Hypermobility of joints ICD 10. Hypermobility of joints - what is it, how to treat? How to prevent joint dislocation after endoprosthetics

The functioning of the musculoskeletal system directly depends on the condition of the connective structures that are located next to the joints: capsules, ligaments and tendons. They are particularly strong and provide a person with normal movement, but at the same time they have flexibility and elasticity. It is these qualities of structures that help maintain the integrity of tissues when stretched under load. Joint hypermobility syndrome in children is a condition in which the range of motion in a joint is exceeded compared to physiological settings.

Reasons for the occurrence of the violation

Joint hypermobility syndrome (in ICD 10 - code M35.7) most often appears in those people who have strong extensibility of the ligamentous tendon fibers, transmitted from their parents. As a result of an inherited disorder, proteoglycan, collagen, glycoprotein and the enzymes that ensure their metabolism change significantly. Disturbances in the synthesis, maturation and breakdown of connective tissue components lead to severe extensibility of the joints.

All the described processes can affect the body of a pregnant woman from the outside. In most cases, such changes occur in the early stages, when the embryo is just beginning to develop and its organs and systems are being formed. The following negative factors affect the connective tissue of the fetus:

• pollution coming from the environment;
• poor nutrition (lack of vitamins, microelements and nutrients);
• infectious lesions of women;
• severe stress, anxiety and stress on the nervous system.

Acquired form

From all this it follows that hypermobility syndrome is a congenital disease. But it is important to distinguish it from other hereditary diseases, in which some changes occur in the structure of the connective tissue (Marfan or Ehlers-Danlos syndrome). It is also important to remember about natural flexibility, which is not a pathological form. Many people do not even realize that they have such a difference, since childhood they consider it quite ordinary.

An acquired form of joint mobility is in most cases diagnosed in dancers or track and field athletes, but it occurs as a result of training and is local in nature, spreading mainly to the lower part of the limb. Difficulty with joint mobility is an uncommon condition but is difficult to identify diagnostically.

Features of the development of the disorder in children

Previously, joint hypermobility was attributed to a peculiar structural feature of the musculoskeletal system. Parents always tried to take a very flexible child to a special section at an early age. It was believed that this skeletal structure ensures the rapid achievement of good athletic results. Now hypermobility of joints in a child is considered a form of deviation.

When actively involved in sports, the joints of children and adults with this disorder experience severe loads that significantly exceed those allowed. In people with normal joints, such a load leads to various injuries - sprains or dislocations. After proper treatment, many athletes quickly resume training. With hypermobility, everything happens differently. Even a harmless injury can greatly change the structure of cartilage, bone tissue, tendons and ligaments, and can also lead to osteoarthritis.

Prohibited sports

A sick child is prohibited from engaging in the following sports:

• gymnastics and acrobatics;
• running, biathlon;
• hockey, football;
• long jump;
• sambo and karate.

Treating specialists recommend that parents of especially flexible children do not send them to sports institutions right away. Such a child must undergo a full examination in the hospital. If he is found to have hypermobility of the joints, then he will have to give up all sports that are dangerous for him.

Clinical picture of the syndrome

Joint hypermobility is classified as a systemic non-inflammatory lesion of the musculoskeletal system. This condition has so many symptoms that it may seem that the patient is suffering from a completely different disease. Such patients are often misdiagnosed.

Special diagnostic measures in a medical institution help to specify the boundaries of hypermobility and distinguish this lesion from other diseases with similar symptoms. When determining the main symptoms of the disease, it is important to consider the articular and extra-articular forms of manifestation of the disease.

Articular manifestation

The first signs of damage in this case appear for the first time in childhood or adolescence, when the child is actively involved in sports and various physical activities. Most often, they are not considered as a consequence of pathological changes in the structure of tissues and are quite common; for this reason, the disease is detected quite late.

At the first stage of development of joint hypermobility syndrome in adults and children, quiet clicking or crunching sounds are observed in the joints; such sounds occur arbitrarily or when physical activity changes. Over time, the sounds may go away on their own. But other, more severe signs are added to the symptoms, which help to accurately identify joint hypermobility syndrome in children and adults:

• pain (myalgia or arthralgia);
• recurrent dislocations and subluxations;
• scoliosis;
• flat feet of varying degrees.

Joint pain occurs after playing sports or at the end of the day. In most cases, it spreads to the legs (hip hypermobility syndrome in children), in addition the shoulders, elbows and lower back may be affected. Constant myofascial pain may occur in the shoulder girdle. At an early age, a child with this syndrome gets tired too quickly and asks to be held back.

Dangerous complications

Overuse causes damage to joints and nearby tissues. People susceptible to hypermobility are at risk of developing the following conditions:

• ligament ruptures and various sprains;
• bursitis and tenosynovitis;
• post-traumatic arthritis;
• tunnel syndromes.

Against the background of general weakness, the patient may feel instability in the joints, which appears when the stabilizing role of the capsule and ligamentous apparatus decreases. Most often this occurs in the ankles and knees, which are heavily stressed every day. In the future, hypermobility syndrome can lead to degenerative joint diseases, for example, osteoarthritis.

Joint mobility assessment

When assessing joint movement, the specialist first determines their volume. If it is higher than normal values, then we can safely say that the patient has hypermobility. The assessment primarily relies on the following clinical tests:

• the thumb is retracted towards the forearm;
• the elbow or knee joint is extended (angle no more than 10 degrees);
• the patient should touch the floor with his hands without bending his knees;
• the metacarpophalangeal joints are extended (the angle should not exceed 90 degrees);
• The thigh is moved to the side (angle about 30 degrees).

This helps to accurately establish high joint flexibility, which is important in identifying disorders in ligaments, tendons and capsules. It is important to remember that the sooner such signs are identified, the less dangerous the consequences for the human musculoskeletal system will be.

The joint signs of joint hypermobility syndrome in children from birth are a good example of connective dysplasia. But they are not the only ones that make up the general symptoms of the disease.

Extra-articular signs

Since hypermobility has a systemic form, it is characterized by extra-articular manifestations. Connective tissue is important for human organs and systems, so dysplasia can negatively affect all functions and even lead to significant disturbances in the overall structure. In most cases, pathological disorders extend to the skeletal system. In addition to joint disorders, the doctor may notice some external features: high palate, delayed development of the upper or lower jaw, curvature of the chest, excess length of the fingers or toes.

There are other signs of hypermobility:

• strong stretchability of the skin, increased chance of injury and damage;
• mitral valve prolapse;
• varicose veins in the legs;
• prolapse of the kidneys, intestines, uterus, stomach;
• different forms of hernia (inguinal, umbilical hernia);
• strabismus, epicanthus.

Often people suffering from hypermobility complain of fatigue, general weakness of the body, anxiety, aggression, headaches, and problems sleeping.

Treatment of the disease

After establishing an accurate diagnosis, the doctor remains to choose an effective treatment method. The choice of treatment for joint hypermobility in children and adults will depend on the cause of its occurrence, the main symptoms and severity of pain.

At the same time, it is very important that the patient understands that such a lesion cannot lead to disability, and that with properly selected treatment, all negative symptoms will quickly go away.

To improve his condition, the patient must exclude from his daily life any stress that leads to pain or any discomfort in the joints.

For high intensity pain in individual joints, specialized elastic braces are used, which are also called orthoses (you can purchase elbow pads or knee pads).

In case of particularly severe pain, it is allowed to use medications. In most cases, analgesics (analgin, Dexalgin and Ketanov) are taken to eliminate pain. For many patients, doctors prescribe special ointments with a warming effect and ointments containing non-steroidal anti-inflammatory components.

Physiotherapeutic procedures will bring no less benefit: laser therapy, paraffin treatment, therapeutic mud.

Special exercises and gymnastics are considered the main ones in the treatment of hypermobility syndrome. When they are performed, joints, ligaments and muscles receive the necessary stability and strength.

Exercise therapy for joint hypermobility in children helps the joints to fully flex and straighten. Therapeutic exercise also helps to tense all muscles well. With joint hypermobility, exercises can be strength and static, they are performed at a slow pace and without special weights. Stretching exercises are strictly prohibited, as they only worsen the condition of the joints.

Accurate diagnosis

The doctor can make a diagnosis by examining the patient’s appearance and listening to his main complaints. The child may talk about frequent injuries, the appearance of bruises on the body after minor external influences.

To distinguish hypermobility syndrome from osteoarthritis, arthritis, coxarthrosis, special instrumental diagnostics must be carried out:

• radiography;
• magnetic resonance or computed tomography.

It is necessary to proceed to treatment only if there is a joint disorder caused by hypermobility of the limbs. In other situations, a child or adult is recommended to strengthen muscles and ligamentous tendons: do therapeutic exercises, swim or just walk.

Relief of condition

The following orthopedic products help to significantly relieve pressure on joints:

• elastic bandages;
• posture correctors;
• inserts between fingers.

The results obtained after the research will help to accurately understand the severity of damage to the tendon-ligamentous apparatus, as well as the number of complications obtained.

Summary

Summary. The article provides diagnostic criteria for joint hypermobility syndrome, discusses complications of this syndrome, and describes therapeutic measures.

Summary. The article establishes diagnostic criteria for joint hypermobility syndrome, considers complex syndrome, and describes therapeutic approaches.

Summary. The article deals with diagnostic criteria of joint hypermobility syndrome; complications of this syndrome were considered, therapeutic measures were described.

Keywords

Key words: joint hypermobility syndrome, criteria, treatment.

Key words: hypermobility syndrome, criteria, treatment.

Key words: joint hypermobility syndrome, criteria, treatment.

Relevance

For many years, the problem of hypermobility syndrome as a manifestation of connective tissue dysplasia remains relevant due to its significant prevalence (from 10 to 21.5% in the general population). Among European schoolchildren, joint hypermobility syndrome (JHS) was diagnosed in 11.7% of cases. Our epidemiological studies of the prevalence of GHS among 10-17-year-old schoolchildren in Ukraine and Belarus yielded similar figures - 11.2-12.8%. The significance of the problem of hypermobility syndrome lies in the fact that it plays an important role in the development of the child and largely determines the nature and course of a number of diseases of the musculoskeletal system, cardiovascular system, disorders of the vegetative status, and often leads to chronicity of the underlying pathology, and therefore is considered as a serious disabling factor and is one of the reasons for resistance to therapy.

Despite the importance of the problem, diagnosis of HHS by primary care physicians remains very low. So, back in 1997 N.I. Korshunov, V.R. Gowert pointed out that the percentage of detection of GHS at the clinic level is 0. After 15 years, the situation has hardly changed. With this article we begin a discussion on the issue of GHS on the pages of our magazine.

Definition, terminology

The very concept of “joint hypermobility” (JH) is defined as a condition in which most joints have a range of motion greater than normal for a given age, gender and nationality. Hypermobility can be hereditary, acquired over time as a result of training, or develop as a result of chronic diseases (myopathies, endocrine disorders, birth injury of the spine, etc.).

The term “joint hypermobility syndrome” was first proposed by a group of researchers J. Kirk, B. Ansell, E. Bywaters in 1967. They described a condition in which there are certain musculoskeletal complaints in hypermobile individuals in the absence of signs of any other rheumatic disease

Later R. Grahame derived the GHS formula:

GHS = HS + symptoms.

Diagnostics

Today, there are a number of regulatory documents that describe algorithms for the diagnosis and treatment of diseases associated with connective tissue disorders, namely:

— Berlin nosology of hereditary connective tissue disorders;

- hereditary connective tissue disorders. Russian recommendations.

According to these documents, to diagnose HS, the criteria of P. Beighton (1998) should be used:

— passive flexion of the metacarpal joint of the fifth finger 90° in both directions (1-2 points, Fig. 1A);

- passive flexion of the first finger towards the forearm when flexing at the wrist joint (1-2 points, Fig. 1B);

— hyperextension of both elbow joints > 10 degrees (1-2 points, Fig. 1B);

— hyperextension of both knee joints > 10 degrees (1-2 points, Fig. 1D);

— when bending forward with fixed knee joints, the planes of the patient’s palms touch the floor (1 point).

The absence of hypermobility is determined with a score of 1 to 4, moderate hypermobility - from 5 to 6 points, severe hypermobility - from 7 to 9 points.

To make a diagnosis of GHS, you should use the Brighton criteria for GHS, which are divided into major and minor (Table 1).

GHS is diagnosed if two major criteria are present, or one major and two minor criteria, or four minor criteria. Two minor criteria are sufficient if there is a close relative suffering from this disease. GHS is excluded in the presence of Marfan or Ehlers-Danlos syndromes. It is believed that the diagnosis of GHS in some patients today can be confirmed by laboratory tests of the level of serum tenascin X glycoprotein (muscle tendon antigen) and by analyzing the polymorphism of the tenascin X gene.

Diagnosis of ICD. In ICD-10, GHS has its own code and is assigned to class XIII - diseases of the musculoskeletal system and connective tissue, to block M30-M36 - systemic lesions of connective tissue and has code M35.7 - hypermobility syndrome. ICD-10 also presents synonyms for GMS - familial ligamentous laxity and benign joint hypermobility.

Diagnostic problems. Despite the existing diagnostic criteria, the proposed approach to diagnosis is not unambiguous. Since GHS is accompanied by damage not only to the joints, and also taking into account genetic aspects and the results of a number of morphological studies of the fibrous structures of connective tissue, some scientists have proposed that GHS and Ehlers-Danlos and Marfan syndromes be classified as one group of hereditary diseases located at opposite ends of the clinical spectrum. Today, the terms “joint hypermobility syndrome” and “hypermobile type of Ehlers-Danlos syndrome” are trying to be considered as synonyms, but an analysis of 3330 publications conducted in 2009 did not reveal reliable differential criteria for GHS, familial HS and the hypermobile type of Ehlers-Danlos syndrome. The authors consider genetic characteristics to be the cause of HS in children and propose a multidisciplinary approach to the management of children with HS and arthralgia with the goal of early initiation of preventive measures. In addition, it is suggested that the term “joint hypermobility syndrome” be preferred to describe the combination of joint hypermobility and functional signs, since the term “benign” in the description of “benign joint hypermobility syndrome” is misleading and inappropriate.

