Post-traumatic contracture ICD 10. What is contracture of the elbow joint? M20 Acquired deformities of fingers and toes

Excluded:

• chondrocalcinosis (M11.1-M11.2)
• intra-articular lesion of the knee (M23.-)
• ochronosis (E70.2)

Instability due to old ligament injury

Ligament laxity NOS

• congenital - see congenital anomalies and deformations of the musculoskeletal system (Q65-Q79)
• current - see joint and ligament injuries by body area
• repeating (M24.4)

Excluded:

• acquired limb deformities (M20-M21)

Excluded:

• spine (M43.2)

Excludes: iliotibial ligament syndrome (M76.3)

In Russia, the International Classification of Diseases, 10th revision (ICD-10) has been adopted as a single normative document for recording morbidity, reasons for the population's visits to medical institutions of all departments, and causes of death.

ICD-10 was introduced into healthcare practice throughout the Russian Federation in 1999 by order of the Russian Ministry of Health dated May 27, 1997. No. 170

The release of a new revision (ICD-11) is planned by WHO in 2017-2018.

With changes and additions from WHO.

Processing and translation of changes © mkb-10.com

Joint contracture - description, treatment.

Short description

Joint contracture is a persistent limitation of mobility in a joint.

Classification By origin: Congenital Acquired By etiology: Arthrogenic - with pathology of the articular surfaces of articulating bones, ligaments and joint capsule Painful (antalgic) - reflex restriction of movements in the joint with painful movements Dermatogenic - with extensive scar changes in the skin Desmogenic - with scar changes in connective tissue formations ( fascia, aponeuroses, etc.) Myogenic - with shortening of muscles as a result of injury, inflammatory or dystrophic processes Neurogenic - with disturbances of innervation Paralytic - with paralysis of a muscle or group of muscles Post-amputation contracture - a complication of amputation of a limb in the form of contracture of the joint closest to the stump; develops due to incorrect surgical technique or errors in postoperative management Professional - contracture due to chronic trauma or overstrain of certain muscle groups in connection with professional activities Psychogenic (hysterical) - neurogenic contracture due to hysteria Reflex - contracture due to prolonged irritation of the nerve, leading to the emergence of a persistent reflex in the form increasing the tone of a muscle or muscle group Cicatricial - contracture with gross scar tissue changes Spastic - contracture with central paralysis (paresis) Tendon (tendon) - contracture with shortening of the tendon Functional - adaptive (compensatory) - contracture that develops to compensate for an anatomical defect, for example flexion contracture joints of one leg when the other is shortened By nature: Extensor - contracture with limited flexion in the joint Flexion - contracture with limited extension in the joint.

Treatment

Treatment Early and comprehensive treatment of the underlying disease exercise therapy, physiotherapy (electrophoresis with lidase, ronidase, phonophoresis with hydrocortisone, disodium salt of ethylenediaminetetraacetic acid), massage For arthrogenic contractures - intra-articular hydraulic novocaine blockades If conservative treatment is unsuccessful - surgical (arthrolysis, plastic surgery, etc. ).

Prevention - passive and active early therapeutic exercises for diseases leading to the formation of contractures.

Application. Arthrogryposis is congenital multiple contractures due to underdevelopment of the muscles of the limbs. There are several genetic varieties, in particular autosomal dominant forms (*108110; - arthrogryposis multiple congenital, distal, type 1;;;;), autosomal recessive (*208080;;;;;) and X - linked (*301820; - multiple congenital arthrogryposis, distal) “Congenital amyoplasia “Congenital arthromyodysplasia. ICD-10 Q74.3 Congenital arthrogryposis multiplex

Joint contracture

Definition and general information [edit]

Contractures are common consequences of joint injuries.

Based on pathogenetic factors, two large groups of contractures are distinguished: active (neurogenic) and passive (structural). TO active Contractures include the following.

In case of disorders of autonomic innervation.

Passive contractures are constant companions of injuries and orthopedic diseases; they pose a serious problem in the diagnosis and (especially) treatment of these persistent disorders of joint function.

In accordance with the localization of the primarily injured tissue structures, contractures are divided into separate types:

According to the limitation of the type of movements, flexion, extension, abduction, adduction, rotational (supination and pronation) contractures are distinguished.

The term “flexion contracture” refers to the condition of a limb when it cannot be straightened, while “extension” is the opposite, when the limb does not bend.

An adductor contracture is a contracture in which the amplitude of abductor movements is reduced, and an abduction contracture is a limitation of adduction in the joint.

Similar designations are used to limit supination, pronation, and rotational movements.

Limitations of movement in the joint in both directions are called flexion-extension, or concentric contracture.

Based on the installation and possible functioning of the limb, contractures are distinguished in a functionally advantageous position and in a functionally disadvantageous (vicious) position.

Etiology and pathogenesis[edit]

Factors, or rather errors in treatment, leading to dysfunction of the joints and complications:

Inaccurate comparison of fragments in intra-articular fractures;

Errors in permanent immobilization: defects in plaster technique, arbitrary timing of immobilization (both excessive duration and early elimination of immobilization);

Lack of orthopedic prevention of contractures;

Late timing of the start of functional treatment of injuries and diseases;

Complications in the form of inflammatory diseases;

Clinical manifestations[edit]

The development of contracture occurs gradually, unnoticed by the patient, without causing him any suffering. This course of the pathological process leads to the fact that, after apparent well-being, a formed contracture is discovered.

Clinical manifestations mainly depend on the type of contracture and the duration of the process. Desmogenic and myogenic contractures in their “pure” form are extremely rarely diagnosed. Ischemic contractures are also rarely found. Dermatogenous post-burn contractures are more common, but they do not present diagnostic difficulties, so we should focus on the three most widespread types of contractures - arthrogenic, post-immobilization contractures and myofasciotenodesis - especially since it is not always easy to distinguish them.

Joint contracture: Diagnosis [edit]

Using the example of one specific joint, we can consider not only the clinical symptoms of various contractures, but also their differential diagnostic signs. A striking example is extensor contractures of the knee joint, which are the most common after injuries and inflammatory diseases.

Anamnesis helps to identify the consequences of injury or inflammation in the hip area (usually in the middle and lower thirds). It is typical that after the elimination of immobilization, which lasts 2-3 months, a persistent restriction of joint mobility occurs.

In the early stages of scar formation, patients complain of pain during development, since scar tissue is elastic and stretches with movement, causing irritation of nerve endings. Subsequently, the scar hardens and does not stretch when bending the leg, so the pain disappears.

The feeling of impediment to flexion of the leg is associated with the tension of the scar, which limits the functions of the knee joint. Subsequently, due to myofibrosis of the quadriceps femoris muscle, the patella shifts upward and its congruence with the femoral condyles is disrupted. This creates an additional obstacle in flexing the lower leg, which comes to the fore.

Examination and physical examination

In some patients, skin scars are visible in the thigh area; they are often retracted and retracted even more when attempting to move the knee joint. As a rule, the zone of scar retraction remains motionless and corresponds to the site of fusion of soft tissues with the femur.

Limitation of mobility of the fasciocutaneous sheath. This symptom is associated with adhesions around the femur. This symptom is checked this way: the doctor tries with his hands to move the soft tissue of the patient’s thigh up, down, and also around the vertical axis. There is no movement of the skin and subcutaneous tissue. This sign is characteristic of extension contracture and is not detected in other types of contractures of the knee joint.

In patients with long-term, persistent extension contractures that developed in childhood, the lower limb is shortened by 2-5 cm. This is due to changes in the statics and dynamics of the knee joint. The constant pressure of the body weight on the metaepiphyseal sections and the absence of the usual rolling movements when the knee joint is extended lead to subsidence and deformation of the condyles of the femur and tibia. Their height decreases, the anteroposterior size increases significantly. The articular surfaces are flattened, as if trying to capture a larger area of ​​support. It is possible that compression of the metaepiphyses leads to trauma to the growth zones. However, limb shortening can also be considered as a compensatory adaptation of the body.

Muscle atrophy is a constant companion to passive contractures. It also happens with myofasciotenodesis. Atrophy is most pronounced in the middle third of the thigh.

A symptom of uneven muscle tone - when trying to actively straighten the leg, palpation determines good muscle tone above the fusion site and its absence in the distal region. Some patients clearly notice differences in muscle tension at different levels of the thigh.

A symptom of muscle tension disorder is identified in a patient as follows: passive flexion of the knee joint leads to tension of the tendon and the quadriceps muscle itself to the point of adhesion. Proximal tension is not determined.

Laboratory and instrumental studies

X-rays of the hip reveal a rough callus in the area of ​​the former fracture or osteotomy of the femur. Sometimes the callus has spiny-like growths associated with ossification of soft tissues. In patients with persistent contractures, deformation of the condyles of the femur and tibia is detected: a decrease in their height and an increase in anteroposterior size. The distal metaepiphysis of the femur takes the shape of a “boot” facing slightly posteriorly. The knee joint becomes valgus, and regional osteoporosis of the bones that form it occurs.

A study of the bioelectrical activity of muscles showed a peculiar picture: above the fusion site, the electromyographic curve is almost no different from that on a healthy limb. The electromyogram below the fusion is characterized by a sharp decrease in oscillations, unevenness of their height, and a decrease in the frequency of oscillations. Sometimes the curve approaches a straight line.

Differential diagnosis[edit]

Differential diagnosis is carried out between contractures and myofasciotenodesis.

Myofasciotenodesis differs from other types of contractures in that it allows us to outline the prevention of this suffering and pathogenetically substantiate the treatment.

Joint contracture: Treatment[edit]

Treatment of contractures requires a lot of time and labor and must be strictly individualized.

Rehabilitation of patients with contractures begins, as a rule, with conservative measures. Their nature largely depends on the underlying disease, location and type of contractures. However, there are general principles of treatment:

Very gradual stretching of contracted tissues, carried out after preliminary relaxation of the muscles;

Strengthening muscles stretched due to contracture (muscles antagonistic to contracted muscles);

Ensuring the painlessness of therapeutic and diagnostic treatments. It is important to achieve a conscious attitude of the patient towards treatment measures. The basis of complex treatment of contractures is positional treatment and kinesitherapy (active and passive therapeutic exercises, hydrokinesitherapy, mechanotherapy).

