The ankylosis is the functional limitation in a joint due to morphological alterations. The origin of the changes in joint architecture has to do with anatomical alterations, as well as inflammatory processes or trauma. The term comes from the Greek word anchylosis , which means link or tie.
The joint is a structure that allows the union of two bones through a joint capsule, ligaments and cartilaginous components. The articular surfaces of the bones are covered by the synovial membrane, whose function is to protect it and produce synovial fluid.
The union of bone structures fulfills certain functions, both protection and mobility. In ankylosis there are changes in the structures of mobile joints, reducing or preventing their normal movement.
The main symptoms of ankylosis are stiffness or functional limitation, in addition to inflammation and localized pain. This condition can involve all structures related to mobility – such as muscles and tendons – as well as the ligaments within the joint.
There are multiple causes that cause this disorder, both congenital diseases and inflammatory, infectious processes or degeneration of joint components. Injuries to limbs – which include joints – can affect their function and mobility. These are related to work and sports activity.
There is also a form of spontaneous ankylosis whose origin is undetermined. It is called idiopathic ankylosis, the cause of which is not clear. The importance of ankylosis is in the impact it has on the life, independence and productivity of the person presenting it.
Because this disorder is potentially disabling, prompt and timely medical intervention is necessary. The treatment -both pharmacological and surgical- provides the opportunity to recover joint movements. Physiotherapy is a conservative treatment alternative that can be very beneficial.
The symptoms of ankylosis are related to joint dysfunction, the structures of which limit or impede normal mobility. The cardinal symptom is stiffness, which causes functional limitation and disability.
Functional limitation or stiffness
When it comes to the partial or total loss of function of a mobile joint. This implies the loss of the joint range of motion. The consequence is the inability of the patient to perform specific functions related to the affected joint.
Intra-articular inflammatory processes are both causes and consequences of ankylosis. They tend to be processes that evolve progressively, affecting joint structures.
It is a symptom that requires no description. The pain occurs due to progressive joint stiffness, especially with mobilization. Furthermore, as a consequence of the ankylosing process, inflammatory mediators are released that stimulate pain receptors in joint structures.
In the case of ankylosing spondylitis – a condition that causes immobility of the spine – the pain is usually located in the lumbar region. This symptom contributes to the loss of mobility and disability characteristic of the condition.
The cause of some rheumatic diseases – such as arthritis and spondylitis – may be accompanied by other symptoms, including cardiovascular or gastrointestinal involvement.
Fever is usually associated with infectious arthritis. The weakness occurs due to muscle atrophy and present functional limitation. The disability and limitation of physical activity is also the cause of symptoms of anxiety, stress and even depression.
Ankylosis has several classifications -or types- taking into account the characteristics of this disorder. These types depend on the structures involved, location, evolution and laterality.
Ankylosis can affect both the extra-articular and intra-articular structures. A true ankylosis is generally considered when it involves two bones that have joined together within the joint, termed bone ankylosis.
On the other hand, when the symptoms attend to inflammation or fibrosis of the soft tissues, it is called fibrous ankylosis, or false ankylosis.
-According to the region involved
Refers to the specific joint that is affected:
– Spinal column, as in spondylitis.
– Temporo-mandibular joint, one of the most frequent.
– Cervical spine.
-According to evolution
When it comes to a progressive and irreversible ankylosis. It is very common that both bone and fibrous ankylosis lead to permanent disability.
They occur due to extra-articular and reversible conditions, including:
– Synovitis and accumulation of synovial fluid.
– Joint or periarticular fibrosis.
– Myositis or inflammation of the muscles related to the joint.
– Tendinitis or fasciitis.
– Presence of intra-articular foreign bodies.
With the exception of enpondylitis or ankylosis of the spine, the condition can be unilateral or bilateral.
All conditions that affect a joint can lead to the development of immobility typical of ankylosis. The most common causes include inflammatory and degenerative processes, birth defects, trauma, and infections. Some authors also mention a spontaneous or idiopathic clinical form.
This is due to the development of rheumatic-type disorders, which involve both a genetic factor and immunological mechanisms. Both rheumatoid arthritis and ankylosing spondylitis are included in this group.
In the first place, some alterations of the articular structures or defects that lead to ankylosis at birth can be observed. These are defects that can be disabling from the beginning of life when it is not possible to solve them.
Ankylosis secondary to trauma can cause from local joint inflammation to the entry of foreign bodies into the joint. Sometimes direct joint trauma produces hemarthrosis – intra-articular hemorrhage – which, if not resolved, can cause local disability.
This cause can affect both bones and joint soft tissues, that is, tendons, muscles or ligaments. Joint trauma frequently due to work and sports activities. The evolution of the injury depends on the magnitude of the trauma and how quickly the injury is treated.
The most common degenerative process is osteoarthrosis, which consists of wear and tear of the articular cartilage. Consequently, the bone surfaces within the joint impact and produce wear and tear and functional limitation. It is a more common process in women and affects weight-bearing joints, such as the knees and hips.
The invasion of germs – especially bacteria – into the joint space can produce local inflammation and trigger permanent immobility due to fibrosis.
The most common infections are secondary to penetrating joint trauma, or systemic infections such as tuberculosis.
Osteolmyelitis – a bone infection – is capable of destroying the bone and, consequently, affecting the joint.
-Spontaneous or idiopathic ankylosis
It corresponds to a joint defect whose cause is unknown. The pattern of appearance and evolution of ankylosis is different from those studied, however, the presence of this condition attends more to a specific cause than to a natural predisposition to suffer it.
The treatment of ankylosis has the purpose of both improving the symptoms and correcting the cause that originated it. The spectrum of treatment includes the use of analgesics, antirheumatic drugs or steroids, even requiring surgery and physical therapy.
At the beginning – when there is pain – therapy is aimed at the use of anti-inflammatory and analgesic drugs to improve symptoms. The most common medications include steroids, in addition to non-steroidal anti-inflammatory pain relievers (NSAIDs).
The steroids used -such as betamethasone- have the property of acting as anti-inflammatories and, in addition, as immunosuppressants. They can be administered both orally and injected. The most commonly used parenteral steroids are depot or long-acting steroids.
NSAIDs – such as diclofenac, ketoprofen, or ibuprofen – provide pain relief while acting as anti-inflammation agents.
Ankylosing spondylitis is an inflammatory and progressive condition. NSAIDs, steroids, immunosuppressants, and interleukin inhibitors are commonly used for its treatment.
Other medications include the use of specific drugs to treat specific conditions such as arthritis. Methotrexate, biological therapy -antiTNF- or diascerin are used in arthritis and osteoarthritis.
Even the preventive treatment of osteoarthropathies includes the use of combinations of chondroitin sulfate and glucosamine.
It consists of a series of exercises, directed by physiatrists and physiotherapists, with the aim of improving joint mobility and providing relief from symptoms.
The indication of physiotherapy as a treatment is done when the exercises are useful and do not worsen the pre-existing condition. Physiotherapy is a conservative treatment alternative that can be beneficial for the patient.
The use of surgical interventions is indicated when other therapeutic alternatives have failed. The main objective is the repair of damaged structures and joint release.
Surgery can be open or laparoscopic, less invasive than the first.
Finally, the repercussion that ankylosis has on the performance of physical activities makes its timely diagnosis necessary. The establishment of an adequate treatment provides symptomatic relief and, consequently, eliminates or reduces the disability of the affected person.
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