Difficulties in diagnosing GHS in children and adolescents also lie in the fact that the Brighton criteria were created for persons from 16 to 85 years old and their use in pediatric practice may be unjustified. Thus, epidemiological studies conducted among 6022 14-year-old children in Great Britain revealed 4 or more points on the Beighton scale in 27.5% of girls and 10.6% of boys. According to the authors, the results obtained cast doubt on the existing diagnostic criteria for HS in young patients whose musculoskeletal system is in a state of growth and development, which requires clarification of the diagnostic algorithms for HS in children and adolescents.

Complications of GHS

In the GHS clinic, in addition to the symptoms listed above, there are: chronic pain syndrome localized in typical places(Fig. 2). Such patients complain of constant pain in the shoulder and elbow joints, transient pain in the knee joints and in the lumbar spine, instability of the ankle and hip joints, clicking and subluxation of the joints, paresthesia in the thigh, calf muscles and distal phalanges of the hands, myofascial pain in the muscles of the shoulder belts

We offer an adaptation from R. Keer, R. Gra-hame (2003) with additions, a classification of neuromuscular and musculoskeletal complications and clinical manifestations that are observed in children with joint hypermobility syndrome.

1. Acute or traumatic:

- sprain;

- damage:

Recurrent ankle injuries;

Knee joint, meniscus tear;

Acute and recurrent dislocations/subluxations:

Shoulder joint;

Patella;

Metacarpophalangeal joints;

Traumatic arthritis/synovitis;

Fractures.

2. Chronic non-traumatic:

- rheumatic soft tissue damage:

Tenosynovitis;

Synovitis;

Juvenile arthritis/synovitis;

- pain in the knee joints;

- back pain (HSS is diagnosed in 55% of young people under the age of 30 with pain in the lower back);

- chronic widespread musculoskeletal pain syndromes;

— compression-radicular syndromes;

- flat feet and pain in the ankle joint;

- nonspecific arthralgia;

- scoliosis (GHS occurs in half of children with idiopathic scoliosis).

With GHS, it is not only the joints that are affected. Thus, there is an opinion that one of the causes of postural tachycardia syndrome in people 15-40 years old and chronic daily headache syndrome is hypermobility of the spinal joints. In patients with GHS, even psychiatric abnormalities - panic disorders - are more often detected.

Results of our own research

As part of the joint Ukrainian-Belarusian epidemiological study “Study of the health status and structural-functional state of bone tissue in children and adolescents who live in environmentally unfavorable regions,” we examined 1259 students aged 10-17 years from seven regions of Ukraine:

— Poltava region, urban-type settlement Mashevka — 231 children;

— Kharkov region, Merefa — 240 children;

— Transcarpathian region, urban settlement Kobyletskaya Polyana — 208 children;

- Donetsk region, Olenivka village - 88 children, Krasny Liman - 104 children, Mariupol - 98 children;

— Zaporozhye — 290 children,

and 594 schoolchildren from three regions of Belarus:

— Minsk — 205 children;

— Gomel region, Lelchitsy village — 194 children;

— Vitebsk region, Lepel — 195 children.

The examination program included a survey using a questionnaire developed by us, an objective examination by a pediatrician, anthropometry (42 indicators), assessment of sexual development, analysis of outpatient cards of child development and family history, ultrasound densitometry using the Sahara apparatus (Hologic, USA), and, if necessary, the use of other instrumental methods (EchoCG, ECG, X-ray) and examination by specialists.

Results:

1. The frequency of registration of GHS among schoolchildren aged 10-17 years living in Belarus was 11.2 ± 1.3%, in Ukraine - 16.8 ± 1.7%. The average Beighton score in children was 5.2-6.4, which corresponded to a pronounced degree of joint hypermobility.

2. Individual symptoms of connective tissue deficiency were diagnosed in relatives of almost half of the children with GHS (40.5 ± 2.5% of children from Ukraine and 54.9 ± 2.9% of children from Belarus). In relatives of children with GHS, varicose veins of the lower extremities, mitral valve prolapse and minor cardiac anomalies, myopia, and joint hypermobility were identified significantly more often than in the group without GHS. The mothers of more than half of those examined with GHS had pathological pregnancy, regardless of their place of residence (65.8 ± 2.3% in Ukraine and 69.0 ± 2.5% in Belarus). The data obtained indicated the indirect influence of heredity (manifestations of dysplasia in relatives) and the pathological course of the intrauterine period of child development (preeclampsia) on the nature of connective tissue metabolism.

3. 40.5% of schoolchildren with GHS complained of headache, back pain, and fatigue. In children with GHS, the dominant manifestations of connective tissue inferiority, in addition to joint hypermobility, were minor cardiac anomalies and vision pathology, and poor posture.

4. In girls with GHS, a delay in the onset of sexual development was detected in the age range of 10-14 years. From the age of 15, the rate of maturation leveled off. Sexual development of boys with GHS was characterized by a later start (from 12 years of age) with a gradual equalization of the rate of maturation.

5. GHS in 25% of schoolchildren was accompanied by a decrease in bone mineral density, while low physical activity as one of the causes of osteopenia was recorded in 3/4 of those examined with GHS, especially among schoolchildren in Ukraine (91-95% versus 69-78% in Belarus) .

Treatment

Considering the polymorphism of GHS, the approach to the management of such patients should be individualized. A decisive role in treatment is given to optimizing lifestyle and non-drug measures, which includes the following activities:

1. Psychological support.

2. Selection of an adequate daily routine.

3. Diet therapy, providing a complete fortified diet with the appropriate amount of microelements.

4. Physiotherapeutic methods, the basic principles of which for GHS were involuntarily formulated by D.V. Grigorovich in the story “The Gutta-Percha Boy”: “...After the first experiments, Becker (athlete-mentor. - Note authors) was convinced that he was not mistaken about the boy; Petya was light as feathers and flexible in his joints; there was, of course, not enough muscle strength to control these natural qualities; but there was no trouble yet. Becker had no doubt that strength would come from exercise...” Indeed, physical therapy and exercise in patients with GHS should be aimed at reducing pain, improving muscle strength, posture and proprioception, and correcting the movement of individual joints. Physical activity, which cannot be deprived of a child, must be dosed and meet the threshold of tolerance for the given patient. The physical therapy complex includes isometric exercises, during which significant muscle tension occurs, but the range of motion in the joints remains minimal. Depending on the degree of manifestation of GHS, it is recommended to strengthen the muscles of the thigh and lower leg (knee joints), shoulder girdle, back, etc. It is easier for patients with GHS to achieve significant results in those sports that require flexibility, jumping ability, and small muscle mass from the athlete. Therefore, the most indicated for this category of patients are gymnastics, swimming, basketball and volleyball, choreography and dancing. If any complaints arise during sports, they should be temporarily stopped. Physiotherapy includes hydrokinesitherapy, massage and other techniques, depending on the degree of hypermobility and the presence of other symptoms.

5. Conducting vocational guidance for teenagers. Unfortunately, there are currently no regulatory documents on medical supervision and career guidance for adolescents with GHS. In our opinion, such patients should abandon professions associated with prolonged standing, heavy lifting, and vibration.

6. Depending on the clinical manifestations, children with GHS are recommended to be registered with a pediatrician, who will work closely with specialists (orthopedist, neurologist, dentist, etc.), draw up a treatment and rehabilitation plan for patients, and monitor the effectiveness of measures.

7. Disputed methods of treating GHS. One of these is prolotherapy (Proliferative Injection Therapy) - one of the methods of treating the pathology of the ligamentous apparatus, which is used to stimulate reparative processes in it. The technique is used for pain associated with weakening of ligaments and tendons. The authors of the method claim that solutions injected into the places where ligaments and tendons attach to bone tissue promote the proliferation of damaged tissue. Various irritating solutions are used as proliferators, so the technique can also be called sclerosing therapy.

8. Drug therapy.

In addition to general principles, a number of therapeutic measures are used, which are determined by the characteristics of the course and the nature of complications of GHS.

Thus, despite the low level of evidence (C or D), some authors recommend that patients with GHS take courses of basic drugs that directly or indirectly affect the metabolism of connective tissue:

- stimulators of collagen formation - vitamins C, B1, B2, B6, folic acid, L-carnitine, microelements (calcium, zinc, magnesium, manganese);

— correctors for disorders of the synthesis and catabolism of glycosaminoglycans;

— stabilizers of mineral metabolism;

— local medicinal effect on joints when complications occur (plasters, ointments, etc.);

— surgical correction of deformities of the musculoskeletal system and chest.

9. Considering the data of a number of authors on the high (25-60%) frequency of osteopenia in children and adolescents with GHS, which may be associated with the characteristics of remodeling processes or impaired mineral metabolism in this condition, one of the main directions of treatment of GHS is the prevention of early osteopenic syndrome .

Conclusion

Thus, in pediatric practice, the problem of GHS requires further study, since, on the one hand, the opportunity to distinguish between physiological and pathological HS appears only in the period of 18-30 years, on the other hand, the earlier GHS is diagnosed, the more effective measures will be to prevent the occurrence pathological symptoms caused by HS. The issue of preventing complications and rehabilitation of children and adolescents with GHS, their medical and professional counseling remains insufficiently developed, which requires further research.

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The most complete answers to questions on the topic: “hip dysplasia code according to ICD 10.”

Congenital diseases of the musculoskeletal system are becoming increasingly common, and among them is hip dysplasia. Due to the mother’s poor lifestyle during pregnancy, bad habits, as well as taking certain medications, children are born with underdeveloped limbs, cartilaginous and musculoskeletal systems. One of the most unfavorable outcomes is congenital hip dislocation.

In the international classification of diseases, this disease is allocated a separate class and group: M24.8 - specified joint damage, not reflected and not classified in other groups.

What causes this condition most often to develop?

Pathology of joint development in a newborn

In newborn children during intrauterine development, there is underdevelopment of the articular surfaces that form the hip joint, which can lead to the disease congenital dysplasia of the hip joints.

The acetabulum is represented mainly by cartilage tissue. During the period of intrauterine development and newborns, its cavity increases due to the cartilaginous lip (limbus). The cavity itself consists of three bones, the final ossification of which ends by the age of 18. The head of the femur, its neck and greater trochanter consist predominantly of cartilage (these formations are not visualized on an x-ray). The head of the femur in newborns is always larger than the articular surface of the pelvis. All of the above factors cause insufficient joint strength.

The discrepancy between the articular surfaces (discongruence) creates conditions for the development of hip predislocation - a condition in which spontaneous dislocation of the femoral head occurs and its reverse reduction (this does not require much effort). In some children, spontaneous reduction of the head of the bone occurs, after which the joint develops normally. In others, due to long-term preluxation, the head of the bone is displaced relative to the glenoid cavity, after which subluxation of the femur develops (the femoral head is displaced, but it does not extend beyond the limbus).

If such a condition exists for quite a long time, then over time, due to the traction of muscles gaining tone, the limb is pulled up and to the side (which depends on the displacement of the head), which is why a dislocation of the femur develops. Gradually ossifying, the head is fixed in the area of ​​the anteroinferior pubic bone, receiving a new fulcrum there (in severe cases, displacement of the head can occur in the area of ​​the posterior surface of the iliac wing). In this case, the relative length of the limb decreases.

Typically, children develop type 2a hip joints. There are several types of joints that correspond to the stages of development of dislocation:

• Type 1 - healthy joint;
• type 2 - violation and slowdown of ossification;
• Type 3 - hip subluxation;
• Type 4 - complete dislocation.

Type 2a (develops in children under 3 months) is characterized by the presence of a rounded and short bony roof of the acetabulum, alpha and beta angles within 55 degrees (these angles characterize the position of the head along certain landmarks or axes), as well as a centered head of the bone without displacement. When the process is started, a stage-by-stage transition to dislocation is observed.

In the development of this pathology, a decisive role is played by the incorrect position of the fetus during pregnancy. Statistics show that hip dysplasia most often develops in a breech position with the arms and legs crossed in front. This is usually observed in girls, especially with the left-sided position of the fetus in the womb.

Due to the adoption of this position of the body, the heads of the femoral bones are displaced relative to the joint cavity, which is why hip dysplasia develops. If you remain in this position for a long time, the cartilage of the bones cannot fully develop (since this requires their complete conformity).

Diagnosis begins immediately after the birth of the child. Already in the maternity hospital, in order to establish dysplasia, it is necessary to determine the presence of a “clicking symptom” - this symptom appears only when the joint is dislocated (which can occur as a result of improper management of labor and midwife assistance to the baby). The symptom is determined due to the fact that the baby’s joint capsule is overstretched, due to which the femoral head “walks.” The click is detected after it slides off the edge of the acetabulum. This symptom, which indicates hip dysplasia, is checked very carefully so as not to damage the baby’s delicate tissues and blood vessels.

To identify the symptom, the baby is placed on the table, his legs are bent at the hip and knee joints. The thumb is located on the inside of the baby's thigh, and the other four are on the outer surface of the joint (in this case, the middle finger of the hand must be on the greater trochanter of the femur). The baby's hip is moved to the side at a slight angle (usually up to 40 degrees), after which traction of the baby's hip is carried out along its axis. At the same time, pressure is applied to the greater trochanter. If the procedure is carried out correctly, you can feel a loud click (it is not perceived by hearing, but is felt through tactile sensations).

Standard diagnostics for patients with pathology of joint development

As you grow older, this symptom loses its value, and others take its place. First of all, it becomes possible to determine the increased muscle tone of the limb.

This symptom should be identified together with neurologists to differentiate a dislocation from a neurological pathology. The symptom is defined as follows. The baby is carefully placed on the table. Place your hands on the child’s inner thighs and move his hips to the sides. Normally, the child’s hips should lie on the surface of the table (for a newborn); if the child is older, then the angle between the table surface and the leg should be at least 60 degrees. This limitation develops due to high muscle tone, and also, in later life, due to the fact that the femoral head rests on the ilium.

With unilateral dislocation, an important place is occupied by the symptom of violation of the symmetry of the longitudinal axes. When the legs are bent at the knee joints, when they are abducted to the sides, a visual decrease in the longitudinal axis of the limb is observed (due to the fact that the head is not in the articular cavity, but is shifted away from it). In parallel, on the side of the dislocation, there is retraction of the soft tissues in the area of ​​Scarpa's triangle. Along with them, asymmetry of skin folds is observed.

There are several signs of hip dysplasia. At the age of one year, one of the main symptoms of the development of a dislocation is diving lameness (with a unilateral dislocation) or a duck's gait (with a bilateral lesion).