If conservative treatment of contractures is ineffective and it is necessary to eliminate the inhibitory effect of tissues that impede the action of corrective manipulations, surgical treatment is used. It consists of various plastic surgeries on soft tissues and bones: types of skin grafting, myotenolysis, tenotomy, tendon lengthening and transplantation, capsulotomy, arthrolysis, arthroplasty, corrective osteotomies, etc.

Prevention[edit]

It should be remembered that preventing the occurrence of contracture is much easier than eliminating it.

The main methods of prevention are:

Ensuring the correct position of the limb during immobilization;

Timely appointment of measures aimed at eliminating pain, swelling, and tissue ischemia;

Early provision of movement in the joints of the affected limb.

Contractures of different groups of joints, causes, symptoms and treatment methods

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A persistent restriction in joint mobility is called contracture. Physiology is based on the occurrence of inflammatory and pathological changes in soft tissues, tendons, facial and other muscles. The classification is associated with the causes and nature of impaired mobility of the joints of the legs, arms and face.

According to the International Classification of Diseases, 10th revision (ICD-10), the ICD 10 code is assigned to M24.5. There are contractures with other highlighted ICD-10 codes. Most often it affects the most active joints - the knee, elbow, temporomandibular joint (TMJ).

The physiology, occurrence and types of contractures are still being studied. The classification divides them into congenital and acquired joint pathologies. Congenital ones appear due to malformations of muscles and joints (congenital clubfoot, torticollis).

Acquired pathologies, in turn, are divided into several types:

1. Neurogenic – occurs when there are disorders in the central or peripheral nervous system. There is a violation of facial facial functions (TMJ), innervation of other organs.
2. Myogenic is characterized by pathological changes in muscles, leading to atrophic processes. Extensor function is often impaired.
3. Desmogenic contracture is associated with shrinkage of the fascia and ligaments.
4. Tendogenic appears when there is damage and inflammation in the tendons.
5. Arthrogenic – consequences of pathological processes of the joint.
6. Immobilization contracture appears after long-term immobilization of the injured limb after injury or surgery or anesthesia.

Mixed types are often encountered in practice. This is due to the fact that the resulting contracture of a certain type leads to disruption of normal nutrition and blood supply to the affected joint, and over time other pathological processes are added.

The physiology of the process of joint damage differs into primary and secondary. The primary process is limited to the affected joint. Secondary contracture involves a healthy adjacent joint.

The general classification is divided into flexion, extension, adduction and abduction. There is also rotational pathology of the joint, which disrupts rotational movements.

Etiology of the disease

Based on the above types and types, it can be determined that there are many reasons that can cause joint contracture. The term itself is essentially a symptom meaning a restriction in the movement of a joint. Despite this, it is assigned a separate ICD-10 code. Consequently, a pathological process can occur after illness, injury, anesthesia or a congenital anomaly.

The resulting mechanical damage causes post-traumatic contracture. This could be a dislocation, bruise, fracture or even a burn. The formation of a scar reduces the elasticity around the joint tissue and makes it difficult for the joint to move.

Degenerative-inflammatory processes of bones and joints have a similar effect. Damaged nerve fibers and muscle tissue also have a negative impact on the normal functioning of the joint.

A period of prolonged restriction of the functions of certain parts of the body due to the application of a cast, splint or anesthesia causes immobilization contracture. Depending on the recovery period for post-traumatic immobilization, the severity of the process is revealed.

The clinical picture affects the joints of the face, limbs and other parts of the body.

Lower jaw lesion

A fairly common disease is contracture of the lower jaw of the face (TMJ) due to the fact that the muscles and joints of the face are constantly in motion. The function of the facial muscles is almost constant.

Contracture of the lower jaw is a consequence of pathological changes in the properties of soft tissues (decreased elasticity). The natural functions of the facial and chewing muscles of the TMJ are disrupted. Unstable contracture occurs with inflammatory diseases of the lower jaw of the face, facial muscles, and after prolonged use of a splint. Persistent contracture occurs after facial trauma, anesthesia during dental procedures, or injury to facial muscles. The period of immobilization affects the development of the disease and the condition of the facial muscles. According to ICD-10, it refers to other diseases of the jaws.

Symptoms of contracture of the lower jaw are based on difficulty eating, dysfunction of facial muscles, and speech. A person feels a feeling like after anesthesia at the dentist.

Treatment of contracture of the lower jaw of the face (TMJ) is performed using surgical methods. The resulting scars are dissected, which leads to the return of normal function of the facial muscles and chewing activity. Of particular importance is the recovery period after surgery, which includes therapeutic exercises and physiotherapy.

Hand lesion

Volkmann's contracture manifests itself as a persistent limitation of hand mobility. The hand begins to resemble the clawed paw of an animal. The left hand is less affected than the right.

Volkmann's ischemic contracture is characterized by rapid development and affects the joints of the shoulder and forearm. According to ICD-10, it has the number M62-23; M62-24. The condition can provoke pain associated with injury to the joints of the hand. There is a disturbance of innervation and motor activity, a feeling like after anesthesia.

The physiology is based on a violation of both extensor and flexion functions. The position of the hand is constantly bent and motionless. The consequence of the pathological process is a disruption of the blood supply due to a fracture or dislocation in the elbow or shoulder joint. Prolonged compression of the bandage can also lead to contracture.

• type of clawed paw;
• difficulty in normal hand movement;
• disturbance of innervation (condition as after anesthesia);
• hand deformation.

The period of blood supply disturbance affects the course and consequences of the disease. If this is due to objects or bandages pinching the surface, then freeing the hand as soon as possible is necessary. In post-traumatic conditions, treatment is aimed at stopping further pathological processes and partially preserving normal muscle function. Surgical treatment methods using anesthesia are also allowed.

Volkmann's ischemic contracture requires an individual approach to treatment. Conservative methods such as physical therapy, physiotherapy, and gentle massage are quite effective. The recovery period, which includes sanatorium-resort treatment with the use of compresses, hydrogen sulfide baths, and mud treatments, has a positive effect.

Palmar fibromatosis

In practice, Dupuytren's contracture is quite common - a disease that leads to deformation and disruption of the normal function of hand movement. It has a separate ICD-10 code M72.0. The ring and little fingers are often affected. Dupuytren's disease is not fully understood and is a chronic disease.

Due to degenerative-inflammatory processes, the tendons of the palm become wrinkly and the extensor ability of the fingers is impaired.

Dupuytren's contracture is characterized by three degrees of severity, characterized by impaired sensitivity and severity of motor function of the joints. As the process progresses, there is an increase in pain and stiffness of the joints and muscles.

Due to the fact that predisposing factors are not precisely established, Dupuytren's contracture often occurs with concomitant diseases. One example is scleroderma (spotted idiopathic atrophoderma).

Idiopathic atrophoderma tends to affect young girls under 20 years of age and children. One of the stages of the disease is damage to the small joints of the legs and arms. It is characterized by a symptom such as Dupuytren's contracture. In children, there is a combination of diseases such as Raynaud's syndrome, idiopathic atrophoderma and Dupuytren's contracture.

The treatment algorithm for Dupuytren's disease is determined by an orthopedist. In mild stages, conservative therapy is prescribed. To restore normal joint function, surgical treatment using anesthesia is used.

Contracture of fingers

Weinstein's contracture according to ICD-10 is included in group M24. Associated with injury to the top of the finger. The cause is a post-traumatic condition, after a direct blow to the finger.

With timely treatment it does not pose a threat. But if you delay going to a medical facility, it threatens the process of deformation and disruption of motor activity of the injured finger and its muscles.

ICD 10. Class XIII (M00-M25)

ICD 10. CLASS XIII. DISEASES OF THE MUSCULOSCAL SYSTEM AND CONNECTIVE TISSUE (M00-M49)

Excludes: selected conditions arising in the perinatal period (P00-P96)

complications of pregnancy, childbirth and the puerperium (O00-O99)

congenital anomalies, deformities and chromosomal disorders (Q00-Q99)

diseases of the endocrine system, nutritional disorders and metabolic disorders (E00-E90)

injuries, poisoning and some other consequences of external causes (S00-T98)

symptoms, signs and abnormalities identified by clinical and laboratory tests, not classified elsewhere (R00-R99)

This class contains the following blocks:

M30-M36 Systemic connective tissue lesions

M65-M68 Lesions of synovial membranes and tendons

M80-M85 Bone density and structure disorders

M95-M99 Other musculoskeletal and connective tissue disorders

The following categories are marked with an asterisk:

M01* Direct infection of a joint in infectious and parasitic diseases classified elsewhere

M07* Psoriatic and enteropathic arthropathy

M09* Juvenile arthritis in diseases classified elsewhere

M36* Systemic connective tissue disorders in diseases classified elsewhere

M49* Spondylopathies of tissue in diseases classified elsewhere

M63* Muscle lesions in diseases classified elsewhere

M68* Lesions of synovial membranes and tendons in diseases classified elsewhere

M73* Soft tissue lesions in diseases classified elsewhere

M82* Osteoporosis in diseases classified elsewhere

M90* Osteopathies for diseases classified elsewhere

LOCALIZATION OF MUSCULAR LESION

In Class XIII, additional signs have been introduced to indicate the location of the lesion, which can optionally be used with the corresponding subheadings Since the place of distribution or

special adaptation may vary in the number of digital characteristics used, it is assumed that the additional subclassification by localization should be placed in an identifiable separate position (for example, in an additional block) Various subclassifications used in specifying the damage

knee, dorsopathies or biomechanical disorders not elsewhere classified are given on pages 659, 666 and 697, respectively.

