The reasons Kinds Symptoms of chronic pharyngitis Diagnostics Treatment of chronic pharyngitis Complications Prevention Chronic pharyngitis is a disease in which persistent inflammation of the…
When the tonsils (or simply the tonsils) become infected with various pathogens, they speak of angina (acute tonsillitis ). Its purulent form is most difficult.
Purulent tonsillitis can affect both children and adults. The peak incidence occurs in the autumn-winter period.
By the nature of the structural changes and the involvement of the tonsils in the process, there are the following types of angina:
- catarrhal – without pus, the easiest form;
- follicular – with the formation of pus;
- lacunar – also purulent form of tonsillitis;
Depending on the pathogen that caused the infection in the glands, angina can be streptococcal, staphylococcal, mixed etiology.
According to the course of the disease, a sore throat can be mild, moderate or severe.
The causes of the disease are:
- B-hemolytic streptococcus group A (usually);
- penetration into the tonsils of staphylococci (single or in combination with streptococci);
- viruses ( Coxsackie virus, herpes virus);
- pale spirochete (causative agent of syphilis).
Predisposing factors for the development of the disease include:
- weakening the body’s defenses;
- gas pollution, dustiness of the environment;
- harmful working conditions (contact with dust, temperature changes);
- lack of vitamins;
- life in megacities;
- use common with diseased dishes.
Purulent tonsillitis is quite a serious disease and is difficult.
The incubation period for angina ranges from several hours to two days. The disease begins acutely, and the signs of intoxication of the organism come to the fore. These include:
- increase in body temperature (up to 38-40 ° C);
- body aches;
- head aching pain without a certain localization;
- weakness and lethargy;
- decrease or lack of appetite.
In addition, there is an increase in regional lymph nodes or lymphadenitis (swelling of the submandibular, ear, occipital lymph nodes).
On examination of the throat, bright red enlarged tonsils are visible, on which there are dilated follicles or lacunae with yellow (purulent) contents. Pus that expires from bursting follicles or lacunae forms a fibrous plaque on the tonsils, which is easily removed with a swab.
Also, patients may be disturbed by:
- pains in the joints and muscles, in the stomach;
- runny nose
Depending on the degree of swelling and enlarged tonsils, there is pain in the throat when swallowing. In severe cases, the tonsils are so hypertrophied that they almost overlap the throat, the patient not only cannot swallow, it is even difficult for him to open his mouth.
It is necessary to differentiate purulent quinsy and diphtheria , purulent tonsillitis and infectious mononucleosis . The diagnosis of the disease is determined by a combination of characteristic complaints and examination of the patient.
Obligatory palpable regional lymph nodes and pharyngoscopy.
Pharyngoscopy is a visual examination by the doctor of the oral cavity and pharynx with the help of a medical spatula; in the process of such examination, enlarged lacunae and / or follicles with purulent discharge and a deposit on the tonsils are detected.
In addition, a general blood test is prescribed, in which signs of inflammation are determined (accelerated ESR, an increase in the number of white blood cells).
To exclude diphtheria a swab is taken from the mucous membrane of the pharynx and nose, and a discharge is taken from the tonsils for planting and sensitivity to antibiotics.
An otolaryngologist is engaged in treating a sore throat, and in the case of his absence – a general practitioner.
As a rule, patients with mild and moderate severity of the disease are treated on an outpatient basis, but hospitalization is also possible with severe intoxication or the appearance of complications.
The patient is assigned bed rest, limited contact and, especially, conversations with loved ones.
Abundant warm drink shown:
- fruit and berry fruit drinks;
- still mineral water;
- Loose tea with lemon.
Since the body is weakened, and the patient himself is difficult to eat because of unpleasant sensations when swallowing, the food should be rich in vitamins, easily digestible, warm and soft in consistency.
Mandatory rinsing throat warm, but not hot solutions with antiseptics and decoction of herbs. To do this, you can use:
- a solution of soda, salt and iodine;
- furatsilina and chlorhexidine solution;
- weak potassium permanganate solution;
- decoctions of sage, chamomile, calendula and other herbs.
Gargles not only act as a disinfectant, but also relieve swelling of the tonsils, relieve sore throat.
Undoubtedly, in the treatment of purulent tonsillitis can not do it alone rinses, therefore, antibiotics must be prescribed. Preference is given to:
- antibiotics penicillin (amoxiclav, Augmentin);
- cephalosporins 2 and 3 generations ( ceftriaxone , cefuroxime , cefix );
- macrolides (azithromycin, sumamed ).
The course of antibiotic therapy is at least 7 days. It is important to take drugs within three days after the temperature normalizes.
Nonsteroidal anti-inflammatory drugs (paracetamol, nurofen ) and antihistamines (suprastin, claritin) are prescribed to relieve swelling and relieve pain in the throat.
Purulent tonsillitis is dangerous for its complications, which can be both late and early.
- otitis media;
- laryngitis ;
- purulent lymphadenitis;
- soft tissue abscesses.
Later may develop:
The prognosis for timely and high-quality treatment of the disease is favorable.
Epicondylitis is a lesion of the elbow joint with the formation of the so-called “tennis elbow” – a progressive dystrophic process in the joint, where the muscles are attached to the protrusions on the humerus.
The process leads to severe inflammation of the surrounding tissues and dysfunction of the hand, often the professional trauma of athletes whose activity is associated with active hand movements – tennis, golf, baseball.
The main cause of epicondylitis are constant loads and microtraumas in the elbow area, associated with professional or sports activities. Usually this happens when playing with active involvement of hands, when lifting and carrying weights, with inadequate loads on the elbows.
Mostly, epicondylitis occurs as a result of monotonous actions in flexion-extension of the elbows, with simultaneous loading on the arm in the area of the hand and forearm.
Provoke epicondylitis professional actions by twisting or untwisting hands (repairmen, car mechanics, athletes), blows to the elbow.
Mostly this condition develops in people with congenital connective tissue dysplasia and “loosening” of the joints, often epicondylitis is combined with osteochondrosis in the area of the cervical or thoracic spine.
Men suffer more often than women. Epicondylitis is widespread in athletes, massage therapists, carriers, and painters. More often it is right-hand, for left-handers it is the opposite.