In addition to determining the gait, the Trandeleburg symptom is also detected: when standing on the sore leg with the healthy one raised and bent at the knee, the body shifts towards the healthy leg with a parallel retraction of the tissues in the area of ​​the sore joint. There is a descent of the gluteal fold.

Incorrect gait in pathology of hip joint development

Additional symptoms are displacement of the greater trochanter above the Roser-Nelaton line and increased curvature of the lumbar spine.

X-ray diagnostics are not carried out for children under one year old, since cartilaginous structures do not retain X-rays, and they pass by the bone. For a more reliable diagnosis, ultrasound examination (ultrasound) is used.

X-rays can be used from the age of one (by this age the femoral head has already ossified), and it is already possible to determine the displacement of the femur.

To determine the degree of head displacement, special schemes are used. The most widespread among them is the Hildenreiner scheme. It evaluates the spatial arrangement of the hip joint structures. In addition, additional schemes can be used, but the essence of their use is one thing: they all allow you to determine the position of the displaced femoral head and identify the degree of displacement and the possibility of active movements in this joint.

The most complete and reliable information regarding the joint is provided by arthrography and tomography of the joint.

There are currently no specific treatments for dysplasia. If the defect was discovered during the newborn period, most often the displaced femoral head is set back into place and the joint begins to develop normally on its own. If the condition has been neglected, they resort to correction of the displaced limb. To do this, use the so-called wide swaddling for dysplasia or placing a spacer.

Swaddling for dysplasia is applicable in young children (most often used under the age of 4 months). Due to the tight swaddling of the legs, they are given a forced abduction position, in which the articular head returns to its place.

In children who have reached the age of six months, tight swaddling, a Freik pillow or the use of Pavlik stirrups will no longer have the desired effect. In order to correct the joint, they begin to use plaster of the limb according to Ter-Egizarov. At the same time, spacers are placed in the area of ​​the knee joints. As the joints straighten and muscle tone decreases, abduction of the limb increases, which allows for wider spacers to be placed and thus achieve normal abduction and recovery in the joints. At the same time, to achieve relaxation in the thigh muscles, warm baths are used. Spacers and other treatment in this manner takes about 3-4 months.

If these methods are ineffective, they resort to skeletal traction of the limb. Traction is carried out using the overhead technique, thanks to which it is possible to bring the femoral head closer to the glenoid cavity. After this, it is reduced using the closed reduction method, and always under anesthesia. After reduction, the hip is fixed in a coxite bandage for up to six months. After this period, the development of movements in the affected limb begins, and the load is allowed at the end of the year, carried out in a special Vilensky splint.

In parallel with treatment, appropriate rehabilitation therapy and exercise therapy are recommended. Sessions of manual therapy, massage, and physiotherapy with medications on the affected joint to restore metabolism in it will be useful.

With the development of this pathology in adults, it is possible to use manual therapy and hydrotherapy. If the disease is severe, the only way out of this situation is surgical treatment with complete replacement of the articular surfaces.

Prevention of the disease should first of all include the normal course of pregnancy and the prevention of its pathology. In addition, due attention should be paid to determining the tone of the uterus (which can affect the intrauterine position of the fetus) and proper nutrition (which can often lead to the development of congenital dystrophy of cartilage tissue).

To prevent recurrence of dysplasia or pre-dislocation in a baby, it is recommended to carry out special exercises. Komarovsky developed a special program for the treatment of hip dysplasia. These exercises help your baby learn to crawl and prepare him for his first steps. Exercises tone the muscles of the limb and restore the normal position of bone structures.

Komarovsky recommends doing exercises on a soft mat and on a gymnastic ball with the support of mom or dad.

The following exercises are carried out:

1. “Hands up.” A towel or cushion is placed under the baby's chest, and his attention is attracted to some bright object. The baby begins to actively reach for the toy, while leaning on the bolster. In this case, there is a slight load on the pelvis and joints.
2. "Turtle". Similar to the previous one, but the cushion is placed under the stomach. This roller should be tightened little by little and at the same time make sure that the baby actively helps himself with his arms and legs. This strengthens the muscles of the limb girdles.
3. “Criss-cross.” The baby's arm is folded with a parallel leg in the abdomen, and care is taken that the baby pushes off the stop with his leg.

Dr. Komarovsky notes that the exercises must be done in conjunction with medical supervision.

Due to the fact that it is not always possible to diagnose this disease, it is necessary to familiarize parents with self-treatment of dysplasia (tight swaddling, but before doing it, be sure to show the child to a doctor).

With age, changes that occurred in childhood can affect the health of an adult. There are frequent cases of the development of coxarthrosis in people who suffered from hip dysplasia in childhood. This can be triggered by joint injury, pregnancy, or hormonal changes in the body. The disease is quite severe, and the prognosis for it is unfavorable, most often ending in disability.

Oddly enough, people who suffered from joint dysplasia in childhood show significant success in gymnastics. This is due to pathological hypermobility of the joint - an echo of dysplasia. If joint hypermobility does not reach significant levels, then usually no joint pathology will be detected.

Women are at risk for developing this pathology. At the same time, the likelihood of them having a child with a hip dislocation is quite high, provided that they themselves had a similar dislocation.

In addition, quite often in adults it is possible to identify a pathology such as neoarthrosis - the formation of a new joint. People with such a pathology can walk for years and not realize that they have a pathological displacement of the joint. Neoarthrosis occurs, as stated above, when the head of the femur is displaced towards the posterior surface of the iliac wing. The disease is usually detected during an X-ray of the joint.

In severe stages of hip dysplasia, especially with the development of coxarthrosis, surgical correction of the hip joint or endoprosthetic surgery may be required. And any operation on hip dysplasia is dangerous.

Disability for these diseases is established based on the decision of a medical and social examination. ITU is called upon to monitor the increase in the incidence and severity of disabling diseases, keep records of all factors of disability, determine the risk of its development in certain groups of people, and be able to determine the degree of occupational risk for these diseases. In addition, this body is responsible for developing prevention programs for various diseases.

As can be seen from what has been written, hip dysplasia is one of the most common causes of disability in children, and when the process is complicated, in adults. It is extremely important to know the necessary signs of hip dysplasia and the diagnostic algorithm. Only such an approach can affect the incidence of dysplasia and reduce its incidence. Only competent work of doctors at all levels can affect the incidence and serve as a prevention of diseases of the musculoskeletal system in the future.

Hip dysplasia in adults and children

Dysplasia is translated from ancient Greek as a disorder of education. Simply put, it is a developmental defect. Dysplasia can be observed in any staves. But hip dysplasia is most often observed.

Causes

Apparently, this is due to the peculiarities of the anatomical structure and development of the hip joint in children. Our hip joint is formed by the articular acetabulum of the pelvis and the head of the femur, or simply the head of the femur. The head is connected to the rest of the bone through the femoral neck. To increase the area of ​​contact between the articular surfaces of the head and the acetabulum, the latter is surrounded by a cartilaginous plate - the limbus.

The hip joint begins its formation at approximately 5-6 weeks of intrauterine development. In an embryo at 2 months, movements are already possible in it. However, the complete formation of the hip joint ends only when the child begins to walk - without adequate load, the joint remains anatomically and functionally immature.

In most cases, congenital dysplasia occurs, which is first diagnosed in childhood. This fact is reflected in ICD-10 - the international classification of diseases, 10th revision. In this classification, hip dysplasia is placed in the XVII section - congenital anomalies (developmental defects), deformations and chromosomal disorders, in the block congenital anomalies (developmental defects) of the musculoskeletal system. According to this classification, this pathology is congenital. Causes of hip dysplasia include:

• Genetic disorders leading to inferiority of connective tissue structures - bones, cartilage, ligaments;
• Damage to the hip and hip joint as a result of birth injuries caused by increased uterine tone and breech presentation of the fetus;
• The impact of external negative factors on the pregnant woman’s body - stress, industrial, household toxins, infections;
• Hormonal imbalance - increased synthesis of progesterone during pregnancy, which relaxes muscles and ligaments;
• Drinking alcohol, drugs, smoking during pregnancy.

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Not the least role in the development of dysplasia of the hip joints with their congenital immaturity is played by tight swaddling, during which the femoral axis shifts and the head of the femur extends beyond the acetabulum. In some cases, hip dysplasia is observed in adults. It is believed that this pathology in adulthood is predisposed by increased loads on the joint - sports, dancing, gymnastics. Apparently, in adults this pathology is also congenital. Simply, anatomical changes in the joint and ligaments are minimally expressed and are not diagnosed until a certain time. And physical activity is not a cause, but a provoking factor.

Types and degrees

Depending on the nature of the anatomical disorders, the following types of hip dysplasia are distinguished:

• Acetabular. The glenoid cavity is changed - it is flattened, the limbus is thinned or displaced.
• The femoral head has been changed. When the femoral head changes, the anatomical correspondence (congruence) of the articular hip surfaces is also disrupted. Along with the head, the femoral neck is often affected, which leads to a decrease or increase in the angle between the neck and the femur.
• Rotary. Caused by pathology of the femur and often the knee joint and lower leg. In this case, the entire lower limb is turned (rotated) inward.

Structural changes in the hip joint are of varying severity, and therefore the following degrees of hip dysplasia are distinguished:

1. Pre-luxation - the articular surfaces are changed, but the head is within the acetabulum.
2. Subluxation is a further displacement of the head relative to the articular surface. The head partially extends beyond the glenoid cavity.
3. Dislocation - the head of the femur is completely out of the socket.

All these degrees, with the appearance of corresponding symptoms of hip dysplasia, develop against the background of the so-called. immaturity of the joint. This immaturity is characterized by weakness of muscles, ligaments and the above signs of joint disorders.

Symptoms

Congenital dysplasia is most often observed in first-born females. This is due to the fact that girls respond to maternal progesterone to a greater extent than boys, as well as the increased tone of the uterine muscles during the first pregnancy. Although dysplasia is sometimes diagnosed in male children. According to statistics, this pathology is observed in 2-3% of newborns of both sexes.

Among the main signs of hip dysplasia:

• Different lengths of the lower limbs. On the dysplasia side the leg is shortened.
• Inward rotation of the entire lower limb.
• Abduction limitation. The child is laid on his back and his hands are wrapped around his legs, bent at the knees and hip joints. In this position, the legs are spread apart. With normal development of the hip joint, the leg is abducted at a right (or close to right) angle. With dysplasia, the abduction angle is much smaller.
• Clicking symptom. In some cases, when the hip is abducted in the above position, a click of the femoral head is heard, indicating a dislocation. When the hips are brought together, the click is heard again - the dislocation has been reduced.
• Asymmetrical arrangement of skin folds. In the prone position, 3 folds are identified on the surface of the thighs. On the dislocated side these folds are higher than on the healthy side.

Asymmetry of skin folds

According to statistical data, all of the above symptoms are more often observed on the left lower limb.

Diagnostics

Diagnosis of hip dysplasia is carried out during an external examination and instrumental studies. Pathology can be suspected based on the characteristic symptoms listed above. X-ray confirms the diagnosis. X-ray images clearly show structural abnormalities of the articular elements. In babies up to 6 months. Ultrasound of the hip joint can be used for diagnosis.

This is what dysplasia looks like on an x-ray

Treatment

The earlier the diagnosis is made, the more effective the treatment, which should be carried out literally from the cradle. Otherwise, there may be consequences of hip dysplasia such as lameness, persistent limitation of movements in the hip joint, atrophy of the muscles of the thigh and lower leg.

In adults, these factors lead to arthrosis changes in the hip joint and disability. The problem is that in the anatomically modified acetabulum, connective tissue grows over time, and subsequently it is almost impossible to achieve complete anatomical compliance of the articular surfaces.

Currently, various types of fixation bandages are used for hip dysplasia.

Fortunately, in most cases in young children, congenital dislocations and subluxations of the hip are reduced spontaneously. To do this, the lower limb must be given an abduction position in the hip joint. For this purpose, special fixing orthopedic devices are used - Pavlik stirrups, Freik pillow. These devices are used until six months of age. In this case, you should avoid tight swaddling, which provokes hip dislocation and subluxation.

In parallel with the orthopedic correction, health-improving gymnastics are performed - flexion and extension of the legs at the knee and hip joints, abduction of the legs in a prone position. During the exercises, the child’s legs and buttocks are massaged with soft stroking movements. If there is a dislocation of the hip, the latter is reduced in a closed manner, after which the hip joint is fixed with a plaster cast. However, closed reduction can only be performed in early childhood. After 5-6 years, this can no longer be done, and the dislocation can only be reduced in an open way, during surgery. Other types of surgical interventions to eliminate hip dysplasia involve various types of plastic surgery of the acetabulum, limbus and articular ligaments.

A disease such as hip dysplasia in adults is extremely rare, because this disease is detected in infancy. But anything can happen in life. Why is a congenital disease sometimes found in adults? And in what form? To understand this, you need to understand everything in detail.

What does dysplasia mean?

Dysplasia is a tissue formation that differs in some way from their normal (true) development. When, for example, cartilage or bone is formed incorrectly in a person during fetal development or after birth, it is said that there is dysplasia of this tissue. Accordingly, this concept is general for any type of living tissue.

Hip dysplasia is also known as congenital hip dislocation. This illness is very serious. It is characterized by a violation of the formation of all components of the joint and a change in the location of the epiphysis of the femur (head) in relation to the acetabulum.

Of all the congenital ailments of the musculoskeletal system, hip dysplasia occupies one of the first places, and the female sex suffers from this disease twice as often. It is known that obstetric aspects of pregnancy are also important. Breech presentation of the fetus increases the likelihood of dysplasia in the hip joint. Women suffering from this pathology have a high probability of having a child also with dysplasia.

Causes and classic signs of the disease

The true causes of hip dysplasia are still unknown. The predisposing factors are the following:

• underdevelopment of the acetabulum;
• inclusion of new mechanisms in joint movement during the period of the beginning of walking.

In approximately 2-3% of cases, dislocation occurs in utero.

As mentioned above, hip dysplasia is detected in early childhood during routine visits to an orthopedic doctor. The following symptoms may raise suspicion:

• excessive hip rotation;
• shortening of the lower limbs, one or two at once;
• when moving in the area of ​​the hip joint, there is a sort of slipping or clicking;
• if you bend your legs at an angle of 90º at the hip and knee joints and try to separate them, incomplete abduction of the limbs is noted;
• asymmetrical arrangement of skin folds.

