
Foot diseases are largely due to urbanization, fashion, and excessive sports or work load on the feet.
Why are the metatarsal joints of the big toes most often affected? The human skeleton is designed in such a way that in the vertical position of the body it is they that bear the greatest load. If this load is excessive, the joints cannot stand it and begin to gradually collapse.
Read on for a comprehensive description of the disease: the main causes, symptoms, stages and methods of treating the pathology.
Wearing shoes that are harmful to the feet. Orthopedic doctors include in this category shoes with flat soles (sneakers, ballet shoes), with heels higher than 7–8 cm, with narrow toes (pumps) that deflect the big toes outward.
Football activities that lead to microtrauma of the foot joints.
Walking barefoot or wearing shoes with very thin soles on a hard surface (floor, asphalt).
Chronic arthritis of the feet, resulting from hypothermia, deposition of uric acid salts (gout) or systemic disease (rheumatoid polyarthritis, lupus erythematosus, etc.).
A harbinger of this type of arthrosis is transverse flatfoot. In most patients, it appears by the age of 30–35, and in those who have congenital weakness or high extensibility of the ligaments, such flat feet sometimes occur earlier. Unlike longitudinal flatfoot, which almost everyone knows about, transverse flatfoot does not make itself felt for a long time and is manifested only by slight fatigue in the legs after long walking or standing. Many people begin to notice the problem when an ugly “bone” grows at the base of the thumb.
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“Bone” is a typically female symptom; In men, transverse flatfoot is usually not accompanied by its appearance, so it remains unnoticed longer. As a result, men suffer from arthrosis of the metatarsal joint 4 times more often, but among patients, visible foot deformation is 8 times more common in women.
The development of metatarsal arthrosis is divided into 3 degrees: initial, moderate and severe (severe).
The first degree may not have clinical manifestations - it is characterized only by minor structural changes in the ligamentous apparatus: micro-tears of the ligaments and mild inflammation in them.
Feeling (palpation) of the joint will help to recognize the disease at this stage: as a rule, pain will occur at individual pressure points. Bending and straightening the finger up and down, especially towards the sole, can also be painful.
The x-ray does not reveal any abnormalities.
The second degree of metatarsophalangeal arthrosis in the majority of patients already causes complaints: pain when walking, swelling of the feet in the afternoon, discomfort when standing for a long time (feeling of heaviness, aches in the legs). In women and some men, a “bump” begins to form near the thumb.
The third stage has bright and characteristic manifestations. Even those who previously considered a “bunion” on the foot to be the norm are beginning to understand that this is not so.
The pain becomes constant and severe, walking becomes extremely difficult, and the shape of the foot takes on the typical appearance of this disease: the big toe is strongly deviated outward (hallux valgus) and is sometimes located under the second toe, and the head of the metatarsal bone is noticeably thickened. The joint area swells, thickens and becomes covered with corns on the side of the sole.
At this stage, arthrosis is almost always accompanied by foot fungus, which can be recognized by itching, redness and peeling of the skin between the toes, as well as an unpleasant odor. If treatment is not started during this period, you may completely lose the ability to walk.
You need to start treating arthrosis of the metatarsophalangeal joints as early as possible. At first, this does not require a lot of money and time: medications are usually not prescribed; Sometimes doctors recommend rubbing pain-relieving ointments (finalgon, ketonal, nise, etc.) into the joints.
The most important thing during this period is to eliminate the damaging factor. If shoes lead to the development of the disease, urgently replace them with the correct ones (refuse sneakers, ballet flats, high-heeled shoes and flat soles). Instead, women should wear shoes with 3-5 centimeter heels or wedges with a loose front, and men should use orthotics that correct transverse flat feet (if necessary).
Massage and self-massage of the plantar area perfectly strengthens the ligaments and muscles of the feet.
Walking barefoot on soft earth, sand or small pebbles, plus hardware physiotherapy, will help stop arthrosis.
When arthrosis has begun, it is important to keep the feet warm and not subject them to excessive stress.
When the disease has already gone far, conservative methods can only help relieve the most unpleasant symptoms: pain and itching that occurs due to the addition of fungus.
The ability to fully rest on the foot can only be restored by surgery: removing part of the head of the overgrown metatarsal bone and restoring the transverse arch of the foot. The metatarsophalangeal joint most often becomes immobile after such operations.
Legs, as doctors say, are a second heart. Therefore, in order not to lose the ability to walk by the age of 50–60, take care of your second heart no less than your first.
Arthrosis-arthritis is a disease that combines the symptoms of arthritis and arthrosis. Arthritis is characterized by thinning of the cartilage tissue of the joint due to mechanical stress or due to disturbances in the functioning of internal organs. Arthrosis refers to inflammatory diseases caused by infection in the body.
