4 Possible Causes & How To Treat a Bruise

Bruises are so common that you probably don’t think twice when you see a small black-and-blue mark on your shin or forearm. A bruise is a sign that you’ve been injured, but it’s usually not the sign of a serious injury.

To get a bruise, you have to be hit by something or you have to run into something. When this happens, small blood vessels are broken and bleed. Because there’s no cut in the skin above them, your red blood cells are trapped under the skin after your tiny blood vessels carrying them have burst open. So the blood pools at the site of the injury, leaving a mark for a while.

A bruise doesn’t just discolor the skin. It can be painful, too. And there’s likely to be swelling at the site where you’ve been hurt.

How Bruises Change

The pooled blood beneath your skin looks different as time passes, from the moment you get hurt to when you’re fully healed.

At first, a bruise is a reddish color, just like the blood beneath the surface.

After a day or two, the as the oxygen from the blood cells is resorbed, and the color of the bruise changes to purple, blue or black. This is why many people call bruises “black-and-blue marks.” The sore spot may stay this shade for up to a week.

After the black-and-blue phase, the bruise begins to fade. It turns green or yellow from the breakdown of hemoglobin, which carries oxygen in your red blood cells. A few days later, it turns brownish yellow or light brown.

In about 2 weeks, the bruise should be fully healed, and the skin should appear normal again.

Go see your doctor if you start to have a lot of bruises and you don’t remember getting hurt.

How People Get Bruises

Many things increase your chances of bruising:

Being active. Children who are learning how to run, ride a bike or play a sport may bruise if they fall down or crash into things.

If you play contact sports, you’re likely to get bruises. Boxers may get black eyes. Soccer players may get bruised shins. Football players may get bruises on their arms and legs. You can also get bruised if someone hits or kicks you.

As you get older, you may be more likely to fall when you lose your balance or trip over something.

Taking medicine. Certain types of drugs can make you more likely to bruise:

• Blood thinners. If you start taking a blood thinner or another drug (like aspirin) that makes it harder for your blood to clot, you may get more bruises than you’ve had in the past. This is because every time you bump into something, if you happen to break any small blood vessels beneath your skin, it will take much longer for your blood to clot, so a fair amount of blood will pool at the site of your bump.
• Corticosteroids (steroids). These drugs can cause your skin to thin, so there’s less buffer between anything that you bump into and the small blood vessels beneath your skin. They’re more likely to break and bleed when they have less protection.

Aging. Older people are more prone to bruising than younger people. This is because the blood vessels beneath the skin are more fragile and more likely to break as someone ages.

Also, your skin thins as you get older, so there isn’t as much fat beneath the skin. That layer of fat you had when you were younger helped cushion the blood vessels from blows. That’s why the same sort of contact that causes a bruise today didn’t leave a mark on you years ago.

Having a health condition. Some diseases can make you more likely to bruise:

• Blood-clotting disorder. If you have a blood clotting disorder such as hemophilia, you’re more likely to bruise than someone without the condition. If your blood takes a long time to clot, then more blood will pool at the site of the injury.
• Blood disease. A blood disease can also lead to more bruising than normal. People who have certain forms of leukemia bruise easily if their platelets are low, even when they barely bump into something. Low platelets are also seen in cirrhosis and can cause increased bruising. In severe renal disease, platelets don’t function normally (called uremia) and you can also see increased bruising.

Do You Bruise Easily? When to Get It Checked Out – Cleveland Clinic

You’re undressing or showering and discover a bruise on your leg or arm. Baffled, you wonder: “Where did that come from? I don’t remember bumping into anything.”

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You may never pinpoint the source. The bruise eventually disappears, along with your concern. But bruising shouldn’t always be dismissed so easily, says hematologist Dana Angelini, MD.

“It’s common to bump into things, not remember, and see small bruises on your legs or arms,” she says. “However, unprovoked bruises on your torso, back or face are unusual. And that’s a reason to get them checked out.”

Here’s what you should know about bruising.

How bruises develop

You may get a bruise from a bump or injury to the skin or the tissues beneath the skin. Since the skin isn’t cut or broken, you won’t see external bleeding. But damage to blood vessels below the skin causes them to rupture and leak blood.

Blood pooling and clotting beneath the surface causes skin discoloration. At first, the skin is often red or purplish. As the bruise heals, it may turn brown, green or yellow. The area often is swollen, tender or painful.

Why do I bruise so easily?

Minor accidents — running into furniture, falling, dropping something on your leg, hand or foot — are the most common cause of bruising.

Some over-the-counter medicines such as aspirin, non-steroidal anti-inflammatory drugs (like ibuprofen), Plavix® (clopidogrel) and blood thinners (like Coumadin®) can increase your tendency to bruise. So can prescription medicines, such as certain antidepressants.

“Even over-the-counter supplements such as garlic, ginkgo, ginseng and fish oil can inhibit normal platelet function and cause bruising,” Dr. Angelini says.

Age is another factor. Older adults may bruise more easily than younger people. Their thinning skin often has less fat underneath to cushion the blood vessels.

Other possible causes of bruising include:

When bruising is cause for concern

Bruises due to minor injuries or accidents usually disappear on their own after a week or two. During the healing process, the bruise will change color before fading away. But it’s a good idea to get a bruise checked out by your doctor if it:

• Shows no signs of improvement after a week.
• Is located on a part of your body where injury or accident is unlikely.
• Keeps occurring or comes back.
• Is unusually large and unprovoked.

