Loose joint

A loose joint is a pathological condition characterized by an increase in the volume of passive and a significant decrease in the volume of active movements. It can be congenital, develop against the background of injuries, polio, after resection or arthroplasty of the joint. It is accompanied by restriction of function, shortening or lengthening of the limb, muscle atrophy. The diagnosis is established on the basis of anamnesis, external examination and neurological examination data, results of radiography, CT, MRI and electrophysiological studies. Treatment – orthopedic devices, surgical restriction of mobility, arthrodesis, endoprosthetics.

A loose joint is a polyethological condition that occurs when one or more mechanisms that ensure the preservation of the physiological volume of movements are violated. It can be detected in people of any age, men suffer somewhat more often than women. Due to a decrease in the volume of movements, often complete or almost complete, pathology becomes the cause of disability and limitations of self-service.

The cause of the development of this condition is a gross violation of the shape of the articular surfaces, damage or weakness of the muscles and ligamentous apparatus, elongation of the articular bag. Pathology can be congenital or acquired. The main etiofactors of the occurrence of an acquired loose joint are considered to be:

  • Muscle paralysis. Most often, the violation is detected after polio. Other possible causes of paralysis include traumatic nerve damage, syringomyelia, spinal dryness.
  • Ligament tears. A loose joint is formed when the ligamentous apparatus is damaged, usually by ruptures of the lateral and cruciate ligaments of the knee joint.
  • Intra-articular fractures. The most common looseness after gunshot fractures associated with significant destruction of articular surfaces. Less often, the condition is provoked by ordinary multi-fragmented fractures.
  • Neoplasms. With surgical excision of periarticular and intraarticular tumors, extensive bone defects may form that violate the functionality of the joint.

A congenital loose joint is formed when the articular end of the bone is underdeveloped due to negative influences during pregnancy. Some chemicals, radiation exposure, intrauterine infections have a teratogenic effect. The anomaly may also be due to insufficient nutrition or chronic diseases of the mother.

A joint is a movable joint of bones that move freely relative to each other in a certain range due to the congruence of the articular surfaces. The range of movements is normally limited due to the capsule, ligaments and muscles, as well as the shape of the articular ends of the bones.

With a change in the configuration of articular surfaces, weakness or damage to soft-tissue structures, restrictive mechanisms cease to act, the joint is not held in physiological positions and begins to hang out. For the same reason, active movements become impossible or their volume is limited.

The knee, ankle and shoulder joints are more often affected. With the defeat of the femoral and sciatic nerve, unilateral looseness of two or three joints is possible – hip, knee and ankle. The patient makes complaints about violations of functionality. With the elbow and shoulder joints loose, the ability to use the sick arm is almost completely lost, since the lack of movement in the upper parts does not allow productive use of the lower segments of the limb.

In a loose knee joint, in mild cases, bending is detected when walking, especially when climbing uphill or up stairs. In severe cases, the ability to support and walk is completely lost, because the leg cannot withstand the load, bends in different directions. The defeat of the ankle joint is manifested by the sagging of the foot when lifting the limb, turning outward, less often - inward at the moment of support on the surface.

An objective examination reveals the redundancy of passive movements. There are no active movements or their volume is significantly reduced compared to the norm. The muscles of the diseased leg or arm are atrophied. There is a recurvation of the joint, a valgus or varus curvature, sometimes a shortening of the limb. The usual dislocations or subluxations are revealed in the anamnesis.

Functional inferiority of the joint causes partial or complete disability. There is a cosmetic defect. Degenerative changes develop rapidly in the affected joint, arthrosis forms, fibrous degeneration of soft-tissue components occurs, including those not affected by the primary pathological process that led to the formation of a loose joint.

The diagnosis is made by an orthopedic surgeon based on the patient's complaints, medical history, objective examination data and the results of additional studies. In case of neurological disorders, a neurologist's examination is indicated. Determining the nature of the pathology usually does not cause difficulties. Instrumental techniques are prescribed to determine the cause of the disease, assess the condition of bones, joints and nearby tissues. Apply:

  • Radiography of the joint. The images may reveal changes in the shape of the epiphyses and metaepiphyses, signs of deforming arthrosis (narrowing of the articular gap, osteophytes, areas of enlightenment in the subchondral bone).
  • Ultrasound of the joint. The technique allows you to study cartilage and soft tissues, diagnose ligament ruptures, detect foci of degeneration and fibrous degeneration. To increase the information content, sonography is often performed from two sides.
  • CT and MRI of the joint. Performed at the final stage of the examination. They are prescribed to clarify the data obtained during ultrasound and radiography, to determine the tactics of surgical treatment.
  • Electrophysiological techniques. They are indicated with the hereditary nature of pathology and with a loose joint formed against the background of neurological diseases. They make it possible to determine the degree of preservation of nerve conduction.

Conservative therapy

Most conservative measures (physiotherapy procedures, massage) are ineffective in this pathology. The main conservative method of treatment is the manufacture of orthopedic devices:

  • patients with a loose ankle joint are recommended to wear orthopedic shoes with side retainers;
  • when the knee joint is affected, special lockless devices are made to prevent overextension and lateral deviation of the leg when resting on the limb;
  • the loose elbow joint in persons who are not engaged in physical labor is fixed with orthopedic products that increase the functionality of the limb in the process of self-service.

Surgical interventions

Treatment tactics are determined by the localization of the loose joint, the cause of its appearance, the severity and prevalence of concomitant degenerative processes, and the age of the patient. Usually, the operation of choice is arthrodesis in a functionally advantageous position, which provides the possibility of self-service in case of damage to the upper limb, the function of support and walking – with the involvement of the lower.

With a loose shoulder joint due to paralysis of the deltoid muscle, neighboring muscles are transplanted to restore the functions of the limb. With a loose hip joint, arthrodesis is rarely used. The leading techniques are auto- or homo-articular ends, ligament repair and endoprosthetics.

In the pathology of the knee joint, several surgical methods of treatment are used. It is possible to restrict movements by osteotomy and the formation of a bony protrusion at the articular end of the femur, preventing overextension. Excessive lateral mobility and recurvation are eliminated by transplanting the heads of the striated and biceps femoral muscles with their simultaneous elongation with allografts. In some cases, homoplasty, compression arthrodesis, lengthening arthrodesis or endoprosthetics are performed.

Depending on the causes of development, the severity of the underlying pathology and secondary joint changes, the prognosis is doubtful or relatively favorable. In most cases, after surgical treatment, there is an expansion of functions sufficient for self-service or independent walking. Complete restoration of limb functionality is rarely noted.

Preventive measures include the correct choice of tactics for the treatment of intra-articular fractures and sluggish paralysis of various origins, timely procedures aimed at preventing overstretching of paralyzed muscles in neurological diseases. When treating gunshot fractures, it is necessary to avoid extensive resections of bone tissue, when removing intra- and periarticular tumors, use grafts to restore articular surfaces.

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