Depending on the location of the lesions and tenderness, there are three types of epicondylitis:
Lateral (external) epicondylitis
- This form is also called “tennis elbow”, with a lesion mainly localized on the outer part of the elbow.
- An overwhelming sensation arises over bones entering the joint area and tendon sprains.
- Such a movement of the arms as carrying, grabbing or lifting objects with a hand is disturbed.
Medial (internal) epicondylitis
- It is also called the “golfer’s elbow,” with damage localized on the inside of the joint, where the tendons tend to stretch and bone discomfort occurs.
Inflammation of the back of the elbow
In this condition, bursitis develops, the mucosa of the bag is affected.
Usually occurs when falling on the elbow, with excessive extension of the arm, when making sharp movements.
The most initial and main symptom of external epicondylitis is pain – this is a local pain in the outer part of the elbow.
The pain may give up the shoulder and on the outer edge of the arm, may radiate to the forearm. There is also pain when moving, it can occur when feeling the elbow area on the outer part of it, as well as when twisting the arm inward with bending it in the elbow, the arm does not hurt alone. Passive movements in the elbow are also not painful, pain occurs only with active resistance, with muscle tension.
The pains can be aggravated by clenching the fist and flexing the wrist, and pain gradually intensifies, manifesting already with slight movements or holding small weights in the hand.
Externally, the hand is not changed, the range of movements in it is not limited, while probing, the doctor can determine the point of maximum pain, which is located both in the area of tendon attachment and in the area of muscle attachment.
Sometimes tissue swelling in the area of damage squeezes the branches of the radial nerve, which is manifested by paresis of the muscles that unbend fingers and hand.
Usually, external epicondylitis occurs chronically, when creating rest and rest for injured muscles and tendons, the pain disappears, but with significant exertion or resumption of training, it recurs. Increased load provokes severe pain attacks.
Internal epicondylitis usually occurs in those who are exposed to mild, but prolonged and monotonous physical exertion (machinists, seamstresses, assemblers, golfers). This form is not uncommon in women.
Pain in the medial epicondylitis occurs in the inner part of the elbow, with pressure on the internal epicondyle . The pains are aggravated by bending the arm and twisting it inward, giving it to the inside of the shoulder to the armpit and the forearm to the thumb. This form also occurs chronically.
The basis of the diagnosis is clinical manifestations, as well as a thorough examination and clarification of the type of activity of the patient.
In the future, apply X-rays of the joint in several projections, and if necessary, computed tomography . Changes in the joint can be identified only in chronic long-term course.
Blood tests and biochemistry with epicondylitis do not change.
Persistent epicondylitis must be distinguished from an epicondyle fracture , rheumatic and other damage to the elbow joint, intra-articular fracture of the humerus.
The treatment is dealt with by a traumatologist-orthopedist. The treatment is mostly conservative, primarily carried out:
- external use of anti-inflammatory drugs based on ibuprofen or diclofenac,
- for pain, administration of a mixture of corticosteroid hormones with anesthetics is indicated,
- in advanced and difficult cases, extracorporeal shock wave therapy is used,
- hirudotherapy (use of medical leeches),
- acupuncture, acupuncture,
- postisometric relaxation of the zone of tense muscles,
- tincture of horse sorrel root, oil solution of bay leaf on the affected area,
- rest on the joint area with immobilizing bandages (bandage in the form of a figure eight using protective elbow pads).
The load on the arm must be given gradually, first applying the methods of physiotherapy exercises and small amounts of movement.
With timely diagnosis, you can achieve complete healing of epicondylitis in a few weeks, on average, relief comes in 3-5 days, but rehabilitation lasts about a month.
The process is prone to recurrence , so it is necessary to carry out prophylaxis with dosing loads on the arm, avoiding stereotypical movements.
The heel spur is a disease characterized by painful sensations in the sole area, which is caused by the formation of bone growth of the heel bone at the site of attachment of the plantar muscle.
At the onset of the disease, pain occurs when walking.
It is especially difficult to start walking when a sharp pain arises under load. Then during the day, the pain while walking somewhat subsides, and by the end of the day it intensifies again. Over time, the pain becomes persistent. In working patients, the spur on the heel leads to a decrease in efficiency and loss of working days.
Patients with overweight, diseases of the spine and large joints of the lower extremities, flatfoot , as well as athletes with prolonged local overloads of this area have a predisposition to the development of spurs on the heels .
Currently, the treatment of heel spurs is to provide unloading using various kinds of insoles and thrust bearings, physiotherapy complex treatment:
- mud applications
- ultrasound therapy
- mineral baths
- local administration of hormones.
In the absence of effect – surgical treatment (excision of bone overgrowth and excision of altered tissues).
The traditional treatment of the spur on the heel requires a long time (from 3 to 6 weeks).
Shock wave therapy (SWT) – the principle of the method is based on the fact that the shock waves generated using a special apparatus are not retained by the aqueous medium and soft tissues of the human body, and therefore do not cause any damage, since the acoustic resistance of these environments are almost the same.
At the same time, waves have a devastating effect on bones and calcifications, since their acoustic resistance is usually 5 times higher than the acoustic resistance of water.
Such a course of spur treatment on heels consists of 3-5 sessions using low and medium level shock waves. One session takes 15-20 minutes with an interval of 7-10 days.
Cervical osteochondrosis refers to progressive dystrophic-degenerative lesion of intervertebral discs in the region of 1-7 vertebrae belonging to the cervical region.
As a result of cervical osteochondrosis, deformation, exhaustion, and then damage to the vertebral bodies occur. This disrupts the normal blood supply and nerve conduction in the neck and in those areas that are innervated by the nerve roots of the cervical region.
Cervical osteochondrosis can be both isolated and combined with osteochondrosis of other departments – thoracic , lumbar and sacral.
The causes of degenerative and degenerative changes in the intervertebral discs are still not well understood. The assumption that osteochondrosis is not confirmed by the senile phenomenon. It is found even in children and adolescents.
There are a number of factors predisposing to the development of osteochondrosis. These include:
- stiffness and sedentary lifestyle
- sedentary types of work with a static load on the neck,
- overweight, lack of physical development,
- connective tissue dysplastic processes,
- circulatory disorders in the neck,
- neck injuries
- scoliosis , defects in posture, uncomfortable pillows and mattresses,
- genetic predisposition, metabolic defects.