During an office visit, your doctor will review your family and personal medical history. You’ll answer questions like:

• Do any family members have an inherited blood disorder?
• Have you been bleeding from your nose or oral cavity?
• Have any surgeries resulted in above-average bleeding?
• Which medications and supplements do you take; have you recently started new ones?
• If you’re a woman, has your menstrual flow been heavier?
• Have you had other blood loss, such as in the urine or stool?
• Have you ever had bleeding in unusual locations, like the joints, muscles or brain?

If your doctor decides medication is probably causing your bruising, he or she will discuss other options. “We’ll do a risk-benefit analysis,” Dr. Angelini says. “If life is going well, we might opt to keep you on the drug if it’s helping you control another disease. If the bruising is severe or interfering with your daily life, we’ll talk to the prescriber about replacing it with another medication.”

When the cause of bruising is unclear, your doctor will likely order blood work to check for platelet problems or other blood clotting abnormalities.

But don’t hesitate to ask your doctor for help. “We do a lot of consultations for bruising. When a serious bleeding disorder is ruled out, we’re happy to provide reassurance,” she says.

Bone bruise – Physiopedia

A bone bruise is a type of bone injury.

• Other examples of bone injuries include stress fractures, osteochondral fractures and a variety of different patterns of bone fractures._^[1]
• A bone bruise is characterised by three different kinds of bone injuries including: sub-periosteal hematoma, inter-osseous bruising and a sub-chondral lesion, or a combination of these. _^[2]
• A bone bruise is differentiated from the alternative fracture types in that only some of the trabeculae are broken._^[3]

Clinically Relevant Physiology[edit | edit source]

Bone tissue is a specialised form of connective tissue that is made up of an organic matrix (collagen and glycosaminoglycans) and inorganic minerals (calcium and phosphate). _^[4] An adult human skeleton contains 80% cortical bone and 20% trabecular bone. Both types of bone are composed of osteons. Cortical bone is the solid type of bone and trabecular bone resembles honeycomb which is comprised of a network of trabecular plates and rods. Read more about the histology and physiology of bone here.

The most common cause of bone bruise is trauma however the condition can also be associated with normal stress loading and haemophilia A and B._^[5]

The most commonly affected area is the lower limb. _^[6]

Patients with a bone bruise tend to have protracted clinical recovery, with more effusion and a slower return of motion. _^[1]

In patients with ACL rupture there is an 80% probability of concurrent associated bone bruising at the femoral condyle or tibial plateau._^[1][4] According to Boks et al. 2007, the presence of bone bruising in these zones is the most important secondary sign in the diagnosis of ACL injury.

MRI with white arrow indicating presence of bone bruising in the (a) post-lateral talus area and (b) the caudal tibia epiphysis.

For the all bone injuries, incidence rates tend to be higher amongst professional athletes and those that run and jump frequently on hard surfaces, for example football and basketball players. _^[1][2]

Although an x-ray should identify whether or not there is a bone fracture, a bone bruise is not able to be diagnosed using x-ray imaging. The current “gold standard” diagnostic imaging method for bone bruises is the MRI, in particular T2-weighted fat-suppressed images or T1-weighted imaging._^[4]

^[1][2][7]

Physical Therapy Management[edit | edit source]

The treatment of a bone bruise consists of RICE, pain relief and/or anti-inflammatories as prescribed by a medical practitioner and load restriction dependant on the circumstances of the injury. _^[8] The time for the resolution of a bone bruise is variable. Literature suggests that the healing time to completely resolve this injury can take anywhere between three weeks to up to two years after the trauma._^[1][2]

1. ↑ ^{1.01.11.21.31.41.5} V. Mandalia, A.J.B. Fogg, R. Chari, J. Murray, A. Beale, J.H.L. Henson. Bone bruising of the knee. Clinical Radiology 2005; 60, 627–636 Grades of recommendation:A
2. ↑ ^2.02.12.22.3 V. Mandalia, J.H.L. Henson. Traumatic bone bruising – A review article, European Journal of Radiology 2008; 67; 54–61 Grades of recommendation A
3. ↑ Janice Polandit, 5 Things You Need to Know About a Bone Bruise, 2011; http://www. livestrong.com/article/5521-need-bone-bruise/ Grades of recommendation F
4. ↑ ^4.04.14.2 L.C. Jungueira and J. Carneiro, “Functional Histology” 2010; 167
5. ↑ Prof. Dr. S. Van Creveld and Dr. M. Kingma Subperiostal haemorrhage in haemophilia A and B. Ned. T. Geneesk. 105. I. 22. 1961; 1095-1098 Grades of recommendation F
6. ↑ Christoph Rangger, Anton Kathrein, Martin C Freund, et al. Bone Bruise of the Knee. Acta Orthop Scand 1998; 69(3) : 291-294. Grades of recommendation B
7. ↑ Simone S. Boks, Dammis Vroegindeweij, Bart W. Koes, et al. MRI Follow-Up of posttraumatic Bone Bruises of the knee in General Practice. AJR 2007; 189:556–562 Grades of recommendation B
8. ↑ The Basics of Bone Bruises; Grades of recommendation F
   http://bruises.knowingfirstaid.com/permalink.php?article=Bone%20Bruises.txt

Contusions in Adults (Inpatient Care)

1. CareNotes
2. Contusions in Adults
3. Inpatient Care

This material must not be used for commercial purposes, or in any hospital or medical facility. Failure to comply may result in legal action.