0 Multiple localization

1 Shoulder region Clavicle, Acromial->

2 Shoulder Humerus Elbow joint bone

3 Forearm, radius, wrist joint - bone, ulna

4 Hand Wrist, Joints between these fingers, bones, metacarpus

5 Pelvic Gluteal Hip joint, region and hip region, sacroiliac, femoral joint, bone, pelvis

6 Tibia Fibula Knee joint, bone, tibia

7 Ankle Metatarsus, Ankle joint, tarsal joint and foot, other joints of the foot, toes

8 Others Head, neck, ribs, skull, torso, spine

9 Localization unspecified

ARTHROPATHIES (M00-M25)

Disorders affecting primarily peripheral joints (extremities)

INFECTIOUS ARTHROPATHIES (M00-M03)

Note This group covers arthropathy caused by microbiological agents. The distinction is made according to the following types of etiological connection:

a) direct infection of the joint, in which microorganisms invade synovial tissue and microbial antigens are detected in the joint;

b) indirect infection, which can be of two types: “reactive arthropathy”, when microbial infection of the body is established, but neither microorganisms nor antigens are detected in the joint; and “postinfectious arthropathy,” in which the microbial antigen is present, but recovery of the organism is incomplete and there is no evidence of local proliferation of the microorganism.

M00 Pyogenic arthritis [see location code above]

M00.0 Staphylococcal arthritis and polyarthritis

M00.1 Pneumococcal arthritis and polyarthritis

M00.2 Other streptococcal arthritis and polyarthritis

M00.8 Arthritis and polyarthritis caused by other specified bacterial pathogens

If necessary, identify the bacterial agent using an additional code (B95-B98).

Excludes: arthropathy due to sarcoidosis (M14.8*)

post-infectious and reactive arthropathy (M03. -*)

Excludes: postmeningococcal arthritis (M03.0*)

M01.3* Arthritis due to other bacterial diseases classified elsewhere

M01.5* Arthritis due to other viral diseases classified elsewhere

Excludes: Behcet's disease (M35.2)

rheumatic fever (I00)

M02.0 Arthropathy accompanying intestinal shunt

M02.1 Post-dysenteric arthropathy

M02.2 Post-immunization arthropathy

M02.8 Other reactive arthropathies

M02.9 Reactive arthropathy, unspecified

M03* Post-infectious and reactive arthropathy in diseases classified elsewhere

[localization code see above]

Excluded: direct infection of the joint due to infectious

M03.0* Arthritis after meningococcal infection (A39.8+)

Excludes: meningococcal arthritis (M01.0*)

M03.1* Post-infectious arthropathy in syphilis. Clutton Joints (A50.5+)

Excludes: Charcot arthropathy or tabetic arthropathy (M14.6*)

M03.2* Other post-infectious arthropathies in diseases classified elsewhere

Post-infectious arthropathy with:

M03.6* Reactive arthropathy in other diseases classified elsewhere

Arthropathy due to infective endocarditis (I33.0+)

INFLAMMATORY POLYARTHROPATHIES (M05-M14)

M05 Seropositive rheumatoid arthritis [see localization code above]

Excludes: rheumatic fever (I00)

M05.0 Felty's syndrome. Rheumatoid arthritis with splenomegaly and leukopenia

M05.2 Rheumatoid vasculitis

M05.3+ Rheumatoid arthritis involving other organs and systems

M05.8 Other seropositive rheumatoid arthritis

M05.9 Seropositive rheumatoid arthritis, unspecified

M06 Other rheumatoid arthritis [localization code see above]

M06.0 Seronegative rheumatoid arthritis

M06.1 Adult-onset Still's disease

Excludes: Still's disease NOS (M08.2)

M06.4 Inflammatory polyarthropathy

Excludes: polyarthritis NOS (M13.0)

M06.8 Other specified rheumatoid arthritis

M06.9 Rheumatoid arthritis, unspecified

M07* Psoriatic and enteropathic arthropathy [localization code see above]

Excludes: juvenile psoriatic and enteropathic arthropathy (M09. -*)

M07.0* Distal interphalangeal psoriatic arthropathy (L40.5+)

M07.4* Arthropathy in Crohn's disease [regional enteritis] (K50. -+)

M07.6* Other enteropathic arthropathies

M08 Juvenile arthritis [localization code see above]

Includes: arthritis in children that begins before age 16 and lasts for more than 3 months

Excludes: Felty syndrome (M05.0)

juvenile dermatomyositis (M33.0)

M08.0 Juvenile rheumatoid arthritis. Juvenile rheumatoid arthritis with or without rheumatoid factor

M08.1 Juvenile ankylosing spondylitis

Excludes: ankylosing spondylitis in adults (M45)

M08.2 Juvenile arthritis with systemic onset. Still's disease NOS

Excludes: Adult-onset Still's disease (M06.1)

M08.3 Juvenile polyarthritis (seronegative). Chronic juvenile polyarthritis

M08.4 Pauciarticular juvenile arthritis

M08.8 Other juvenile arthritis

M08.9 Juvenile arthritis, unspecified

M09* Juvenile arthritis in diseases classified elsewhere

[localization code see above]

Excludes: arthropathy in Whipple's disease (M14.8*)

M09.1* Juvenile arthritis in Crohn's disease and regional enteritis (K50. -+)

M09.8* Juvenile arthritis in other diseases classified elsewhere

M10 Gout [localization code see above]

M10.0 Idiopathic gout. Gouty bursitis. Primary gout

Gouty nodes [urate tophi] in the heart + (I43.8*)

M10.2 Drug-induced gout

If it is necessary to identify the drug, use an additional code for external causes (class XX).

M10.3 Gout due to impaired renal function

M10.4 Other secondary gout

M10.9 Gout, unspecified

M11 Other crystalline arthropathies [see location code above]

M11.0 Hydroxyapatite deposition

M11.1 Hereditary chondrocalcinosis

M11.2 Other chondrocalcinosis. Chondrocalcinosis NOS

M11.8 Other specified crystal arthropathies

M11.9 Crystalline arthropathy, unspecified

M12 Other specific arthropathy [localization code see above]

Excludes: arthropathy NOS (M13.9)

cricoarytenoid arthropathy (J38.7)

M12.0 Chronic post-rheumatic arthropathy [Jaccoux]

M12.2 Villous nodular [villonoduric] synovitis (pigmented)

M12.3 Palindromic rheumatism

M12.4 Intermittent hydrarthrosis

M12.5 Traumatic arthropathy

Excluded: post-traumatic arthrosis:

M12.8 Other specified arthropathies, not elsewhere classified. Transient arthropathy

M13 Other arthritis [localization code see above]

M13.0 Polyarthritis, unspecified

M13.1 Monoarthritis, not elsewhere classified

M13.8 Other specified arthritis. Allergic arthritis

M13.9 Arthritis, unspecified. Arthropathy NOS

M14* Arthropathy in other diseases classified elsewhere

Excluded: arthropathy (with):

neuropathic spondylopathy (M49.4*)

psoriatic and enteropathic arthropathy (M07. -*)

M14.0* Gouty arthropathy due to enzyme defects and other hereditary disorders

Gouty arthropathy with:

M14.1* Crystalline arthropathy in other metabolic diseases

Crystalline arthropathy in hyperparathyroidism (E21. -+)

Excludes: diabetic neuropathic arthropathy (M14.6*)

M14.5* Arthropathy in other diseases of the endocrine system, nutritional disorders and metabolic disorders

M14.6* Neuropathic arthropathy

Charcot arthropathy, or tabetic arthropathy (A52.1+)

Diabetic neuropathic arthropathy (E10-E14+ with common fourth digit.6)

M14.8* Arthropathy in other specified diseases classified elsewhere

ARTHROSIS (M15-M19)

Note In this block, the term “osteoarthritis” is used as a synonym for the term “arthrosis” or “osteoarthrosis” Term

"primary" is used in its usual clinical meaning.

Excludes: spinal osteoarthritis (M47.-)

M15 Polyarthrosis

Included: arthrosis of more than one joint

Excludes: bilateral involvement of the same joints (M16-M19)

M15.0 Primary generalized (osteo)arthrosis

M15.1 Heberden's nodes (with arthropathy)

M15.2 Bouchard nodes (with arthropathy)

M15.3 Secondary multiple arthrosis. Post-traumatic polyarthrosis

M15.9 Polyarthrosis, unspecified. Generalized osteoarthritis NOS

M16 Coxarthrosis [arthrosis of the hip joint]

M16.0 Primary coxarthrosis bilateral

M16.1 Other primary coxarthrosis

M16.2 Coxarthrosis due to dysplasia, bilateral

M16.3 Other dysplastic coxarthrosis

M16.4 Post-traumatic coxarthrosis, bilateral

M16.5 Other post-traumatic coxarthrosis

M16.6 Other secondary coxarthrosis, bilateral

M16.7 Other secondary coxarthrosis

M16.9 Coxarthrosis, unspecified

M17 Gonarthrosis [arthrosis of the knee joint]

M17.0 Primary gonarthrosis bilateral

M17.1 Other primary gonarthrosis

M17.2 Post-traumatic gonarthrosis bilateral

M17.3 Other post-traumatic gonarthrosis

M17.4 Other secondary gonarthroses, bilateral

M17.5 Other secondary gonarthroses

M17.9 Gonarthrosis, unspecified

M18 Arthrosis of the first carpometacarpal joint

M18.0 Primary arthrosis of the first carpometacarpal joint, bilateral

M18.1 Other primary arthrosis of the first carpometacarpal joint

Primary arthrosis of the first carpometacarpal joint:

M18.2 Post-traumatic arthrosis of the first carpometacarpal joint, bilateral

M18.3 Other post-traumatic arthrosis of the first carpometacarpal joint

Post-traumatic arthrosis of the first carpometacarpal

M18.4 Other secondary arthrosis of the first carpometacarpal joint, bilateral

M18.5 Other secondary arthrosis of the first carpometacarpal joint

Secondary arthrosis of the first carpometacarpal joint:

M18.9 Arthrosis of the first carpometacarpal joint, unspecified

M19 Other arthrosis [localization code see above]

Excludes: arthrosis of the spine (M47. -)

rigid big toe (M20.2)

