Degenerative changes in the meniscus of the knee joint occur for various reasons, the most common of which are: excessive loads and degenerative processes that develop in elderly patients. These cartilage pads perform an important function - they protect the hard tissues of the joint. In addition, the menisci play the role of shock absorbers. They take on a significant part of the load, thanks to which the structure of articular cartilage and bone heads is preserved longer.
There are lateral (outer) and medial (inner) meniscus. Both cartilages may undergo changes. Degenerative processes usually develop under the influence of a number of factors:
Most often, meniscal pathology develops in old age, when the structure of cartilage tissue changes.
The risk group also includes people who regularly experience significant physical activity: professional athletes, loaders, etc. Any careless movement can lead to degenerative changes in the lateral meniscus or medial cartilage. When injured, the integrity of the ligaments is disrupted and cartilage and bone tissue are affected. Changed position of bones or torn ligaments cause redistribution of the load on the joint. As a result, mucinous degeneration of the meniscus develops.
The nature of pathological processes may be different. Sometimes a cyst develops in the meniscus - this is a neoplasm in the cartilage tissue, which contains fluid inside. This condition is defined as mucoid degeneration.
There is another type of pathology - meniscopathy. In this case, there are dystrophic changes in the structure of cartilage tissue caused by a chronic disease of the musculoskeletal system (osteoarthritis, rheumatism) or injury.
In addition, degenerative damage to the inner meniscus or outer cartilage may occur. Consequences:
The symptoms will be different in any case. The more serious the damage, the more severe the pain.
Most types of joint pathologies affect the menisci. When injured, symptoms appear immediately. If degenerative processes are a consequence of a disease of the musculoskeletal system, the discomfort increases gradually. Damage to the medial meniscus may be accompanied by hemorrhage into the joint cavity. This condition is called hemarthrosis. Symptoms common to all pathologies:
If mucoid degeneration occurs, swelling occurs. This condition is accompanied by intense pain. The most common sign of degenerative processes is an extraneous sound (clicking) made by the joint when moving.
Injuries usually involve rolling, a condition in which there is excessive mobility in the knee. This may be a consequence of displacement or separation of the meniscus from the attachment site.
In case of injuries, the pathology is much easier to identify, since in this case the symptoms appear acutely. Damage to the outer meniscus occurs more often because this cartilage is more mobile.
If there is a blockage of the joint in a certain position, a crunch occurs, in most cases this means that pathology is developing in the meniscus. But moderate degenerative and dystrophic processes do not occur so clearly, which complicates diagnosis. Signs may not appear soon, but only if the disease of the musculoskeletal system develops sufficiently strongly.
To confirm the diagnosis if the external or internal meniscus is damaged, additional examination is prescribed:
For most types of pathologies in the menisci of the knee joint, conservative treatment is ineffective. This method can improve the condition of medial cartilage deformities. Medications help prevent the development of pathology: they stop the inflammatory process, eliminate pain and swelling. However, if you are deciding how to treat a joint with degenerative changes in the meniscus, you should know that conservative therapy does not completely cure the knee.
When the first symptoms appear, it is necessary to reduce the load on the affected joint. First, you need to eliminate the signs of the acute form of the disease, since in this state it is prohibited to carry out any manipulations. To prevent displacement, a fixing bandage or splint is applied for 2 weeks.
For hemarthrosis, puncture is indicated. This procedure removes accumulated blood. Thanks to this, swelling and pain intensity are reduced, and mobility is partially restored.
Analgesics are prescribed. Drugs in this group eliminate pain. This cannot always be done using non-steroidal drugs (Ibuprofen, Diclofenac), therefore, in case of pronounced degenerative processes in the meniscus, narcotic drugs are prescribed - Promedol and the like. In some cases, it is recommended to use anti-inflammatory drugs. Glucocorticosteroids are injected into the joint.
After removing the splint, when the manifestations of the acute condition have been eliminated, they proceed to the next stage - physiotherapeutic procedures (phonophoresis, UHF, ozokerite, iontophoresis), as well as exercise therapy.
