Joint asymmetry is observed in traumatic injuries, developmental anomalies, inflammatory and degenerative articular pathologies. Sometimes it occurs as a reaction of the body to diseases of other organs and systems. May be due to edema, fluid accumulation, changes in the configuration of solid structures, atrophy, fibrosis of the periarticular soft tissues. The cause of the asymmetry is determined according to the data of the survey, external examination, radiography, ultrasound, and other imaging and laboratory methods. Painkillers and anti-inflammatory drugs may sometimes be taken before a diagnosis is made.
Why does joint asymmetry occur?
fluid accumulation
The accumulation of blood or inflammatory fluid is accompanied by many diseases and injuries. Hemarthrosis often occurs in the first days after traumatic injury. Synovitis is formed 1-2 weeks after the injury, it is formed against the background of acute inflammatory pathologies, exacerbation of chronic degenerative, inflammatory processes. The asymmetry is visible and often pronounced. The joint becomes spherical, its contours are smoothed out. The patient complains of a feeling of fullness. Palpation reveals fluctuation.
Injuries
The symptom is detected with the following traumatic injuries:
- Injury. The violation of symmetry is due to soft-tissue edema, which disappears within 1-2 weeks. Movements are limited due to pain, limb function is preserved.
- Dislocation. Asymmetry occurs due to a gross violation of the configuration, gradually aggravated by progressive edema. The pains are intense, there are no movements when you try to move, and springy resistance is found. The function of the limb is lost.
- Fracture. The cause of the symptom is significant edema, sometimes displacement of fragments with an intra-articular or periarticular fracture. Movements are practically absent due to pain, limb functions are sharply limited, and crepitus and pathological mobility are possible.
- Ligament damage. The asymmetry is caused by edema, more pronounced in the projection of the injured ligament. The support is limited, and movements are painful, especially when trying to move the leg or arm to the side opposite the damaged ligament.
Post-traumatic deformities
The cause of asymmetry after severe injuries is often deformities caused by inaccurate matching of fragments, excessive callus formation, and proliferation of scar tissue. As a result, an increase in the volume of the injured joint, shortening or curvature of the limb, due to which paired joints look asymmetrical, contracture or ankylosis, in which the joint loses not only mobility but also its original configuration, is possible.
Joint asymmetry
Asymmetry in arthritic changes is explained by the growth of bone tissue and concomitant changes in the surrounding soft tissue structures. It can develop with damage to any joint of the upper or lower limb but is most visually noticeable with unilateral involvement of the knee or ankle. The symptom is most often detected in patients with post-traumatic arthrosis since the paired joint remains intact.
Another possible reason is the development of non-traumatic arthrosis due to overload of one limb or a faster progression of the process on the one hand. With a pathology of non-traumatic origin in older people, the symptom is often absent, since the joints are equally or almost equally deformed against the background of symmetrical arthrosis.
Aseptic arthritis
Asymmetry is characteristic of some aseptic arthritis (except for rheumatoid arthritis), due to inflammatory edema:
- Psoriatic arthritis. One of the options for the course of the disease is asymmetric mono- or oligoarthritis. Skin symptoms usually precede articular manifestations.
- Gouty. In a typical course, 1 metatarsophalangeal joint is affected. It is characterized by an acute onset with intense pain, severe edema, and skin hyperemia. Sometimes the cause of asymmetry is the involvement of one large joint or oligoarthritis.
- Reactive. Asymmetric articular edema appears within a month after the development an intestinal or urogenital infection and may be combined with urethritis, conjunctival lesions, lymphadenitis, and skin manifestations.
Infectious arthritis
Explicit asymmetry is determined in nonspecific infectious arthritis. The disease begins acutely. Severe edema, severe pain, general and local hyperthermia, and fever are detected. The joint is sharply edematous, and the skin over it is red, sometimes with a purple tint. Due to the involvement of surrounding tissues, the symptom is most pronounced with panarthritis. For specific arthritis, a less noticeable asymmetry is characteristic:
- Tuberculous. Affects one large joint, and proceeds chronically. Symmetry violations increase gradually over several months in parallel with the increase in edema.
- Gonococcal. The course is acute or subacute, and the knee, ankle, and elbow joints are more often affected. Articular symptoms are combined with skin rashes, sometimes with pain, and pathological discharge from the urethra.
- Brucella. Arthritis is observed mainly in the chronic course of the disease and can capture several joints, and be symmetrical or asymmetric. Over time, destruction progresses, and deformations are formed.
Arthropathy due to infections
An asymmetric lesion can develop against the background of infectious diseases and the pathological conditions caused by them:
- Reiter's syndrome. Occurs with chlamydia, less often with salmonellosis, dysentery, yersiniosis, and enterocolitis. Asymmetric arthritis manifests itself 1-1.5 months after the appearance of signs of the underlying pathology, which is the leading symptom, combined with damage to the eyes, and genitourinary system.
- meningococcal infection. Symmetry violations are detected in the second week from the onset of the disease. One knee suffers, and asymmetric oligoarthritis is less often observed.
- Chickenpox. Asymmetry is short-term, due to swelling of one or more joints.