M19.0 Primary arthrosis of other joints. Primary arthrosis NOS

M19.1 Post-traumatic arthrosis of other joints. Post-traumatic arthrosis NOS

M19.2 Secondary arthrosis of other joints. Secondary arthrosis NOS

M19.8 Other specified arthrosis

OTHER JOINT LESIONS (M20-M25)

Excluded: spinal joints (M40-M54)

M20 Acquired deformities of fingers and toes

Excludes: acquired absence of fingers and toes (Z89.-)

M20.0 Deformation of finger(s). Deformation of fingers and toes in the form of a boutonniere and swan neck

Excluded: drumstick fingers

Palmar fascial fibromatosis [Dupuytren's] (M72.0)

M20.1 External curvature of the thumb (hallus valgus) (acquired). Bunion of the big toe

M20.2 Stiff big toe

M20.3 Other deformities of the big toe (acquired). Internal curvature of the thumb (hallus varus)

M20.4 Other hammertoe deformities (acquired)

M20.5 Other toe deformities (acquired)

M20.6 Acquired deformities of toe(s), unspecified

M21 Other acquired deformities of the extremities [localization code see above]

Excludes: acquired absence of limb (Z89. -)

acquired deformities of fingers and toes (M20. -)

M21.0 Hallux valgus, not elsewhere classified

Excludes: metatarsus valgus (Q66.6)

calcaneal-valgus clubfoot (Q66.4)

M21.1 Varus deformity, not elsewhere classified

Excluded: metatarsus varus (Q66.2)

M21.2 Flexion deformity

M21.3 Foot or hand drop (acquired)

M21.4 Flat foot (acquired)

Excludes: congenital pes planus (Q66.5)

M21.5 Acquired claw hand, clubfoot, cavus foot (high arched) and bowed foot (clubfoot)

Excludes: bowed foot, not specified as acquired (Q66.8)

M21.6 Other acquired ankle and foot deformities

Excludes: toe deformities (acquired) (M20.1-M20.6)

M21.7 Different limb lengths (acquired)

M21.8 Other specified acquired deformities of limbs

M21.9 Acquired limb deformity, unspecified

M22 Patella lesions

Excludes: patellar luxation (S83.0)

M22.0 Habitual luxation of the patella

M22.1 Habitual subluxation of the patella

M22.2 Disorders between the patella and femur

M22.3 Other lesions of the patella

M22.4 Chondromalacia patella

M22.8 Other lesions of the patella

M22.9 Patella lesion, unspecified

M23 Intra-articular lesions of the knee

The following additional fifth characters indicating localization

lesions are given for optional use with the corresponding subcategories under heading M23. -;

0 Multiple localization

1 Anterior cruciate or anterior horn of the medial meniscal ligament

2 Posterior cruciate ligament or posterior horn of the medial meniscus

3 Internal collateral or Other and unspecified ligament medial meniscus

4 External collateral or anterior horn of the lateral meniscus ligament

5 Posterior horn of the lateral meniscus

6 Other and unspecified lateral meniscus

7 Capsular ligament

9 Unspecified ligament or Unspecified meniscus

current injury - see knee and lower injury

osteochondritis dissecans (M93.2)

recurrent dislocations or subluxations (M24.4)

M23.1 Discoid meniscus (congenital)

M23.2 Meniscus lesion due to old tear or injury. Old meniscal horn tear

M23.3 Other meniscus lesions

M23.4 Loose body in the knee joint

M23.5 Chronic instability of the knee joint

M23.6 Other spontaneous ruptures of knee ligament(s)

M23.8 Other internal lesions of the knee. Weakness of the knee ligaments. Crunch in the knee

M23.9 Internal lesion of the knee joint, unspecified

M24 Other specific joint lesions [see location code above]

Excludes: current injury - see joint injury in the ganglion body region (M67.4)

disorders of the temporomandibular joint (K07.6)

M24.0 Loose body in joint

Excluded: loose body at the knee joint (M23.4)

M24.1 Other disorders of articular cartilage

intra-articular lesion of the knee (M23. -)

disorders of calcium metabolism (E83.5)

M24.2 Ligamentous lesions. Instability due to old ligament injury. Ligament laxity NOS

Excludes: hereditary ligament laxity (M35.7)

M24.3 Pathological displacement and subluxation of a joint, not elsewhere classified

Excluded: displacement or dislocation of the joint:

Current - see joint and ligament injuries by body area

M24.4 Recurrent dislocations and subluxations of the joint

Excludes: acquired limb deformities (M20-M21)

vaginal tendon contracture without joint contracture (M67.1)

Dupuytren's contracture (M72.0)

joint stiffness without ankylosis (M25.6)

M24.7 Acetabular protrusion

M24.8 Other specified joint disorders, not elsewhere classified. Unstable hip joint

M24.9 Unspecified joint lesion

M25 Other joint disorders not elsewhere classified [see location code above]

Excludes: impairment of gait and mobility (R26. -)

deformations classified under headings M20-M21

difficulty moving (R26.2)

Excluded: trauma, current case - see joint injuries by body region

M25.3 Other joint instability

Excluded: secondary joint instability

Excludes: hydrarthrosis with yaws (A66.6)

M25.6 Joint stiffness, not elsewhere classified

M25.8 Other specified joint diseases

M25.9 Disease of the joint, unspecified

What is Dupuytren's contracture and is it possible to treat it without surgery?

Dupuytren's contracture is a non-inflammatory disease accompanied by cicatricial degeneration of the tendons of the palm, in which the fingers remain constantly bent, and their full extension becomes impossible.

This condition significantly impairs the coordination of finger movements and can cause disability, as the hand loses some of its functions. In the early stages of the disease, conservative therapy can be used; in other cases, surgery remains the only effective treatment method.

Causes and mechanism of development

The term “contracture” means a sharp limitation of mobility and the inability to perform flexion-extension movements in the problem area. With Dupuytren's contracture, fibrotic changes and tissue scarring affect the tendon plate in the middle part of the palm (palmar aponeurosis). This is a special layer of connective tissue that ensures the mobility of the muscles of the palm and fingers.

When metabolic processes are disrupted or under the influence of other unfavorable factors, small tears and other microtraumas of this layer occur, which quickly heal. In this case, the area of ​​the palmar aponeurosis gradually decreases, which leads to the development of flexion contracture of the fingers.

The exact causes of the disease have not yet been established, but experts have identified some factors that provoke the development of the pathology. The formation of contracture can be affected by:

• hand injuries;
• regular high loads on the hands and fingers associated with long, hard physical labor;
• connective tissue pathologies;
• hereditary predisposition;
• inflammatory processes in the soft tissues of the hand;
• bad habits (alcoholism, smoking);
• metabolic diseases.

There are several main theories explaining the development of contracture. Among them:

• traumatic (consequences of injury);
• hereditary (congenital structural features of the palmar aponeurosis);
• neurogenic (associated with damage to peripheral nerves).

In almost 30% of patients, the disease develops against the background of a genetic predisposition, when a special gene is inherited. For the time being, the disease “dormants” and is activated under the influence of negative factors that trigger the pathological process. Such factors can be a variety of infections, metabolic disorders due to pathologies of the thyroid gland (diabetes mellitus, thyrotoxicosis), severe liver pathologies (hepatitis C), injuries, diseases of the nervous system or alcohol abuse.

The problem is aggravated by constant overload of the hands if a person is engaged in heavy physical labor. However, not all representatives of working professions develop contracture, which once again confirms the hereditary theory of the development of pathology.

Symptoms

Dupuytren's contracture manifests itself with a characteristic clinical picture that cannot be confused with the symptoms of other diseases. The main and most noticeable symptom is decreased mobility of the little finger and ring finger. In this case, the fingers take a forced position - they are always bent at the metacarpophalangeal joints. As the disease progresses, forced flexion extends to the interphalangeal joints.

The first sign of pathology is the appearance of a seal in the area of ​​the metacarpophalangeal joints of the little and ring fingers. Gradually, the dense nodule increases in size, and cords are formed extending from it to the affected joints. The tendon shortens, which leads to the formation of contracture, first in the metacarpophalangeal and then in the interphalangeal joint.

Gradually, the skin around the node becomes denser and fuses with neighboring tissues. As a result, retractions or bulges appear in the affected area. When you try to straighten the affected fingers, the cords become clearly visible, and a pain syndrome appears that radiates to the forearm or shoulder.

The extension process in the fingers is sharply limited in the early stages of the disease and completely impossible in the later stages. In advanced cases, the little finger and ring finger can be completely pressed against the palm without the ability to straighten them. The lesion is most often bilateral, but on one arm the process may progress faster than on the other.

Conventionally, there are four periods of development of Dupuytren’s contracture (ICD-10 code – M72.0).

• The preclinical period does not allow making a diagnosis - at this time the manifestations of pathology are insignificant. Only dry skin, sore fingers, and impaired skin sensitivity may be observed. Fingers get tired quickly when performing movements that require fine motor skills.
• The initial period is characterized by the appearance of nodules under the skin. Atrophy of the palm tissue gradually develops, trophic ulcers may occur, and finger mobility deteriorates, especially in the morning, but there is no permanent contracture yet.
• As the disease progresses, the aponeurosis of the palm undergoes increasing scar changes, permanent deformation of the finger joints is formed, and the process begins to affect the phalanges. Due to damage to the nerve fibers, the fingers become numb.
• At a late stage, the contracture has already been formed, and secondary changes in the hand appear - contractures of the nail phalanges. The affected fingers are bent at an angle of 90°, their extension is impossible. In severe cases, the phalanges of the fingers are located at an acute angle to each other, and their subluxation or ankylosis (complete loss of mobility) is possible.

The rate of development of the disease cannot be predicted. In some cases, a slight limitation of mobility can be observed for several years, in others, only a few months pass from the appearance of the first signs of pathology to the loss of hand function.

The acute course of the disease with the rapid development of negative changes is more often observed at a young age. After 40 years, the symptoms are less pronounced, the pathology is sluggish and develops slowly.

Diagnostics

Diagnosis of the disease is not difficult. If alarming symptoms appear, you should consult an orthopedist. The diagnosis is made on the basis of a characteristic clinical picture, which usually does not require the use of laboratory or instrumental research methods. During the visual examination, the specialist performs palpation, assesses the degree of mobility of the fingers and hand, and listens to the patient’s complaints.