WHAT YOU SHOULD KNOW:

Contusions (bruises) may appear as black and blue marks on your skin after an injury. A bruise happens when your blood vessels tear, but your skin does not. When blood vessels tear, blood leaks into nearby tissue, such as soft tissue or muscle.

CARE AGREEMENT:

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

RISKS:

• You may cause tissue damage if you leave ice on a bruise for longer than 20 minutes at a time. Some bruises may scar your muscles. Scar tissue may make you more likely to get bruises in the future. Certain types of bone bruises may lead to osteoarthritis. Osteoarthritis affects joints, such as the knees and shoulders, and can cause stiffness and pain. You may have a hematoma (swelling filled with blood) that does not get smaller, and need surgery to drain it. You may get a hernia if you get a tear in the thin layer of tissue that covers the muscle. A hernia happens when muscle and fatty tissue push through the tear.
• Bony deposits may form within your muscles. You may also develop compartment syndrome. Compartment syndrome occurs when a hematoma or swelling at the injured site presses on nearby tissue. Muscles and blood vessels may be damaged. You may need surgery to relieve the pressure caused by swelling. If you do not get treatment for your bruise, it may not heal well. Treatment may decrease your pain, prevent further injury, such as muscle scarring, and help your bruise heal faster. Talk with your caregiver about questions or concerns that you have about your bruise, treatment, or medicines.

WHILE YOU ARE HERE:

Informed consent:

A consent form is a legal document that explains the tests, treatments, or procedures that you may need. Informed consent means you understand what will be done and can make decisions about what you want. You give your permission when you sign the consent form. You can have someone sign this form for you if you are not able to sign it. You have the right to understand your medical care in words you know. Before you sign the consent form, understand the risks and benefits of what will be done. Make sure all your questions are answered.

Medicines:

• Pain medicine: You may be given medicine to decrease or take away pain. Do not wait until the pain is severe before you take your medicine.
• Steroid medicine: Steroid medicine may be given to decrease redness, pain, and swelling.

Tests:

• Blood tests: You may need blood taken to give caregivers information about how your body is working. The blood may be taken from your hand, arm, or IV.
• Imaging tests:
  • Magnetic resonance imaging: This test is also called an MRI. During an MRI, magnetic waves take pictures inside your body. An MRI can show damage to your bones, muscles, blood vessels, and other tissues. It can show if a hematoma has started to form. You may be given contrast (dye) in your vein to show the problem. You need to lie still during an MRI. Never enter the MRI room with any metal objects. This can cause serious injury.
  • Ultrasound: This test uses sound waves to see the bruise and how deep it is. It can show if any of your organs, such as your liver, are injured.
  • X-ray: An x-ray is a picture of a body part that shows any broken bones near the bruise.

Treatments:

Treatment depends on what tissues and organs in your body are injured, and how serious your injury is. You may need any of the following treatments:

• Physical therapy: You may need to see a physical therapist to teach you special exercises. These exercises help improve movement and decrease pain. Physical therapy can also help improve strength and decrease your risk for loss of function.
• Surgery: Caregivers may do surgery to drain blood from a hematoma that is very large or is not getting smaller. Surgery may also repair a tear in the muscle or relieve pressure in the muscle caused by swelling.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

Learn more about Contusions in Adults (Inpatient Care)

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Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Medical Disclaimer

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How to get rid of bruises

Most bruises happen when you sustain an injury that fails to break the skin, but crushes the small blood vessels underneath. Blood then leaks and becomes trapped under the surface, leaving the telltale mark.

How does toothpaste get rid of bruises?

There’s little evidence it does. Search online and you’ll find this tip listed as a “hack” for helping bruises disappear, which may be related to other advice recommending peppermint oil for the same purpose. But dermatologists say peppermint oil could irritate the skin, and toothpaste may have even more potentially skin-irritating ingredients. If you really want to put something soothing on the bruised skin, you may be better off trying aloe vera, though it won’t get rid of a bruise.

How long do bruises take to heal?

Most bruises will heal within a week.

How to get rid of bruises overnight

Unless you put make-up or concealer on the bruise to cover it up, there isn’t much that can be done. Putting ice on a bruise can help minimize swelling.

What is easy bruising a sign of?

“Easy bruising” refers to bruising that appears without an injury, or bruising from minor trauma that wouldn’t have caused bruising in the past.

Possible causes of easy bruising include taking blood thinners and steroids. The effects of chemotherapy can also lead to easy bruising. Aging is another factor, because blood vessels become more fragile as people get older.

Easy bruising might be a sign that a person isn’t getting enough vitamin K, found in leafy green vegetables, broccoli, and Brussels sprouts, in the diet. In rare cases, easy bruising can be a sign of blood, bone marrow or lymph node cancers. Liver disease could also be a factor.

What if a bruise doesn’t go away?

See a doctor if you have a bruise that lasts longer than two weeks without changing. It may not be a bruise at all or it may be caused by an underlying problem. Tell your physician if you have recurrent bruises without any clear causes.

A bruise accompanied by significant pain and swelling also warrants medical attention. That could represent a larger bleed under the skin, especially if you’ve had a significant fall or injury.

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TBI, Traumatic brain injury | Cincinnati, OH Mayfield Brain & Spine

Overview

Traumatic brain injury (TBI) is sudden damage to the brain caused by a blow or jolt to the head. Common causes include car or motorcycle crashes, falls, sports injuries, and assaults. Injuries can range from mild concussions to severe permanent brain damage. While treatment for mild TBI may include rest and medication, severe TBI may require intensive care and life-saving surgery. Those who survive a brain injury can face lasting effects in their physical and mental abilities as well as emotions and personality. Most people who suffer moderate to severe TBI will need rehabilitation to recover and relearn skills.