Arthrosis-arthritis of the metatarsophalangeal joint is common. This is due to the fact that the small joints of the foot receive greater stress. Foot injuries are not uncommon, often resulting in arthrosis-arthritis. Happens to professional athletes (football players). The disease is caused by congenital flat feet; women suffer from the disease due to their love for high-heeled shoes.
Arthrosis-arthritis is also caused by viruses or infections - a common cause of arthritis. You can have a sore throat or intestinal infection and find signs of arthritis. There are many reasons for the disease: from genetic predisposition to bad habits and a sedentary lifestyle. It is important to pay attention to the symptoms of the disease in time and go to see a doctor. The doctor will make the correct diagnosis and prescribe effective treatment.
They appear gradually as a slight malaise and discomfort in the foot. They can manifest quickly as an acute inflammatory process. Do not delay your visit to the doctor - the sooner you start treatment, the easier and faster it will be to cure it.
What to pay attention to:
If you notice symptoms of arthrosis-arthritis of the metatarsophalangeal joint, go for a diagnostic examination. The symptoms of joint diseases are similar, it is difficult to determine them “by eye”; to make an accurate diagnosis, you will need an x-ray of the foot to know the severity of the disease, and donate blood for a general blood test to determine the number of leukocytes and ESR.
Arthrosis-arthritis of the metatarsophalangeal joint is a complex disease that has signs of two articular diseases. Treatment is complex. It is necessary to relieve the inflammatory process, get rid of the harmful infection, restore destroyed cartilage tissue and prevent deformation of the metatarsophalangeal joints.
Treatment begins with taking prescribed medications:
Take medications as prescribed by your doctor. The treatment should include vitamin complexes containing B vitamins, vitamin D, C and E. Add to the diet foods or supplements containing calcium and collagen, which help restore the cartilage tissue of the joints, make the joints and bones strong, and the tissues elastic.
Physiotherapeutic procedures are involved in the treatment of arthrosis-arthritis of the metatarsophalangeal joint. They complement drug treatment and have no contraindications or side effects.
Arthrosis-arthritis of the metatarsophalangeal joint is treated with a special bandage for the foot, which prevents deformation of the toes and the appearance of a lump near the big toe. Such bandages relieve pain when walking and playing sports, and help when the feet are already deformed.
Arthrosis arthritis does not exclude sports. Heavy loads on the legs will not benefit the joints, but daily, light exercises will strengthen the muscle frame and improve blood circulation in the feet and toes. Walking, swimming in the pool, yoga and Pilates are useful. Stretching is good for the ankle, blood stops stagnating, swelling and pain in the legs disappear.
Women should avoid tight, high-heeled shoes. Wear shoes with heels not exceeding 4 cm. High heels have a detrimental effect on the joints of the toes and on the spine. Improperly distributed load contributes to the curvature of the spine, which leads to diseases of the joints and internal organs. Treatment of arthritis will be in vain if you do not change your favorite stiletto heels and replace them with comfortable orthopedic shoes.
The area of the metatarsophalangeal joint is formed from the articular surfaces of the heads of the metatarsal bones and the base of the proximal phalanges of the heads of the 2nd and 3rd metatarsals. The articular capsules in this area are characterized by weak tension, their dorsal part is thinned. Between the heads of the metatarsal bones there is a deep transverse metatarsal ligament.
This type of joint belongs to the spherical type. In terms of strength and endurance, the metatarsophalangeal joint is vulnerable to diseases such as arthritis and arthrosis. People of all ages are susceptible to the development of these pathologies, regardless of gender and other factors.
Most people are familiar with the feeling of discomfort and pain in the metatarsophalangeal joint when walking and at rest. If a person walks for a long time or professionally engages in active sports, then his risk of traumatic damage to this joint increases, as well as the formation of degenerative-inflammatory diseases in this area.
In order to prevent irreversible changes in the joint area, it is recommended to familiarize yourself with the key manifestations of injuries and diseases.
Traumatic injury to the metatarsophalangeal joint can be recognized by a number of characteristic signs:
Arthrosis of the metatarsophalangeal joint
Inflammatory and degenerative changes in the metatarsophalangeal joint often cause pain, discomfort, changes in the shape of the joint and a decrease in its motor activity. The clinical picture of arthrosis increases gradually, manifesting itself in the form of mild discomfort in the foot area and mild malaise.
In rare cases, the disease begins acutely. The key manifestations of arthrosis of the metatarsophalangeal joint are the following symptoms:
The following factors can provoke inflammatory-degenerative changes in small joints:
To make a reliable diagnosis, consultation with an orthopedist and traumatologist is recommended. The general picture of the disease is built on the basis of anamnesis, patient complaints, visual examination of the joint area and the results of additional research methods.
Additional diagnostic measures include:
Most often, assessing the appearance of the metatarsophalangeal joint is sufficient to make a diagnosis.
