Today we offer an article on the topic: Chondromic body: chondrosis of the shoulder and knee joints. We tried to describe everything clearly and in detail. If you have questions, ask at the end of the article.
Chondromatosis belongs to the group of chronic diseases and is a pathological degeneration of the islets of the synovial membrane of the joint into cartilage or bone tissue. Such a pathological process leads to the formation of benign cartilaginous or bone bodies in the articular cavity, ranging in size from a few millimeters to 4-5 centimeters.
Chondromatosis is a rare disease, is more common in men of middle and mature age, rarely there are cases of the appearance of the disease in newborns.
- acquired (postnatal)
Congenital abnormality is a consequence of improper differentiation of cells at the stage of intrauterine joint formation. Chondromatosis may be the only anomaly that has arisen due to pathological differentiation, and may be observed in combination with other congenital diseases.
Acquired chondromatosis occurs under the influence of external factors that provoke pathological biochemical reactions, which leads to the degeneration of the cells of the synovial membrane into cartilage or bone structures.
Also, chondromatosis can be malignant and benign.
• Chondrosarcoma (malignant chondromatosis) • Chondroma (benign chondromatosis)
In addition, chondromatosis can be classified according to the nature of the course of the disease, it is customary to single out: stable and progressive forms. In a separate group, you can make rare forms of the disease. For a stable form of the disease, the presence of single bodies is typical – up to 10 pieces or a multiple variant – the number of bodies up to 25. With a stable form, the process of formation of new bodies does not occur at all or is sharply slowed down during the course of the disease. As for the progressive form, in this case, tens or even hundreds of bodies can be counted inside the joint. Rare forms of chondromatosis include – osteomatosis, chondromatosis of mucous bags and tendon sheaths.
Causes of pathology
Chondromatosis may occur due to developmental disorders in the embryonic period. Also, development can be triggered by long-standing or new knee injuries, features of professional activity associated with high loads on the lower limbs and infectious agents. The specific etiological factor of the disease was not identified.
Signs of disease
Chondromatosis of the knee may be asymptomatic, and may be characterized by clear signs. The main symptoms of the disease are pain, limited movement in the knee joint, visual enlargement of the joint.. At the beginning of the development of the disease, as a rule, the symptoms do not manifest themselves. The pathological process develops slowly, and after the appearance of large nodes in the knee joint or a large number of small nodules, pain and crunch begin to appear. As the symptoms increase, a deformity of the knee joint can be visually noted. The joint increases in size, swells, against the background of which there is a sharp decrease in motor activity and limited movements in the knee joint.
The diagnosis is based on clinical signs and on the results of instrumental studies. X-ray imaging serves as a diagnostic method; in the picture one can detect a body or bodies of a spherical, ellipsoid shape. The body has a clear outline. A survey radiograph of the knee joint allows you to select only intra-articular formations containing calcium salts. In addition to radiography, methods of ultrasound diagnosis, computed tomography and magnetic resonance imaging are used. Additional methods allow you to most accurately get an idea of the size, number and location of bodies.
Chondromatosis in the knees allows you to determine a method such as arthroscopy or biopsy of the synovial membrane. The operation, carried out for the purpose of diagnosis, allows to verify the presence of chondromes, to analyze the state of the articular surfaces and the synovial membrane. Chondromatosis should be differentiated from chondrocalcinosis and chronic arthritis.
Treatment of chondromatosis of the knee
The presence of islet metaplasia of the synovial membrane requires only surgical intervention. Treatment may be minimally invasive or total removal of the synovial membrane. The volume of surgical intervention depends entirely on the shape and characteristics of the course of the disease. In the case of a stable form of pathology, treatment is more often based on arthroscopic removal of chondromic bodies or by partial synovectomy. Partial synovectomy removes the metaplastic islands of the synovial membrane. A progressive form of chondromatosis implies a more radical treatment – arthrotomy or total synovectomy. Such treatment is based on the need to prevent the possibility of relapse.
Postoperative treatment implies a set of measures aimed at restoring functions in the knee joint. Good results can be achieved as a result of physiotherapy treatment in combination with physical therapy and training on simulators.
Treatment of congenital chondromatosis
The operation should be carried out immediately after the diagnosis. Otherwise, the growth of cartilaginous bodies can provoke a curvature of the bone structures of the joint and a curvature of the lower limbs. Conservative treatment in the case of chondromatosis is ineffective, as it leads to the development of relapse. With conservative treatment, there may be temporary relief, due to the relief of symptoms. This is achieved by squeezing the cartilage of the body into the mucous bag, which leads to a decrease in pressure in the joint cavity and facilitate the implementation of functional actions.