In doubtful cases or in order to clarify the extent of damage to the palmar aponeurosis, the patient is recommended to undergo ultrasound, radiography or MRI.

Treatment without surgery

Treatment of Dupuytren's contracture without surgery is ineffective. However, in the early stages of the disease, specialists try to use techniques to slow down the pathological process. If the patient seeks medical help in time, the chance of recovery with the help of conservative treatment methods is quite high.

Treatment with medications

The most effective treatment method is the introduction of enzyme preparations into the areas where nodules have formed under the skin. A special collagenase enzyme softens scar tissue and prevents further development of contracture. This method has proven itself especially well in combination with taking vitamin complexes that stimulate metabolic processes in the limbs.

At the stage of scarring of tendon tissue, accompanied by pain, novocaine blockades or injections of hormonal drugs (Diprospan, Kenalog) are used.

Compresses with the drug Ronidase help slow down the pathological process. It is used topically to treat contractures. For this purpose, a powder form of the drug is used. The powder is applied to a damp cloth, applied to the affected area, covered with polyethylene, secured with a bandage and left as a compress for a day. The course of treatment takes from 2 weeks to 2 months.

Physiotherapeutic treatment

Physiotherapy can also be involved in the treatment of the disease. Wave therapy and electrophoresis with a solution of collalysin or novocaine (to eliminate pain), medicinal herbs, and hyaluronidase are used. The method can be used both in the early stages of the disease and after surgery to accelerate the recovery of connective tissue.

A good therapeutic effect is achieved by using medicinal and mud baths. Some of these methods can be prescribed after surgery to restore mobility.

Additionally, to restore the mobility of the fingers, special splints or an Ilizarov apparatus are used, which does not allow the fingers to bend; it is recommended to perform a set of special exercises aimed at developing the fingers and increasing their mobility. Regular hand massage has a good effect.

Compliance with the regimen is extremely important - the patient should reduce the load on the upper limbs. Most often, this requires changing your profession or changing working conditions. At home, you need to devote time to hand exercises and use skin care products. Be sure to completely give up alcohol and smoking.

Surgery

Surgery for Dupuytren's contracture is the most effective way to treat the disease. It can be carried out using several methods. Indications for it are contracture in the progression stage. At a later stage, when there are secondary changes, several sequential operations may be required.

There are a number of restrictions under which surgical intervention is excluded. Contraindications to the operation are:

• the presence of a purulent process on the skin of the hand;
• severe pathologies of the heart and blood vessels (if the intervention occurs under general anesthesia);
• blood clotting disorders;
• decreased immunity, severe immunodeficiency states.

Percutaneous fasciotomy

This minimally invasive type of surgery is used at the initial stage of the disease. Connective tissue bridges and scars on the palmar aponeurosis are destroyed using a needle that is inserted through the skin of the palm. At the same time, the risk of postoperative complications is minimal, but such intervention is effective only for small areas of scarring.

Open aponeurosotomy

This method involves removing part of the aponeurosis and the skin above it. Allows you to get rid of large scars and restore finger mobility. Often requires plastic surgery - replacement of removed areas with transplanted skin and fascia. After the operation, an open wound remains, which takes a long time to heal. The patient will have to wear a cast and splint for a long time to restore the normal shape of the fascia.

Aponeurosectomy

The intervention is aimed at removing the palmar fascia. The operation can be partial, when only areas affected by scar tissue are removed, and complete, when the fascia is completely removed. These are the most radical and most traumatic methods, which, nevertheless, make it possible to stop further progression of the disease.

The most traumatic and radical method is finger amputation. The operation is performed in severe, advanced cases. Often, this type of intervention is insisted on by elderly patients who are not ready for a long recovery period.

Surgery is performed under general anesthesia or local anesthesia, taking into account the general condition of the patient and the type of operation. Before the operation, preliminary preparation of the palms is necessary using the introduction of enzyme preparations and physiotherapeutic techniques. This approach eliminates difficulties in separating scar formations and skin.

If the intervention is carried out according to all the rules and is carried out by a qualified surgeon, there is usually no need for skin excision and subsequent reconstructive plastic surgery. After rehabilitation using physiotherapeutic procedures, hand functions are restored and the patient can return to a full life.

Treatment of Dupuytren's contracture with folk remedies

Doctors are skeptical about the use of traditional recipes, since their effectiveness is extremely low. A patient who replaces drug treatment with folk remedies is at great risk, since time may be lost. To fully restore the mobility of the hand in the future, a series of several operations and a long recovery period will be required.

Warm baths

They help improve blood circulation and metabolism in the affected palm and have a relaxing effect. It is recommended to steam your hands for minutes in a hot saline solution, a decoction of chamomile, sage, and pine needles.

Compresses

For compresses, use aloe juice, a decoction of black poplar buds, and a tincture of horseradish roots. A gauze napkin is soaked in the prepared base, applied to the affected palm, covered with plastic wrap and secured with a bandage. The compress should be kept for 12 to 24 hours.

Rubbing

The best remedy for rubbing the palm is considered to be a tincture of hot pepper on kerosene. To prepare it, finely chop 10 pods of hot red pepper, pour it with a mixture of 250 ml of kerosene and the same volume of vegetable oil. Close the container with the rubbing mixture with a lid and place it in a dark, warm place for 10 days. Use the prepared composition for daily rubbing into the affected area of ​​the palm.

Another popular rub recipe is prepared using horse chestnut. Finely chop the chestnut fruits (500g), pour into a dark glass bottle, pour in 500 ml of vodka and leave for 2 weeks in a dark place. Strain the finished infusion and use for rubbing.

A good effect is achieved by homemade ointment, which is prepared on the basis of butter (200g), beeswax (100g), pine resin powder (100g). Combine the ingredients, boil for 10 minutes, add 30g of celandine powder, pour in 50 ml of St. John's wort oil, simmer over low heat for another 5 minutes. Transfer the thickened mass into a jar and use it to rub into the sore palm.

Conclusion

Dupuytren's contracture is a serious disease that can lead to disability. Most often it affects older men of working professions, but the disease can also occur in women, less often in young people and teenagers. It is impossible to accurately determine its causes, and therefore prevent the disease.

Arthrosis of the elbow joint is a pathological condition that is caused by degenerative changes in the area of ​​the epicondyles of the shoulder. It is not as common as arthrosis of other joints, but it is a rather dangerous disease.

Based on the International Classification of Diseases, 10th revision (ICD-10), arthrosis of the elbow joint belongs to the group of diseases of the musculoskeletal system and connective tissue. The disease is assigned a diagnosis code M19 according to ICD-10 and is divided into the following groups:

Post-traumatic arthrosis localized to the shoulder (ICD-10 code - M19.12), forearm (ICD-10 code - M19.13).

Arthrosis of other joints is primary, localized to the shoulder (ICD-10 code - M19.02) and forearm (M19.03).

Secondary arthrosis (ICD-10 code - M19.22 – 19.23).

The other is unrefined with localization in the shoulder and forearm (ICD-10 code - M19.82-19.83).

Unrefined arthrosis (ICD-10 code - M19.92-19.93).

The elbow joint is quite mobile and rarely undergoes inflammatory processes. Therefore, the most common causes of pathological conditions are injuries or professional “harm” associated with prolonged forced positioning of the arm.

Symptoms

The main symptoms characteristic of elbow arthrosis manifest themselves in the occurrence of pain and cause impaired mobility of the arm. The nature and frequency of clinical manifestations depend on the stage of joint damage. In total, it is customary to distinguish three degrees of the disease depending on degenerative and structural changes in the structure of the elbow.

In order to distinguish arthrosis of the elbow joint from other diseases of the arm joints with characteristic symptoms, special diagnostic techniques have been identified.

Thompson's symptom is based on the inability to keep the hand in a compressed position during dorsiflexion. The hand quickly moves into a palmar flexion position.

The second way to identify arthrosis is a positive Welt sign. It is necessary to simultaneously bend both arms. A healthy hand performs this procedure faster. During the two diagnostic methods, the entire process is accompanied by painful sensations.

1st degree

The first degree is characterized by the weakest manifestations of the disease. There are still no visible structural changes in the joint, so the clinical picture is based on rare periods of exacerbations and long-term remissions.

Symptoms in the form of pain appear only after physical exertion on the affected arm. They can be insignificant and tolerable. It is almost impossible to determine deviations externally and by palpation. There may be a feeling of discomfort when making sudden movements of the hand or when performing the flexion-extension process. Treatment is still quite effective for this condition.

2nd degree

If the disease is not treated, then in the second degree, arthrosis of the elbow joint begins to progress, the tissue becomes deformed, and structural changes are observed radiographically. The feeling of pain increases significantly and can occur even during rest.

Symptoms such as a dry crunch in the elbow, atrophy of the arm muscles, impaired mobility of the arm and the inability to move it back are added.

It is at the second stage of development of the disease that the patient realizes that treatment is necessary and most often seeks medical help.

Performance is impaired, painful sensations are expressed quite clearly, reaching the shoulder girdle area.

3rd degree

In the third degree, quite severe aching pain appears, which can occur at any time of the day. Motor activity is limited not only in the elbow, but also in the shoulder joint. Symptoms in the form of pain subside only when the arm is fixed in a forced position. In addition, even changes in the weather or a change in climate zone can trigger an attack of pain.

This degree is considered an advanced condition, leading to the destruction of cartilage tissue and severe bone growth, which is not typical in a healthy state. Visually, you can see that the affected arm becomes somewhat shorter than the healthy one. With degree 3 damage, a medical advisory commission can assign a disability associated with limited physical capabilities of a person, guided by the ICD-10 diagnosis - arthrosis.

Treatment of arthrosis

Treatment requires an integrated approach and monitoring of the patient with arthrosis. Regardless of whether it is post-traumatic or age-related arthrosis, immobilization of the injured arm is required. This measure allows you to stop the process of further destruction of the joint due to motor activity.