The cervical spine is particularly vulnerable to the development of osteochondrosis due to the peculiarities of the skeleton, erect position, and also because of the large size of the head – the vertebrae are the smallest in comparison with other parts of the spine, and the muscular skeleton is not very pronounced.
The most characteristic symptom that patients complain about is pain in the cervical region. Depending on the affected area, the pain may be localized.
- in the clavicle and shoulder;
- throughout the cervical spine;
- on the front surface of the chest.
Pain in cervical osteochondrosis due to the peculiarities of the cervical spine.
The first signs of cervical osteochondrosis are minor and of little specific:
- pain in the neck in the evening,
- feeling of heaviness in the head, headaches in the back of the head,
- feeling of numbness or tingling in the shoulders and arms,
- crunching in the neck when turning the head, clicking vertebrae.
- quite severe “shooting” pains in the neck and, especially, in the area just below the nape;
- pain occurs after a long stay in one position (for example, after sleep);
- neck muscles are constantly tense;
- there are difficulties with the abduction of the hand to the side;
- on the affected side, fingers are constrained in movement.
Since compression of the vertebral arteries occurs, neurological manifestations are observed: headache, nausea, and syncope are frequent.
pain localized behind the sternum on the left.
This type of pain should be distinguished from angina pain (with angina pectoris, nitroglycerin brings relief, with osteochondrosis, no).
With a gradual disruption of the structure of the intervertebral discs, they are compressed (compression) and nerve root impairments occur, as well as narrowing or pinching of the arteries and veins that pass in the region of the vertebral bodies.
This leads to the formation of special syndromes – radicular and ischemic.
- lesion of the roots of the first cervical vertebra (C1): violations affect the neck, reducing skin sensitivity;
- C2 lesion gives pain in the region of the crown and occiput;
- C3 lesion gives pain in the neck from the side of infringement, reduced sensation in the tongue and sublingual muscles, in some cases with speech impairment and loss of control over the tongue;
- defeat C4 and C5 gives pain in the shoulder and collarbone, lowering the tone of the muscles of the head and neck, hiccups, respiratory disorders and pain in the heart;
- C6 lesion happens most often, giving pain from the neck to the scapula, forearm, up to the thumbs, skin sensitivity may suffer:
- C7 lesion gives similar symptoms with pain in the neck, back of the shoulder, right up to the back of the hand, impaired strength of hands and reduced reflexes.
Circulatory disorders due to compression of vessels in the cervical vertebrae give headaches up to migraine, severe dizziness, visual disturbances and tinnitus, flashing flies before the eyes, disorders of vegetative functions.
There may be manifestations of cardiac syndrome with squeezing heart pain, lack of air and palpitations, rhythm disturbances.
Serious complications of cervical osteochondrosis are
- protrusion of intervertebral discs with the formation of a hernia (protrusion);
- rupture of the intervertebral disk with the infringement of nerves and blood vessels, possible compression of the spinal cord, which can be fatal;
- there may also be radiculopathy (damage to the roots), the formation of osteophytes (spines on the vertebral bodies) with the manifestation of paresis and paralysis.
In the presence of the above complaints, it is necessary to contact an orthopedic surgeon or a neurologist.
First of all, the doctor will evaluate the mobility and soreness in the neck, sensitivity and other disorders of function. Then you will need a radiography of the cervical spine in several projections, if necessary, computed tomography or magnetic resonance imaging for a hernia.
If blood circulation is disturbed, rheoencephalography and fundus examination will be needed.
Today, there are both traditional and nontraditional methods of treatment of osteochondrosis in the cervical spine.
Mostly conservative methods are used:
- symptomatic analgesic therapy (baralgin, analgin, ketorol) to relieve pain
- taking nonsteroidal anti-inflammatory drugs (diclofenac, indomethacin, meloxicam) – to relieve inflammation and swelling of tissues
- spasmolytics are used to eliminate muscle spasms – no-silos, blood circulation medications – mydocalm, trental.
In the treatment of cervical osteochondrosis, substances that restore the structure of intervertebral discs – chondroprotectors (teraflex, arthracin) – are used.
A course of vitamin B therapy is shown, external remedies are applicable for therapy – gels and ointments, creams with anti-inflammatory, warming and anesthetic components – voltaren, diclogel, nikoflex. The stimulators of intervertebral disc regeneration are shown – teraflex or chondroxide.
Excellently helps in the treatment of osteochondrosis, point and general massage, acupuncture, physiotherapy, physical therapy and gymnastics. The osteopathy method has proven itself well – a mild effect on the “clamped” zones of muscles and vertebrae.
When treating cervical osteochondrosis, it is recommended to wear a special collar (Schantz collar).
Complications of cervical osteochondrosis with intervertebral hernia, which violate the sensitivity and blood circulation, can be treated promptly.
The duration of treatment depends on the neglect of the condition, since osteochondrosis is a progressive chronic disease. Treatment can be long, and preventive courses are held for life.
Exercises for the treatment of cervical osteochondrosis:
- Self-stretching: in a position with a straight back, shoulders should be lowered as low as possible, while the neck should be pulled upwards. It is necessary to make at least 10 approaches at least 3 times a day.
- Self-massage: clasp the neck with a towel, take it by the ends and pull them alternately, flexing the muscles of the neck. At the same time, it is necessary to ensure that the towel does not slip over the neck (does not rub it).
- Gymnastics for the cervical osteochondrosis: shows a slight bending of the neck, as well as turns and tilts of the head. 5-7 tilts are made at a time. This exercise is most useful to perform after self-massage of the cervical spine.
The basis of the health of the cervical spine is a strong and healthy back, physical activity, a comfortable bed with anatomical pillows and a mattress, correct posture and proper nutrition.
It is necessary to avoid neck injuries and weight lifting. It is necessary to combine a long sitting with rest periods and warm-ups.
Cervical migraine is one of the typical manifestations of vertebral artery syndrome, which manifests itself in agonizing, migraine-like pain.
Cervical migraine occurs as a result of impaired blood flow in one or both vertebral arteries (right and left).
Synonyms of the disease are – “vertebral artery syndrome”, “posterior cervical sympathetic syndrome”, which causes confusion in terminology.