Physical exercise strengthens muscles, which helps reduce stress on the joint and menisci in particular. At the initial stage, static exercises are performed. In this case, there is no load on other parts of the body; only the muscles of the affected limb are involved.
These are drugs of a special group. They are offered in different forms: injections, tablets. The main purpose of such drugs is to restore cartilage tissue and stop degenerative processes. In addition, chondroprotectors significantly reduce the likelihood of developing pathology in the future. They deliver nutrients to the joint.
For degenerative changes in the meniscus, the following is prescribed:
Serious pathologies (strongly developed degenerative processes, deformation, separation from the attachment site) cannot be treated with a conservative method. In such cases, the joint is restored through surgery. The entire knee may need to be replaced with a prosthesis. A sliding, rotational, hinged or surface prosthesis is used.
Menisci are crescent-shaped layers inside the knee joint between the surfaces of the thigh and tibia bones, consisting of cartilage tissue.
There are medial (inner) and lateral (outer) menisci. Conventionally, the meniscus of the knee joint (MKS) is divided into the posterior horn, the anterior horn and the body.
Cartilaginous discs evenly distribute the load on the knee joint, reduce surface friction and act as a shock absorber during movement.
Degenerative changes are the loss of function and the process of reverse development of cartilage that occurs as a result of injury, developmental abnormalities, or after an illness. The outer meniscus is less susceptible to injury than the inner meniscus due to better mobility.
separation of cartilage at the attachment site;
rupture of the body, anterior or posterior horn;
excessive mobility due to damage to the intermeniscal ligaments;
meniscopathies are degenerative-dystrophic changes that develop after injuries.
Types of dystrophic lesions
Degenerative changes in the ISS occur in people of all ages. The risk group includes patients whose activities involve active movements: ballerinas, athletes, dancers.
changes in the development and formation of tissues (dysplasia);
gout, rheumatism, osteoarthritis, bone tuberculosis and other diseases affecting the knee joint;
flat feet (change in foot shape);
excessive physical activity;
Symptoms of lesions of the meniscus of the knee joint depend on the causes of the disease.
There are acute and chronic knee injuries.
The main symptoms include joint swelling, redness, limited mobility, and pain. In case of serious damage, blood may enter the joint cavity.
The duration of the acute stage depends on the causes of the disease.
After ten to fourteen days, the acute stage becomes chronic. At this stage, the patient complains of pain that intensifies with movement. A characteristic sign is the appearance of crunching and clicking sounds when walking; when palpated, the joint ridge is determined. The cartilage tissue becomes thinner, joint instability develops, and the muscles of the thigh and lower leg atrophy. The patient is advised to lie down more so as not to put stress on the injured leg.
If left untreated, meniscopathy may develop contractures (limited joint mobility).
limitation and stiffness of movements;
cracking and crunching when bending and straightening the knee;
blockade of the joint in a bent position.
In the first degree of degenerative changes in cartilage tissue, minor damage to the horn, swelling and pain of the knee occur. After three weeks, the symptoms described above disappear. The development of the first degree of dystrophic changes in the medial meniscus is possible with injuries received during jumping, squatting with a heavy load, or walking on an inclined plane.
In the second (severe) degree, the pain intensity increases and tissue swelling increases. Blood accumulates in the joint capsule, the horn of the meniscus comes off and its parts fall into the joint cavity, causing blockage of movements. At this stage, surgery is indicated.
Damage to the lateral ISS is more common in childhood and adolescence.
pain in the area of the collateral ligament tissue;
pronounced inflammatory process in the synovium (synovitis);
discomfort and pain in the area of the fibular fold;
decreased muscle tone of the anterior thigh.
If the outer cartilage is torn, the knee is at an angle of 900 and the patient can unblock it himself. The symptoms of this pathology are mild and difficult to diagnose due to the variability of pain. There is a congenital anatomical anomaly, which is sometimes confused with a rupture of cartilage tissue - a disc-shaped (solid) lateral meniscus. When ruptured, the cartilage is shaped like a disc. A continuous external meniscus is determined mainly in adolescents, but it also occurs in older people.