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How to cure pathology

Treatment of hip dysplasia must be carried out from the moment this disease is detected. Massage activities are usually used as therapy. Massage is performed only by a specialist to avoid injury to the child. The course of treatment depends on the degree of dysplasia, in some cases ten days is enough. In other situations, in addition to massage, you will need to wear a special corset until complete healing.

But there may be cases when the pathology is missed or not detected for one reason or another in childhood. Then serious consequences await an adult. After all, hip dysplasia in adults in such cases is the result of an untreated or incompletely cured disease in childhood. Therefore, it is necessary to start treatment on time and work only with qualified specialists in order to avoid serious consequences.

The consequences of childhood dysplasia can be expressed in the development of diseases such as neoarthrosis or coxarthrosis in adults.

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Neoarthrosis as a consequence

One of the consequences of childhood dysplasia in adults is neoarthrosis. Neoarthrosis, or pseudarthrosis, is the formation of a new joint in a place where it should not be. It appears when the head of the femur is displaced towards the posterior surface of the iliac wing. People may not know about such a disease for many years. It is detected only during radiography.

Symptoms of neoarthrosis:

• good mobility at the site of the former injury;
• immobility of the limb;
• overlap of the bone marrow canals with the endplate;
• formation of cartilage and false joint capsule;
• shortening of the diseased limb up to 10 centimeters.

This consequence of dysplasia can only be cured surgically. The new joint is removed and homografts are inserted for rapid healing. After the operation, rehabilitation is required: physiotherapy, massage, therapeutic physical training.

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Coxarthrosis as a consequence

Coxarthrosis is another consequence of advanced dysplasia. Symptoms of this disease include muscle atrophy combined with limb shortening. Like neoarthrosis, it develops over several years.

Symptoms:

• discomfort in the pelvic area, especially in the morning;
• increased pain during physical activity;
• inactivity;
• inflammation;
• growth of osteophytes.

For coxarthrosis, multi-stage, complex and rather lengthy treatment is required. The most important thing is the immediate start of treatment, regardless of the stage of the disease.

During the initial stage of development of coxarthrosis, it is only necessary to adjust the patient’s lifestyle, adjust nutrition, and solve problems of metabolism and blood circulation. Other stages of this pathology require more serious actions, which include drug treatment and surgical intervention.

Medicines are used to relieve pain, eliminate swelling and inflammation. The following groups of medications are used in treatment:

1. Non-steroidal anti-inflammatory drugs (used to relieve swelling, inflammation and numb the damaged area): Piroxicam, Diclofenac, Indomethacin, Ketoprofen.
2. Muscle relaxants (used to relieve muscle spasms and improve blood circulation, used with caution): “Sirdalud”, “Mydocalm”.
3. Vasodilators (used to relieve spasms and improve blood circulation): xanthinol nicotinate, Cynaresin, Pentoxifylline.
4. Hormonal drugs (injectable): triamcinolone acetamide, metipred, hydrocortisone.
5. Chondroprotectors (used to restore the structure of cartilage): Rumalon, Arteoparon, glucosamine, Dona, Arthrochondroitin.
6. Medicines for topical use.

The use of medications is not the main treatment. The process of rubbing in certain medications helps to achieve a positive effect; this improves blood circulation.

ZdorovyiSkelet.ru

Hip dysplasia in children: photos, treatment, consequences of DTS

What is it - congenital malformations caused by pathologies of the musculoskeletal system, which are elements of the hip joint, in medicine called hip dysplasia (HJD). All its elements can be affected to one degree or another by the defect:

• acetabulum;
• femoral head and capsule;
• underdevelopment of surrounding muscles and ligaments.

a brief description of

The role of the hip joints is very important; they experience the main loads when a person walks, runs or just sits. Perform a huge variety of movements. The joint is a spherical head located in the deep crescent-shaped acetabulum. It is connected to the other parts by the neck. The normal, complex functioning of the hip joint is ensured by the configuration and correct internal structure of all its components. Any disturbances in the development of at least one of the components of the link are expressed:

• pathology and changes in the outline of the femoral head, discrepancy between its size and the size of the socket;
• stretching the joint capsule;
• not the standard depth and structure of the cavity itself, its acquisition of an ellipsoidal, flat shape, thickening of the bottom or bevel of the “roof”;
• pathologies of the cartilaginous edge - limbus;
• shortening of the femoral neck with a change in its antiversion and diaphyseal angle;
• ossification of articular cartilaginous elements;
• pathologies of the ligamentous apparatus of the head, manifested by hypertrophy or aplasia

This leads to disruption of the functional development of the entire hip “apparatus”, which is the disease of DTS. Depending on the nature of the pathology, hip dysplasia is divided into various types.

DTS classification

Three main types characterize the pathology of DTS.1) Acetabular dysplasia includes a disorder in the structure and pathology in the acetabulum itself, mainly pathologies in the cartilages of the limbus, along the edges of the cavity. Under the influence of pressure from the head, it is deformed, forced outward or wrapped inside the joint. This contributes to stretching of the capsule, development of ossification of articular cartilage and increased displacement of the femoral head. 2) Mayer's or epiphyseal dysplasia - characterized by point ossification of cartilage tissue, causing stiffness of joints, pain and deformation of the legs. Damage to the proximal femur, expressed by pathological changes in the position of the femoral neck of two types - dysplasia caused by an increase in the inclination angle, or dysplasia with a decrease in the diaphyseal angle. 3) Rotational dysplasia - characterized by slow articular development and pathologies, expressed by obvious disturbances in the relative position of bones relative to the horizontal plane. In itself, this situation is not considered dysplasia; most likely, it is a borderline condition. The degree of development of the disease depends on the severity of the pathological process.

1. The 1st, mild degree of DTS is called pre-dislocation - it is characterized by small deviations caused by the oblique acetabular angles of the roof of the acetabulum. In this case, the position of the femoral head, located in the articular cavity, is slightly shifted.
2. 2nd degree - subluxation - only part of the head of the femoral joint is in the articular cavity. In relation to the cavity, it shifts outward and upward.
3. 3rd - degree - dislocation, characterized by complete exit of the head from the cavity in the upward direction.

Causes of hip dysplasia

The reasons that result in the formation of articular pathological processes in the hip joints are due to several theories: 1) Theory of heredity - suggesting inheritance at the gene level; 2) Hormonal - an increase in progesterone levels in the last stages of pregnancy causes functional and structural changes in the muscle-ligamentous structures fetus, expressed by instability in the development of the hip apparatus. 3) According to the multifactorial theory, the development of DTS is influenced by several factors at once:

• breech position of the fetus;
• lack of vitamins and microelements;
• limited movement of the child in the womb - usually, the mobility of the child’s left leg is limited by pressing it by the wall of the uterus, so the left hip joint is more often susceptible to dysplasia.

As a result of long-term research, a direct connection has been proven between the development of the disease and swaddling of children. For example, in African and Asian countries, children are carried on their backs, without swaddling, while maintaining relative freedom of motor functions. Taking this as a basis, the Japanese violated their age-old foundations (tight swaddling during DTS). The results amazed even the most distrustful scientists - the growth of the disease decreased almost ten times compared to usual.

Symptoms of hip dysplasia in children

A big role in identifying early symptoms of hip dysplasia belongs to parents if they pay due attention to the characteristic signs of dysplasia in children, which are pronounced:

1. 1) Asymmetry of the location of the folds on the thighs. There should be three of them in front and behind. When examined, the legs should be straightened with the feet brought towards each other. With pathology, additional, deeper folds are added on the affected side, both in front and on the buttock side.
2. 2) Limitation of abduction of the legs - typical for the second and third degrees of dysplasia. In a normal state, the child’s legs, in a bent state, can be spread completely by ninety degrees, with dysplasia no more than sixty.
3. 3) According to Marx Ortolani’s definition, it is a symptom of the head slipping with a characteristic click when the legs are abducted and adducted.
4. 4) Shortening of the affected leg. Can be determined by comparing the height of the knee joints.

Associated symptoms of dysplasia in children may include:

• softening of the skull bones;
• x-shaped legs or clubfoot;
• curvature of the neck;
• suppression of unconditioned reflexes (sucking and searching)

Diagnosis of hip dysplasia

The diagnosis of hip dysplasia is determined during an examination by an orthopedist during a profile examination, usually before the age of six months. The diagnosis is based on a physical examination of the baby, certain tests and accompanying symptoms are used. Ultrasound and, less often, radiography are used for confirmation in outpatient settings.

1. 1) Ultrasound has an advantage over many other research methods, as it is used from birth. It is the safest method (non-invasive), available, and can be used multiple times.
2. 2) The X-ray method is not inferior in reliability, but has a number of features. Firstly, irradiation is not recommended for children under one year of age (except in cases where the ultrasound diagnosis is in doubt or it is not possible to perform it). Secondly, it is necessary to place the child under the device while maintaining symmetry, which is difficult in childhood.
3. 3) Computer or magnetic resonance imaging is used when there is a question about surgical treatment. Gives a more complete, structured picture.
4. 4) Arthrography and arthroscopy are used to complete the full picture when making a diagnosis in advanced conditions. The methods are invasive, performed under anesthesia, and are not widely used.

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What to do with hip dysplasia in children: Dr. Komarovsky.

Treatment of hip dysplasia in newborns

In pediatric orthopedics, there are many treatments for hip dysplasia in a child. Each doctor chooses a treatment program individually for his little patient, based on the severity of the disease. These are methods from basic wide swaddling to casting a baby. And so on. In order, about some methods of treating dysplasia.

1. 1) Wide swaddling is the most accessible method, even a young mother can do it; it is used for uncomplicated forms.
2. 2) Becker's pants - the same as wide swaddling, but more convenient to use.
3. 3) Frayka tire or pillow - functionally the same as panties, but has stiffening ribs.
4. 4) Pavlik stirrups - came to us from the last century, but are still in demand.
5. 5) Splinting - use a Vilensky or Volkov splint (they are an elastic type of splinting), also a spreading splint for walking, and gypsum splinting.
6. 6) Surgical treatment - this method is used for severe forms, frequent relapses, in children over one year of age.

Additional methods for the treatment of dysplasia, which can also be the main ones when it comes to the immaturity of articular elements, or the prevention of DTS in children with a predisposition, include:

• general massage with an emphasis on hip joints;
• gymnastics for newborns;
• physiotherapy (using vitamins, lidase, calcium);
• paraffin therapy, applications to the hip joint area;
• dry heat, mud therapy.

The main principle of treatment is the timeliness and adequacy of the chosen method.

What are the consequences of dysplasia?

Children with dysplasia are not at risk of a recumbent lifestyle, but they begin to walk much later than their peers. Their gait is characterized by instability and lameness. Children waddle like ducks and clubbing. If you do not start early treatment for hip dysplasia, this threatens the development of spinal pathologies in the form of lordosis, kyphosis or osteochondrosis. With age, unresolved hip joint pathologies lead to an inability to withstand prolonged loads. The formation of new outlines of the joints and cavity begins, the formation of a false joint, which cannot be full, since it is not able to perform the function of support and full abduction of the leg. Neoarthrosis develops. The most serious complication is the formation of dysplastic coxarthrosis, in which joint replacement surgery is inevitable. If treatment of dysplasia in the early stages takes a maximum of six months, then treatment after twelve years can last twenty years.

MyMedicalPortal.net

Hip dysplasia: on healthy legs into adulthood

Hip dysplasia is a pathological condition associated with improper formation of muscles, tendons, ligaments, and blood vessels in newborns. The problem may be a defect in the head of the femur or the acetabulum (articular socket), or a combination of both pathologies.

Why is the formation of the baby’s pelvis disrupted?

The exact cause of dysplasia in children cannot be determined, but many factors can increase the likelihood of disorders:

• Presence of relatives with this pathology.
• Presentation of the fetus by the pelvic end during pregnancy and childbirth.
• Breech placenta presentation and other problems of fetal position.
• Lack of amniotic fluid during pregnancy.
• Gynecological and hormonal diseases of women.
• Poor nutrition of a pregnant woman, lack of iron, phosphorus, calcium, iodine, B vitamins.

The disease occurs in approximately 0.4% of newborns. Girls are 5 times more likely than boys to be susceptible to pathology, especially those whose mothers had their first child. Dysplasia of the left hip joint is more common than right-sided and bilateral lesions due to the fact that it is more often pressed against the wall of the uterus during fetal development.

How is pathology determined?

The first examination of the child by an orthopedist in the maternity ward provides grounds for making a diagnosis. Further treatment and observation of children who are suspected of joint disposition are carried out by orthopedists at local clinics.

To identify dysplasia, the doctor places the child on his back, bends the legs in the pelvis and hips. In this case, the fingers lie on the outer and inner sides of the hip joint of the bones. Then the doctor spreads the legs apart. The sensation of a push during movement of the hips indicates the sliding of the articular head into the acetabulum. This technique is called the “Marx-Ortolani symptom,” which is considered the main indication of the presence of pathology.

When determining slippage, the doctor performs ultrasound diagnostics, which shows the shape and position of all articular elements. For example, the head extends beyond the acetabulum, or its recess is too small. X-rays cannot diagnose diseases in infants until about 6 months of age.

How can a mother of a child suspect congenital dysplasia?

If signs of a congenital disease were missed during the initial orthopedic examination, then as the child grows they become obvious and appear in the appearance of the lower extremities. During diaper changes, the mother may notice asymmetry in the skin folds in the groin, buttocks, and knees. Shortening of one femur also becomes evident due to the fact that the head of the articular surface is displaced past the acetabulum. Sometimes women note that it becomes difficult to evenly move the baby’s legs to the sides. All these symptoms indicate the need to visit an orthopedist, because this is how hip dislocation manifests itself - the most complex form of pathology.

Orthopedists distinguish three degrees of the disease, which are recorded in the diagnosis:

• The first means underdevelopment of articular tissues and a slight displacement of the femur.
• The second indicates the presence of a slight displacement of the head of the hip joint.
• The third means dislocation or complete mismatch of the head of the joint and the acetabulum.

Most often, the examination determines mild dysplasia. Komarovsky puts forward his opinion on the reinsurance of orthopedists who find mild signs and questionable X-ray results. We are talking about minor deviations from the norm, and most often this concerns premature babies. However, all doctors advise treatment if dysplasia is suspected in order to prevent the pathology from becoming more severe.