In the general understanding of this concept, there is a disorder of blood circulation in the brain area due to a violation of blood flow through one or both of the vertebral arteries.
Circulatory disorders in the vertebral arteries provide up to 30% of the blood flow, their problems do not lead to catastrophic consequences in the form of strokes, but can give subjectively unpleasant sensations with bouts of excruciating headaches combined with disorders of coordination, sight or hearing.
All causes of cervical migraine can be divided into two groups.
- non-vertebrogenic (not associated with vertebral problems),
- vertebral (associated with lesions of the vertebrae).
For non-vertebral causes include:
- atherosclerotic vascular disease,
- congenital anomalies of the arteries,
- congenital anomalies of vascular location,
- whiplash (sharp deflection or tilting of the head back when struck or braking hard in the car),
- spasmodic contraction of the neck muscles
Vertebral causes include spinal problems:
- congenital anomalies of the vertebral structure,
- traumatic vertebral abnormalities,
- osteochondrosis of the first-second cervical vertebra,
- instability of the cervical spine,
- idiopathic (with unexplained cause) problems.
As a result of the impact of all the above reasons, irritation of the nerve trunks and vertebral arteries occurs, which causes a spasm of muscular elements in their wall and a sharp narrowing of the lumen of the arteries – a neck migraine begins.
Spasms can be constant or occur when turning the head, bending or changing the position of the body. This leads to a decrease in blood flow to the head and impaired cerebral circulation, to the occurrence of headache attacks.
The process proceeds in two stages:
- episodic vasoconstriction occurs in the first or reversible stage, which is manifested by bouts of headache and associated symptoms.
- in the second stage, an irreversible narrowing of the vascular wall occurs, gradually increasing. Manifestations at the same time become heavier and occur more often.
The main symptom of cervical migraine are headaches. Wherein:
- constant or paroxysmal pain
- excruciating pain, burning, throbbing, localized in the nape,
- during an attack, the pain may be given to the area of the orbits or the bridge of the nose, the region of the crown, ears or forehead,
- the pain is more often unilateral, the seizures increase with a change in the position of the head and neck,
- head soreness when combing or touching
- head turns are accompanied by itching and burning,
- there may be dizziness, nausea with vomiting, especially when lifting the head up,
- ringing or tinnitus, pulsing to the beat of the heartbeat,
- there may be visual and hearing impairment, a veil or a sight before the eyes, dvonie,
- there may be a feeling of a coma in the throat or a violation of swallowing,
- feeling hot or chills,
- in rare cases, when an artery is pinched, there may be bouts of loss of consciousness during sharp head turns.
The characteristic feature is characterized by a lesion of the arteries – when pressing on the area of the spinous processes or the back of the head, there is a sharp increase in the sensitivity of the skin in the neck.
Diagnosis of cervical migraine is based on the characteristic complaints of patients, an indication of injuries or diseases of the cervical spine, as well as on samples with pressing of the projection of additional vertebral arteries with increased symptoms.
In addition, additional research is needed:
- radiography of the cervical region, which reveals clear changes in the vertebral region and clarifies the causes of the disease,
- Doppler ultrasound with assessment of blood flow in the vertebral arteries,
- rheoencephalography with the definition of cerebral blood flow and the specific artery patency,
- CT or MRI of the neck with a layer-by-layer study of the structure of the vertebrae and the state of the arteries,
- blood test for lipids and cholesterol.
Neurologists are engaged in the treatment and diagnosis of cervical migraine. Conservative treatment methods are applied:
- anti-inflammatory and analgesics (meloxicam, nimesulide, nurofen),
- drugs that improve blood circulation and the patency of the vertebral arteries (instenon, cinnarizine),
- B vitamins to improve brain nutrition,
- neuroprotective drugs to protect nerve cells from hypoxia (Cerebrolysin, Piracetam or Actovegin),
- metabolite drugs (mildronate),
- antispasmodics to eliminate spasm of the arteries and muscles (no-spa, papaverine, mydocalm),
- vegetotonic drugs (phenibut),
- anti-migraine drugs (sumatriptan),
- cervical massage, physiotherapy, acupuncture, electrophoresis.
- osteopathic practices
- in severe cases, the surgical stabilization of the cervical vertebrae, the elimination of bone processes.
In the case of a full and timely start of treatment, the prognosis is favorable, manifestations of cervical migraine can be stopped or significantly alleviated. When running with organic disorders, the prognosis is less favorable, you can only relieve seizures.
Fibromyalgia is a form of lesions of extra-articular soft tissue, characterized by diffuse musculoskeletal pain and the presence of specific painful points or hypersensitivity points, determined by palpation.
The disease affects predominantly middle-aged women.
A characteristic feature of fibromyalgia is the abundance and variety of complaints and subjective sensations of the patient with very scarce objective signs of the disease.
The main symptom of fibromyalgia is diffuse musculoskeletal pain. Pain is considered spilled if it is present in various anatomical areas of the right and left half of the body above and below the belt, as well as in the projection of the spine.
The pain is usually combined with a feeling of morning stiffness, a sensation of swelling of the extremities, muscle fatigue and goosebumps or tingling sensations. Characteristic strengthening of these signs when changing weather, fatigue, stress.
In accordance with the diagnostic criteria of the American College of Rheumatology, the duration of fibromyalgic symptoms should exceed 3 months, since the appearance of diffuse muscle pain and fatigue can be caused by a viral infection, temporary sleep disturbance and stressful situations.
Significant psychological disorders largely determine the manifestations of fibromyalgia and bring this disease closer to chronic fatigue syndrome.
One of the most typical complaints is fatigue, which marks 87% of patients. Sleep disturbance , manifested by difficulty in falling asleep, intermittent restless sleep and lack of recovery from sleep, is observed in 79% of patients. More than half of patients with fibromyalgia report frequent migraine- type headaches.
150 shades of PMS: symptoms, causes and treatment
PMS is far from a homogeneous phenomenon: someone today is crying over trifles, someone is suffering from pain, and someone does not recognize himself in the mirror because of edema. Symptoms of PMS, known to doctors, are estimated in dozens (there are about 150 of them) and only detailed …
Patients are characterized by emotional disorders, which can vary from a slight decrease in mood to severe depression and anxiety and anxiety state.