To treat such arthrosis, it is necessary to prescribe a gentle regimen. You should temporarily refrain from physical activity during treatment. It is recommended to follow a diet limiting the consumption of fatty and spicy foods, products made from yeast dough, and reduce the amount of salt.

There are 4 main areas of treatment:

1. Drug therapy.
2. Physiotherapy and exercise therapy.
3. Surgical intervention.
4. Therapy with folk remedies.

Treatment with medications is the most common. In the first stages of the disease, it makes it possible to achieve good results. The administration of non-steroidal anti-inflammatory drugs intramuscularly or in tablet forms is indicated. Intra-articular administration of these drugs is also effective.

Chondroprotectors are the main component of medicine in the treatment of arthrosis, such as the shoulder, knee, elbow and other joints. They are the ones who restore cartilage tissue and help cure the disease. They are used in the form of tablets, ointments, and powders.

For a positive effect after relieving the exacerbation of the disease, treatment with physiotherapy is required. Electrophoresis sessions, laser therapy, wraps, and warming are prescribed. During the recovery period, a course of massage and, if desired, manual therapy is carried out. Self-prescription without consulting a doctor is contraindicated.

Therapeutic exercise and gymnastics are on a par with drug therapy in the healing process. Exercises for the muscles of the shoulder girdle and arms are selected individually by the doctor so as not to harm the joint. You should be especially careful with exercises in situations where arthrosis is post-traumatic. It is necessary to ensure that the procedures will not harm the patient.

Treatment with folk remedies is aimed at enriching bones and joints with collagen, strengthening general immunity and alleviating painful symptoms. Compresses, baths, and rubbing joints are popular.

By combining classical medicine and using traditional methods of treatment, you can shorten recovery time and reduce negative consequences in the future. Therefore, if you have the slightest suspicion of arthrosis, you should not delay consulting a doctor.

Gouty arthritis code according to ICD 10

A disease that develops due to the deposition of uric acid salts in the joints and organs. This happens when the human body has a metabolic disorder and uric acid (or urate) crystals are deposited in the kidneys and joints. This leads to inflammation, difficulty moving, and deformation of the joint.
The kidneys are also affected, in which crystals are deposited, which disrupts the normal functioning of the excretory system. There is a classification of diseases in which all names are listed and categorized according to development, treatment, and clinical picture. This classification is called ICD (International Classification of Diseases). Gouty arthritis is classified under the ICD 10 category.

Gout and gouty arthritis and their place in ICD 10

When a patient comes to a medical facility and is diagnosed with gouty arthritis, ICD 10 code is written on the card. This is done precisely so that doctors and other staff understand what the patient’s diagnosis is. All diseases according to the ICD classification are clearly divided into their own groups and subgroups, where they are designated by letters of the alphabet and numbers, respectively. Each group of diseases has its own designation.

Also, there are generally accepted norms of therapy, as a single main criterion, tactics or method of treatment that is prescribed to all patients with a particular disease. Further, judging by the patient’s condition, the development of the disease or other concomitant pathologies, he is prescribed symptomatic therapy.

The entire classification of diseases of the musculoskeletal system in the ICD is located under the letter M and each type of such pathology is assigned its own number from M00 to M99. Gouty arthritis in the ICD is in place of M10, in which there are subgroups with designations for various types of gouty arthritis. This includes:

• Unspecified gout
• Gout associated with impaired renal function
• Medicinal
• Secondary
• Lead
• Idiopathic

When a patient comes to a medical institution, a detailed medical history is taken, laboratory (tests) and instrumental methods (X-ray, ultrasound, etc.) to study the disease. After an accurate diagnosis, the doctor sets a code according to ICD 10 and prescribes appropriate treatment and symptomatic therapy.

Cause of gouty arthritis according to ICD 10

It has been proven that gouty arthritis most often affects men and only in old age, and women, if they get sick, do so only after menopause. Young people are not susceptible to the disease due to the fact that hormones, which are secreted in sufficient quantities in young people, are able to remove uric acid salts from the body, which does not allow the crystals to linger and settle in the organs. With age, the amount of hormones decreases due to the inhibition of certain body processes and the process of removing uric acid no longer proceeds as intensively as before.

But, nevertheless, scientists still cannot accurately name the reason why gouty arthritis occurs. According to statistics and studies of the disease, risk factors are identified that can give impetus to the development of the pathological process of accumulation of uric acid in organs. These are risk factors such as:

• Heredity. Many types of chronic inflammatory joint pathologies are inherited. It may be that the disease does not manifest itself during a person’s entire life, but this is extremely rare.
• Diseases are precursors. Kidney pathologies, heart disease, hormonal disorders.
• Incorrect or inadequate nutrition. Abuse of meat or offal, strong tea and coffee, alcohol, chocolate.
• Long-term use of certain medications. Such as blood pressure lowering agents, cytostatics and diuretics.

In addition, primary and secondary gout are distinguished. Primary occurs due to a combination of genetic inheritance and consumption of large quantities of undesirable foods. Secondary develops with cardiovascular diseases, hormonal disorders and medications. The difference in the occurrence of the disease does not affect the clinical picture of the manifestation of symptoms; the whole point is how exactly gouty arthritis developed, what organs and mechanisms it affected, in order to assess at what stage the pathological process is. If necessary, they explain to the patient what caused the disease and how exactly to make lifestyle adjustments in order to remove the additional factor that provokes the disease.

Classification of the disease in ICD 10

There is a wide variety of gouty arthritis due to the clinical symptoms, pathogenesis of the disease, the mechanism of uric acid deposition, and the manifestation of articular forms of gouty arthritis.

Primary and secondary gout differ in the mechanism of disease development. According to the different mechanism of accumulation of uric acid crystals, gout comes in different types:

• Hypoexcretory;
• Metabolic;
• Mixed type.

The clinical picture of the course of gouty arthritis varies:

• Asymptomatic manifestations of the disease;
• Acute form of gouty arthritis;
• Development of tophi;
• Kidney pathologies that developed against the background of gout.

According to the manifestation of articular forms, there are:

• Acute form;
• Intermittent form;
• The chronic form is manifested by the deposition of tophi.

Gouty arthritis and its other types and manifestations are listed in ICD 10 and each form of the disease is assigned its own personal number.

Gouty arthritis and its clinical manifestations

The disease has one peculiar negative quality, which is that the accumulation of uric acid crystals can occur unnoticed by the patient. Gouty arthritis does not show any symptoms, there is no clinical picture, but if a severe stressful situation occurs, a serious illness occurs, this can give impetus to the development of the disease. In this regard, a rather vivid clinical picture develops, since the amount of deposited uric acid in the organs is large and gouty arthritis seems to be “pausing” and waiting for the moment for rapid development.

There are three stages of the disease, differing in the number of symptoms and severity.

Gouty arthritis does not affect large joints, but is localized in small ones. Most often these are the joints of the legs and hands. In 9 out of 10 cases, the big toe joint is the first to be affected. The first manifestations of the disease are always pronounced and the person begins to worry and seek help from a medical institution.

During a clear pathological process, the symptoms are extremely specific. There is severe pain, inflammation, swelling, redness, and increased temperature at the joint. Uric acid crystals are deposited in the cavity and on the surface of the joint, as well as under the skin. If the course of an acute attack is prolonged, then the disintegrating tissues of the joint together with uric acid form tophi (nodules). In places where there is no joint tissue, it is replaced by urates, which leads to a decrease in functioning and to a severe modification of the limb. Gradually the joint becomes unable to do its job and the person becomes disabled.

In women, the gouty form rarely causes such severe changes in the joint; tophi are even less likely to form, so the disease does not cause significant deformation and loss of function of the joint. In men, on the contrary, the gouty form is extremely aggressive and if no measures are taken to eliminate the disease, the person becomes unable to work.

Diagnostics

Hyperurinemia in a laboratory blood test is not a reliable sign confirming gouty arthritis. This may indicate a metabolic disorder in the body and not manifest itself in the articular form. During an acute attack, a puncture of the joint (or tophi, if any) is performed and the resulting material is analyzed in the laboratory, in which white crystalline deposits of uric acid are found.

When an attack of gouty arthritis occurs, it is quite difficult to determine what kind of inflammatory process is present at the moment. Since the symptoms are similar to other chronic diseases of the joint tissue.

X-ray examination, during a long-term course of an acute attack, makes it possible to differentiate the pathology due to the detection of joint destruction on the x-ray, the presence of punctures (places where the joint tissue has undergone decay).

Basic treatment methods

There are three main directions, according to ICD 10:

1. Medication. NSAIDs are prescribed to reduce pain and inflammation, glucocorticoids regulate the body’s hormonal levels, colchicine reduces the temperature, stops the crystallization of uric acid and its production, which significantly affects the inflammatory process already at the early stage of an attack of gouty arthritis.
2. Physiotherapeutic. Treatment is aimed at local reduction of inflammation, pain, swelling and temperature. Methods such as electrophoresis with drugs allow the drug to penetrate locally into the tissue and intensively perform its work. Applications to the site of injury (for example, using dimexide) also increases the chances of a speedy recovery and relief from a number of symptoms during an acute attack.
3. Exercise therapy. Aimed at improving the mobility of the joint apparatus and restoring partially lost mobility through a combination of drug treatment, physiotherapy and physical education. Special exercises have been developed that allow you to gradually increase the load during exercise, which over time makes it possible to completely restore all lost functions.

For example, exercises for the feet:

Prevention and prognosis of the disease

Gouty arthritis can be prevented by simply monitoring your diet and limiting alcohol consumption to acceptable doses. Exercise or do daily morning exercises. It's quite simple, but effective.

The prognosis is quite positive, but only on the condition that the patient makes lifestyle adjustments, which will prevent the manifestation of acute attacks of the disease and reduce it to a long period of remission.

Bottom line

Gouty arthritis according to ICD10 is a systemic disease associated with metabolic disorders. This can be avoided if you monitor your health, nutrition and moderate physical activity on the body.

Many joint diseases are accompanied by limited mobility of the limb and the inability to perform the simplest movements. Contracture of the elbow joint occurs for various reasons, and with the combined form, movement in any direction is limited.