Therapy for inflammatory and degenerative diseases of the metatarsophalangeal joint includes medication, massage, therapeutic exercises and physiotherapy.
To eliminate pathological changes in the joint area, it is recommended to take the following groups of medications:
This technique acts as an effective addition to drug therapy. In the treatment of arthrosis of the metatarsophalangeal joint, the following physiotherapeutic techniques are used:
In the treatment of arthrosis of the metatarsophalangeal joint, massage is of great importance. This procedure involves stroking, rubbing and moderate kneading of the soft tissue over the metatarsophalangeal joint. Therapeutic massage can be performed either by a medical specialist or independently.
People suffering from inflammatory and degenerative diseases of the metatarsophalangeal joint are recommended to wear a fixing bandage. This device acts as a prevention of deforming changes in the fingers.
Thanks to reliable fixation, the risk of forming the so-called hallux valgus, that is, a lump near the big toe, is reduced. In addition, fixing bandages reduce the intensity of pain and eliminate discomfort while walking and increased stress on the joints.
During inflammation of the joints in the legs, motor activity decreases, the joints swell or swell, and the patient feels pain not only while walking, but also while standing still.
Such signs are common symptoms for many diseases. Inflammation of the joints of the first toe occurs in various diseases, including arthrosis, arthritis, and bursitis.
The main signs of arthritis are:
At the first signs of the development of the disease, you should seek help from a doctor to prevent complications from occurring.
In the acute form, the metatarsophalangeal joint of the first toe hurts severely and often; in the chronic form, pain occurs periodically.
Particularly chronic disease is dangerous due to the presence of unexpressed symptoms, while the inflammatory process deforms the joints. Leading to their gradual destruction.
Among all types of diseases, arthritis of a rheumatoid, infectious and reactive nature, as well as gout, are most often diagnosed.
Each disease requires specific treatment, since arthritis progresses individually.
This disease is characterized by certain symptoms. The disease is also diagnosed based on X-rays and tests. In rheumatoid arthritis, the metatarsophalangeal joints of the first toe are affected symmetrically on both lower extremities.
Rheumatoid arthritis develops due to autoimmune disorders in the patient's body. The immune system begins to attack the tissues of the joints and perceives them as foreign. Often this inflammatory process begins two weeks after suffering from a sore throat or a cold.
If the first signs of the disease are detected, you should consult a rheumatologist. This disease is incurable, but signs of the inflammatory process can be reduced with medications or surgery.
Thanks to this, the progressive disease can be stopped, which will improve the overall well-being of the patient.
Treatment is carried out using basic antirheumatic drugs Levamisole, Mesalazine, Azathioprine, Cyclosporine, Dixycycline and biological agents.
Due to the fact that this disease develops due to the deposition of substances that are formed during the metabolism of purines on the joints, gout is also called a meat-eater's disease. It is this substance that is found in large quantities in meat. The disease is often diagnosed among middle-aged men.
The main symptoms of gout include:
The disease can be caused by frequent consumption of fatty and meat dishes, and alcoholic beverages. Also, advanced gout is often accompanied by the deposition of urate in the kidneys, which causes pyelonephritis and urolithiasis.
Treatment of gout involves prescribing a therapeutic diet and limiting the consumption of meat products. The patient also takes medications that normalize the metabolism of purines in the body.
To get rid of painful sensations, use Nimulid, Ibuprofen, Movalis, Voltaren. Colchicine is prescribed as a short-acting drug. When choosing medications, it is important to consult with your doctor and not self-medicate.
This disease is accompanied by an inflammatory process, and the patient feels constant pain when moving. In the morning, stiffness occurs, the joints swell, the skin turns red and the body temperature rises greatly.
Infectious arthritis develops due to an infection that enters the joints of the fingers through the blood from other organs. The patient experiences the following symptoms:
Treatment of the disease depends on the causes of the disease. The first step is to detect and treat the infection. The doctor prescribes antibiotics and non-steroidal anti-inflammatory drugs - Paracetamol, Ibuprofen, Diclofenac.
Arthrosis is accompanied by characteristic dull pain, which most often occurs during the daytime. The pain may worsen with prolonged standing and physical activity. After the patient has rested, the pain decreases. Relief is also observed in the morning.
Most often, arthrosis provokes the appearance of crunching and clicking in the area of the affected joints. The toes may deviate to the side, lose mobility and become deformed. Arthrosis can also be caused by wearing uncomfortable and tight shoes, which leads to joint deformation.
Osteoarthritis is diagnosed using x-rays and a blood test to check uric acid levels. It is important to identify the disease in time; in this case, treatment can be done by wearing orthopedic shoes, physiotherapy, therapeutic massage, water treatments, and mud therapy.
To prevent arthrosis from causing severe pain, a local anesthetic is injected into the joint cavity. In order to reduce the inflammatory process, treatment is carried out using corticosteroid drugs, as described in the video in this article.