The most common damage to the internal ISS are ruptures of its middle part while the ends are intact.
rupture of the ligament fixing the organ;
rupture of the cartilage itself;
rupture of cartilage tissue.
Blocking the knee with limited flexion temporarily provokes separation of the anterior horn of the ISS with pinching. After unblocking, movement in the joint is restored. A more serious injury, in which the knee joint locks, bends, and pops out, includes injury to the posterior horn of the internal meniscus.
Acute injuries to the ISS in 85–90% of cases are diagnosed based on characteristic signs:
blockade of the knee joint in a certain position of the leg;
the appearance of pain and clicking when trying to straighten the lower limb.
To clarify the diagnosis, instrumental research is used:
X-rays are used to determine the stage of degenerative damage. In the first degree, the image shows an uneven narrowing of the articulation gap; in the second, bone growths appear on the articular surfaces.
Having done an MRI and CT, the degree of damage and tissue of the knee joint are determined in a three-dimensional image: articular surfaces, ligaments, articular cavity and bones. In the sagittal (imaginary vertical) plane, the cartilage cushion is shaped like a butterfly. When the meniscus ruptures, it adjoins the posterior cruciate ligament, enters the intercondylar fossa of the femoral bone, and the symptom of “double posterior cruciate ligament” is determined.
Arthroscopy allows you to determine the condition of tissues and joint (synovial) fluid using an endoscope inserted into the joint cavity through minimal incisions.
Treatment methods for changes in the ISS depend on the causes, stage and form of the disorders. Acute injuries are treated conservatively.
Immediately after the injury, the patient must be provided with complete rest.
Apply a cold compress or ice pack to your inner thigh.
To relieve severe pain, narcotic analgesics are used, since other painkillers do not bring relief to the patient.
The damaged limb is immobilized (immobilized) by applying a plaster cast for two weeks.
In order to eliminate swelling and restore movement in the knee joint, a puncture is performed. In the first three to four days of active release of fluid (exudate) into the joint capsule, the cavity is punctured several times.
The duration of treatment for degenerative-dystrophic changes in the menisci ranges from six to twelve months.
During the blockade, reposition (reduction) of the knee joint is carried out using manual methods.
To restore damaged cartilage tissue of the ISS, hyaluronic acid and chondroprotectors are prescribed.
Non-steroidal anti-inflammatory drugs are used to relieve pain and signs of inflammation (caver, dona, sinarta, ibuprofen, indomethacin).
To reduce swelling and speedy recovery of damaged ISS of the first or second degree, ointments (dolgit, diclofenac, voltaren) are used externally on the skin.
Physiotherapeutic procedures (UHF, shock wave therapy, ozokerite, iontophoresis) and exercise therapy are prescribed.
Massaging the affected area of the knee has a good restorative effect.
In case of the second severity of degenerative changes in the internal meniscus (tears, displacement, separation of the anterior and posterior horn of the ISS, crushing of the cartilage), surgical intervention is indicated.
It includes: removal of cartilage completely or a damaged horn, suturing the rupture, fixing detached horns, transplantation.
A minimally invasive surgical operation includes arthroscopy, in which an arthroscope is inserted through two incisions up to one centimeter, the torn part of the meniscus is removed and its inner edge is aligned.
The following prostheses are most often used during transplantation:
To replace worn out internal or external ISS, a sliding prosthesis is used.
Surface substitutes are used for more pronounced destruction (abrasion) of cartilage tissue.
The knee joint is replaced using a rotary prosthesis secured with pins in the femur and tibia.
A hinged prosthesis allows you to completely replace the entire joint and guarantee its stabilization.
All operations are carried out only after signs of acute inflammation have reduced.
After surgery, rehabilitation measures are carried out to restore the functions of the knee joint, namely: therapeutic exercises, massage and physiotherapeutic procedures.