What is a traumatic brain injury?

TBI is an injury to the brain caused by a blow or jolt to the head from blunt or penetrating trauma. The injury that occurs at the moment of impact is known as the primary injury. Primary injuries can involve a specific lobe of the brain or can involve the entire brain. Sometimes the skull may be fractured, but not always. During the impact of an accident, the brain crashes back and forth inside the skull causing bruising, bleeding, and tearing of nerve fibers (Fig. 1). Immediately after the accident the person may be confused, not remember what happened, have blurry vision and dizziness, or lose consciousness. At first the person may appear fine, but their condition can decline rapidly. After the initial impact occurs, the brain undergoes a delayed trauma – it swells – pushing itself against the skull and reducing the flow of oxygen-rich blood. This is called secondary injury, which is often more damaging than the primary injury.

Figure 1. During impact to the head, the soft brain crashes back and forth against the inside of the hard skull causing bruising, bleeding, and shearing of the brain.

Traumatic brain injuries are classified according to the severity and mechanism of injury:

• Mild: person is awake; eyes open. Symptoms can include confusion, disorientation, memory loss, headache, and brief loss of consciousness.
• Moderate: person is lethargic; eyes open to stimulation. Loss of consciousness lasting 20 minutes to 6 hours. Some brain swelling or bleeding causing sleepiness, but still arousable.
• Severe: person is unconscious; eyes do not open, even with stimulation. Loss of consciousness lasting more than 6 hours.

Types of traumatic brain injuries

• Concussion is a mild head injury that can cause a brief loss of consciousness and usually does not cause permanent brain injury.
• Contusion is a bruise to a specific area of the brain caused by an impact to the head; also called coup or contrecoup injuries. In coup injuries, the brain is injured directly under the area of impact, while in contrecoup injuries it is injured on the side opposite the impact.
• Diffuse axonal injury (DAI) is a shearing and stretching of the nerve cells at the cellular level. It occurs when the brain quickly moves back and forth inside the skull, tearing and damaging the nerve axons. Axons connect one nerve cell to another throughout the brain, like telephone wires. Widespread axonal injury disrupts the brain’s normal transmission of information and can result in substantial changes in a person’s wakefulness.
• Traumatic Subarachnoid Hemorrhage (tSAH) is bleeding into the space that surrounds the brain. This space is normally filled with cerebrospinal fluid (CSF), which acts as a floating cushion to protect the brain. Traumatic SAH occurs when small arteries tear during the initial injury. The blood spreads over the surface of the brain causing widespread effects.
• Hematoma is a blood clot that forms when a blood vessel ruptures. Blood that escapes the normal bloodstream starts to thicken and clot. Clotting is the body’s natural way to stop the bleeding. A hematoma may be small or it may grow large and compress the brain. Symptoms vary depending on the location of the clot. A clot that forms between the skull and the dura lining of the brain is called an epidural hematoma. A clot that forms between the brain and the dura is called a subdural hematoma. A clot that forms deep within the brain tissue itself is called an intracerebral hematoma. Over time the body reabsorbs the clot. Sometimes surgery is performed to remove large clots.

Although described as individual injuries, a person who has suffered a TBI is more likely to have a combination of injuries, each of which may have a different level of severity. This makes answering questions like “what part of the brain is hurt?” difficult, as more than one area is usually involved.

Secondary brain injury occurs as a result of the body’s inflammatory response to the primary injury. Extra fluid and nutrients accumulate in an attempt to heal the injury. In other areas of the body, this is a good and expected result that helps the body heal. However, brain inflammation can be dangerous because the rigid skull limits the space available for the extra fluid and nutrients. Brain swelling increases pressure within the head, which
causes injury to parts of the brain that were not initially injured. The swelling happens gradually and can occur up to 5 days after the injury.

What are the symptoms?

Depending on the type and location of the injury, the person’s symptoms may include:

• Loss of consciousness
• Confusion and disorientation
• Memory loss / amnesia
• Fatigue
• Headaches
• Visual problems
• Poor attention / concentration
• Sleep disturbances
• Dizziness / loss of balance
• Irritability / emotional disturbances
• Feelings of depression
• Seizures
• Vomiting

Diffuse injuries (such as a concussion or diffuse axonal injury) will typically cause an overall decreased level of consciousness. Whereas, focal injuries (such as an ICH or a contusion) will have symptoms based on the brain area affected (Fig. 2).

Figure 2. The brain is composed of three parts: the brainstem, cerebellum, and cerebrum, which is divided into lobes. The table lists the lobes of the brain and their normal functions as well as problems that may occur when injured. While an injury may occur in a specific area, it is important to understand that the brain functions as a whole by interrelating its component parts.

Every patient is unique and some injuries can involve more than one area or a partial section, making it difficult to predict which specific symptoms the patient will experience.

What are the causes?

Common causes include falls, car or motorcycle crashes, vehicular accidents involving pedestrians, athletics, and assaults with or without a weapon.

Who is affected?

Approximately 1.5 to 2 million adults and children suffer a traumatic brain injury (TBI) each year in the United States. Most people who experience a head injury, about 1. 1 million, will have a mild injury that does not require an admission to the hospital. Another 235,000 individuals will be hospitalized with a moderate to severe head injury, and approximately 50,000 will die.