Along with psychological disorders, a number of disorders can be detected in patients with fibromyalgia.
These disorders include manifestations such as irritable bowel syndrome , premenstrual syndrome , primary dysmenorrhea , vestibular disorders, joint hypermobility syndrome, irritable bladder syndrome, fluid retention syndrome, Raynaud’s syndrome and shegren-like syndrome, mitral valve prolapse , dysfunction of the temporomandibular joint syndrome , detection of mesh livedo.
Great importance is attached to the search for specific painful points, the presence of which distinguishes fibromyalgia from other diseases accompanied by chronic musculoskeletal pain.
When determining painful points, the finger pressure should be considered the most optimal with a force not exceeding 4 kg. The point is counted as positive if the subject notes pain. According to the criteria of the American College of Rheumatology, the presence of 11 painful out of 18 possible points is necessary for the diagnosis of fibromyalgia. Their localization predominates in the muscles of the shoulder girdle, back, lumbosacral and gluteal region.
The essential point in the diagnosis of fibromyalgia is the search for painful points. To eliminate the factor of subjectivity, it is necessary to re-determine the number of painful points by different persons. In addition, the determination of pain sensitivity in the control points (in the frontal, above the fibula head) is necessary.
The presence of pronounced psychological disorders dictates the need to include antidepressants in the treatment of fibromyalgia. The most commonly used amitriptyline, melipramine at a dose of 10-25 mg 1 time per night. The course of treatment is 4-6 weeks. Fluoxetine administered 20 mg 1 time in the first half of the day.
Non-steroidal anti-inflammatory drugs have found widespread use in the treatment of fibromyalgia. Prolonged ingestion of nonsteroidal anti-inflammatory drugs is undesirable due to possible side effects. Recently, preference has been given to local therapy in the form of ointments, gels, as well as local injections in combination with painkillers, in particular with lidocaine.
It is considered expedient to include muscle relaxants of the so-called local action: baclofen at a dose of 15-30 mg per day or dantrolene at a dose of 25-75 mg per day contribute to a decrease in muscle tone, have an analgesic effect.
There are reports on the effectiveness of antioxidants (ascorbic acid, alpha-tocopherol).
Of the non-drug treatments, various physiotherapeutic procedures are widely used, in particular, massage, balneotherapy, cryotherapy.
Much attention in recent years has been paid to physical exercise, namely aerobics, as an effective way to eliminate chronic muscle pain and fatigue. The importance is also attached to the methods of psychological rehabilitation of patients with fibromyalgia – psychotherapy and autogenic training.
Tendinosis is a symptom of dystrophic lesions in the area of the tendons of the large muscles.
Tendinosis is manifested by severe pains and impaired motor activity in the affected joint, pains are expressed during movements, and are practically not felt at rest. Tendinosis is dangerous by injury, that is, the separation of the affected tendons from the attachment to the bone.
If the loads on the muscles and ligaments under conditions of active sports training are so strong that the muscles and tendons do not have time to rest and restore the micro-damage caused by the loads, then they are destroyed – a so-called chronic (fatigue) injury is formed.
The most common of these injuries is tendinosis – progressive dystrophy, degeneration sites in the tendon area.
The most common causes of tendinosis:
- tendon microtraumas,
- excessive, increased motor load on the tendons.
The result is the formation of areas of necrosis, fatty degeneration of tendons and cartilage, the deposition of calcium salts. As the process progresses, the tendon ossifies, loses its elasticity and leads to dystrophy and inflammation.
Tendinosis is evidence of excess loads on these muscles, very hard training.
Most often tendinosis are post-traumatic or post-exercise as professional athletes with their heavy loads, and at construction sites and factories with workers in heavy physical labor.
However, tendinosis of rheumatic origin as a result of gout and arthritis is separately distinguished .
Common symptoms of tendinosis include:
- pain when making movements, passing at rest,
- passive limb movements are virtually painless,
- probing the affected tendon is unpleasant, painful,
- it is compacted, visible redness on the surface, the temperature rises over the affected area,
- when moving, you can hear a crunch or crackle.
Depending on the location, there are specific characteristics of tendinosis.
Tennis Elbow ( Lateral Epicondillite )
– defeat of the extensors of the wrist. In this case, pain occurs in the elbow and give up, in the shoulder, on the outer part and forearm. There may be a weakness in the hand, difficulty in raising the cups, when shaking hands or when pressing clothes.
Hand golfer , baseball player (medial epicondillitis )
– defeat of the extensors and muscles that rotate the forearm. Manifested by pain in the inner part of the elbow, pain when bending the brush down, pressing on the brush.
Querven ‘s disease
– tendinosis of the thumb tendons, will manifest by pains when straightening and lifting the thumb. Pain when palpating the base of the thumb, as well as pain when connecting the thumb pad with the little finger.
Tendinosis of the patella (jumper knee)
– pain in the knees, swelling of the tendon, swelling. With untreated tendinosis , the patellar can detach.
resembles a problem with the patella, but usually occurs in older athletes.
Post- tibial tendonitis
with damage to the tibial muscle gives pain in the tendon, pain in the heel, in the arch of the foot. Can lead to flat feet and heel spurs . The pains are aggravated by running and carrying weights.
The basis of the diagnosis of tendinosis is the patient’s complaints and their connection with excessive and prolonged exertion, mainly in athletes.
The basis of the diagnosis is the examination and thorough probing of the tendons and muscles, the conduct of active and passive movements with an assessment of their pain and the degree of restriction of movements.
X-ray inspection of the damaged joint and tendon is complemented, and data can also be supplemented by magnetic resonance scanning.
Treatment tendinous engaged trauma orthopedic.
Conservative or operative therapy is prescribed. In the early stages, conservative primary and secondary measures are shown.
To primary can be attributed:
- ensuring complete peace
- cold and rest tendon
- imposing tight or supporting dressings and giving the limb an elevated position.
Secondary measures of conservative treatment of tendinosis include the use of:
- physiotherapy and physiotherapy,
- drug injections
- rehabilitation methods
- anti-inflammatory drugs.
All methods of therapy at all stages are prescribed by a doctor, special dressings and bandages are applied based on the specific location of the injury and the type of injury. Sometimes it is necessary to use a special type of fixing bandages.