What's happened?

The elbow joint is a complex joint and is therefore often subject to various injuries.

In a healthy person, the arm at the elbow bends and extends without problems. If a person bends his arm, then the elbow is at an angle of 40 degrees, and when extended, it is at 180. You can turn the arm back, rotate and unfold the forearm.

Contracture of the elbow joint is a partial or complete limitation of the range of motion. Difficulties may occur with a certain type of movement, for example, with flexion or extension. With the combined form of the pathology, the hand becomes almost lifeless.

Causes

Factors provoking contracture:

• congenital pathologies in the form of underdevelopment of bone tissue, shortened muscle fibers, altered structure of muscle tissue;
• the presence of scars in the articular cavity formed after an inflammatory process, or in the post-traumatic period;
• violation of the integrity of articular tissues;
• the growth of connective tissue, which begins to replace the muscle tissue of the joint, and it becomes impossible to bend the arm;
• joint injuries, which include fractures and dislocations. Any traumatic injury. Elbow contracture after fracture is common;
• gunshot wound;
• blood flow problems;
• severe burns;
• abscess;
• diseases of the nervous system;
• arthritis that occurs in a purulent form;
• hysterical psychosis.

In elderly patients, a post-traumatic type of contracture is diagnosed.

The post-traumatic type of pathology is most often caused by unsuccessful falls on the elbow, bruises, problems with blood circulation, and pathological loss of elasticity of soft tissues.

Classification of contractures

Post-traumatic contracture is classified as follows:

• Stage 1 occurs a month after the injury. Limited movement occurs after motor fixation and pain. The psychological factor also influences the development of the phenomenon. If you seek medical help at the initial stage, the problem can be easily eliminated;
• Grade 2 contracture can develop when more than a month has passed since the joint injury. It is difficult to make basic movements due to the formation of adhesions and scars;
• Grade 3 contracture appears several months after the joint is injured. During this time, scars on the flexor muscle degenerate into fibrous tissue and shrink, which leads to limited mobility.

Elbow flexion contracture is classified into 4 stages:

• 1st degree. You can straighten your arm at the elbow no less than 170 degrees;
• Stage 2. The extension angle decreases from 170 to 130 degrees;
• Stage 3 is characterized by an extension angle from 90 to 130 degrees;
• Grade 4 is the most severe. It is possible to perform extension less than 90 degrees.

With a flexion contracture, extension of the limb is limited, with an extension contracture, flexion is limited. Flexion contracture is the most common phenomenon.

You can see what a joint looks like during contracture in the photo.

Diagnosis of contractures

To confirm the diagnosis and prescribe the correct treatment for contracture of the elbow joint, a comprehensive diagnosis is prescribed, consisting of the following measures:

1. X-ray examination to study the condition of cartilage and bone tissue;
2. Computed tomography or MRI to examine internal joint tissues and detect articular changes in them;
3. Laboratory blood tests.

After the above procedures, additional diagnostics may be required if the contracture is caused by neurogenic factors.

When making a diagnosis, ICD10 - International Classification of Diseases is used. Code M24.52 indicates contracture in the shoulder area. These are the humerus and elbow joint.

The post-traumatic type of elbow contracture according to ICD10 is coded M24.5 and refers to acquired deformities designated by code M20-M21.

Treatment

For contracture of the elbow joint, traditional treatment methods are usually used. Conservative treatment is effective if you consult a doctor in a timely manner and consists of the following procedures:

• applying plaster casts to correct the position of the joint;
• physiotherapy;
• thermal physiotherapeutic procedures;
• massage;
• traction technique.

During active medical procedures, pain may occur during treatment. Therefore, in order to avoid additional inflammation of the joint tissues, they begin to treat with medications from the group of non-steroids. These are drugs with analgesic and anti-inflammatory effects. For severe pain, an elbow joint block is indicated.

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If massive scar tissue is detected in the connective apparatus of the elbow joint, the problem is treated with surgery in the form of arthroscopy. Surgical intervention is also prescribed in cases where traditional methods have not been able to eliminate the limitation of movements.

An effective surgical method for contracture is arthrolysis of the elbow. During arthrolysis, the joint cavity is opened, then a part of the connective tissue that interferes with the normal motor activity of the limb is excised.

After excision of scars during arthrolysis, the affected tissue is replaced with implants.

If all the connective tissue is affected by scars, then joint replacement is indicated.

If the contracture begins to develop against the background of a fracture and subsequent malunion of the bones, then surgical intervention cannot be avoided. A number of activities are carried out before the operation. These are physiotherapy sessions, special exercises for exercise therapy, intra-articular injections that help eliminate signs of contracture. This comprehensive approach to surgery allows you to reduce the recovery period and also prevents the development of negative consequences after surgery.

If the elbow contracture is advanced and lasts for a long time, if surgical intervention is not performed, the patient may remain disabled.

In case of timely treatment, both conservative and surgical techniques give a favorable outcome. Therefore, when signs of pathology appear, it is important to seek medical help in time.

Physiotherapy

Physiotherapeutic procedures are part of complex conservative treatment for limited joint mobility. Physiotherapy gives the following results:

1. Improves blood supply to the joint. The tissues receive the necessary amount of oxygen and nutrition.
2. Scars dissolve faster.
3. The swelling goes away.
4. The inflammatory process stops.

The following types of physiotherapeutic procedures are prescribed:

• electrophoresis with non-steroidal drugs to relieve pain and relieve the inflammatory process. Electrophoresis can also deliver drugs from the group of corticosteroids and analgesics to the joint;
• magnetic therapy;
• laser treatment;
• shock wave procedures;
• applications with paraffin and ozokerite;
• balneotherapy.

Physiotherapy is effective at the initial stage of elbow contracture. During this period, galvanization procedures are indicated, when the affected area is exposed to low-frequency current. If you consult a doctor in a timely manner, several galvanization sessions are enough to eliminate the problem.

Massage

For the treatment and subsequent development of the elbow joint, massage sessions are included in the complex treatment.

Benefits of massage for contractures:

• blood flow stabilizes. Tissues receive the right amount of nutrition and oxygen;
• swelling in the elbow area is eliminated;
• pain goes away;
• general well-being and mood improves.

After each massage session, the injured arm should be at rest. Any overexertion of the affected limb is prohibited.

Massage sessions are performed with the patient in a lying or sitting position. Stroking and squeezing movements are used.

The massage begins from the area above the shoulder. First comes stroking, squeezing and kneading, then shaking manipulations. The movements are directed from the elbow joint to the shoulder joint, affecting all the muscles of the shoulder girdle.

Massage sessions are carried out in a gentle manner. Painful and other uncomfortable movements are excluded. The areas where the tendons attach are thoroughly massaged.

The duration of the session depends on the stage of contracture and the size of the elbow joint. Massage goes well with thermal procedures and therapeutic exercises.

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The most complete answers to questions on the topic: “post-traumatic contracture of the elbow joint ICD 10.”

A persistent restriction in joint mobility is called contracture. Physiology is based on the occurrence of inflammatory and pathological changes in soft tissues, tendons, facial and other muscles. The classification is associated with the causes and nature of impaired mobility of the joints of the legs, arms and face.

According to the International Classification of Diseases, 10th revision (ICD-10), the ICD 10 code is assigned to M24.5. There are contractures with other highlighted ICD-10 codes. Most often it affects the most active joints - the knee, elbow, temporomandibular joint (TMJ).

The physiology, occurrence and types of contractures are still being studied. The classification divides them into congenital and acquired joint pathologies. Congenital ones appear due to malformations of muscles and joints (congenital clubfoot, torticollis).

Acquired pathologies, in turn, are divided into several types:

1. Neurogenic – occurs when there are disorders in the central or peripheral nervous system. There is a violation of facial facial functions (TMJ), innervation of other organs.
2. Myogenic is characterized by pathological changes in muscles, leading to atrophic processes. Extensor function is often impaired.
3. Desmogenic contracture is associated with shrinkage of the fascia and ligaments.
4. Tendogenic appears when there is damage and inflammation in the tendons.
5. Arthrogenic – consequences of pathological processes of the joint.
6. Immobilization contracture appears after long-term immobilization of the injured limb after injury or surgery or anesthesia.

Mixed types are often encountered in practice. This is due to the fact that the resulting contracture of a certain type leads to disruption of normal nutrition and blood supply to the affected joint, and over time other pathological processes are added.

The physiology of the process of joint damage differs into primary and secondary. The primary process is limited to the affected joint. Secondary contracture involves a healthy adjacent joint.

The general classification is divided into flexion, extension, adduction and abduction. There is also rotational pathology of the joint, which disrupts rotational movements.

Etiology of the disease

Based on the above types and types, it can be determined that there are many reasons that can cause joint contracture. The term itself is essentially a symptom meaning a restriction in the movement of a joint. Despite this, it is assigned a separate ICD-10 code. Consequently, a pathological process can occur after illness, injury, anesthesia or a congenital anomaly.

The resulting mechanical damage causes post-traumatic contracture. This could be a dislocation, bruise, fracture or even a burn. The formation of a scar reduces the elasticity around the joint tissue and makes it difficult for the joint to move.

Degenerative-inflammatory processes of bones and joints have a similar effect. Damaged nerve fibers and muscle tissue also have a negative impact on the normal functioning of the joint.

A period of prolonged restriction of the functions of certain parts of the body due to the application of a cast, splint or anesthesia causes immobilization contracture. Depending on the recovery period for post-traumatic immobilization, the severity of the process is revealed.

The clinical picture affects the joints of the face, limbs and other parts of the body.

Lower jaw lesion

A fairly common disease is contracture of the lower jaw of the face (TMJ) due to the fact that the muscles and joints of the face are constantly in motion. The function of the facial muscles is almost constant.