Therapeutic measures - strictly as prescribed by the orthopedist

The age of the child affects the treatment of hip dysplasia, the goal of which is correct positioning. It is necessary to fix the joint tissues in a normal state, which will allow the body to adapt to the new position of the hip. The younger the child, the better the chances of a full recovery. Over time, the body loses the flexibility to reposition itself. The orthopedist answers the question of how to treat this disease, depending on the degree of dislocation and the age of the child:

1. The period from birth to 6 months is the most favorable period for correcting congenital anomalies. It is recommended to start with a wide swaddling, in which the diaper is folded in the form of a spacer and fixes the legs in a position spread 60-80 degrees. The diaper can be placed directly on the diaper if the baby is wearing a onesie. Pavlik stirrups are suitable for babies after the third week of life. They are specially designed to place the head of the joint in its natural place. About 90% of newborns get rid of dysplasia using this method.
2. From 6 months to 1 year, a splint is used that provides hip extension with the help of splints. Also used is the Frejka pillow, which is plastic pants that hold the legs in the “frog” position. They need to be changed as the child grows.
3. After a year, spacers become ineffective against newly diagnosed hip dysplasia. However, ambulation splints may be used as a continuation of treatment. It is after one year that it is recommended to put a child with congenital dislocation or dysplasia on his feet.

Children 1-2 years old require surgical intervention, since by this period, without adequate treatment, scar tissue forms, interfering with the correct movement of the hip. After that, a splint is applied to the hip joint, fixing it in the desired position.

Treatment should begin as early as possible and be carried out regularly until ultrasound and x-rays confirm the stability of the hip joint.

Auxiliary methods and an integrated approach to dysplasia

The use of additional treatment methods is one of the principles for the successful development of a child with hip dysplasia:

1. Electrophoresis supplies minerals (calcium, phosphorus, iodine) through the skin to the joint tissues for full development. A weak current is applied alternately to two electrodes in the desired area. A total of 10-15 sessions are required.
2. Ozokerite (paraffin) is applied in the form of warm applications. At a temperature of 50 degrees, it accelerates blood flow in the joint, nourishes tissues and promotes regeneration.
3. It is better to entrust the massage to a professional who will carry out the necessary manipulations, paying special attention to the buttocks, hip joint, and thighs, performing stroking and rubbing. The procedure includes an element of simulating crawling, hovering, circular movements, spreading and bending the knees.
4. Gymnastics ensures the correct physical development of the baby and the formation of legs, strengthens muscles and improves blood circulation. Children under one year old undergo passive gymnastics in combination with massage. It is needed during conservative treatment to prevent complications and accelerate the normal adaptation of bones, ligaments, and tendons to the correct position.

Gymnastics for children under three years of age may include walking, crawling, lifting the body to a vertical position from a lying position, and then bringing it to its feet. The hip flexors are developed, the leg muscles and abs are trained, and breathing exercises are prescribed.

A complex of exercise therapy for hip dysplasia is developed individually for the duration of rehabilitation in the postoperative period. Every child who was treated before the age of three continues to be at risk and needs to introduce physical activity into their lifestyle. Cycling, swimming, and exercises focusing on the leg muscles are recommended at any age. During puberty, it is recommended to avoid injuries and not put excessive stress on the joint.

Hip dysplasia, which remains untreated, affects the development of the body as a whole with age: it causes scoliosis, disrupts the symmetry of the pelvis, and provokes early osteochondrosis. In adults who did not undergo adequate treatment in infancy, severe changes called dysplastic coxarthrosis begin after 35 years. This disease can only be treated surgically - endoprosthetics.

Timely detection of pathology is the main way to prevent many troubles. Every parent who wants to avoid many problems in the future should follow the rules of nutrition during pregnancy, stay active and be monitored at the clinic with their child.

Causes of pathology

Depending on the severity of its course, it is divided into:

1. Pre-dislocation. It is considered the mildest form of development of dysplasia and is expressed in the form of overstretching of the joint capsule (connective tissue membrane). At the same time, their joints do not move, and any defects can be eliminated quite easily. However, without appropriate treatment, the pathological condition transforms into a dislocation.
2. Subluxation. Accompanied by a partial disruption of the connection between the acetabulum and the head of the hip bone. In this case, the femoral head cannot return to its original place, and pelvic movements become limited. As a result of this, severe overstretching of the ligaments and the resulting displacement inevitably leads to deterioration of blood circulation in the hip joint.
3. Dislocation. It is characterized by complete protrusion of the femoral head beyond the boundaries of the acetabulum and represents the most severe form of the disease.

The International Classification of Diseases includes 22 classes, including pathologies of the human connective tissue and musculoskeletal system. Code 10 indicates the number of revisions of the document (it is revised by the World Health Organization once every 10 years). This international act implies the systematization of all diseases existing today that affect human health.

Hip dysplasia is a fairly common congenital pathology, the development of which is more often observed in girls than boys and accounts for about 80% of all registered cases. If such a disease is not detected in time or the child for any reason does not receive timely medical care, then as a result the baby may experience partial or complete dysfunction of the lower extremities, and, as a result, he will become disabled. Therefore, for successful treatment of dysplasia, its diagnosis should be carried out at the initial stages of the development of the disease, that is, in the early period of the child’s life.

The musculoskeletal system of the fetus begins to form already at 4-5 weeks of intrauterine development and completes its formation completely at the time when the newborn learns to walk fully. During this period, various disorders may appear, provoking the occurrence of pathological changes in the joint tissue. Therefore, there are many factors that contribute to the development of hip dysplasia.

At the moment, scientists have not established the exact cause of the disease, but nevertheless, in the course of a number of studies, it was found that the predisposing factors that provoke underdevelopment of the articular tissue of the pelvis, formed on the part of the unborn child, include:

1. Fruit size is too large.
2. Poor water-salt metabolism.
3. Hereditary predisposition to dysplasia. It is considered the most common cause of congenital disease and is characterized by the appearance of orthopedic anomalies at the genetic level in a developing child, which in turn becomes the main factor in the formation of defects in the formation of internal organs and their systems.

On the part of a pregnant woman, the causes of hip dysplasia in a newborn include:

• non-compliance with a healthy lifestyle, that is, smoking and drinking alcohol;
• vitamin deficiency (lack of various vitamins and minerals in the body, resulting from poor nutrition over a long period of time);
• deterioration of material metabolism;
• the course of any diseases affecting the cardiovascular system of a pregnant woman, including rheumatic heart defects;
• all sorts of diseases of viral and infectious origin suffered during pregnancy;
• the presence of late or early gestosis (complications that arise during pregnancy, which can be expressed in the form of swelling of the extremities of the expectant mother, increased blood pressure, seizures, protein excretion from the body along with urine, or have no clinical manifestations at all);
• toxicosis (a pathological condition characterized by the negative effects of various toxic substances on the pregnant woman’s body).

Methods for diagnosing the disease

It is difficult to detect hip dysplasia in the initial stages of its development, since the manifestations of the disease become noticeable only when the child begins to try to walk. But, nevertheless, with regular medical examinations, a good specialist can promptly determine the presence of such an ailment. Therefore, parents must necessarily take their child to see all relevant doctors, the referral to whom is prescribed by the pediatrician.

Incorrect formation of the hip joint is determined primarily by performing a special test. It is carried out by the doctor only after feeding the newborn. The condition of the joint is checked as follows: the baby is placed on his back and his legs are bent at the knees. After this, the legs are spread apart. The doctor monitors their extension and adoption of a normal position. With uneven and limited extension of the lower extremities, a specialist may suspect the presence of dysplasia.

The doctor also pays attention to the femoral skin folds (normally they should be symmetrical). Asymmetry of the popliteal, gluteal and inguinal folds of the skin is mainly determined in children over 2 or 3 months of age. Up to 2 months, this phenomenon in some cases can be observed even in completely healthy babies. In this regard, this diagnostic method is considered uninformative.

A special role in detecting abnormal development of the hip joint is played by the symptom of a shortened hip, which consists in the asymmetrical arrangement of the knees of the baby’s legs. Its presence will indicate the occurrence of a severe form of the pathological process - congenital dislocation of the femur.

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Other diagnostic methods

Another sign that allows one to suspect dysplasia is the Marx-Ortolani slip symptom. To establish its presence, the child is placed on his back, after which the doctor bends his lower limbs and clasps his hips with his palms. Then the specialist gradually and evenly spreads the baby’s legs to the sides. In the case of the disease, a push or click will be felt on the affected side of the pelvis, indicating the reduction of the head of the femur into the acetabulum. This diagnostic method cannot be used on children of one week of age, since the Marx-Ortolani symptom at this time is practically uninformative and is observed in almost 40% of infants.

To confirm the presence of the disease, the following instrumental procedures are used:

1. X-ray.
2. Ultrasonography.
3. Ultrasound – ultrasound examination. Compared to the above examinations, it is considered the safest and most informative.

The diagnosis of hip dysplasia is made only after receiving the results of all the necessary studies.

Pathology treatment method

The choice of tactics for eliminating dysplasia depends primarily on the stage of development of the disease, as well as the age characteristics of the child. For example, if the disease was discovered in the maternity hospital, that is, before the age of three months, wide swaddling (swaddling in which the baby’s lower limbs are fixed in a widely spread position), therapeutic massage, gymnastics and pelvic manual therapy are prescribed.

If dysplasia is detected at an age older than 3 months, but before six months, then elastic fixing structures are used to treat the problem, making it possible to give a stable position to the joint. The main ones are:

• Pavlik stirrups (a special system designed to hold the baby’s legs in an uncompressed state);
• Freika orthopedic pillow (a design that is a cushion that fixes the lower limbs of a newborn in an extended position).

If conservative treatment of the disease is ineffective, surgical intervention to reduce the dislocation is used. Basically, prompt elimination of the problem is used only in extreme cases, when dysplasia is in a very advanced state.

In order to prevent the development of a pathological process in the developing fetus, the expectant mother needs to eat well and regularly undergo all scheduled examinations. In addition, periodic professional examinations of the newborn play an important role in the premature diagnosis of dysplasia.

The tenth code according to the IBC, hip dysplasia, although considered a serious pathology, is still highly treatable, especially if detected in a timely manner.

The dangers of hip dysplasia

​Q65 Congenital deformities of the hip​

Hip dysplasia in ICD 10

​Treatment​

​limited hip abduction, internal rotation of the hip.​

​the occurrence of pathological curvature of the spine;​

​Asymmetry of skin folds - gluteal, inguinal, patella. Determined when the baby is placed on his stomach.​

​Poor nutrition;​

​It should be taken into account that the results of additional studies alone are not enough to make a diagnosis of hip dysplasia. The diagnosis is made only when both clinical signs and characteristic changes on radiographs and/or ultrasonography are identified.​

What threatens type 2a: hip dysplasia in children

​Hip dysplasia is one of the most common congenital pathologies. The average frequency is 2-3% per thousand newborns. There is a dependence on race: in African Americans it is observed less frequently than in Europeans, and in American Indians it is observed more often than in other races. Girls get sick more often than boys (about 80% of all cases).​

• To prevent recurrence of dysplasia or pre-dislocation in a baby, it is recommended to carry out special exercises. Komarovsky developed a special program for the treatment of hip dysplasia. These exercises help your baby learn to crawl and prepare him for his first steps. Exercises tone the muscles of the limb, restore the normal position of bone structures.​
• ​As you grow older, this symptom loses its value, and others take its place. First of all, it becomes possible to determine the increased muscle tone of the limb.
• ​Congenital diseases of the musculoskeletal system are becoming increasingly common, and among them is hip dysplasia. Due to the mother’s poor lifestyle during pregnancy, bad habits, as well as taking certain medications, children are born with underdeveloped limbs, cartilaginous and musculoskeletal systems. One of the most unfavorable outcomes is congenital hip dislocation.​
• ​Frequency​

​Coxarthrosis of the 3rd degree is characterized by the appearance of constant pain not only during the day, but also at night. The process of walking is difficult, which leads to the patient beginning to use a cane for support. This degree of development of the disease is characterized by a sharp restriction of freedom of movement in the joint, atrophy of the muscular structures of the thigh and lower leg. Shortening of the limb also occurs, which leads to a tilt of the body towards the damaged joint.​

Hip dysplasia in children: causes

​disturbance of blood circulation, hormonal balance in the body, metabolic processes;​

​inflammatory and non-inflammatory joint diseases.​

Detection and treatment of hip dysplasia in children

​Shortening of the limb on the side of the dislocation.​

​Household and occupational hazards;​

​Treatment should begin as early as possible. Various means are used to hold the child’s legs in a position of flexion and abduction: devices, splints, stirrups, panties and special pillows. When treating children in the first months of life, only soft elastic structures are used that do not interfere with the movements of the limbs.​

The hip joint is formed by the head of the femur and the acetabulum. In the upper part, a cartilaginous plate is attached to the acetabulum - the acetabular lip, which increases the area of ​​​​contact of the articular surfaces and the depth of the acetabulum.​

Signs and consequences of hip dysplasia

​This symptom should be identified together with neurologists to differentiate a dislocation from a neurological pathology. The symptom is defined as follows. The baby is carefully placed on the table. Place your hands on the child’s inner thighs and move his hips to the sides. Normally, the child’s hips should lie on the surface of the table (for a newborn); if the child is older, then the angle between the table surface and the leg should be at least 60 degrees. This limitation develops due to high muscle tone, and also, in later life, due to the fact that the femoral head rests on the ilium.​

​In the international classification of diseases, this disease is allocated a separate class and group: M24.8 - specified joint damage, not reflected and not classified in other groups.​

- over 3% of all orthopedic diseases. It is registered more often in girls. It is 10 times more common in children born in a breech position. Unilateral hip dislocation is noted 7 times more often than bilateral hip dislocation.

​When diagnosing this disease, the patient is primarily interested in the question of how to treat coxarthrosis.​

​development of pathologies of the spine and feet;​

In addition to the listed reasons that contribute to the development of the disease, the process of its occurrence may be influenced by genetic predisposition. In some cases, the development of the disease occurs for no apparent reason.