Anti-inflammatory gels and ointments are used in the first three days of injury, then they will be most effective.
For advanced tendinosis, surgical treatment is used – sections with altered tissues are excised, with subsequent plastic surgery to repair the tendon.
The rehabilitation process takes up to three months or more, using the methods of stretching and developing the strength of the operated tendon.
The prognosis for life is favorable, but relapses are possible.
Rheumatoid arthritis is an inflammatory disease characterized by symmetrical lesions of the joints and inflammation of the internal organs.
The cause of rheumatoid arthritis is unknown. Various viruses, bacteria, trauma, allergies , heredity, and other factors can serve as probable causes .
The frequency of occurrence is 1% in the general population. The prevailing age is 22–55 years. The predominant gender is female (3: 1).
- Slight increase in body temperature
- Swollen lymph nodes
Symmetry of joint damage is an important feature of rheumatoid arthritis (for example, right and left elbow joints or right and left knee joints are affected)
- Morning stiffness of joints longer than 1 hour
- Rheumatoid hand: deformations like “boutonniere”, “swan neck”, “hands with lorgnet”
- Rheumatoid foot: 1 finger deformity
- Rheumatoid knee: Baker’s cyst, flexion deformities
- Cervical spine: subluxation of the atlanto-axial joint
- Cricoid joint: coarseness of voice, violation of swallowing.
Damage to periarticular tissues
Tendosinovitis in the area of the wrist joint and hand (inflammation of the tendon, characterized by swelling, pain and a distinct creak during movement).
Bursitis , especially in the elbow joint.
The defeat of the ligament apparatus with the development of increased mobility and deformities.
Muscle damage: muscle atrophy, often drug-induced (steroid, as well as on the background of taking penicillamine or aminoquinoline derivatives).
Rheumatoid nodules are dense subcutaneous lesions, in typical cases localized in areas often undergoing traumatization (for example, in the area of the olecranon, on the extensor surface of the forearm). Very rarely found in the internal organs (eg, in the lungs). Observed in 20–50% of patients.
Anemia due to slower iron metabolism caused by impaired liver function; platelet count reduction
Felty’s syndrome, including a decrease in blood neutrophils , an enlarged spleen,
- fever 39 ° C and above for one or more weeks;
- joint pain 2 weeks or more;
- salmon-colored spotted rash that appears during fever.
Sjogren syndrome – dryness of the mucous membrane of the eyes, mouth.
Also, in rheumatoid arthritis, signs of osteoporosis (this is a bone loss) and amyloidosis may appear.
Frequent are ulcers on the skin of the legs, inflammation of the arteries.
In general, and biochemical analysis of blood:
- increased ESR,
- increasing the content of C-reactive protein.
The articular fluid is cloudy, with low viscosity, the number of leukocytes and neutrophils is increased.
Rheumatoid factor (antibodies to immunoglobulins of class M) is positive in 70–90% of cases.
Urinalysis: protein in the urine.
Increased creatinine , serum urea (evaluation of renal function, the necessary stage of selection and control of treatment).
Criteria for the diagnosis of rheumatoid arthritis of the American Rheumatological Association (1987). Having at least 4 of the following symptoms:
- morning stiffness more than 1 hour;
- arthritis of 3 or more joints;
- arthritis of the joints of the hands;
- symmetric arthritis;
- rheumatoid nodules;
- positive rheumatoid factor ;
- radiological changes.
Drug therapy includes the use of three groups of drugs:
Nonsteroidal anti-inflammatory drugs
Representatives of nonsteroidal anti-inflammatory drugs are
These drugs have a minimal side effect and retain a high anti-inflammatory and analgesic activity.
Meloxicam (moval) at the beginning of treatment with the activity of the inflammatory process is prescribed at 15 mg / day, and later on it goes to 7.5 mg / day. as maintenance therapy.
Nimesulide is prescribed in a dose of 100 mg twice a day.
Celecoxib (Celebrex) is administered 100–200 mg twice a day.
For older people, the selection of the dosage of the drug is not required. However, in patients with a body weight below average (50 kg), it is desirable to begin treatment with the lowest recommended dose.
A combination of two or more nonsteroidal anti-inflammatory drugs should be avoided, since their effectiveness remains unchanged and the risk of side effects increases.
Basic drugs are recommended immediately after diagnosis.
The main drugs of basic therapy for rheumatoid arthritis are:
- aminoquinoline preparations
- cyclosporin A (sandimmune),
- remikeid (infliximab),
- enbrel (etanercept),
- systemic enzyme therapy drugs (wobenzym, phlogenzyme),
- leflunomide (arava) and others.
Basic preparations that are ineffective for 1.5–3 months should be replaced or their combinations used with hormones in small doses, which can reduce the activity of rheumatoid arthritis.
Six months is a critical period, no later than which an effective basic therapy should be selected.
In the course of treatment with basic drugs, the disease activity and side effects are carefully monitored.
The use of high doses of hormones (pulse therapy) in combination with slow-acting agents allows to increase the effectiveness of the latter.
In therapy, systemic enzyme therapy is used, most commonly the drug Wobenzym.
The drug has anti-inflammatory, immunomodulatory and secondarily analgesic effect. This allows it to be widely used for rheumatoid arthritis in combination with nonsteroidal anti-inflammatory drugs, basic drugs, hormones.
Assign 7-10 tablets 3 times a day 30 minutes before meals; Tablets are washed down with a glass of water, without chewing. Maintenance therapy – 3-5 tablets 3 times a day.
With a high degree of inflammation activity, hormones are used, and in cases of systemic manifestations of rheumatoid arthritis – in the form of pulse therapy (hormones alone or in combination with a cytostatic agent – cyclophosphamide), without systemic manifestations – in the form of a course treatment.
Hormones are also used as a supportive anti-inflammatory therapy with the ineffectiveness of other drugs.
In some cases, hormones are used as local therapy. The drug of choice is diprospan, which has a prolonged effect.
Ointments, creams, gels based on nonsteroidal anti-inflammatory drugs (ibuprofen, piroxicam, ketoprofen, diclofenac) are used in the form of applications on inflamed joints.
To enhance the anti-inflammatory effect, applications of the above-mentioned ointment forms of drugs are combined with applications of dimethyl sulfoxide solution at a dilution of 1: 2–1: 4.
