traumatology

Ankylosis: What is it? Causes, Associated Symptoms, Diagnosis and Therapy of A.Griguolo

Generality

Ankylosis is rigidity, understood as a loss of mobility, which afflicts the mobile or semi-mobile joints, when they are victims of damage or there is a fusion between their bone components.

The ankylosis recognizes its main causes in the articular traumas and in the various forms of existing arthritis.

The ankylosis may be partial or complete, depending on whether the present joint stiffness allows the movement of the affected joint to still or not.

Ankylosis is often associated with other symptoms; the ankylosed joints tend, in fact, to be also painful, swollen, noisy, hot to the touch and reddened at the level of the skin that covers them.

The presence of an ankylosis requires the use of a causal therapy, that is a therapy aimed at eliminating / correcting the triggering factor. All this makes it essential, during the diagnosis phase, to identify the condition from which the ankylosis originated. The ankylosis recognizes its main causes in the articular traumas and in the various forms of existing arthritis.

The ankylosis may be partial or complete, depending on whether the present joint stiffness allows the movement of the affected joint to still or not.

Ankylosis is often associated with other symptoms; the ankylosed joints tend, in fact, to be also painful, swollen, noisy, hot to the touch and reddened at the level of the skin that covers them.

The presence of an ankylosis requires the use of a causal therapy, that is a therapy aimed at eliminating / correcting the triggering factor. All this makes it essential, during the diagnosis phase, to identify the condition from which the ankylosis originated.

What is ankylosis?

Ankylosis is the medical term indicating the partial or total rigidity that a normally mobile or semi-mobile joint develops, after damage to it or after the fusion of its bone components.

To sum up, therefore, the key points of the concept of ankylosis are:

  • The ankylosis is a suffering of the movable or semi-mobile joints, which consists in the loss, by the involved articular structure, of its natural mobility;

    The loss of mobility, by a mobile or semi-mobile joint, is called rigidity;

  • The ankylosis can affect the mobility of a mobile or semi-mobile joint in a partial or complete manner;
  • The ankylosis is the consequence of joint damage or the fusion of the bony portions constituting the affected mobile or semi-mobile joint.

From the term "ankylosis" the words " ankylosed " and " ankylosing " derive.

Short review of the Joints

To fully understand what is happening in the ankylosis, it is necessary to review what the joints are, reminding the readers to focus attention on the mobile and semi-mobile joint elements:

  • Elements of the musculoskeletal system, the joints are anatomical structures, sometimes simple and sometimes complex, which indirectly connect two or more bones ;
  • In the human body, the approximately 360 joints present allow the skeleton to fulfill its functions, which are: support, mobility and protection of internal organs ;
  • According to the most classical anatomical view, there are 3 types of joints: the fibrous joints (or synarthrosis ), the cartilaginous joints (or amphiarthrosis ) and the synovial joints (or diarthrosis );
  • Fibrous joints, or synarthrosis, are joints without mobility, in which the bones are held together by fibrous tissue.

    Typical examples of synarthrosis are the joints between the bones of the skull;

  • The cartilaginous joints, or amphiarthrosis, are semi-movable joints, in which the bones are connected together by cartilages and, sometimes, by ligaments.

    Classic examples of amphiarthrosis are the joints that connect the various vertebrae of the spine between them;

  • The synovial joints, or diarthrosis, are extremely mobile joints, consisting of various components, including: the joint capsule, the articular surfaces and the cartilage that covers them, the synovial membrane, the synovial bags and a series of ligaments.

    Typical examples of diarthrosis are the shoulder joint, the knee, the hip, the elbow, the ankle, the wrist and the joint between the phalanges of the fingers and toes.

Types

This section is devoted to the explanation of the concepts: partial ankylosis, complete ankylosis, false ankylosis and true ankylosis .

Partial ankylosis

With the expression "partial ankylosis", doctors mean a non-total joint stiffness; therefore, a mobile or semi-mobile joint victim of partial ankylosis is a joint that has lost only part of its mobility.

In general, partial ankyloses characterize the conditions in which there was a structural alteration of the articular components (eg, rupture of a ligament or degeneration of articular cartilage).

Ankylosis Complete

With the term "complete ankylosis", doctors refer to total joint stiffness; therefore, a mobile or semi-mobile joint subject to total ankylosis is a joint that completely loses its ability to move.

As a rule, complete ankyloses characterize the conditions in which there was a fusion of the bony portions constituting the affected joint.

When the portions of two bones involved in a joint merge together, generating ankylosis, it is as if these two bones become one element.

Ankylosis Fake

The medical expression "false ankylosis" describes an articular rigidity resulting from a suffering of the muscles or tendons that have relations with the ankylosed joint and which, under normal conditions, guarantee the correct movement.

In false ankylosis, therefore, the problem is not inherent in the rigid articulation, but in those neighboring anatomical elements that improve mobility.

Ankylosis Vera

The medical expression "true ankylosis" describes an articular stiffness due to a suffering of one or more components of the ankylosed joint.

In real ankylosis, therefore, the problem is internal to the stiff joint, ie it can relate to ligaments, joint capsule, cartilages, synovial bags, etc.