Clicking symptom. A characteristic click is heard, indicating the reduction of the dislocation when the legs are extended to the sides, bent at the knee and hip joints. Observed in children with hip dislocation up to 2-3 months.​

​Smoking, drinking alcohol and drugs;​

​Wide swaddling is used when it is impossible to carry out full treatment, as well as during the treatment of babies at risk and patients with signs of an immature joint identified during ultrasonography.​

Treatment of hip dysplasia

The hip joint of a newborn baby, even normally, differs from the joint of an adult: the acetabulum is flatter, located not obliquely, but almost vertically; ligaments are much more elastic. The femoral head is held in the socket by the round ligament, articular capsule and acetabular labrum.​

​Exercises are carried out such as:​

In case of unilateral dislocation, an important place is occupied by the symptom of violation of the symmetry of the longitudinal axes. When the legs are bent at the knee joints, when they are abducted to the sides, a visual decrease in the longitudinal axis of the limb is observed (due to the fact that the head is not in the articular cavity, but is shifted away from it). In parallel, on the side of the dislocation, there is retraction of the soft tissues in the area of ​​Scarpa's triangle. Along with them, asymmetry of skin folds is observed.

​What causes this condition most often to develop?​

​Code according to the international classification of diseases ICD-10:​

​The doctor treats coxarthrosis in the initial stages by using conservative methods of influencing the patient’s body. Treatment of grade 1 and 2 coxarthrosis during periods of exacerbation is carried out with the help of non-steroidal anti-inflammatory drugs. The disease can be treated during the period of exacerbation using the following drugs:​ ​elderly;​

A set of exercises for hip dysplasia

​The disease can occur in both unilateral and bilateral forms.​

​Limitation of abduction. In healthy children, the angle of abduction to the side of the legs, bent at the knee and hip joints, is 80-90 degrees. With hip dysplasia this value is much less. Observed in children under one year of age.​

​Infectious diseases;​

​One of the most effective methods of treating young children is Pavlik stirrups - a soft fabric product, which is a chest bandage, to which is attached a system of special straps that hold the child’s legs abducted to the sides and bent at the knee and hip joints. This soft design fixes the baby's legs in the desired position and, at the same time, provides the child with sufficient freedom of movement.​

1. ​There are three forms of hip dysplasia: acetabular (impaired development of the acetabulum), dysplasia of the upper femur, and rotational dysplasia, in which the geometry of the bones in the horizontal plane is disrupted.​
2. ​“Hands up.” A towel or cushion is placed under the baby's chest, and his attention is attracted to some bright object. The baby begins to actively reach for the toy, while leaning on the bolster. In this case, there is a slight load on the pelvis and joints.​
3. There are several signs of hip dysplasia. At the age of one year, one of the main symptoms of the development of a dislocation is diving lameness (with a unilateral dislocation) or a duck's gait (with a bilateral lesion).

Pathology of joint development in a newborn

​Etiology​

Hip dysplasia in adults

​piroxicam;​

​sedentary lifestyle.​

​At the early stage of disease progression, conservative methods of treatment are used. In case of joint destruction, especially if such a development of the disease is observed in young or middle age, endoprosthetics surgery is recommended.

Unfortunately, not all parents pay attention to these signs, and hip dysplasia is diagnosed at a later age, when the child begins to walk. At this time, warning signs are lameness (with unilateral dysplasia), a waddling duck gait (with bilateral dysplasia), as well as the fact that the child began to walk much later than his peers.​

​Low water;​

​Special exercises to strengthen the muscles play a major role in restoring range of motion and stabilizing the hip joint. At the same time, for each stage (spreading the legs, keeping the joints in the correct position and rehabilitation), a separate set of exercises is compiled. In addition, during treatment, the child is prescribed a massage of the gluteal muscles. If the development of any part of the hip joint is impaired, the acetabulum, articular capsule and ligaments cannot hold the femoral head in its proper place. As a result, it moves outward and upward. In this case, the acetabular labrum also shifts, finally losing its ability to fix the head of the femur. If the articular surface of the head partially extends beyond the socket, a condition occurs, called subluxation in traumatology.​

​“Turtle”. Similar to the previous one, but the cushion is placed under the stomach. This roller should be tightened little by little and at the same time make sure that the baby actively helps himself with his arms and legs. This strengthens the muscles of the limb girdles.​

Hip dysplasia

In addition to determining the gait, the Trandeleburg symptom is also detected: when standing on the sore leg with the healthy one raised and bent at the knee, the body shifts towards the healthy leg with a parallel retraction of the tissues in the area of ​​the sore joint. There is a lowering of the gluteal fold.​ ​In newborn children during intrauterine development, there is underdevelopment of the articular surfaces that form the hip joint, which can lead to the disease congenital dysplasia of the hip joints.​

Hip dysplasia

- underdevelopment of the hip joint (dysplasia).

​diclofenac;​

Anatomy of the hip joint, changes in dysplasia

​This disease is not inherited, but certain features of metabolism, the structure of the musculoskeletal system and cartilage tissue can still be determined at the genetic level.​

​In orthopedics and traumatology, the disease is one of the most common types of arthrosis. The frequency of occurrence of this type of disease is due to the high load placed on the hip joint during life and the high prevalence of congenital pathological disorder - joint dysplasia.​

Knee dysplasia is much less common than hip dysplasia. Most often it is a consequence of impaired growth of the cartilage tissue of the patella, femur and tibia. Clinically, it is manifested by a visible change in the configuration of the knee joint, pain when walking, valgus (O-shaped) or varus (X-shaped) curvature of the legs. Occasionally, ankle dysplasia is observed. The main symptom is deformation of the ankle joint, foot and lower leg like clubfoot. The pathology is bilateral in nature and in the vast majority of cases is observed in boys.​

​Stress.​

In severe cases, a one-stage closed reduction of the dislocation is performed, followed by immobilization with a plaster cast. This manipulation is performed in children from 2 to 5-6 years old. Once the child reaches the age of 5-6 years, reduction becomes impossible. In some cases, with high dislocations in patients aged 1.5-8 years, skeletal traction is used.​

Causes of development of hip dysplasia

​If the process continues, the femoral head moves even higher and completely loses contact with the glenoid cavity. The acetabular labrum is below the head and is wrapped inside the joint. A dislocation occurs. If left untreated, the acetabulum gradually fills with connective and fatty tissue, making reduction difficult.​

​“Criss-cross.” The baby's arm is folded with a parallel leg in the abdomen, and care is taken that the baby pushes off the stop with his leg.​

​Irregular gait due to pathology of the development of the hip joints​

The acetabulum is represented mainly by cartilaginous tissue. During the period of intrauterine development and newborns, its cavity increases due to the cartilaginous lip (limbus). The cavity itself consists of three bones, the final ossification of which ends by the age of 18. The head of the femur, its neck and greater trochanter consist predominantly of cartilage (these formations are not visualized on an x-ray). The head of the femur in newborns is always larger than the articular surface of the pelvis. All of the above factors cause insufficient joint strength.​

Diagnosis of hip dysplasia

​Classification.​

Brufen, etc.

​For this reason, if blood relatives have this disease, the likelihood of developing the disease increases significantly.​

The hip joint is formed by two bones - the ilium and the femur. The head of the femur articulates with the acetabulum, located on the ilium; the articulation of bones forms a joint in the form of a hinge. In the process of movement, the acetabulum is a stationary element of the articular joint, and the head of the femur is capable of movement in various directions, thereby providing flexion, extension, abduction and rotation in the hip joint.​

​With genetically determined connective tissue dysplasia, pathological changes such as hypermobility are multiple in nature and manifest themselves in different groups of joints. There are frequent cases of dysplasia of tubular bones and vertebrae, as a result of which various types of spinal curvatures develop - scoliosis, pathological lordosis and kyphosis. Although curvatures of the spine can also be secondary in nature, when the load on the normal spine increases with dysplasia of the joints of the lower extremities. In most cases, the chest is deformed along with the spine.​

​Genetically determined articular dysplasia is one of the manifestations of connective tissue dysplasia. These conditions combine a group of hereditary pathologies, including Ehlers-Danlos syndrome, Marfan syndrome, and osteogenesis imperfecta. Along with some clinical differences, these diseases have one common feature. This is a violation of the synthesis of protein compounds - glycoproteins, collagen, which ensure the strength of connective tissue structures - bones, joints, muscles. In these conditions, not only the joints suffer, but the entire musculoskeletal system - the configuration of the chest, spine, legs, and feet is disrupted. In addition, pathological changes develop in various systems of internal organs - cardiovascular, nervous, digestive, respiratory.​

​If conservative therapy is ineffective, corrective operations are performed: open reduction of the dislocation, surgical interventions on the acetabulum and the upper part of the femur.​

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The occurrence of dysplasia is caused by a number of factors. There is a clear hereditary predisposition - this pathology is 10 times more likely to be observed in patients whose parents suffered from a congenital disorder of the development of the hip joint.​

​Dr. Komarovsky notes that the exercises must be done in conjunction with medical supervision.​

​Additional symptoms are displacement of the greater trochanter above the Roser-Nelaton line and increased curvature of the lumbar spine.​

Treatment of hip dysplasia

​The discrepancy between the articular surfaces (discongruence) creates conditions for the development of hip predislocation - a condition in which spontaneous dislocation of the femoral head occurs and its reverse reduction (this does not require much effort). In some children, spontaneous reduction of the head of the bone occurs, after which the joint develops normally. In others, due to long-term preluxation, the head of the bone is displaced relative to the glenoid cavity, after which subluxation of the femur develops (the femoral head is displaced, but it does not extend beyond the limbus).​

​There are 3 degrees of underdevelopment of the hip joint: 1 - preluxation (obliquity of the acetabulum, late appearance of ossification nuclei in the head of the femur, pronounced antetorsion, the head is centered in the joint) 2 - subluxation (the femoral head is displaced outward and upward, but does not extend beyond the limbus, remaining in the joint; the center of the head does not correspond to the center of the acetabulum) 3 - dislocation with upward displacement of the femoral head (the femoral head is displaced even more outward and upward, the limbus, due to elasticity, is wrapped in the cavity of the socket, the head of the femur is outside the articular cavity outside the limbus).​

​Medicines have an analgesic effect, but when using them, you should remember that these drugs are not recommended for use for a long time. Medicines in this group can have a negative effect on the internal organs of a person, in addition, they can suppress the ability to restore the cartilage tissue of the joint.

The main symptoms of coxarthrosis are as follows:

​In the process of movement, the articular surfaces that are part of the bone joint move unhindered relative to each other. This movement occurs due to the presence of a smooth and elastic layer of hyaline cartilage, which covers the articulating surfaces and has a high level of strength. In addition to providing sliding, hyaline cartilage performs the function of shock absorption and redistribution of loads on the joint when walking.​

At the same time, along with the musculoskeletal system, internal organs suffer. On the part of the cardiovascular system, disorders can take the form of paw defects, aneurysms (thinning of the walls) of large vessels. Visual disturbances take the form of lens subluxation and retinal detachment. Prolapse of the gastrointestinal tract and kidneys occurs.

Prognosis for hip dysplasia

​Although in most cases, joint dysplasia occurs in isolation, is mild, and is first discovered during adulthood. At the same time, attention is drawn to the “looseness” of the articular ligaments and excessive mobility (hypermobility) of some joints. Joint dysplasia in adults can be a consequence of premature wear and tear during regular exercise during sports and dancing.​

With early initiation of treatment and timely elimination of pathological changes, the prognosis is favorable. In the absence of treatment or if therapy is insufficiently effective, the outcome depends on the degree of hip dysplasia. With minor changes, there may be no painful symptoms at a young age. Subsequently, at the age of 25-55 years, the development of dysplastic coxarthrosis (arthrosis of the hip joint) is possible. As a rule, the first symptoms of the disease appear against the background of a decrease in physical activity or hormonal changes during pregnancy.​

​The likelihood of developing dysplasia increases 10 times with a breech presentation of the fetus. In addition, the likelihood of this pathology increases with toxicosis, drug correction of pregnancy, a large fetus, oligohydramnios and some gynecological diseases in the mother.​

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What is joint dysplasia and its treatment

​Due to the fact that it is not always possible to diagnose this disease, parents should be sure to familiarize themselves with the independent treatment of dysplasia (tight swaddling, but before doing it, be sure to show the child to a doctor).​

• ​X-ray diagnostics are not carried out for children under one year of age, since cartilaginous structures do not block X-rays, and they pass by the bone. For a more reliable diagnosis, ultrasound examination (ultrasound) is used.​
• If such a condition exists for quite a long time, then over time, due to the traction of muscles gaining tone, the limb is pulled upward and to the side (which one depends on the displacement of the head), which is why a dislocation of the femur develops. Gradually ossifying, the head is fixed in the area of ​​the anteroinferior pubic bone, receiving a new fulcrum there (in severe cases, displacement of the head can occur in the area of ​​the posterior surface of the iliac wing). In this case, the relative length of the limb decreases.
• ​Clinical picture​
• To restore cartilage tissue in the joint, drugs belonging to the group of chondroprotectors are used. Such drugs are:
• ​pain in the joint area;​

​In the joint cavity there is a small amount of fluid that performs the function of lubrication. In addition, the joint fluid provides nutrition to the cartilage tissue. The articular joint is surrounded by a dense and durable connective tissue membrane. Large femoral and gluteal muscle structures are located above the capsule, designed to provide movement in the articular joint. Muscular structures also play the role of shock absorbers, which protect the articular surfaces from injury when making unsuccessful movements.​

Causes

In order for treatment of articular dysplasia in children to be as effective as possible, it should begin as early as possible. Otherwise, even with a minimal degree of dysplasia, degenerative arthrosis changes form in the joint. Subsequently, this leads to irreversible motor disorders and disability. Among all articular dysplasias, structural and functional disorders in the hip joint in newborns predominate. According to statistics, this pathology is observed in approximately 2-3% of children born. This condition is also called congenital hip dislocation. Moreover, girls get sick more often than boys. Why the hip joint? There are certain prerequisites for this. The bottom line is that even in healthy children during the newborn period, the hip joint is immature from an anatomical point of view. This joint is formed by the acetabulum of the pelvis and the head of the femur, has its own capsule and is strengthened by muscles and ligaments. The acetabulum is surrounded by a cartilaginous lip, which further increases the area of ​​contact between the head and the acetabulum.​