Physical activity is strictly contraindicated for the operated patient.
In the treatment of degenerative damage to the ISS, a significant role is given to therapeutic exercises and massage, due to the fact that the restoration of damaged tissue occurs faster with adequate physical activity, prevents the development of contractures and allows you to regain the lost range of motion in the joint.
Exercise therapy during immobilization is carried out for undamaged parts of the lower limb, and when the plaster cast or splint is removed, gymnastics is aimed at restoring the joint. The load is gradually increased by adding exercises with weights and on simulators.
return of muscle tone of the damaged limb;
restoration of the full range of motion of the knee joint.
A set of exercises and their intensity are developed by the doctor individually for each patient based on the complexity of the disease and the injury suffered.
With conservative treatment of meniscal injuries, exercise therapy begins two to three weeks after injury, and after surgery - two months later.
If a person takes care of his health and adheres to basic preventive measures, then the risk of ISS injuries is reduced by 90–95% of cases.
It is necessary to play sports in stable, well-fixed and comfortable sports shoes that can minimize the risk of falling.
To distribute the load evenly and safely, fix the knee using special pads (knee pads, orthoses, bandages) or an elastic bandage.
Before physical work or playing sports, it is necessary to warm up, gradually increasing the range of movements, warming up the muscles and joints.
Monitor your body weight, do exercises and eat rationally, but do not overeat, as excess weight increases the load on the joints.
Degenerative changes in the ISS are very common and manifest themselves in various types of pathologies, some of which require immediate consultation with a doctor to clarify the diagnosis and prescribe adequate treatment. A timely visit to a specialist will help maintain the functionality of the knee and prevent the involvement of other joint tissues in the pathological process.
Degenerative changes are usually understood as existing anatomical damage to an articular element resulting from a previous injury to a person.
As medical practice shows, degeneration of the menisci in most cases occurs as a natural consequence of injury (often it can even be a non-obvious injury).
For example: there was an unsuccessful rotation of the tibia, which resulted in damage to the cartilaginous disc itself. In the future, quite painful sensations arise in parallel.
Degenerative changes in the medial meniscus are common occurrences, which is associated with the peculiarities of its anatomy. Comparing the medial meniscus with the outer cartilage, it is worth noting that the second does not have a sufficiently rigid fixation in the knee joint, therefore, it can easily shift to any direction if such a need arises.
The medial meniscus is quite rigidly fixed. At the same time, its horns are located in close proximity (even dangerous proximity) to the condyles, which often prevents the meniscus from slipping away during a sharp turn of the tibia from the influence of dangerous processes. In this case, there is damage to the meniscus and its subsequent rupture, which will certainly cause severe complications, pain and discomfort when walking.
Having considered what degenerative changes in the menisci are, it is imperative to analyze the classification of the injuries themselves:
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Degenerative damage to the meniscus of the knee joint has characteristic symptoms that appear regularly and do not allow a person to feel good while walking.
For example, it could be pain in the knee; the damaged part emits aching vibrations that can then be felt throughout the entire leg.
The painful manifestations here either disappear or appear again, intensifying over time - if this is the case, then we can safely establish the fact that the cause of such a manifestation is precisely damage to the meniscus, which is degenerative in nature.
Citing rather sad statistics on this issue, it is worth noting that about 90% of all possible pathologies are caused by damage to the meniscus .
The treatment of such a disease should be treated with the greatest possible attention.
Actually, the symptoms and their subsequent manifestation will largely depend solely on the nature of the pathology itself.
If we take into account that there are degrees of the disease (first, second, etc.), therefore, the painful manifestations will be fundamentally different from each other each time, making it impossible to most accurately establish and coordinate your actions on the issue of treatment, or to use universal medications.
The following characteristic manifestations can be established that allow you to feel a degenerative meniscus tear:
Degenerative meniscal tears have another characteristic feature. Detachments and tears can be chronic in nature and manifest themselves in the future as periodic painful sensations, a kind of interference in the process of movement that cannot be ignored.