Other arthropathies
Sometimes asymmetry is detected in vasculitis, metabolic, and endocrine pathologies:
- Hydroxyapatite arthropathy. The symptom is observed with monoarthritis and synovitis against the background of chronic polyarthritis. In 75% of patients, the shoulder suffers, lesions of the wrist or knee joint, and hand joints are less common.
- diabetic arthropathy. It is more commonly diagnosed in young women with type 1 diabetes. A unilateral lesion of the joints of the foot is revealed, less often - the knee or ankle. The upper extremities are even more rarely involved.
- Hyperparathyroidism. The occurrence of acute mono- or polyarthritis is typical.
- Nodular periarteritis. Accompanied by migratory arthritis of large joints.
Anomalies of development
The appearance of a symptom is due to developmental disorders of the joints themselves or a difference in the length of the limbs with underdevelopment of bones. The most common pathology is hip dysplasia, and less common is congenital dislocation of the hip. Other possible causes of asymmetry include:
- congenital dislocation of the leg;
- varus and valgus deformities of the hip or knee;
- underdevelopment of the femur, and tibia;
- congenital clubhand;
- limb segment gigantism.
Other reasons
Asymmetry of the wrist joint can occur with hygromas of the hand, the back surface of the knee - with a Baker's cyst. Sometimes a violation of symmetry is provoked by diseases of the burs, ligaments, and tendons: bursitis, enthesopathy, tendinitis, tendovaginitis.
In addition, increasing deformation is detected in oncological diseases. In patients with benign tumors, the asymmetry increases gradually; in patients with malignant tumors, the joint deforms within a few months. The rapid (in a few days) progression of asymmetry in neoplasia indicates the addition of inflammation or the development of synovitis.
Ultrasound of the joints
Diagnostics
The cause of non-traumatic asymmetry is established by rheumatologists. Patients with injuries are examined by traumatologists. According to the indications, consultations with a phthisiatrician, endocrinologist, or infectious disease specialist are prescribed. The doctor conducts a survey, examines the joints, compares their size and configuration, determines the range of motion, and detects local hyperemia and hyperthermia, and fluid in the joint cavity. The survey plan is drawn up taking into account the data obtained, and may include the following procedures:
- Radiography. Produced in two projections. If necessary, images of two symmetrical joints are taken. On radiographs, marginal growths, narrowing of the joint space, and zones of osteolysis or destruction are visible.
- Joint ultrasound. Informative in the study of soft tissue structures. Confirms the presence of fluid, and detects signs of inflammation, hemorrhage, and calcification zones.
- CT and MRI of the joint. Appointed to refine the data obtained in the course of basic research. They allow you to accurately determine the location, nature, and size of the pathological focus, select the most effective scheme of conservative therapy, and plan the tactics of surgical intervention.
- Joint puncture. It is carried out with asymmetry due to fluid accumulation. The exudate is studied by microbiological, immunological, or cytological research.
- Arthroscopy. Indicated for suspected tumor, tuberculosis, and autoimmune pathology. It is performed for a detailed study of intra-articular structures, for additional diagnostic (biopsy sampling) and therapeutic measures.
- Laboratory tests. In the course of laboratory studies, signs of inflammation are revealed, markers of autoimmune and oncological diseases are detected, and pathogens of infectious diseases are identified.
Treatment
Help at the prehospital stage
Patients with traumatic injuries should be immobilized. To reduce swelling, a cold should be applied, to reduce the severity of the pain syndrome, an analgesic can be given. In other cases, the rest is shown. With slightly pronounced local symptoms, anti-inflammatory and analgesic drugs can be used for a short time. If symptoms persist or worsen, you should consult a doctor.
Conservative therapy
Patients with injuries are shown to reduce dislocations, reduce fractures, and apply a plaster cast or skeletal traction. With hemarthrosis and synovitis, joint punctures are performed. The scheme of conservative treatment of diseases and traumatic injuries may include:
- Protective mode. The level of physical activity, the volume of motor restrictions, and the need to use additional means (crutches, canes) are determined by taking into account the characteristics of the pathology.
- NSAIDs. Reduce pain and inflammation. They are prescribed in the form of injections, tablets, and topical agents.
- Antibiotics. Shown in the infectious nature of the disease. The drug is selected taking into account the sensitivity of the pathogen.
- Chondroprotectors. They provide nutrition and restoration of cartilage, are used in the form of generic medicines, or are injected into the joint cavity.
- Hormonal agents. They are injected into the joint or periarticular tissues to quickly eliminate swelling, pain, and inflammation.
- Cytostatics. Necessary for malignant tumors, can be supplemented with radiation therapy.
- Physiotherapy. For non-tumor diseases, UHF, drug electrophoresis, magnetotherapy, acupuncture, massage, and other techniques can be recommended.
Surgery
In pathologies with asymmetric joints, the following operations are performed:
- Injuries: osteosynthesis of periarticular and intraarticular fractures, open reduction of dislocations, suture, and plastic surgery of ligaments.
- Post-traumatic deformities: arthroplasty, arthrodesis, endoprosthetic.
- Infectious arthritis: arthrotomy, removal of altered tissues in tuberculosis, reconstructive surgery in the long term.
- Developmental anomalies: corrective osteotomy, limb lengthening using compression-distraction devices, osteoplastic interventions.
- Volumetric formations: removal of Baker's cyst, excision of hygroma, removal of a benign tumor, bone resection, amputation for malignant neoplasia.