Moderate disease activity with insufficient efficacy of other treatment methods requires the administration of hormones at low maintenance doses (5–7.5 mg per equivalent of prednisolone) in combination with other drugs, primarily with systemic enzyme therapy drugs (3-5 tablets 3 times / day).
In the absence of a response to standard drug treatment in patients with high activity of rheumatoid arthritis, plasmapheresis and lymphocytepheresis are used.
An important point in the treatment of rheumatoid arthritis is the prevention of osteoporosis – the restoration of impaired calcium balance in the direction of increasing its absorption in the intestine and reducing excretion from the body.
To do this, apply a diet with a high content of calcium.
Sources of calcium are dairy products (especially hard varieties of cheese, as well as processed cheese; to a lesser extent, cottage cheese, milk, sour cream), almonds, hazelnuts and walnuts, etc., as well as calcium preparations in combination with vitamin D or its active metabolites.
The drug that can be attributed to the basic anti-osteoporotic drugs is miacalcium. It is available for intramuscular administration of 100 ME and as a nasal spray; appointed by the scheme in conjunction with calcium preparations (calcitonin) and vitamin D derivatives.
Laser therapy is also used to treat rheumatoid arthritis. Especially in severe exacerbations of rheumatoid arthritis in recent years, extracorporeal treatment methods (primarily hemosorption and plasmapheresis) have been widely used.
Laser therapy is especially indicated at an early stage of the process. The course is not more than 15 procedures.
In order to reduce pain and eliminate spasm of periarticular tissues, cryotherapy is used (cold treatment), for a course of 10–20 procedures.
In order to influence allergic processes, improve tissue nutrition and eliminate inflammation, other physical methods of treatment are also used.
In the early stage of rheumatoid arthritis, ultraviolet irradiation of the affected joints, electrophoresis of dimethyl sulfoxide, calcium, and salicylates is recommended.
With the appearance of more persistent changes in the joints and in the absence of signs of high activity, phonophoresis of hydrocortisone, magnetic therapy, and impulse currents are prescribed.
Physical therapy and massage are prescribed to all patients with the aim of relieving muscle spasm, the most rapid restoration of joint function.
All patients with rheumatoid arthritis should be systematically monitored and examined by a rheumatologist.
Patients with a slowly progressive course without damage to internal organs should appear at a rheumatologist 1 time in 3 months. If there is a lesion of the internal organs, patients are examined by a rheumatologist once every 2–4 weeks.
Spa treatment of patients with rheumatoid arthritis is recommended annually outside the acute phase.
In case of a benign course of the process without marked changes in the joints, the use of radioactive baths in Tskaltubo and Belokurikha is shown; with a typical progressive process – treatment with hydrogen sulfide baths in Sochi, Sernovodsk, Pyatigorsk, Kemeri; with severe deformities and contractures – treatment with mud applications in Evpatoria, Saki, Pyatigorsk, Odessa.
Sprain is one of the most pressing and common causes that limit the physical activity of people leading an active lifestyle.
The main causative factor of sprain is an acute traumatic injury, called a sprain, or an overload for a long time – overvoltage.
There are three degrees of sprain:
- Grade I – slight pain due to the rupture of several ligament fibers.
- Grade II – moderate pain, swelling and disability.
- Grade III – severe pain due to rupture of the ligament and subsequent instability of the joint.
Stretching the muscle in turn is a traumatic damage to the muscle fibers themselves or to the joints of the muscle and tendon and is also classified according to three degrees of severity:
- I – moderate.
- II – the average degree of damage associated with the weakness of the affected muscle, its painful contraction.
- III – complete rupture of the joints of the muscles and tendons, manifested by severe pain and the inability to reduce the damaged muscle.
Repeated movements during long-term work lead to the appearance of damage from “overvoltage” in people of some professions. Approximately 10–20% of musicians, typists, cashiers and conveyor workers complain of a relapse of sprains, among athletes this percentage ranges from 30 to 50.
Sprains due to overstrain (overtraining) are divided into four degrees:
- I degree – pain only after physical activity.
- Grade II – pain during and after exercise, not affecting the result of work.
- Grade III – pain during and after exercise, affecting the result of work.
- Grade IV – constant pain, disrupting daily physical activity.
It should also be noted that the defeat of the tendon apparatus can occur in the form of “tendinitis”, “tendinosis” and “tenosynovita.”
Tendonitis occurs because of a tendon injury and the associated destruction of blood vessels and inflammation.
Tendinosis is a non-inflammatory lesion of the fibers inside the tendon, which can lead to a partial or complete rupture of the tendon.
Tenosynovitis is an inflammation of the lining of the stomach.
The most common types of sprain due to overvoltage (overtraining):
- ligaments – “baseball player’s elbow”, “swimmer’s knee”, “jumper knee”;
- tendons – inflammation of the Achilles tendon, upper knee tendon tendon, biceps tendon of shoulder, tendon of posterior tibial muscle, “tennis player’s elbow”.
“Tennis player’s elbow” occurs as a result of overtraining and is manifested by pain on the outer surface of the elbow joint. Patients usually associate his appearance with a game of tennis. The provoking movement — the forced extension of the middle finger of the hand against resistance — causes pain, as the muscle attaches to the base of the metacarpus of the middle finger.
“Golfer’s elbow” – occurs when over-training is damaged by the flexor muscles of the forearm.
“Baseball player’s elbow” – this type of stretching occurs with frequent movement of the hand along the curve of the throw of the ball. The injured have microfissures of the muscle tendons.
The friction syndrome of the oriotibial tract is pain on the external surface of the knee joint due to irritation and inflammation. Syndrome friction or tibia occurs when excessively intense running, running over rough terrain.
“Swimmer’s knee” – a condition that occurs in the knee joint due to sudden movements of the foot during swimming breaststroke.
“Jumper knee” – the so-called inflammation of the patellar tendon. Often found in high jumpers, basketball and volleyball players. It is characterized by pain in the lower pole of the patella, at the site of attachment of the patellar ligament. It develops due to permanent damage to this area, when there is no recovery and healing of the injury.
Inflammation of the biceps tendon of the shoulder is manifested by pain in the front of the shoulder joint, which is aggravated by movements in the shoulder joint.