Causes

The phenomenon of ankylosis recognizes various causes; in fact, the result can be:

  • A joint trauma . A trauma of a certain entity to a joint can damage more or less deeply:
    • The bone surfaces that interact with each other, to form the affected joint (eg: in the knee, these surfaces are the lower portion of the femur, the upper portion of the tibia and the posterior portion of the patella);
    • The ligaments that serve to guarantee stability to the joint involved (eg: in the knee, a fundamental ligament to joint stability is the anterior cruciate ligament);
    • When present, the cartilage that covers the bony surfaces joined to form the affected joint (eg: in the knee, this cartilage consists of the medial meniscus and lateral meniscus);
    • The muscles or tendons connected to the suffering joint and having the task of favoring their movement and stability (eg: in the knee, a quadriceps femoris is a fundamental muscle for the movement and stability of the joint, while a tendon with an analogous role is the so-called patellar tendon).

Joint traumas capable of causing ankylosis are usually those following fractures, sprains or dislocations .

  • A form of arthritis . The word "arthritis" indicates any condition of an inflammatory nature affecting one or more mobile or semi-mobile joints.

    Arthritis can be the consequence of:

    • A combination of factors (eg, advanced age, associated with obesity and a history of joint injuries);
    • An autoimmune reaction (ie some elements of the immune system attack the tissues of the joints);
    • An infection (eg: chlamydia, salmonella, smallpox, etc.);
    • Unidentifiable causes .

There are many forms of arthritis; among these, the best known and those most associated with ankylosis are: arthrosis (or osteoarthritis ), rheumatoid arthritis, gout and ankylosing spondylitis .

  • Conditions of various kinds, including, for example, Paget's disease, achondroplasia, osteochondritis, hemophilia and amyotrophic lateral sclerosis.

This group of causes of ankylosis includes hereditary diseases, hereditary conditions that require certain environmental factors to reveal themselves, neurodegenerative diseases, autoimmune diseases and infections.

Favoring factors of the ankylosis

Ankylosis is more frequent among:

  • The elderly . Advanced age is associated with osteoarthritis and rheumatoid arthritis, two of the main causes of ankylosis in the general population;
  • Sedentary people or forced, despite themselves, to prolonged periods of immobility . Poor use of the joints favors certain forms of arthritis (eg arthrosis) and weakens the muscles that guarantee efficient joint mobility (false ankylosis);
  • Individuals who practice jobs or hobbies (eg sports) where the risk of joint trauma is high . Joint traumas are the primary cause of ankylosis;
  • Subjects with a genetic predisposition to arthritis or diseases, such as Paget's disease;
  • People with genetic diseases associated with joint problems, such as, for example, haemophilia.

Symptoms and Complications

Ankylosis is often associated with other symptoms; in fact, in fact, an articulation affected by ankylosis is also: painful, swollen, warm to the touch, reddened at the level of the skin that covers it and noisy at the attempted movement (it emits crunches and crackles).

Symptoms typically associated with ankylosis:

Ache

Swelling

Skin redness

Heat

Crunching emission

Most common areas of ankylosis

Any mobile or semi-mobile joint can suffer from ankylosis.

However, it is a fact that, in the human body, there are mobile or semi-mobile joints more prone to the ankylosing phenomenon; between the articulations in question, they include:

  • The knee;
  • The elbow;
  • Ankle;
  • Shoulder;
  • The joints between the phalanges of the fingers of the hand;
  • The joints that connect the adjacent vertebrae of the spine;
  • The temporomandibular joint.

An explanation of the predisposition of the aforementioned joints to the phenomenon of ankylosis is to be found in the position and frequency of use.

Complications

The ankylosis, especially when it involves the fusion of the bony surfaces that form a joint, can drastically limit or completely prevent the movements of the joint element involved, significantly affecting the quality of life of the patient.

Did you know that ...

One of the most known ankyloses due to the fusion of the articular surfaces is that deriving from ankylosing spondylitis, a form of chronic arthritis that affects the joints of the spine.

Diagnosis

Diagnosis of ankylosis results from the patient's telling of symptoms to the doctor during a classic physical examination .

Once the presence of ankylosis has been established, the next step is to understand the causes of stiffness and establish its severity; to trace the causes and establish the severity of an ankylosis phenomenon, a thorough medical history, imaging test (eg: MRI or X-ray) is needed and, if clinical history reveals the possibility of a genetic or infectious cause, DNA tests and blood tests .

Therapy

The treatment of ankylosis is based on the care of the triggering cause ; only by eliminating / correcting the causal factor, in fact, is it possible to resolve joint stiffness and restore normal mobility of the affected joint.

However, readers should be reminded that this therapeutic approach is not always feasible : when the cause of the ankylosis is an incurable or treatable condition only in the symptoms, it is impossible to re-establish the movement capacities of the affected joint.

Useful treatments for ankylosis

Among the treatments useful for the therapeutic management of ankylosis, there are conservative remedies, such as rest, application of ice and physiotherapy, and surgical remedies, such as interventions for the reconstruction of injured ligaments, procedures for restoration of damaged cartilage, operations for the separation of fused bone surfaces against nature and interventions for the reconstruction of injured tendons.

Prognosis

The prognosis in the presence of ankylosis depends on the treatability of the triggering cause: if the causal factor is curable until complete recovery, the ankylosis is a solvable problem with excellent results; if instead the causal factor is not treatable or treatable only in the symptoms, the ankylosis turns out to be a chronic disorder, with which the patient must live together.