Joint Deformity : Causes, Symptoms, Diagnosis & Treatment

• Why Joints Are Deformed
• Traumatic Injuries
• Inflammatory And Degenerative Diseases
• Congenital Anomalies
• Curvature Of The Legs
• Consequences Of Injuries And Diseases
• Hereditary Diseases
• Diagnostics
• Treatment
• Help At The Prehospital Stage
• Conservative Therapy
• Surgery

Joint deformity develops with injuries, inflammatory and degenerative diseases of the joints, is a consequence of congenital anomalies. It is formed in the outcome of diseases, traumatic injuries. It can be detected in the area of ​​one, several or many joints, accompanied by pain, lameness, limitation of movement. The cause of the symptom is established according to the survey, physical examination, radiography, ultrasound of the joints, CT, MRI, laboratory tests. Treatment includes NSAIDs, chondroprotectors, and other means.

Why joints are deformed

Traumatic injuries

Short-term deformation due to soft tissue edema occurs with all joint injuries. More significant reasons for changing the configuration are:

• Dislocations. The articular ends of the bone are displaced relative to each other, as a result, the joint acquires an unnatural appearance, the limb lengthens or shortens. There is a sharp pain, springy resistance when trying to move.
• Fractures. The deformity is provoked by the displacement of bone fragments, aggravated by the accumulation of blood in the joint. There are intense pains, a pronounced violation of the support and movements. Pathological mobility and crepitus are possible but not required.
• Link breaks. With complete or almost complete damage, the ligament ceases to fix the joint, the distal segment deviates to the side, the joint is bent. External changes are more noticeable with knee and ankle injuries.

Inflammatory and degenerative diseases

Deformities are formed against the background of acute and chronic inflammatory diseases of the joints. In acute processes, changes increase over several weeks or months. In patients with chronic pathologies, it can take years from the onset of the disease to noticeable joint deformities. The cause of the development of the symptom is:

• Aseptic arthritis : rheumatoid, juvenile, gouty, psoriatic, with SLE, Reiter's syndrome, Behçet's disease, Bechterew's disease, polychondritis dissecans.
• Infectious arthritis: provoked by nonspecific microflora (including when inflammation moves from the bone against the background of osteomyelitis), with tuberculosis, gonorrhea, and some other diseases.
• Secondary arthritis : with sarcoidosis, malignant tumors, osteomyelitis, diseases of the blood, digestive system, respiratory organs.

Infectious arthritis affects one joint, with gonorrhea, polyarthritis is possible. In other cases, mono-, oligo-, or polyarthritis may be observed, but multiple symmetrical or asymmetrical joint involvement is more common.

Another common cause of deformity is osteoarthritis. Post-traumatic arthrosis occurs at any age, one joint suffers. For arthritis of non-traumatic etiology, late manifestation (middle and old age) is typical. Often there is a lesion of several joints with an uneven course of degenerative processes. The patient may be disturbed by one joint or paired joints against the background of minor symptoms or asymptomatic course of other arthrosis.

Joint deformity

congenital anomalies

The most noticeable visual deformation is detected in pathologies of the knee joint - congenital dislocation of the lower leg or patella. Dislocation of the lower leg is often bilateral, accompanied by a violation of the configuration of the joint, limitation of movement, muscle atrophy. The nature and severity of the deformity vary significantly depending on the characteristics of the displacement of the bones of the lower leg.

When the patella is dislocated, the appearance of the anterior surface of the knee changes. The patella is more often displaced outwards. Due to concomitant underdevelopment of the lateral condyle of the tibia, instability of the limb, repeated injuries, severe deforming arthrosis develops early in patients, contractures form, which aggravates the deformity.

Hip dysplasia and congenital hip dislocation are the most common congenital anomalies, but external deformity in these pathologies is not so noticeable, since the hip joint is deep, hidden by a significant array of soft tissues. First of all, attention is drawn to the asymmetry of the joints, a change in the length of the limb. Over time, the deformities progress due to arthrosis and contractures.

Curvature of the legs

O-shaped legs can be a congenital anomaly (for example, in patients with fibrocystic dysplasia), formed against the background of rickets, Blount's disease, osteitis deformans. With this violation, the knee joints are bent at an angle that is open inwards. Pathology proceeds relatively favorably, but with early onset and significant curvature, it is complicated by arthrosis, which increases the deformity.

X-shaped legs are more often acquired in nature, formed with rickets, premature onset of standing and walking, excessive stress on the joints at an early age due to obesity or weakness of the ligaments, after injuries and tumors. Sometimes there is a hereditary predisposition. The knee forms an angle, open outward. Patients develop gonarthrosis early, which entails a further change in the appearance of the limbs.

Consequences of injuries and diseases

In the long-term period, in patients with intra-articular fractures, the configuration of the damaged joint changes due to improper union of fragments or the formation of excess callus. Concomitant ligament injuries with the subsequent development of instability play a certain role. Fibrous processes in periarticular soft tissues matter.