How is a diagnosis made?

When a person is brought to the emergency room with a head injury, doctors will learn as much as possible about his or her symptoms and how the injury occurred. The person’s condition is assessed quickly to determine the extent of injury.

The Glasgow Coma Score (GCS) is a 15-point test used to grade a patient’s level of consciousness. Doctors assess the patient’s ability to 1) open his or her eyes, 2) ability to respond appropriately to orientation questions, (“What is your name? What is the date today?”), and 3) ability to follow commands (“Hold up two fingers, or give a thumbs up”). If unconscious or unable to follow commands, his or her response to painful stimulation is checked. A number is taken from each category and added together to get the total GCS score. The score ranges from 3 to 15 and helps doctors classify an injury as mild, moderate, or severe. Mild TBI has a score of 13-15. Moderate TBI has a score of 9-12, and severe TBI has a score of 8 and below.

Diagnostic imaging tests will be performed:

Figure 3. CT scan shows a blood clot (hematoma) collecting under the bone (red arrows) and displacing brain (yellow arrow) to the other side of the skull.

• Computed Tomography (CT) is a noninvasive X-ray that provides detailed images of anatomical structures within the brain. A CT scan of the head is taken at the time of injury to quickly identify fractures, bleeding in the brain, blood clots (hematomas) and the extent of injury (Fig. 3). CT scans are used throughout recovery to evaluate the evolution of the injury and to help guide decision-making about the patient’s care.
• Magnetic Resonance Imaging (MRI) is a noninvasive test that uses a magnetic field and radiofrequency waves to give a detailed view of the soft tissues of the brain. A dye (contrast agent) may be injected into the patient’s bloodstream. MRI can detect subtle changes in the brain that cannot be seen on a CT scan.
• Magnetic Resonance Spectroscopy (MRS) gives information about the metabolism of the brain. The numbers generated from this scan provide a general prognosis about the patient’s ability to recover from the injury.

What treatments
are available?

Mild TBI usually requires rest and medication to relieve headache. Moderate to severe TBI require intensive care in a hospital. Bleeding and swelling in the brain can become an emergency that requires surgery. However, there are times when a patient does not require surgery and can be safely monitored by nurses and physicians in the neuroscience intensive care unit (NSICU).

The goals of treatment are to resuscitate and support the critically ill patient, minimize secondary brain injury and complications, and facilitate the patient’s transition to a recovery environment. Despite significant research, doctors only have measures to control brain swelling, but do not have a way to eliminate swelling from occurring.

Neurocritical care
Neurocritical care is the intensive care of patients who have suffered a life-threatening brain injury. Many patients with severe TBI are comatose or paralyzed; they also may have suffered injuries in other parts of the body. Their care is overseen by a neurointensivist, a specialty-trained physician who coordinates the patient’s complex neurological and medical care. Patients are monitored and awakened every hour for nursing assessments of their mental status or brain function.

Figure 4. In the NSICU, the patient is connected to numerous machines, tubes, and monitors. The monitoring equipment provides information about body functions and helps guide care. Some equipment may take over certain functions, such as breathing, nutrition, and urination, until the patient’s body is able to do these things on its own.

Seeing a patient who has suffered a severe TBI can be shocking. It is possible that your loved one’s appearance will be altered because of facial injury and equipment that is used for monitoring. Numerous tubes, lines, and equipment may be used to closely monitor his or her heart rate, blood pressure, and other critical body functions. (Fig. 4)

Figure 5. A brain oxygen and cerebral blood flow monitor is inserted into the brain tissue and secured to the skull with a bolt. A catheter is inserted into the ventricle of the brain to monitor intracranial pressure (ICP). If pressure is too high, the CSF fluid can be drained from the ventricles.

• Intracranial pressure (ICP) monitor. A catheter is placed through a small hole in the skull and positioned inside the ventricle (fluid-filled area deep within the brain) to measure pressure inside the head (Fig. 5). The ICP monitor allows the NSICU team to intervene quickly if the pressure becomes too high. Typical intracranial pressure is less than 20 mmHg. However, there are times when a higher number is safe and acceptable.
• Brain oxygen monitor (Licox). A catheter is placed through a small hole in the skull and positioned within the brain tissue. The Licox measures the oxygen level and temperature within the brain. Adjustments in the amount of oxygen given to the patient are often made to maximize the brain’s oxygen level. A cerebral blood flow monitor, called a Hemedex, is a newer monitor that is placed with the Licox and helps the NSICU team evaluate blood flow through the brain.
• Ventilator. Some patients may require a ventilator, a machine that helps them breathe. The ventilator is connected to the patient by the endotracheal tube, or ET tube. The tube is placed into the patient’s mouth and down into the trachea, or windpipe. The tube allows the machine to push air into and out of the lungs, thereby helping the patient breathe.
• Feeding tube. When patients are on a ventilator or have a decreased level of alertness, they may not be able to eat or get sufficient nutrition to meet their needs. A nasal-gastric feeding tube may be inserted through the patient’s nose and passed down the throat into the stomach. It delivers liquid nutrition as well as any medication that is required.
• Seizures and EEG monitoring. A seizure is an abnormal electrical discharge from the brain. Approximately 24% of patients who suffer a TBI will have a seizure that is undetected unless they are monitored by an electroencephalogram (EEG). Seizures that are not visible to the human eye are referred to as non-convulsive seizures. Because these seizures are serious, all patients with a severe TBI are monitored with continuous EEG for 24 to 72 hours after injury.