To view and identify such a disease, you can try to conduct a relatively simple experiment: it will be enough to go up and down the stairs, when moving down there will be pain in the knee joint, therefore, it will indicate possible problems with the meniscus.
When considering what the treatment of the disease may be, it is worth paying attention to the causes of the damage. For example, this could be an initial weakness of the meniscus itself, or even a genetic pathology. All these points should be paid attention to when establishing the subsequent process of treating the disease.
However, the reasons for the development of meniscal degeneration may be associated with excessive physical stress , which is applied to the injured limb by excessive weight and many other factors.
If there are acute injuries to the meniscus itself, the diagnosis is beyond doubt; this can be determined by blocking the knee in the appropriate position. When straightening, a painful sensation appears and peculiar clicks are felt, which makes it possible to establish an accurate diagnosis in more than 90% of cases.
The situation is more complicated with the determination of degenerative-dystrophic transformations that occur in the knee.
This is due to the patient’s immediate absence of characteristic symptoms and manifestations and a positive result from undergoing a variety of procedures.
As practice shows, in these cases it is worth resorting to special techniques, among which it is customary to distinguish the following 2 methods:
MRI of the knee meniscus to contents ^
It's time to consider how to treat the disease that has arisen. It is worth noting in this case that therapy will completely depend solely on the nature and development of the damage itself.
If there are acute manifestations of the development of the disease, it is worth highlighting the following conservative treatment methods:
With the right and timely approach, the disease can be treated without problems.
Diseases of the knee joint can be divided into two large groups:
1. degenerative diseases
2. traumatic injuries of the knee joint.
On this page you will find information about the most common patterns of diseases in both groups, as well as a description of the corresponding treatment methods.
Degenerative diseases of the knee joint
The human knee joint is one of the most loaded joints. As with the hip joint, articular cartilage decreases throughout life, up to complete loss of cartilage in the joint. In this case, we are talking about arthrosis.
Arthrosis can affect both individual parts of the joint (inside and outside) and the entire knee joint.
The reasons for this process are varied. Damage to cartilage, and along with it arthrosis, can be caused by general “aging processes”, injuries and deformation of the axis of the lower extremities (X- or O-shaped legs).
The aging process refers to the continuous process of loss of elasticity of articular cartilage. The course of the disease is very individual, since other factors, such as excess weight and exercise, also play an integral role in the progression of the disease. Damage to cartilage can also be caused by improper load on the joint (the main load falls on the inner side of the knee joint with an O-shaped deformity of the lower extremities or on the outer side with an X-shaped deformity). Such improper load can lead to the development of the disease at a young age. In such cases, patients may benefit from corrective surgery of the lower extremity axis (corrective osteotomy).
For elderly patients with partial or complete arthrosis of the knee joint, we perform partial or total knee replacement. You will find information about these operations in the section on knee endoprostheses.
Traumatic injuries of the knee joint
As a result of direct or indirect impact on the knee joint, in addition to fractures of the femur or tibia in the area of the knee joint, damage to the knee joint itself may occur.
These include meniscus injuries, torn anterior or posterior cruciate ligaments or collateral ligaments, and damage to articular cartilage.
In these cases, for further treatment and monitoring the course of the disease, it is important to obtain an accurate picture of the severity of the damage that has occurred. For this purpose, patients undergo an “operation” such as an arthroscopic examination of the knee joint (arthroscopy). The advantage of this study is the ability to accurately determine the extent of damage and directly repair many damages.
There are places in the human body where increased stress is felt. These include the cartilage discs between the vertebrae and the menisci of the knee joint. Over time, degenerative processes occur in the lateral (outer) and medial (inner) menisci.
The result of this pathology can cause a sick person a lot of discomfort.
The concept of degenerative changes should be understood as anatomical deformation of an organ of varying degrees (according to Stoller), which was the result of:
Meniscal degeneration is often the result of injury, which is not always obvious. An ordinary unsuccessful turn of the shin can be a prerequisite for the destruction of cartilage tissue, accompanied by severe pain.