In the case when the operative treatment did not give a complete recovery, and there was a relapse of the disease, a decision may be made to remove the joint, followed by its replacement with an endoprosthesis.
In the rehabilitation period, the main goal of treatment is the resumption of the normal blood supply to the tissues of the knee joint and the stimulation of the production of synovial fluid in sufficient volume. Physiotherapy, warming up, compresses, laser therapy significantly help to eliminate the symptoms of the disease. Special simulators that are used in the postoperative period have a positive effect on the restoration of muscle tone and strengthening of the ligament apparatus. Such importance as preventing the development of relapse is achieved only through an integrated approach to treatment. One of the tasks of rehabilitation measures is the treatment of gonartosis, which often develops in parallel with chondromatosis of the knee joint.
What is dangerous disease?
The chondromic body, which develops in the synovial membrane, primarily affects the physiological functions of the joint. Secondly, gonarthrosis can develop on the background of chondromatosis. The chondromic body can eventually bud off and penetrate into the articular cavity, with the result that articular mouse syndrome appears. The presence of a fragment of the cartilage body is capable of provoking the pinching of tissues in the knee joint, as a result of which intra-articular traumatization of the structures of the knee joint occurs. With chondromatosis, it is often possible to observe synovitis –
Prevention of acquired chondromatosis is based on minimizing physical load on the articular surfaces of the knee joints. This includes the struggle with obesity, the alternation of physical activity and rest.
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Chondromatosis of the knee joint is the process by which the synovial membrane, that is, the joint bag, is filled with small cartilaginous bodies. Pathological process leads to loss of mobility of the knee joint and intense pain. Benign growths occur, as a rule, on the inner side of the joint capsule, and then spread everywhere. This disease can be congenital or acquired. There is a hypothesis according to which the formation of cartilage in atypical places is caused by impaired intrauterine development of the fetus.
The main category of victims is men from 18 to 35 years old. Scientific studies have identified a link between professional activity, which involves greater physical stress on the knee joint, and chondromatosis.
In rare cases, the disease may occur as a complication after a fracture, dislocation or subluxation of the knee.
Chondromatosis of the knee joint in its essence is the process of formation of neoplasms consisting entirely of cartilage tissue. Because of their location, the articular bag loses its elasticity. It is significant that cartilaginous nodules arise only adjacent to those bones that have passed through the cartilage phase in their development. Consequently, there is a failure in the formation of the desired tissue types at each time point. Surgical removal of nodules often turns out to be useless, because new ones will soon form in their place. Joints that are most often affected by chondromatosis:
The presence of foreign formations in the articular bag leads to a crunch when moving. In the severe stage of the disease, when the cartilaginous outgrowths extend beyond the joint, they can be felt tactilely. What feels affected by chondromatosis?
- seizure in the knee when moving – it is difficult to smoothly bend and bend the knee to the anatomical limit;
- an inflammatory process may occur in the lesion, leading to reddening of the skin and a sensation of local temperature increase;
- swelling of soft tissue;
- at the severe stage of the disease – increase in joint size, visually noticeable foreign bodies under the skin;
- pain sensations of varying intensity during exercise and during rest.
The size of cartilage formations can vary from a few millimeters to 3-4 centimeters. What specialists should be referred to in case of suspected chondromatosis of the knee joint? To the traumatologist, to the rheumatologist and to the surgeon.
No means of traditional medicine to stop the progress of this chronic disease is impossible, to treat chondromatosis at home is meaningless. The only effective treatment is recourse to official medicine. What studies are conducted for diagnosis?
- Magnetic resonance imaging;
- CT scan;
- ultrasound procedure.
X-rays are not used because the cartilage tissue in the synovial membrane belongs to the soft tissues. The danger of cartilaginous nodules is that they lead to dysfunction of the knee joint, as a result of which the injured person becomes disabled. Because of the penetration between the articular surfaces, epiphyseal cartilages are injured, and the wear and tear of cartilage tissue increases. There are two types of forms: progressive and stable. Stable usually involves stopping the formation of cartilages at some stage, and progressing creates countless sets of them, dozens and even hundreds. Stabilization can occur independently, in quantities of up to 25 pieces. By the nature of the tumors, chondromatosis can be:
- benign, then the cartilaginous bodies are called chondromas;
- malignant, then they are called chondrosarcomas.
Since violations due to which the disease occurs, almost can not be adjusted, the treatment is carried out mainly operational.