Medication

• Sedation and pain. After a head injury it may be necessary to keep the patient sedated with medications. These medications can be turned off quickly in order to awaken the patient and check their mental status. Because patients often have other injuries, pain medication is given to keep them comfortable.
• Controlling intracranial pressure. Hypertonic saline is a medication used to control pressure within the brain. It works by drawing the extra water out of the brain cells into the blood vessels and allowing the kidneys to filter it out of the blood.
• Preventing seizures. Patients who’ve had a moderate to severe traumatic brain injury are at higher risk of having seizures during the first week after their injury. Patients are given an anti-seizure medication (levetiracetam or phenytoin) to prevent seizures from occurring.
• Preventing infection. Although every attempt is made to prevent infection, the risk is always present. Any device placed within the patient has the potential to introduce a microbe. If an infection is suspected, a test will be sent to a laboratory for analysis. If an infection is present, it will be treated with antibiotics.

Surgery

Surgery is sometimes necessary to repair skull fractures, repair bleeding vessels, or remove large blood clots (hematomas). It is also performed to relieve extremely high intracranial pressure.

• Craniotomy involves cutting a hole in the skull to remove a bone flap so that the surgeon can access the brain. The surgeon then repairs the damage (e.g., skull fracture, bleeding vessel, remove large blood clots). The bone flap is replaced in its normal position and secured to the skull with plates and screws.

Figure 6. A large decompressive craniectomy is removed and the dura is opened to allow the brain to expand. Blood clots are removed and bleeding vessels are repaired. The bone flap is frozen and replaced about 6 weeks later.

• Decompressive craniectomy involves removing a large section of bone so that the brain can swell and
  expand. This is typically performed when extremely high intracranial pressure becomes life threatening. At that time the patient is taken to the operating room where a large portion of the skull is removed to give the brain more room to swell (Fig. 6). A special biologic tissue is placed on top of the exposed brain and the skin is closed. The bone flap is stored in a freezer. One to 3 months after the swelling has resolved and the patient has stabilized from the injury, the bone flap is replaced in another surgery, called cranioplasty.

Other surgical procedures may be performed to aid in the patient’s recovery:

• Tracheotomy involves making a small incision in the neck to insert the breathing tube directly into the windpipe. The ventilator will then be connected to this new location on the neck and the old tube is removed from the mouth.
• Percutaneous Endoscopic Gastrostomy Tube (PEG) is a feeding tube inserted directly into the stomach through the abdominal wall. A small camera is placed down the patient’s throat into the stomach to aid with the procedure and to ensure correct placement of the PEG tube (see Surgical Procedures for Accelerated Recovery).

Clinical trials

Clinical trials are research studies in which new treatments—drugs, diagnostics, procedures, and other therapies—are tested in people to see if they are safe and effective. Research is always being conducted to improve the standard of medical care. Information about current clinical trials, including eligibility, protocol, and locations, are found on the Web. Studies can be sponsored by the National Institutes of Health (see ClinicalTrials. gov) as well as private industry and pharmaceutical companies (see CenterWatch.com).

Recovery & prevention

The recovery process varies depending on the severity of the injury, but typically progresses through stages: coma, confusion / amnesia, and recovery.

• When a patient is in a coma, his or her eyes are closed and they show minimal reaction when spoken to or stimulated. Movements that may be seen at this time are basic reflexes or automatic responses to a stimulus. The brain wave activity in a comatose person is very different from that of a sleeping person.
• When a patient begins to awaken, the first natural response is that of bodily protection. Patients at this stage will move away from any stimulus or tend to pull at items attached to them in an attempt to remove anything that is uncomfortable or irritating. His or her eyes may be open more often, but they may not be aware of their behavior or be able to interact in a meaningful way. It is common for a patient to respond to each stimulus (hearing, seeing, or touching) in the same way. Responses may include increased rate of breathing, moaning, moving, sweating, or a rise in blood pressure.
• As the patient continues to wake up, their interactions may become more purposeful. They may look at a person and follow them around the room with their eyes, or follow simple commands such as “Hold up your thumb.” Patients tend to be confused and may have inappropriate or agitated behaviors.

Not all head injuries are the same. Patients recover at different rates and to varying degrees. It is difficult to determine at what point a patient will start understanding and interacting with their caregivers or family in a meaningful way. It is important to have patience; recovery from a brain injury can take weeks, months, or even years.

The Family’s Role
Many family members express feelings of helplessness when their loved one is in the NSICU. You are not alone. Please take care of yourself and use your energy wisely.

Visiting hours are limited in the NSICU. Too much stimulation can agitate the patient and raise his or her blood pressure. You can most effectively convey your concern by sitting quietly and holding your loved one’s hand. Be aware that the patient, though silent, may hear anything you say. Never speak as if the patient were not there.

As patients recover, they need help understanding what has happened to them during this “lost period of time.” Keep in mind that the recovery of consciousness is a gradual process – not just a matter of waking up. Progress is usually tracked in three areas: movement, thinking, and interacting. You can help by keeping a diary of their progress. Family photos may help with regaining memory.

Rehabilitation
Most patients are discharged from the hospital when their condition has stabilized and they no longer require intensive care. A social worker will work closely with the family as preparations are made for a return home or for transfer to a long-term care or rehabilitation center.