Contractures and ankylosis are almost always accompanied by external deformation. Along with injuries of solid structures (dislocations, fractures), their formation is caused by arthritis, arthrosis, and congenital pathologies. In addition, the cause of joint deformity with the development of contracture can be:

• deep scars after severe burns, abscesses, phlegmon, extensive wounds of the periarticular region (especially infected ones);
• prolonged immobilization with subsequent shortening of the muscles, the development of fibrosis of the soft tissue structures of the joint;
• severe limb ischemia due to compression of the arteries by bone fragments during trauma (Volkmann's ischemic contracture);
• paresis and paralysis of neurogenic origin after spinal cord injury, tumors of the spinal cord and brain, stroke, TBI, encephalitis, cerebral palsy, with injuries of peripheral nerves, severe neuropathy.

hereditary diseases

Due to the low prevalence of hereditary pathologies are considered a fairly rare cause of joint deformity. Articular pathology can be part of complex changes in the skeleton, combined with metabolic disorders, disorders of the internal organs, facial deformities. The symptom occurs in the following diseases:

• mucopolysaccharidoses;
• pseudoachondroplasia;
• Ollie's disease;
• Cornelia de Lange syndrome;
• Tiemann's disease;
• Klippel-Trenaunay syndrome;
• Shereshevsky-Turner syndrome;
• Lery-Weil dyschondrosteosis.

Diagnostics

The cause of non-traumatic deformities is established by rheumatologists. Diagnosis of traumatic injuries and their consequences is within the competence of orthopedic traumatologists. According to the indications, consultations of a geneticist, oncologist, and other specialists are prescribed. The initial stage of the examination includes a conversation with the patient, a general physical examination, a detailed examination of the joints with an assessment of their configuration, size, range of motion. Based on the data obtained, a plan of diagnostic measures is drawn up, within the framework of which the following can be carried out:

• Radiography. Standard research is performed in two projections. If necessary, sighting pictures, radiographs of symmetrical joints are prescribed. The technique allows to visualize fractures, dislocations, areas of destruction and osteolysis, changes in the joint space, bone growths.
• Joint ultrasound. Indicated for assessing the condition of intra- and periarticular soft tissues. Confirms the presence of hemorrhages, inflammatory processes, areas of calcification.
• MRI and CT of the joint. Recommended for ambiguous results of basic techniques. They make it possible to accurately determine the nature of the pathology, the volume and location of the pathological focus. They can be carried out at the stage of preparation for surgery in order to plan the tactics of surgical treatment.
• Joint puncture. It is carried out in the presence of liquid. In case of injuries, it is performed with a therapeutic purpose. In diseases of the joint after evacuation, the fluid is sent for cytological, immunological or microbiological analysis to clarify the etiology of the pathological process.
• Arthroscopy. It is produced for autoimmune diseases, tuberculosis, and some other conditions. It can be diagnostic or therapeutic-diagnostic. Provides detailed visualization of joint structures, sometimes including a biopsy.
• Laboratory tests . They confirm the presence of an inflammatory process, identify markers of autoimmune pathologies, and are used to determine the pathogen and its antibiotic sensitivity in infectious diseases.

X-ray of the hands

Treatment

Help at the prehospital stage

In case of injuries, the arm or leg is fixed with the help of a splint or improvised devices (for example, planks), the limbs are provided with an elevated position. Cold is applied to the area of ​​damage, with severe pain they give an analgesic. For pain, swelling, redness of non-traumatic origin, rest is recommended, short-term use of painkillers and anti-inflammatory drugs is acceptable. An increase in symptoms, an increase in general temperature, a deterioration in general condition are the reason for an urgent consultation with a specialist.

Conservative therapy

Patients with traumatic injuries perform a blockade of a fracture or dislocation, carry out reduction, and immobilize with a plaster cast. Sometimes skeletal traction is shown. Conservative therapy for joint deformities may include the following measures:

• Protective mode . It includes load limiting, sometimes - the use of orthopedic devices, canes, crutches, walkers.
• NSAIDs . They are an essential part of the treatment of many diseases and injuries. Reduce pain, reduce the severity of the inflammatory process. They can be used in the form of tablets, injections, creams, ointments, gels.
• Antibiotics . Necessary for the infectious genesis of pathology. For nonspecific infections, they are prescribed in short courses (from one to several weeks). With STIs, they are introduced according to special schemes. With tuberculosis, long-term treatment lasting several months is indicated.
• Hormonal preparations . In the form of blockades, they are used with the ineffectiveness of analgesic and anti-inflammatory treatment during exacerbations. In some autoimmune pathologies, the use of general action agents is required.
• Chondroprotectors . Improve the condition of cartilage. Perhaps intraarticular administration, the appointment of tablets or injections.
• Physiotherapy procedures . Taking into account the peculiarities of the pathology, drug therapy is supplemented with drug electrophoresis, UHF, applications of ozocerite and paraffin, magnetotherapy, laser therapy, shock wave therapy, massage, manual therapy, acupuncture.
• Therapeutic exercise . During treatment, exercise therapy ensures the preservation of limb function, reduces the risk of complications. At the stage of rehabilitation, it allows to improve the functions of the affected segment, to restore working capacity.

Surgery

When deforming the joints, the following surgical techniques are used:

• Traumatic injuries : open reduction of dislocations, osteosynthesis of fractures, suture and plastic surgery of ligaments.
• Infectious arthritis : arthrotomy, joint drainage, excision of affected tissues, reconstructive interventions.
• Malformations : bone grafting, limb lengthening, corrective osteotomy, fixation of the patella in case of dislocation.
• Consequences of diseases and injuries : redressing, arthrodesis, arthroplasty, endoprosthetics.