Often the medial disc may be damaged. If, when the outer cartilage, which absorbs the motor activity of the knee joint, is damaged, there is no rigid fixation, then the cartilage moves to one side.
In this case, its horns will be located next to the condyles. With a sharp turn of the tibia, the meniscus may not have time to escape from the displaced process of bone tissue and immediately damage or even rupture occurs.
Degenerative lesions of the menisci can be different:
If a person is constantly tormented by aching pain, each time arising with renewed vigor, then it is quite possible that he has begun to experience pathological changes in the posterior horn of the medial meniscus. In almost 90 percent of cases, changes in the knee joint are associated with damage to the natural “shock absorber” of the lower extremities.
Symptoms will largely depend on the nature of the pathology itself. The gap is always accompanied by:
Serious damage to the medial meniscus occurs against the background of hemorrhage into the joint cavity (hemarthrosis). Swelling and pain are also characteristic of meniscal cystosis. All tears and detachments are chronic in nature, they can manifest as temporary pain and a feeling of interference with motor activity.
For self-diagnosis, you can conduct a special test. You need to go up and down the stairs. If there is a pathology of the meniscus, then as it descends, the pain in the knee joint will intensify significantly.
The chronic course is accompanied by secondary degenerative and dystrophic changes in the posterior horn of the medial meniscus (caused by other diseases). As a rule, in such situations, clicking and a feeling of pathological joint mobility (rolling) will be noted. This process is especially noticeable in movement after a prolonged state of rest. It can often present as pain in the knees.
As the disease progresses, symptoms gradually increase. The cartilage layer becomes thinner, and salts or uric acid crystals accumulate underneath it. If the patient does not seek adequate medical help, then the final stage of meniscopathy will be contracture.
It should be understood as a stable impairment and significant limitation of joint mobility.
The following symptoms are common to any degree of degeneration:
The high incidence of pathologies among patients of any age is caused by the special anatomical structure and location of the posterior horn of the menisci. As a rule, damage and cysts occur in those people whose activities are associated with high physical activity and significant stress (dancers, ballerinas, athletes).
Degenerative changes in the menisci can be caused by:
If the patient suffers from an acute form of damage to the medial meniscus, then in this case there will be blockade, pain and characteristic clicks when straightening the knee joint. This makes it possible to establish an almost 100 percent correct diagnosis.
Degenerative damage and changes in the internal meniscus cannot always be detected by visual examination due to the lack of clear, vivid symptoms and even a positive reaction to the tests performed.
In such a situation, you should resort to instrumental diagnostic methods:
Therapy for degenerative changes in the meniscus of varying degrees completely depends on the nature of the damage. Acute injuries serve as a direct indication for the use of conservative treatment methods:
During the rehabilitation period, ozokerite, iontophoresis, shock wave therapy and UHF will be excellent auxiliary methods.
Treatment may require splinting the affected limb (for 2 weeks). This will help ensure reliable fixation of the joint in the required position.
If there has been a rupture, then in such cases mandatory surgical treatment is indicated; the surgeon will perform:
If the degenerative changes in the meniscus are severe, then it may be necessary to remove the cartilage and replace it with artificial one.
Almost all surgical procedures should be performed only in a state of remission.
Surgery is only necessary for:
If you consult a doctor in a timely manner, degenerative damage to the internal meniscus will be stopped at the very beginning of its development.
Pain in the knee is considered the most common reason when seeking medical advice. Pain develops for various reasons, but the main one will be degenerative changes in the meniscus of the knee joint. The pathology is diagnosed mainly after 40 years of age, and the stage of development, as well as the origin of the disease, can be different.
Degenerative changes in the menisci do not arise out of nowhere. Pathology can develop due to injuries and damage to the knee. There are other reasons:
Dystrophic changes in the meniscus of the knee joint appear due to disruptions in the immune and endocrine systems, as well as against the background of structural changes that occur after 50.