• A long-term acute care (LTAC) facility is a place for patients who have stabilized from their initial injury but who still require a ventilator or frequent nursing care. Many patients are discharged to an LTAC to continue being weaned from the ventilator. Once off the ventilator, they can be moved to a rehabilitation or skilled nursing facility.
• A rehabilitation facility is a place for patients who do not require a ventilator but who still require help with basic daily activities. Physical and occupational therapists work with patients to help them achieve their maximum potential for recovery. Rehab facilities are either Acute Inpatient Rehab that require patients to participate in 3 hours or more of rehab a day or a Skilled Nursing Facility (SNF) that provide 1-3 hours of rehab a day depending on what the patient can tolerate.

Recovering from a brain injury relies on the brain’s plasticity—the ability for undamaged areas of the brain to take over functions of the damaged areas. It also relies on regeneration and repair of nerve cells. And most importantly, on the patient’s hard work to relearn and compensate for lost abilities.

• A physical therapist helps patients rebuild and maintain strength, balance, and coordination. They can work with the patient in any facility.
• An occupational therapist helps patients to perform activities of daily living, such as dressing, feeding, bathing, toileting, and transferring themselves from one place to another. They also provide adaptive equipment if a patient has difficultly performing a task.
• A speech therapist helps patients by monitoring their ability to safely swallow food and helping with communication and cognition.
• A neuropsychologist helps patients relearn cognitive functions and develop compensation skills to cope with memory, thinking, and emotional needs.

Prevention

Tips to reduce the risk for a head injury:

• Always wear your helmet when riding a bicycle, motorcycle, skateboard, or all-terrain vehicle.
• Never drive under the influence of alcohol or drugs.
• Always wear your seat belt and ensure that children are secured in the appropriate child safety seats.
• Avoid falls in the home by keeping unsecured items off the floor, installing safety features such as non-slip mats in the bathtub, handrails on stairways, and keeping items off of stairs.
• Avoid falls by exercising to increase strength, balance, and coordination.
• Store firearms in a locked cabinet with bullets in a separate location.
• Wear protective headgear while playing sports.

Sources & links

If you have questions, please contact Mayfield Brain & Spine at 513-221-1100.

Support groups provide an opportunity for patients and their families to share experiences, receive support, and learn about advances in treatments and medications.

Sources

1. Brain Trauma Foundation: Guidelines for the Management of Severe Traumatic Brain Injury. J Neurotrauma 24 Suppl 1:S1-106, 2007
2. Johnson G. Traumatic Brain Injury Survival Guide, 2004. www.tbiguide.com

Links
Brain Injury Association of America, www.biausa.org
Brain Injury Association of Ohio, www.biaoh.org
Brain Trauma Foundation, www.braintrauma.org

Glossary

closed head injury: brain injury from an external impact that does not break the skull.

coma: a state of unconsciousness from which the person cannot be aroused; Glasgow Coma Scale score of 8 or less.

concussion: widespread injury to the brain caused by a hard blow or violent shaking, causing a sudden and temporary impairment of brain function, such as a short loss of consciousness or disturbance of vision and equilibrium.

contusion: a bruise to a specific area of the brain; caused by an impact and broken blood vessels.

diffuse axonal injury (DAI): injury to the nerve cell axons from rapid rotational or deceleration of the brain. DAI is often seen in motor vehicle accidents or shaking injuries. The nerve axons, which compose the white matter of the brain, are twisted or torn by shearing forces.

edema: tissue swelling caused by the accumulation of fluid.

hematoma: a blood clot.

hydrocephalus: an abnormal build-up of cerebrospinal fluid usually caused by a blockage of the ventricular system of the brain. Increased intracranial pressure can compress and damage brain tissue. Also called “water on the brain.”

intracranial pressure (ICP):pressure within the skull. Normal ICP is 20mm HG.

ischemia: a low oxygen state usually due to obstruction of the arterial blood supply or inadequate blood flow in the tissue.

open head injury: penetration of the skull pushing skull fragments or  objects (bullet) into the brain. 

ventricles: hollow areas in the center of the brain containing cerebrospinal fluid. There are four ventricles: two lateral ventricles (one on each side of the brain), the third ventricle, and the fourth ventricle.

updated > 7.2018
reviewed by > Michael Kachmann, MD, Mayfield Clinic, Cincinnati, Ohio

Mayfield Certified Health Info materials are written and developed by the Mayfield Clinic. We comply with the HONcode standard for trustworthy health information. This information is not intended to replace the medical advice of your health care provider.

Unexplained Bruising on Your Arms? It Might Be Actinic Purpura

You look down one day and notice some unexplained bruising on your arms. You vaguely remember bumping your arm, but it looks as if you had a major injury. What’s going on? It could be actinic purpura.

Known as actinic, senile, or solar purpura, this condition leaves flat, dark splotches or bruises on the skin. It looks like a bruise, but it takes weeks to go away.

How Do Bruises Develop?

Bruises develop for a reason — even if it’s a subtle one. An injury occurred that made the skin fragile, even if the impact went unnoticed. If you develop unexplained bruising on your arms or legs, something caused it — you touched or bumped against something that resulted in that bruise.

As we age, we bruise more easily due to skin fragility. Our skin becomes thinner and blood vessels become more fragile. Without the thickness of the skin to protect the blood vessels, the little bumps we experience cause the blood vessels to break and bleed more easily, resulting in bruises.

So, What Exactly 

Are Bruises?