• ​Characteristic features of dysplastic coxarthrosis are acute onset and rapid progression. The disease is manifested by unpleasant sensations, pain and limitation of movements in the joint. In the later stages, a vicious position of the hip is formed (the leg is turned outward, bent and adducted). Movements in the joint are sharply limited. In the initial period of the disease, the greatest effect is achieved through properly selected physical activity. In case of severe pain and defective placement of the hip, endoprosthetics is performed.​
• ​Researchers also note a connection between the incidence rate and unfavorable environmental conditions. In environmentally disadvantaged regions, dysplasia is observed 5-6 times more often.​
• ​With age, changes that occurred in childhood can also affect the health of an adult. There are frequent cases of the development of coxarthrosis in people who suffered from hip dysplasia in childhood. This can be triggered by joint injury, pregnancy, or hormonal changes in the body. The disease is quite severe, and the prognosis for it is unfavorable, most often ending in disability.​
• ​X-rays can be used from the age of one (by this age the femoral head has already ossified), and it is already possible to determine the displacement of the femur.​
• ​Children typically develop type 2a hip joints. There are several types of joints that correspond to the stages of development of dislocation:
• ​ In young children, asymmetry of the gluteal folds - the gluteal-femoral and popliteal folds with dislocation and subluxation are located higher than on a healthy leg Shortening of the lower limb External rotation of the lower limb, especially during sleep Marx-Ortolani symptom (slipping or clicking symptom) - a characteristic click of the femoral head sliding into the acetabulum when bending the legs at the knee and hip joints, followed by uniform abduction of the hips. Dupuytren's sign - free movement of the head both up and down. Limitation of hip abduction. In children in the first months of life, the abduction should be at least 70–90° Barlow's test - displacement of the head of the femur when the leg is flexed at the hip joint (at an angle of 90°).​

​arteparon;​

​the appearance of stiffness in movements and stiffness of the joint;​

Signs

As the disease develops, the joint fluid becomes thicker and its viscosity increases. With the further development of the disease, the hyaline cartilage dries out, which leads to a loss of smoothness and elasticity. The cartilage becomes covered with cracks. As a result of roughness, articular cartilage is constantly subject to trauma during movements, which provokes their thinning. These processes additionally lead to aggravation of the changes developing in the joint.​

​Pavlik stirrups are one of the most effective orthopedic devices for the treatment of hip dysplasia. They are adjustable spacers for spreading and fixing the child’s legs

• During the newborn period, the area of ​​the acetabulum significantly exceeds the area of ​​the head of the femur and has a beveled surface, which creates conditions for the development of dislocation. In addition, hip dysplasia can be a consequence of delayed ossification of the head and surrounding parts of the femur, increased elasticity of the joint capsule and ligamentous apparatus. In this regard, there are several types of hip dysplasia:
• With unreduced congenital dislocation of the hip, over time, a new defective joint is formed, combined with shortening of the limb and impaired muscle function. Currently, this pathology is rare.​
• ​The development of dysplasia is also influenced by national traditions of swaddling babies. In countries where newborns are not swaddled, and the baby's legs are in a position of abduction and flexion most of the time, dysplasia is less common than in countries with traditions of tight swaddling.​

​Oddly enough, people who suffered from joint dysplasia in childhood show significant success in gymnastics. This is due to pathological hypermobility of the joint - an echo of dysplasia. If joint hypermobility does not reach significant levels, then usually no joint pathology will be detected.​

• ​To determine the degree of head displacement, special schemes are used. The most widespread among them is the Hildenreiner scheme. It evaluates the spatial arrangement of the hip joint structures. In addition, additional diagrams can be used, but the essence of their use is one thing: they all allow you to determine the position of the displaced femoral head and identify the degree of displacement and the possibility of active movements in this joint.​
• ​Type 1 – healthy joint;​
• ​ In children over 1 year of age, the child begins to walk later than healthy peers (by 14 months). With a unilateral dislocation - an unstable gait, lameness; with bilateral dislocation - waddling gait (duck-like) Increased lumbar lordosis Trendelenburg's symptom - tilt of the pelvis to the affected side, drooping of the gluteal fold, tilt of the child to the healthy side when standing on the affected leg; when standing on a healthy leg, the pelvis rises. Chassaignac's sign - an increase in the amplitude of hip abduction in the hip joint. The head of the femur in the femoral triangle medially from the vascular bundle is not palpable. The greater trochanter is located above the Roser-Nelaton line.​

​chondroitin sulfate;​

​gait disturbance;​

• ​As the disease progresses, the bone tissue that is part of the bones begins to deform, which is caused by the process of bone adaptation to the high loads that arise. With coxarthrosis, there is a deterioration in cartilage nutrition and metabolism.​
• Treatment of hip dysplasia involves bringing the limbs into a position of flexion and abduction. It is in this position that optimal conditions are created for the reduction of hip dislocation. The fixation must be continuous. At the same time, active movements in the limbs must be preserved. All these requirements are met by a variety of orthopedic devices such as splints, walkers, panties, and pillows. In especially severe cases, the dislocation is reduced and the limb is fixed with a plaster cast. Tight swaddling is contraindicated for infants with hip dysplasia. For dysplasia of the knee and ankle joints, various types of fixing bandages are applied to the legs, including plaster. Treatment in these cases begins literally from the first days of life.​
• ​Acetabular - changes in the acetabulum;​
• ​Contents:​

A preliminary diagnosis can be made in the maternity hospital. In this case, you need to contact a pediatric orthopedist within 3 weeks, who will conduct the necessary examination and draw up a treatment regimen. In addition, to exclude this pathology, all children are examined at the ages of 1, 3, 6 and 12 months.​

​Women are at risk for developing this pathology. At the same time, there is a fairly high probability that they will have a child with a hip dislocation, provided that they themselves have had a similar dislocation.​

Related disorders

​The most complete and reliable information regarding the joint is provided by arthrography and tomography of the joint.​

​type 2 – violation and slowdown of ossification;​

Treatment

​Radiography​

​structum;​

​appearance of lameness;​

In medicine, there are two types of developing coxarthrosis - primary and secondary. The primary type of disease occurs in the body for unknown reasons, and the secondary type is a consequence of other diseases.​

​Video about hip dysplasia in a child:​

Causes, degrees, symptoms and treatment of coxarthrosis

Dysplasia of the femur and its head; ​Reasons​

General information about the disease

​Particular attention is paid to children who are at risk. This group includes all patients with a history of maternal toxicosis during pregnancy, a large fetus, breech presentation, as well as those whose parents also suffer from dysplasia. If signs of pathology are detected, the child is referred for additional studies.​

In addition, quite often in adults it is possible to identify a pathology such as neoarthrosis - the formation of a new joint. People with such a pathology can walk for years and not realize that they have a pathological displacement of the joint. Neoarthrosis occurs, as stated above, when the head of the femur is displaced towards the posterior surface of the iliac wing. The disease is usually detected during an X-ray of the joint.​

There are currently no specific treatments for dysplasia. If the defect was discovered during the newborn period, most often the displaced femoral head is set back into place and the joint begins to develop normally on its own. If the condition has been neglected, they resort to correction of the displaced limb. To do this, use the so-called wide swaddling for dysplasia or placing a spacer.​

• ​Type 3 – hip subluxation;​
• ​indicated to confirm the diagnosis. Interpretation of radiographs of newborns is difficult because Until 3–6 months of life, the head of the femur and the acetabulum consist of cartilage and are not visible on the image. The medial and lateral protrusions of the femoral neck and the relationship between the upper end of the femur and the acetabulum are taken into account. For X-ray diagnostics, several schemes are used. Increasing the Hilgenreiner angle, formed by a horizontal line connecting both Y-shaped cartilages and a line running along the edge of the acetabulum. Putti's triad: increased bevel of the acetabulum, upward displacement of the proximal end of the femur relative to the acetabulum and late appearance of the ossification nucleus Putti's diagram - a perpendicular lowered from the most medial point of the femoral neck to a horizontal line connecting both Y-shaped cartilages, normally divides the roof of the acetabulum in half. In case of congenital dislocation, a displacement of the intersection point to the lateral side is noted. Violation of Shenton’s line, which normally runs along the superior internal border of the obturator foramen and passes into the line of the femoral neck. Violation of the correct location of the line indicates a dislocation in the hip joint. Before the appearance of the ossification nucleus of the femoral head, the medial protuberance of the femoral neck is taken as a landmark.
• ​rumalon.​
• ​development of muscle tissue atrophy;​

​The development of secondary coxarthrosis can be a consequence of diseases such as:​

​In addition to orthopedic devices, treatment is carried out using physical therapy exercises. This treatment is aimed at strengthening the muscles of the pelvis and lower extremities. Exercise sets are selected individually for each child. Massage and treatment with physiotherapeutic procedures are required, including ozokerite, paraffin, mud, electrophoresis. If conservative treatment is ineffective or the diagnosis is late, surgical treatment is performed, during which various types of reconstruction and plastic surgery of articular structures are performed. In case of concomitant disorders of the internal organs, symptomatic treatment of these disorders is carried out using drugs of various groups.​

More articles: Joints hurt in turn

​Rotational - change in the axis of the hip joint.​

​Signs​

Anatomy of the hip joint and the mechanism of disease development

A clinical examination of the baby is carried out after feeding, in a warm room, in a calm, quiet environment. Suspicion of dysplasia arises in the presence of shortening of the femur, asymmetry of skin folds, limited hip abduction and the Marx-Ortolani slip symptom.​

​In severe stages of hip dysplasia, especially with the development of coxarthrosis, surgical correction of the hip joint or endoprosthetics may be required. And any operation on hip dysplasia is dangerous.​

​Swaddling for dysplasia is applicable in young children (most often used under the age of 4 months). Due to the tight swaddling of the legs, they are given a forced abduction position, in which the articular head returns to its place.

​Type 4 – complete dislocation.​

​Treatment​

Reasons for the development of coxarthrosis

To improve blood circulation and eliminate spasms of small vessels of the circulatory system, the attending physician prescribes vasodilating drugs such as cinnarizine, nicoshpan, trental and theonicol. Depending on the condition of the muscle tissue, muscle relaxants may be prescribed to help relax the muscles.​

​shortening of the limb;​

• ​hip dysplasia;​
• ​Coxarthrosis, which requires various treatment methods, is a fairly serious disease.​
• ​Hip dysplasia can have several degrees of severity:​
• ​Associated disorders​
• ​Asymmetry of the inguinal, popliteal and gluteal skin folds is usually better identified in children older than 2-3 months. During the examination, pay attention to the difference in the level of location, shape and depth of the folds. It should be borne in mind that the presence or absence of this sign is not enough to make a diagnosis. With bilateral dysplasia, the folds can be symmetrical. In addition, the symptom is absent in half of children with unilateral pathology. Asymmetry of inguinal folds in children from birth to 2 months is not very informative, since it sometimes occurs even in healthy infants.​
• ​Disability for these diseases is established based on the decision of a medical and social examination.​

​In children who have reached the age of six months, tight swaddling, a Freik pillow or the use of Pavlik stirrups will no longer have the desired effect. In order to correct the joint, they begin to use plaster of the limb according to Ter-Egizarov. At the same time, spacers are placed in the area of ​​the knee joints. As the joints straighten and muscle tone decreases, abduction of the limb increases, which allows for wider spacers to be placed and thus achieve normal abduction and recovery in the joints. At the same time, to achieve relaxation in the thigh muscles, warm baths are used. Spacers and other treatment in this manner takes about 3-4 months.​

• ​Type 2a (develops in children up to 3 months) is characterized by the presence of a rounded and short bony roof of the acetabulum, alpha and beta angles within 55 degrees (these angles characterize the position of the head along certain landmarks or axes), as well as a centered head of the bone without displacement . When the process is started, a stage-by-stage transition to dislocation is observed.
• ​should be early (after 2 weeks of life)​
• ​For long-term pain syndrome, people suffering from the disease may be recommended to use intra-articular injections of hormonal agents - hydrocortisone, Kenalog and Metipred.​
• ​limitation of hip abduction and the occurrence of pain when performing movements.​
• ​congenital dislocation of the hip;​

​The choice of treatment depends on the stage of development of the disease.​

​Pre-luxation - the head slides off the articular surface, but with movement it returns to its place;​

Symptoms and severity

​Treatment​

• The symptom of shortening of the femur is more reliable in diagnostic terms. The child is placed on his back with his legs bent at the hip and knee joints. The location of one knee lower than the other indicates the most severe form of dysplasia - congenital dislocation of the hip.​
• ​ITU is called upon to monitor the increase in the incidence and severity of disabling diseases, keep records of all factors of disability, determine the risk of its development in certain groups of people, and be able to determine the degree of occupational risk for these diseases. In addition, this body is responsible for developing prevention programs for various diseases.​
• If these methods are ineffective, they resort to skeletal traction of the limb. Traction is carried out using the overhead technique, thanks to which it is possible to bring the femoral head closer to the glenoid cavity. After this, it is reduced using the closed reduction method, and always under anesthesia. After reduction, the hip is fixed in a coxite bandage for up to six months. After this period, they begin to develop movements in the affected limb, and the load is allowed at the end of the year, carried out in a special Vilensky splint.
• ​In the development of this pathology, a decisive role is played by the incorrect position of the fetus during pregnancy. Statistics show that hip dysplasia most often develops in a breech position with the arms and legs crossed in front. This is usually observed in girls, especially with the left-sided position of the fetus in the womb.​
• ​ From the moment of birth, wide swaddling is used: between the baby’s legs, bent at the knee and hip joints and when the limb is abducted by 60–80°, 2 diapers are placed, folded in the form of a pad up to 20 cm wide, and in this position the baby’s legs are fixed with a third diaper.​
• ​When carrying out treatment, you can use topical agents that do not have a significant therapeutic effect, but help relieve muscle spasms and reduce the degree of pain.​
• ​One of the first symptoms is pain.​

​Perthes disease;​

Many patients diagnosed with coxarthrosis wonder what kind of disease it is. In accordance with ICD-10 (international classification of diseases), the disease is assigned code M-16.​

Subluxation - the head is partially displaced outside the acetabulum;

• ​Useful articles​
• But the most important sign indicating congenital hip dislocation is the “click” or Marx-Ortolani symptom. The baby is lying on his back. The doctor bends his legs and clasps his thighs with his palms so that the II-V fingers are located on the outer surface, and the thumbs are on the inner surface. Then the doctor evenly and gradually moves the hips to the sides. With dysplasia, a characteristic push is felt on the affected side - the moment when the head of the femur is reduced into the acetabulum from a dislocated position. It should be borne in mind that the Marx-Ortolani symptom is not informative in children in the first weeks of life. It is observed in 40% of newborns, and subsequently often disappears without a trace.​
• ​As can be seen from what has been written, hip dysplasia is one of the most common causes of disability in children, when the process is complicated, and in adults. It is extremely important to know the necessary signs of hip dysplasia and the diagnostic algorithm. Only such an approach can affect the incidence of dysplasia and reduce its incidence. Only competent work of doctors at all levels can affect the incidence of illness and serve as a prevention of diseases of the musculoskeletal system in the future.​

​In parallel with treatment, appropriate rehabilitation therapy and exercise therapy are recommended. Sessions of manual therapy, massage, and physiotherapy with medications on the affected joint to restore metabolism in it will be useful.