Pathologies of the cartilage plate, which serves as a shock absorber, can occur in the everyday life of any person. It happens that a shin is accidentally twisted or a limb is damaged in a jump, or while running, an unfortunate fall, or under other circumstances. Thus, a degenerative meniscus tear can be an internal or external knee injury. The lateral or medial view of the cartilaginous plate suffers.
There are such damage to the shock-absorbing cartilage plate:
Before looking at the symptoms of the pathology, let's look at each type of shock-absorbing plate and degenerative tears that occur for various reasons.
Degenerative changes in the medial meniscus occur frequently when compared with the external one. Cartilaginous tissue is connected from the inside to the lateral articular ligaments located inside. The medial plate connects to the joint cavity from the outer edge, and its areas are supplied with a large number of blood vessels (red zone).
Such rigid fixation of the inner layer sometimes causes frequent damage. After surgery for resection of the medial plate, the load on the articular ligaments increases almost 2 times.
The outer cartilage plate is fixed in the joint differently, not like the inner part, and is located on the side of the outer knee area. This is a more mobile part, which is why degenerative damage to the lateral meniscus occurs less frequently, unlike the internal one.
If, due to injury, it is necessary to perform resection of the outer cartilaginous plate, the load on the ligaments will increase by almost 200%. Degenerative changes in the lateral view of the plate reduce the area of contact of the articular surfaces by 50%.
Almost any disease develops gradually. If treatment is not started at the initial stage, then as the disease progresses, it will become increasingly difficult to eliminate the symptoms. Degeneration of the knee meniscus begins with certain signs:
If you do not listen to the first signals, the disease develops and the symptoms become more extensive:
When the disease develops into a degenerative course, the main symptom is constant pain, sometimes accompanied by jamming of the joint. The pain syndrome can be pronounced, when it is almost impossible to move. In another case, pain accompanies specific movements (movements on steps, squats).
Pathological changes occur due to injuries such as avulsions of cartilaginous elements, ligaments, and condylar fractures.
Each knee contains two shock-absorbing plates, which are assembled from a body with horns (front, rear). When a limb is injured, avulsions can be localized in certain areas:
The rupture can also be combined. Often, when a limb is injured, the external shock-absorbing plate suffers due to its greater mobility compared to the internal elements.
There are 1st and 2nd degrees of degenerative changes in the menisci, which differ in symptoms.
Degenerative changes in the meniscus of the 2nd degree occur after complete separation of the meniscal horn. Severe pain in combination with a limb block usually leads to surgical procedures.
Degenerative dystrophic changes in the posterior horn of the medial meniscus are of the following directions:
With dystrophic changes in the posterior horn of the medial meniscus, sudden movement may displace or tear the cartilage. It happens that elements of cartilaginous tissue wander in the cavity area, causing acute pain and complete immobility of the limb.
With grade 1 degenerative changes in the medial meniscus, the pain is insignificant and soon passes. Such signs rarely promptly seek medical advice. As a result, the disease gradually progresses and progresses to stage 2 degenerative damage to the medial meniscus, in which the pain does not go away even during rest. The knee completely ceases to function in the more severe form (stage 3).
An oblique (incomplete) tear occurs at the junction of the body with the horn (posterior). With such an injury to the internal meniscus, a cracking sound is heard, accompanied by pain of varying intensity.
Degenerative changes in the posterior horn of the medial meniscus may have combined symptoms. With such damage, various articular planes and surfaces are affected.
There is also a horizontal tear of the posterior horn, which leads to degeneration of the medial meniscus. The injury is characterized by severe swelling in the area of the joint space.
Pathologies occurring with the participation of the outer cartilage plate differ from the mechanism of internal damage. Movements that lead to damage and lacerations occur in the opposite direction.
Changes in the anterior horn of the medial meniscus, caused by trauma, occur more often in childhood. In children, joint blockade occurs in rare cases.