The presence of chondromatosis in a child is usually detected a short time after birth. Surgical intervention should be carried out as early as possible so that cartilage formations do not lead to abnormal formation of the knee joint.Conservative treatment is rarely used and is usually ineffective. The essence of conservative treatment is to displace neoplasms from the region of the articular sac, which makes it possible to relieve pain and give some freedom to the movements of the joint. Surgical treatment can be carried out in two ways:
- Arthroscopy This is a method of penetration into the articular bag without significant damage to the skin and soft tissues of the knee. Two small cuts are made, surgical instruments are inserted into them, with the help of which all neoplasms are removed.
- Synovectomy. The method is intended for the treatment of a more severe stage of the disease, when the cartilaginous bodies have already reached significant sizes or their number is very large. There is a complete or partial removal of the synovial membrane, together with tumors.
Modern technologies allow replacing a lost joint with an endoprosthesis, which significantly improves the quality of life of a patient with chondromatosis. The decision is made on the basis of the clinical picture of the disease, and the likelihood of a relapse is evaluated, the composition of the neoplasm is specified.
Recovery in the postoperative period
In order to restore healthy mobility of the joint, not only muscles, ligaments and tendons, but also synovial fluid should be put in order. To stimulate blood circulation in the affected area, physiotherapy exercises are used to develop the knee joint, to bring the muscular system of the leg into shape. And to stimulate the production of synovial fluid, specially selected drugs are used by the attending physician.It is dangerous to engage in self-medication after injury, as a complication there may be a deforming arthrosis, a very painful disease of the knee joints. The success of treatment depends largely on the choice of a competent specialist who actually has successful experience in solving such problems. To relieve pain in the first time after surgery, non-steroidal anti-inflammatory drugs are usually prescribed. As a rule, in tablets, but in severe cases, injections can also be used. What symptoms should a medical emergency immediately after the operation?
- the victim rises to a temperature above 38 degrees;
- signs of intoxication, headache, nausea and vomiting, muscle weakness are increasing;
- changes the color of the skin of the knee to more red;
- knee swells, there is a pulsating pain and a feeling of local heat;
- skin sensitivity is disturbed in certain areas of the skin in the lower leg, thigh, or on the foot.
Such symptoms may indicate either infection and the onset of a dangerous inflammatory process, or neurological disorders that have arisen due to trauma to the nerve endings during surgery. Usually physiotherapy procedures are prescribed for the postoperative period to relieve pain and accelerate the regeneration of soft tissues:
- magnetic and laser therapy;
- paraffin therapy.
There are other possible methods of exposure, which are selected individually by the attending physician. For the speedy return of the knee joint to a working state, it is necessary to responsibly treat the rehabilitation period and accurately follow the recommendations of the attending physician.
The transformation of benign cartilaginous neoplasms into malignant ones occurs extremely rarely, however, in order to bring clarity, all tissues removed from the body undergo mandatory histological examination. If any of the two methods of surgical treatment does not work and the cartilaginous bodies continue to form, then it makes sense to perform a complete joint replacement.
Most often, the diagnosis of chondrosis of the shoulder people set themselves independently, immediately starting to treat the disease rubbed. Despite the fact that the scientific term chondrosis exists (it means cartilage dystrophy), doctors rarely use it. The fact is that, as a rule, dystrophic changes occur in parallel in cartilage and bone. Therefore, the name osteochondrosis (osteochondral dystrophy) is more common.
However, the diagnosis of osteochondrosis is often used unnecessarily. Soreness in the shoulder may be associated with osteochondrosis, but this is not its main cause. But in order to cure the disease completely, it is extremely important to establish the diagnosis correctly.
So, what is chondrosis of the shoulder joint? Usually, colloquially, this term refers to any pain in the shoulder area, regardless of its nature. But behind it can hide a whole range of diseases – from bone subluxation to arthritis. Let us examine the most frequent of them.
What diseases are often called chondrosis
Shoulder pain can be with osteochondrosis of the cervical spine. Usually, with this pathology, it first appears in the neck, and only “gives back” to the hand. This is due to the fact that the nerves supplying the shoulder joint exit the spine in the cervical region. There the nerve can be compressed and inflamed due to narrowing of the intervertebral crevices.
Pain in this area can also be with osteoarthritis. Usually, pain occurs at the end of the day and after exercise. The shoulder is not the most common localization of osteoarthritis, however, sometimes it suffers from this disease. Progressive osteoarthritis over time restricts hand movement.
Very hurt the shoulder joint can dislocate or fracture. Usually, painful sensations occur immediately after an injury, the mobility of the upper limb is disturbed. It is necessary to treat traumatic injuries immediately, therefore it is necessary to consult a doctor as soon as possible.