Treatment in the initial stages

Due to the adoption of this position of the body, the heads of the femoral bones are displaced relative to the joint cavity, which is why hip dysplasia develops. If you remain in this position for a long time, the cartilage of the bones cannot fully develop (since this requires their complete conformity).​

​ Conservative treatment: Freik pillow, Pavlik stirrups, therapeutic splints. At the same time, physiotherapy (ozokerite, mud), massage, exercise therapy (abduction of the legs, bent at the knee and hip joints, to the plane of the table; rotational movements of the hip with some axial pressure on the knee joints with the legs bent and spread apart; exercises are done 6–7 times /day, 15–20 exercises in one session).​

• ​During the treatment process, it is also advisable to use specially designed diets, which, in the presence of excess weight, can reduce body weight and the load on the joints. A diet that affects the course of the disease has not been developed today.​
• ​Coxarthrosis of the 1st degree in patients is manifested by certain symptoms. The most common symptom is intermittent pain after exercise. The area of ​​localization of pain is the hip joint and, in rare cases, the hip or knee. After rest, the pain disappears. During this period, a person’s gait is not disturbed, movements are not limited and muscle tissue atrophy is not observed.​
• ​aseptic necrosis of the femoral head;​

Coxarthrosis is a disease of a degenerative-dystrophic nature, which most often affects middle-aged and elderly people. The disease affects the human hip joint. The development of the disease occurs gradually over several years and is accompanied by the appearance of pain in the hip joint and limited mobility in this area.

​Dislocation - the head is completely displaced outside the acetabulum, and the dislocation cannot be reduced.​

• The term “dysplasia” literally translated from the ancient Greek language means a disorder of education (dys - disorder, plasia - education, development). Joint dysplasia is a disorder in the formation of articular structures. Moreover, this pathology affects not only the articular osteochondral surfaces, but also nearby muscles and ligaments. And in some diseases, joint dysplasia is combined with severe damage to internal organs.​
• ​Another symptom indicating joint pathology is restriction of movement. In healthy newborns, the legs are abducted to a position of 80-90° and laid freely on a horizontal table surface. If abduction is limited to 50-60°, there is reason to suspect a congenital pathology. In a healthy child of 7-8 months, each leg is abducted by 60-70°, in a baby with a congenital dislocation - by 40-50°.​
• ​Hip dysplasia​
• With the development of this pathology in adults, it is possible to use manual therapy and hydrotherapy.

​Diagnostics begins immediately after the birth of the child. Already in the maternity hospital, in order to establish dysplasia, it is necessary to determine the presence of a “clicking symptom” - this symptom appears only when the joint is dislocated (which can occur as a result of improper management of labor and midwife assistance to the baby). The symptom is determined due to the fact that the baby’s joint capsule is overstretched, due to which the femoral head “walks.” The click is detected after it slides off the edge of the acetabulum. This symptom, which indicates hip dysplasia, is checked very carefully so as not to damage the baby’s delicate tissues and blood vessels.​

​ When indicating surgical treatment, the degree of anatomical changes in the hip joint should be taken into account. The optimal age for surgical treatment of congenital hip dislocation is considered to be 2–3 years.

It is impossible to completely cure the disease. The disease is incurable; therapy methods can only slow down its development. When the disease reaches the third stage, the patient receives disability of the second group.​

​Coxarthrosis of the second degree is characterized by more intense pain that can occur at rest. Coxarthrosis of the 2nd degree is characterized by the spread of pain to the groin and thigh and some upward displacement of the head of the femur. The main signs of coxarthrosis of the second degree:

​infectious lesions and inflammatory processes occurring in the articular joint;​

Therapy for arthrosis in late stages

​In the later stages of the disease, atrophy of the thigh muscle tissue may appear, and in addition, a process of shortening of the limb may occur. The development of coxarthrosis can be triggered by various reasons. The main ones are the following:​

​Knee dysplasia in combination with other skeletal disorders was complicated by a dislocation of the lower leg. Due to gross structural changes, pathological mobility has formed in the joint

Congenital hip dislocation - description, causes, symptoms (signs), treatment.

​Dysplasia of articular structures is a form of developmental defects​ Short description To clarify the diagnosis, techniques such as radiography and ultrasonography are used. In young children, a significant part of the joint is formed by cartilage, which is not visible on x-rays, so this method is not used until 2-3 months of age, and then special diagrams are used when reading images.​ ​ - this is a congenital disorder of the process of joint formation, which can cause dislocation or subluxation of the femoral head. With this condition, either underdevelopment of the joint or its increased mobility in combination with connective tissue deficiency may be observed. Predisposing factors are unfavorable heredity, maternal gynecological diseases and pregnancy pathology. If not detected in a timely manner and without proper treatment, hip dysplasia can cause dysfunction of the lower limb and even disability. Therefore, this pathology must be identified and eliminated in the early period of the baby’s life. With timely detection and proper treatment, the prognosis is conditionally favorable.​ ​If the disease is severe, the only way out of this situation is surgical treatment with complete replacement of the articular surfaces.​ Causes To identify the symptom, the baby is placed on the table, his legs are bent at the hip and knee joints. The thumb is located on the inside of the baby’s thigh, and the other four are on the outer surface of the joint (in this case, the middle finger of the hand must be on the greater trochanter of the femur). The baby's hip is moved to the side at a slight angle (usually up to 40 degrees), after which traction of the baby's hip is carried out along its axis. At the same time, pressure is applied to the greater trochanter. If the procedure is performed correctly, you can feel a loud click (it is not perceived by hearing, but is felt through tactile sensations). Types of operations Open reduction surgery with arthroplasty Reconstructive surgery on the ilium and proximal femur without opening the joint capsule Combination of open reduction and reconstructive surgery Alloarthroplasty Palliative operations.​ ​At a late stage of the disease, the only effective treatment method is surgery, which consists of replacing the articular joint destroyed by the disease through endoprosthetics. Depending on the degree of the disease, unipolar or bipolar prosthetics are used. With unipolar prosthetics, the femoral head is replaced, and with bipolar prosthetics, both the femoral head and the acetabulum are replaced.​ ​the appearance of lameness during exercise; Symptoms (signs) ​receiving traumatic injuries.​ ​joint injury;​ ​The last degree, hip dislocation, is by far the most severe. Main symptoms of congenital hip dislocation:​ ​. The formation of our musculoskeletal system begins during the period of embryonic development, at approximately the 4th week, and ends already in the neonatal period. The main causes of joint dysplasia are gene mutations or the effect of various unfavorable factors on the body of the mother and fetus during pregnancy. Among these factors:​ ​Ultrasound diagnostics is a good alternative to X-ray examination in children in the first months of life. This technique is practically safe and quite informative.​ Treatment Hip dysplasia is a congenital pathology that can cause subluxation or dislocation of the hip. The degree of underdevelopment of the joint can vary greatly - from gross impairment to increased mobility in combination with weakness of the ligamentous apparatus. To prevent possible negative consequences, hip dysplasia must be identified and treated early - in the first months and years of the baby’s life. ​Prevention of the disease should first of all include the normal course of pregnancy and the prevention of its pathology. In addition, due attention should be paid to determining the tone of the uterus (which can affect the intrauterine position of the fetus) and proper nutrition (which can often lead to the development of congenital dystrophy of cartilaginous tissue).​ ​Standard diagnostics for patients with pathology of joint development​ ​ICD-10 ​ ​Surgical intervention for hip replacement is carried out as planned. To carry out the operation, it is necessary to perform a complete examination of the patient's body. The intervention is performed under general anesthesia. After this, antibiotic therapy is required. The stitches are removed after 10-12 days. During the postoperative period, the patient is undergoing outpatient treatment. After an operation that restores a person’s ability to work, it is imperative that actions are taken to rehabilitate the patient.​ ​reduced range of motion in the joint;​ Coxarthrosis in the primary type is accompanied by concomitant damage to the spine and knee joint. The causes of grade 1 coxarthrosis, which increase the likelihood of its development, are the following:​ ​development of congenital pathologies;​

Connective tissue performs several functions in the human body. It is not responsible for the functioning of any organs, but at the same time forms their supporting frame and outer coverings.

The organs of the human body are 90% composed of connective tissue. In some cases, a person may develop a special systemic connective tissue disease called dysplasia.

This term refers to a failure in the formation and development of connective tissue in humans. Dysplasia is a systemic disease and can affect groups of organs.

The disease can occur both at the stage of intrauterine development of the child and develop after his birth.

The specificity of connective tissue dysplasia is that it is not limited to just one specific manifestation, but represents a group of diseases. Their peculiarity is the non-inflammatory nature of their occurrence.

The syndrome is expressed as:

• damage to tissue structures and substances;
• changes occurring in collagens, complex proteins, fibroblasts, elastic fibrils.

These defects become the main cause of impaired self-regulation in the body at any level, since connective tissue is present in any part of it.

ICD designation

For a long time there was no generally accepted name for this disease in medicine.

With the final confirmation of the systemic nature of the development of dysplasia, a general definition of the disease was officially approved - hypermobility syndrome.

This disease has a code according to ICD-10 - M35.7. According to the International Classification, joint hypermobility is the main symptom of connective tissue diseases. This emphasizes the systemic nature of dysplasia.

In Russian medicine, a group of diseases is called connective tissue dysplasia. This term includes both syndromic and non-syndromic manifestations of the disease.

Reasons for development

The main provoking factor in the development of the disease are various gene mutations to which the child’s body is exposed during the period of intrauterine development. Mutations affect various types of enzymes, protein-carbohydrate complexes.

There may be over 1,000 different variants of genetic changes in proteins that trigger the development of the disease. The disease can be inherited.

The causes of mutations are the following factors:

Mutations can cause the following possible disturbances in protein chains:

• their lengthening;
• truncation;
• development of selective mutations by substitution of amino acids.

Reference. It is assumed that one of the factors causing connective tissue dysplasia in humans is insufficient intake of magnesium into the body during embryonic development.

Symptoms

Manifestations of the disease are different. There are both mild forms and severe ones that require a special approach. Symptoms and treatment of connective tissue dysplasia syndrome highly individual for each patient and in many ways unique.

The following manifestations of the disease are possible:

Symptoms depend on the type of disease. There are differentiated and undifferentiated forms. The signs of the first are:

• aortic aneurysm;
• bone fragility;
• skin atrophy;
• finger deformity (arachnodactyly);
• scoliosis;
• funnel chest deformity;
• increased skin vulnerability (Ehlers-Danlos syndrome);
• Marfan disease in the form of a violation of the shape of the skeleton, pathologies of the organs of vision and the cardiovascular system.

Undifferentiated connective tissue dysplasia syndrome is manifested by symptoms:

• increased skin elasticity;
• excessive joint mobility;
• skeletal abnormalities;
• atypical thinness of the skin;
• various forms of malfunctions in the functioning of myocardial valves and organs of vision.

Attention! People with undifferentiated dysplasia are not classified as sick, but belong to a group of patients prone to exhibiting possible characteristic pathologies.

Diagnostics

The most accurate diagnosis can be made using the following methods:

• endoscope examination;
• skin biopsy;
• X-ray examination of joints, lungs, spine;
• electrophysiological examination (ECG, electroencephalogram);
• blood test for biochemistry;
• Ultrasound of the kidneys and pelvic organs;
• medical genetic examination;
• 24-hour urine test;
• measuring body parts;
• joint mobility test.

The detection of problems in the functioning of several body systems indicates the likely development of connective tissue dysplasia in the patient.

Therapy methods

Therapy for the disease should be comprehensive and individual, depending on the symptoms and damage to specific body systems in the patient. Treatment of the disease includes:

• physiotherapy, performing special exercises;
• taking medications to improve metabolism;
• adherence to diet;
• surgical methods for deformation of the chest and musculoskeletal system.

Non-drug therapy includes:

Drug therapy includes taking the following medications:

• metabolic stabilizers (“Alfacalcidol”);
• stimulators of collagen production (ascorbic acid, magnesium citrate);
• drugs supporting the heart muscle (“Mildronate”, “Lecithin”);
• tissue repair stimulators (“Chondroxide”);
• drugs that normalize amino acid levels (“Glycine”).

Patients need intensive nutrition. It is necessary to consume protein foods, fish, cheeses, and seafood in large quantities. It is important to include meat-based broths, fruits and vegetables in your diet, and also take Omega-class dietary supplements.

Peculiarity! Surgical treatment is carried out only in two cases: when a person is life-threatening with severe vascular pathology and with obvious deformities of the chest.

Features of treatment in children

Connective tissue dysplasia syndrome in children requires a special approach to its treatment. It is important to pay attention to the following methods:

• child's dietary compliance(it should be dense and include various types of meat, legumes, fruits and vegetables, seafood);
• proper organization of lifestyle(refusal of serious sports activities in favor of physiotherapy and light gymnastic exercises);
• competent adaptation of the child to life in society(lesson with a psychologist to prevent the formation of an inferiority complex);
• use of special joint-strengthening splints and casts for young children;
• taking a course of metabolism-stimulating medications(course duration is 60 days, after which there is a break).

In case of serious pathologies associated with the disease, the child requires surgical treatment in the form of surgery. It is carried out in case of serious threats to the life of children with connective tissue dysplasia.

Important! Muscle dysplasia in children, as in adults, due to the genetic factor of its development, cannot be definitively treated. Therapy can only reduce the signs of its manifestation, slow down symptoms or stop the development of the syndrome.

Contraindications

If a person has this disease, the following is not recommended and prohibited:

• engage in hard and harmful work;
• perform exercises to stretch the spine or hang on the horizontal bar;
• expose yourself to stress and psychological overload;
• engage in contact sports and weightlifting.

Conclusion

Connective tissue dysplasia syndrome is a group of diseases of genetic origin. They are characterized by a multiplicity of symptoms, which requires an integrated approach to diagnosis and treatment.

Taking into account the hereditary nature of the development of the disease, it is not amenable to definitive treatment, but the therapy used for it can significantly improve the patient’s quality of life and avoid the progression of pathologies until old age.