The bursitis of the patella is accompanied by pain, swelling and local temperature rise in the patella pouch, which is located more superficially than the patella. Bursitis is caused by repeated trauma or exercise, as when kneeling.
Inflammation of the Achilles tendon is manifested by pain in the heel, sometimes by pain on the back of the foot. Flexion of the foot increases pain, the area of greatest pain is 2-3 cm above the junction of the tendon with the calcaneus. The tendon can be edematous and thickened.
It is also worth mentioning such a pathology as “split shin” – this is damage from overtraining. The pain arises in athletes at the start of the race, while running, subsides and re-intensifies after the end of the race. When palpation is determined by the pain on the posterior edge of the tibia, usually on the border of the middle and lower third.
Therapeutic treatment of damage to the ligaments, tendons and muscles includes primary and secondary therapy.
- Load protection
- Pressure bandage
- Elevated position
- Bandage support
Secondary treatment of sprains:
- Anti-inflammatory drugs
The basis of treatment is early anesthesia and anti-inflammatory therapy of soft tissue trauma. Ice is effective as an anti-inflammatory agent only in the first hours after injury, then it is preferable to use heat. Immobilization with a splint or bandage can be used to enhance the protection of a injured limb or part of it from the load.
It is also necessary to use non-steroidal anti-inflammatory drugs in the form of tablets, and in these situations, drugs of different groups are approximately equally effective. Their prolonged use is recommended for chronic overvoltage states, in case of acute injury, they are effective for 72 hours.
A very effective method of treating traumatic soft tissue injuries and sprains is local therapy using ointments and gels containing nonsteroidal anti-inflammatory drugs (for example, efkamon). The ointment is rubbed into the skin of the affected area in an amount of 3-4 g. 2-3 times a day and covered with a dry warming bandage. The duration of treatment depends on the nature and severity of the disease.
Flat feet – a pathological flattening of the foot, which leads to a violation of its depreciation function, to painful changes in the spine and skeleton as a whole.
In case of flat-footedness, the structure of the normal arch of the foot is rather pronounced or almost completely changed, both longitudinal (along the inner edge of the foot) and transverse along the base of the toes.
As a complication, spinal pain, arthritis and arthrosis of the knee and hip joints occur.
Depending on which arch of the foot is involved in the deformation, the following are distinguished:
- longitudinal flatfoot – flattening of the longitudinal arch of the foot, which is formed on its inner part. With longitudinal flatfoot, shoes are wrinkled inside.
- transverse flatfoot – the formation of a plane in the area of the first phalanges of the fingers because of which the shoe becomes narrow in the toe.
- combined or mixed, with the foot increasing in width and length, the shoe is deformed in two directions.
Flatfoot can also be congenital in nature, as a variant of malformation, it is usually severe and rarely occurs, and acquired during life.
Flatfoot is found in people with sedentary work and with insufficient loads on the legs and feet, as well as in people who are engaged in hard physical labor and have to spend a long time on their feet. This is due to both the deficit and the excess load on the foot. In this case, the muscles and ligaments or not enough exercise, or trite tired and stretched.
Also, flat feet are formed due to rickets , transferred in childhood and osteoporosis in adulthood, due to injuries of the foot and ankle, ligaments and joints, due to lesions of the nervous system in the area of conducting nerves with the formation of hyper- and hypotonia in certain muscle groups.
Hereditary factors and defects of the connective tissue, overweight, lack of fitness and hypodynamia, wearing the wrong shoes, heels, pregnancy, occupational hazards predispose to flat feet.
Symptoms of flatfoot for a long time leave unattended, writing them off for fatigue or manifestations of other diseases.
It can be:
- tired legs when standing and walking,
- pain in the foot, especially after physical exertion and weight lifting,
- tiredness and pain in the legs by the end of the day,
- heaviness in the legs, “lead feet”,
- cramps and swelling in the ankles and shins,
- the impossibility of wearing heels,
- leg resizing,
- problems with choosing comfortable shoes,
- treading the heel inside,
- inconvenience when walking.
In advanced cases, when walking, the area of the sacrum and lower back hurts, headaches can occur, walking long distances is painful and painful.
With longitudinal flatfoot manifestations are as follows:
- very tired legs,
- pain when pressing on the middle of the foot or sole,
- swelling of the rear foot,
- problem with the selection of shoes, the constant stumble on the heels,
- pain in the feet and lower back,
- deformation of the shoe inside, splaying of the heel.
With transverse flatfoot reveal:
- violation of the formation of the transverse arch, stretching the toe of a shoe,
- deformity of the toes, especially large,
- corns on the sole in the pads,
- hammer-shaped fingers.
In case of marked flatfoot, it is enough for the doctor to look at the foot and shoes of the patient.
Additionally, plantography is carried out with measurement of the angle of flatfoot and severity of violations, as well as pomomery. If necessary, conduct an x-ray of the foot and ankle in several projections.
In the treatment of longitudinal and transverse flatfoot there are differences – with transverse conservative therapy can be effective only in the initial stage.
- weight correction
- finding the right shoes
- reduction of loads on the legs,
- wearing special orthopedic rollers and pads.
With the progression of transverse flat-footedness and its transition to 2-3 degrees with severe deformity of the fingers, surgical correction is necessary: resection of protruding bone sections on the first finger, joint repair, and tendon transplantation are performed. But these operations only eliminate the consequences, but do not treat the causes of flat-footedness – problems of muscles and ligaments.
After surgery, life-long wearing of special shoes with special instep supports or insoles is necessary.
In the treatment of longitudinal flatfoot used
- gait correction,
- walking for the maximum amount of time barefoot on pebbles or sand, massage mats,
- applicable regular unloading of the muscles of the foot, periodically rolling on the outer edge of the foot.
With longitudinal flatfoot effective massages, physiotherapy, physiotherapy. In the stage of pronounced violations it is necessary to change working conditions with a decrease in the static load on the legs and feet, and a decrease in body weight.
When pronounced flat foot special orthopedic insoles and individually sewn shoes are used. Surgical treatment is indicated only in very severe and neglected cases.
With timely diagnosis, you can correct flat feet for a few months, but wearing a special shoe can be life-long. With progression and severe forms, the prognosis is poor – disability can form.