The damaged lateral plate has the following symptoms:
The pain is not constant, so it is difficult to diagnose the damage.
If the injury is not treated, the damage gradually progresses to a chronic course of the disease. If the rupture of the anterior horn is severe, then the articular cavity may fill with blood. In this case, the horn comes off and its elements wander around the articular cavities, which leads to complete immobility of the knee. For these types of injuries, surgical intervention is prescribed.
Regardless of the reasons for the knee injury, and what symptoms the victim experiences, it is necessary to seek medical help as soon as possible. Timely diagnosis and subsequent treatment will help avoid irreversible consequences.
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Degenerative diseases of the shoulder joint are accompanied by a violation of its trophism - nutrition. Supraspinatus tendinitis involves inflammation of the tendon due to degenerative changes, ischemia, or calcification. The patient complains of suddenly developing pain in the shoulder or at the beginning of a circular motion in the shoulder joint.
In impact syndromes, the rotator cuff is displaced under the acromion process or acromioclavicular joint, causing pain when the arm is abducted. The appearance of pain when describing an arc with the hand between 30 and 60 degrees indicates the presence of supraspinatus tendinitis; between 45 and 120 degrees is a sign of subacromial bursitis, in which most of the humeral tuberosity extends under the acromial process.
Tears of the rotator cuff (the upper part of the shoulder joint, strengthened by the tendons of the supraspinatus, cavitary, teres minor and subscapularis muscles - the rotator cuff) develop in elderly patients and are likely due to degenerative changes in the cuff. In younger people with seizures, a rotator cuff tear may be caused by severe trauma accompanied by a tear of the supraspinatus muscle. In this case, the patient is unable to remove his arm while maintaining passive movements.
Frozen shoulder (adhesive capsulitis) occurs due to pain in the shoulder at rest and during movement, causing limitation of movement, which contributes to the development of frozen shoulder syndrome. The disease develops in middle-aged people, possibly with a history of trauma. The patient complains of pain and limitation of both active and passive movements in the shoulder. Sometimes the pain is severe and leads to disruption of normal sleep. This disease can also occur in elderly patients after prolonged immobilization of the arm, for example after a Collis fracture (fracture of the lower edge of the radius with posterior displacement of the distal fragment).
Osteoarthritis of the acromioclavicular joint is accompanied by pain that occurs when raising the arm above the head and rotating the shoulder with an arc of more than 140 degrees. Scapulohumeral osteoarthritis may be idiopathic or result from avascular necrosis or necrosis following radiation therapy for breast cancer. The patient complains of pain in the shoulder when moving and at night.
Rheumatoid lesions of the shoulder joint are more common than osteoarthritis. The patient usually has damage to other joints. The patient usually supports the injured arm. On examination, the normal contours of the shoulder are absent (the deltoid appears flat and sunken). Check for possible damage to the axillary nerve (lack of sensation in the area of innervation).
In a patient with a dislocation of the acromioclavicular joint, a local tumor-like formation (possibly the acromial end of the clavicle) is often palpated. When the surgical neck of the humerus is fractured, the patient complains of pain and tenderness on palpation and the inability to move the arm due to pain. Rule out damage to the axillary nerve. By palpation it is possible to determine the location of the fracture.
The patient has limited mobility in the shoulder joint. Check for pain during rotational movements and the ability to begin abduction (supraspinatus tendon ruptures). A patient with a frozen shoulder exhibits limitation of both active and passive movements in the shoulder joint. With osteoarthritis, there is limited movement in the shoulder. When examining, look for any mastectomy scar or signs of previous radiation therapy. With osteoarthritis of the acromioclavicular joint, there is a clear protrusion of the joint with the presence of local pain and the appearance of pain when raising the arm at a large angle.
With rheumatoid damage to the shoulder joint, signs of damage to rheumatoid arthritis and other joints are revealed. The patient experiences fever, malaise, and increased skin temperature over the joint area. When moving, crepitus can be detected in the glenohumeral joint.