Contracture of the lower jaw is a consequence of pathological changes in the properties of soft tissues (decreased elasticity). The natural functions of the facial and chewing muscles of the TMJ are disrupted. Unstable contracture occurs with inflammatory diseases of the lower jaw of the face, facial muscles, and after prolonged use of a splint. Persistent contracture occurs after facial trauma, anesthesia during dental procedures, or injury to facial muscles. The period of immobilization affects the development of the disease and the condition of the facial muscles. According to ICD-10, it refers to other diseases of the jaws.

Symptoms of contracture of the lower jaw are based on difficulty eating, dysfunction of facial muscles, and speech. A person feels a feeling like after anesthesia at the dentist.

Treatment of contracture of the lower jaw of the face (TMJ) is performed using surgical methods. The resulting scars are dissected, which leads to the return of normal function of the facial muscles and chewing activity. Of particular importance is the recovery period after surgery, which includes therapeutic exercises and physiotherapy.

Hand lesion

Volkmann's contracture manifests itself as a persistent limitation of hand mobility. The hand begins to resemble the clawed paw of an animal. The left hand is less affected than the right.

Volkmann's ischemic contracture is characterized by rapid development and affects the joints of the shoulder and forearm. According to ICD-10, it has the number M62-23; M62-24. The condition can provoke pain associated with injury to the joints of the hand. There is a disturbance of innervation and motor activity, a feeling like after anesthesia.

The physiology is based on a violation of both extensor and flexion functions. The position of the hand is constantly bent and motionless. The consequence of the pathological process is a disruption of the blood supply due to a fracture or dislocation in the elbow or shoulder joint. Prolonged compression of the bandage can also lead to contracture.

Main symptoms:

• type of clawed paw;
• difficulty in normal hand movement;
• disturbance of innervation (condition as after anesthesia);
• hand deformation.

The period of blood supply disturbance affects the course and consequences of the disease. If this is due to objects or bandages pinching the surface, then freeing the hand as soon as possible is necessary. In post-traumatic conditions, treatment is aimed at stopping further pathological processes and partially preserving normal muscle function. Surgical treatment methods using anesthesia are also allowed.

Volkmann's ischemic contracture requires an individual approach to treatment. Conservative methods such as physical therapy, physiotherapy, and gentle massage are quite effective. The recovery period, which includes sanatorium-resort treatment with the use of compresses, hydrogen sulfide baths, and mud treatments, has a positive effect.

Palmar fibromatosis

In practice, Dupuytren's contracture is quite common - a disease that leads to deformation and disruption of the normal function of hand movement. It has a separate ICD-10 code M72.0. The ring and little fingers are often affected. Dupuytren's disease is not fully understood and is a chronic disease.

Due to degenerative-inflammatory processes, the tendons of the palm become wrinkly and the extensor ability of the fingers is impaired.

Dupuytren's contracture is characterized by three degrees of severity, characterized by impaired sensitivity and severity of motor function of the joints. As the process progresses, there is an increase in pain and stiffness of the joints and muscles.

Due to the fact that predisposing factors are not precisely established, Dupuytren's contracture often occurs with concomitant diseases. One example is scleroderma (spotted idiopathic atrophoderma).

Idiopathic atrophoderma tends to affect young girls under 20 years of age and children. One of the stages of the disease is damage to the small joints of the legs and arms. It is characterized by a symptom such as Dupuytren's contracture. In children, there is a combination of diseases such as Raynaud's syndrome, idiopathic atrophoderma and Dupuytren's contracture.

The treatment algorithm for Dupuytren's disease is determined by an orthopedist. In mild stages, conservative therapy is prescribed. To restore normal joint function, surgical treatment using anesthesia is used.

Contracture of fingers

Weinstein's contracture according to ICD-10 is included in group M24. Associated with injury to the top of the finger. The cause is a post-traumatic condition, after a direct blow to the finger.

With timely treatment it does not pose a threat. But if you delay going to a medical facility, it threatens the process of deformation and disruption of motor activity of the injured finger and its muscles.

RCHR (Republican Center for Health Development of the Ministry of Health of the Republic of Kazakhstan)
Version: Clinical protocols of the Ministry of Health of the Republic of Kazakhstan - 2016

Sections of medicine: Pediatrics, Traumatology and pediatric orthopedics

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General information Brief description

Approved
Joint Commission on Healthcare Quality
Ministry of Health and Social Development of the Republic of Kazakhstan
dated June 28, 2016
Protocol No. 6

Joint contracture- limitation of passive movements in a joint, that is, a condition in which a limb cannot be completely bent or straightened in one or more joints, caused by cicatricial tightening of the skin, tendons, diseases of the muscles, joints, pain reflex and other reasons.

Correlation of ICD-10 and ICD-9 codes: Appendix 1 to the CP.

Date of development of the protocol: 2016

Protocol users: general practitioners, pediatricians, pediatric traumatologists and orthopedists.

Level of evidence scale:

A	A high-quality meta-analysis, systematic review of RCTs, or large RCTs with a very low probability (++) of bias, the results of which can be generalized to an appropriate population.
IN	High-quality (++) systematic review of cohort or case-control studies or High-quality (++) cohort or case-control studies with very low risk of bias or RCTs with low (+) risk of bias, the results of which can be generalized to an appropriate population .
WITH	Cohort or case-control study or controlled trial without randomization with low risk of bias (+). Results that can be generalized to the relevant population or RCTs with very low or low risk of bias (++ or +) whose results cannot be directly generalized to the relevant population.
D	Case series or uncontrolled study or expert opinion.

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Classification

Classification

By anatomical location: contracture of the shoulder joint;

contracture of the elbow joint;

contracture of the wrist joint;

contracture of fingers;

contracture of the hip joint;

· contracture of the knee joint;

contracture of the ankle joint;

Contracture of the toes.

Functionally: adductor;

· diverting;

· flexion;

· extensor.

By level of damage:· arthrogenic;

· myogenic;

· dermatogenic;

Desmogenic.

Diagnostics (outpatient clinic)

OUTPATIENT DIAGNOSTICS

Diagnostic criteria:Complaints:

History:

Physical examination:

Laboratory research:· general blood analysis;

· general urine analysis;

· X-ray of the affected joint - in order to determine the measurement of the limits of the limitation, expressed in degree equivalent, the possible presence of angular deformation of the bones adjacent to the joint.

· Electromyography – to identify pathology in the muscular system.

· Computed tomography – to determine the spatial relationship in the affected joint.

· Magnetic resonance imaging – to identify intra-articular and extra-articular lesions of soft tissues.

· Scintigraphy – conducting a radioisotope study to identify the focus of bone tissue damage.

Diagnostic algorithm

Diagnostics (hospital)

DIAGNOSTICS AT THE INPATIENT LEVEL

Diagnostic criteria at the hospital level:Complaints:· to restrict movement in the affected joint.

History:

· trauma, burn or other trauma leading to the formation of cicatricial keloid contracture of the joint;

· closed or open damage to the periarticular muscles, the presence of a fracture at the joint level or osteoepiphysiolysis;

· purulent-inflammatory lesions of joints.

Physical examination: a measurement of the limits of a limitation, expressed in degrees.

Laboratory research:· general blood analysis;

· general urine analysis;

· examination of stool for helminth eggs.

Instrumental studies:· radiography of the affected joint - in order to determine the measurement of the limits of limitation, expressed in degree equivalent, the possible presence of angular deformation of the bones adjacent to the joint.

· electromyography – to identify pathology in the muscular system.

· computed tomography – to determine the spatial relationship in the affected joint.

· magnetic resonance imaging – to identify intra-articular and extra-articular lesions of soft tissues.

Joint contracture- persistent limitation of mobility in the joint.

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

• M24.5
• Q74.3

Classification. By origin: .. Congenital.. Acquired. By etiology: .. Arthrogenic - with pathology of the articular surfaces of the articulating bones, ligaments and joint capsule.. Painful (antalgic) - reflex limitation of movements in the joint with painful movements.. Dermatogenous - with extensive scar changes in the skin.. Desmogenous - with scar changes in the connective tissue formations (fascia, aponeuroses, etc.) .. Myogenic - with shortening of muscles as a result of injury, inflammatory or dystrophic processes.. Neurogenic - with disturbances of innervation.. Paralytic - with paralysis of a muscle or group of muscles.. Post-amputation contracture - a complication of amputation of a limb in the form of contracture of the joint closest to the stump; develops due to incorrect surgical technique or errors in postoperative management.. Professional - contracture due to chronic trauma or overstrain of certain muscle groups in connection with professional activities.. Psychogenic (hysterical) - neurogenic contracture during hysteria.. Reflex - contracture due to prolonged irritation of the nerve leading to to the emergence of a persistent reflex in the form of an increase in the tone of a muscle or muscle group.. Cicatricial - contracture with gross cicatricial changes in tissue.. Spastic - contracture with central paralysis (paresis).. Tendon (tendogenic) - contracture with shortening of the tendon.. Functional - adaptive ( compensatory) - a contracture that develops to compensate for an anatomical defect, for example, flexion contracture of the joints of one leg when the other is shortened. By nature: .. Extensor - contracture with limited flexion in the joint.. Flexion - contracture with limited extension in the joint.

Treatment

Treatment. Early and comprehensive. Treatment of the underlying disease. Exercise therapy, physiotherapy (electrophoresis with lidase, ronidase, phonophoresis with hydrocortisone, disodium salt of ethylenediaminetetraacetic acid), massage. For arthrogenic contractures - intra-articular hydraulic novocaine blockades. If conservative treatment fails, surgical treatment (arthrolysis, plastic surgery, etc.) is performed.

Prevention— passive and active early therapeutic exercises for diseases leading to the formation of contractures.

ICD-10. M24.5 Joint contracture.

Application. Arthrogryposis— congenital multiple contractures due to underdevelopment of the muscles of the limbs. There are several genetic varieties, in particular autosomal dominant forms (*108110; 108120 - arthrogryposis multiple congenital, distal, type 1; 108130; 108140; 108145; 108200), autosomal recessive (*208080; 208081; 2081 00;208110;208150; 208200) and X - linked (*301820; 301830 - multiple congenital arthrogryposis, distal) “Congenital amyoplasia “Congenital arthromyodysplasia. ICD-10. Q74.3 Congenital arthrogryposis multiplex