Bursitis is an inflammation of the articular sac,
Another pathological condition, which is often called chondrosis, is a rotator cuff tendonitis. Its essence is that the tendons of muscles attached to the humerus, soft tissues around, the articular capsule itself inflame. Symptoms of tendonitis – local pain, limited mobility of the hand.
A common cause of pain in the shoulder joint is periarthritis. It is believed that its share among chronic diseases of this anatomical region is 60%. Sometimes this disease is also called periarthrosis, adhesive capsulitis, as well as “frozen shoulder”. From the variety of synonyms, we can conclude that there is a certain terminological confusion around periarthritis.
Perhaps, periarthritis is most often called chondrosis. The causes of this disease are unknown. First, after injury or spontaneously, there is pain in the front surface of the shoulder, which often returns to the scapula. Within a year after this, contracture may develop,
Why do you need to go to the doctor
As can be seen from the above, under the common term “shoulder chondrosis” various diseases can be hidden, which also need to be treated differently. They all appear very similar: pain and limitation of mobility of the arm. It is extremely difficult for a non-specialist to understand the symptoms and to independently distinguish one disease from another.
If a person spares his hand for a long time against the background of inflammation and does not move it fully, irreversible changes may develop in the articular bag. It is necessary not to miss the time when the disease can still be completely cured. Therefore, with the appearance of pain in the shoulder joint, a visit to the doctor is strictly required.
Chondromatosis of the knee joint is a chronic pathology in which the synovium partially undergoes changes, gradually turning into cartilage. In severe cases of the disease, complete ossification of the individual damaged areas may occur. In the process of changing the structure of the synovial membrane, multiple benign inclusions are formed, the size of which varies from a few millimeters to several centimeters.
Inflammation of the synovial membrane of the joint (left), which further leads to the formation of chondromic bodies inside the joint
Chondromatosis contributes to the disruption of the blood supply to the knee joint, in which progressively less and less synovial fluid begins to be produced, which leads to rather unpleasant consequences. Over time, benign lesions, located in the articular membrane, can spontaneously detach and be free intraarticular inclusions – articular mice. In this case, the mechanism of the knee joint is disturbed, its structures are clamped, and chronic damage is formed.
From a scientific point of view, the mechanism for the development of chondromatosis has not yet been explained. Doctors believe that the leading role in the occurrence of the disease belongs to genetic predisposition. So there is an assumption that the basis of future transformations in the articular tissues is formed in the prenatal period. Very often, chondromatosis is combined with other disorders of the musculoskeletal system.
If you do not start treatment in a timely manner, then in addition to the pain, other symptoms will gradually begin to appear:
- crunch in the knees;
- fluid accumulation in the joint;
- swelling of the tissues of the knee;
- sharp limitation of the range of motor activity;
- localized temperature rise.
The appearance of tumors in the synovial membrane is primarily dangerous because the blood supply to the knee joint is disturbed and the production of synovial fluid in it. This, in turn, leads to the development of gonarthrosis. The articular mouse syndrome that occurs during chondromatosis provokes pinching of the articular structures, causing chronic traumatization. If you do not start the treatment of the disease at the initial stages of its development, the occurrence of synovitis is possible – accumulation of fluid in the joint, causing its swelling and swelling.
Chondromatosis is diagnosed using the following research methods:
- physical examination in which the affected joint is examined and palpated. It also evaluates its range of mobility;
- X-ray, at which the boundaries of the deformation area are fixed;
- arthroscopy – a visual inspection of the inner surface of the knee joint using a special device – an optical endoscope, which is inserted directly into the joint cavity.
Radiography of the knee with chondromatosis
Primarily in the diagnosis of pathology of the knee joint, non-invasive research methods are used. If the doctor doubts the diagnosis of chondromatosis, arthroscopy is prescribed, as a result of which it is possible to obtain error-free information about the presence of intra-articular inclusions, their structure and size. Based on the data obtained, individual treatment of the disease is being developed.
Chondromatosis is an indication for knee arthroscopy.
Chondromic bodies inside the knee joint with arthroscopy (left). Removal of the chondromic body from the joint cavity (center). Chondromic body after removal from the joint.
During the operation, the removal of chondromic bodies. If multiple formations are observed, a complete excision of the articular membrane is possible. It should be noted that after surgery, the disease may relapse as the disease itself is chronic.
If a congenital form of chondromatosis is diagnosed, surgical intervention is required immediately. The long course of the disease contributes to a strong proliferation of cartilage formations, which ultimately leads to limb deformity and disability.