Bruises show when a blood vessel breaks and leaks the blood it contains. Often, we don’t even notice when we bump against something. That injury causes a blood vessel to break, but the vessel clots almost immediately. We don’t see a bruise or experience a problem.

When we see a bruise, we typically broke a larger blood vessel that takes more time to clot. The blood runs out of the vessel into the tissue underneath the skin and pools between the skin tissue. Typically, there’s pressure and resistance within the skin that keeps the blood trapped in a smaller area. That pressure then works to help the blood coagulate, stop the bleeding, and patch the hole in the blood vessel. That pool of blood is what shows as a bruise.

The red blood cells and platelets that make up the bruise eventually get absorbed by the body. The body breaks them down and carries them away. When we’re left with a brown spot after the bruise has started to disappear, we’re seeing the iron that remains from the pooled blood. While the rest of the cell is absorbed, the iron remains and appears as a lingering brown spot.

Where Are the Most Common Places for Bruising?

You’ll see most bruising on the arms and hands because those areas are most susceptible to injury. We swing our arms and hands around and bump into things, so that’s where the bruises show up. Some people also notice bruising on their lower legs for the same reason.

Plus, these are the areas that have suffered from years of sun damage. What ares on our bodies are exposed most often? The arms, hands, and face. Those areas where we get the most sun is where our skin thins the most.

What Causes Actinic Purpura?

So, why are you suddenly dealing with big bruises from minor bumps? Actinic purpura starts because of thin skin. A combination of sun damage and aging causes our skin to thin over time. To make it worse, our blood vessels become fragile, too. This means even a small bump causes the skin to bleed from underneath, leaving you with with a long-term bruise.

Could the Bruising Be Caused By Medications?

Senile purpura technically comes from sun damage, but similar bruises can show up with regular use of certain medications. If you’re taking aspirin, ibuprofen, or other blood thinners, that could be the source of the trouble. Over time, these medications thin the skin too. Plus, they increase bruising.

Aspirin permanently inhibits platelets that help our blood clot. Once those platelets are exposed to the medication, they can no longer bond. But since you’re always making new platelets, you don’t see the effects immediately. Yet, if you continually take these medications, you’ll likely start seeing more frequent bruising.

Is Actinic Purpura Different From Solar Purpura?

Actinic purpura and solar purpura are the same diagnoses. “Actinic” and “solar” both mean sun. “Purpura“ refers to blood that’s lost from the blood vessels and trapped in the skin resulting in a purple spot.  While we often refer to this as a condition caused by aging, it’s more accurately a condition caused by years of sun damage. Because of sun exposure, the skin has become so thin and fragile that it bruises with very little injury.

When To Be Concerned About Bruising

While bruises are often just a side product of the body’s natural healing process, they’re not always harmless. We become concerned when young people bruise easily and often. If a young adult or child is experiencing unknown bruising, it’s important to talk to your family doctor or pediatrician to identify the cause and begin appropriate treatment.

What Types of Doctors Treat Bruising and Actinic Purpura?

If you’re concerned about bruising easily, start with a visit to your family doctor. If you’re on blood thinners and you’re bruising too much, the doctor who prescribed the blood thinner may need to adjust your dosage.

It’s also appropriate to talk to your dermatologist about bruising concerns. If you suspect your bruising is coming from actinic purpura, you’ll be able to explore your options for treatment. Treatments including over-the-counter products like DerMend can help improve the appearance of bruises and restore some of the protection you’ve lost with age. If frequent bruising is a result of another condition, they’ll be able to point you in the right direction for an accurate diagnosis.

How Do I Treat Actinic Purpura?

These splotches can be frustrating and unsightly, but they aren’t dangerous. However, they tend to accumulate. So you may start with an occasional spot, but over time you’ll have an armful.

If you’re looking to get less bruising, products containing arnica are some of the most effective treatments. These products are available at most health food stores or pharmacies and offer a homeopathic option for dealing with blood clots.

But first, visit your dermatologist. Dermatologists help you understand the causes of your skin problem. Patients often don’t know why they’re having a particular problem. We can help you figure out if it’s a result of sun damage, or if you’re getting too much of your blood thinner medication.

If it’s bruising from all that sun damage, then there may be other problems from sun damage too. This initial bruising could be a sign of other sun damage issues to come. The sooner we start treatment and prevention, the better your skin will be.

Dr. R. Todd Plott is a board-certified dermatologist in Coppell, Keller, and Saginaw, TX. His specialization and professional interests include treating patients suffering with acne, identifying and solving complex skin conditions such as psoriasis, rosacea, atopic dermatitis, and identifying and treating all types of skin cancers. In his spare time, Dr. Plott enjoys cycling, traveling with his wife, and spending time with his children and new grandson.

Learn more about Dr. Plott.

Book an appointment with a provider nearby.

90,000 Important! Why bruises easily: 9 alarming reasons

Bruising from time to time is almost inevitable, but if you get bruises often enough and you can’t figure out where, then there must be a reason. You may have just hit your hand or foot and forgot about it, but just as it could be something completely different.

1. Age . With age, the skin loses some of its protective fat layer, which, like a pillow, protects against bumps and falls.In addition, the skin becomes thinner as collagen production slows down. This means that it usually takes much less force to bruise than it did when you were younger.
2. Hemorrhagic vasculitis . This vascular disease causes thousands of tiny bruises, most often on the shins – from a distance it looks like they were sprinkled with red pepper. Bruises are the result of blood leaking from small capillaries.
3. Blood disorders . Blood disorders such as hemophilia and leukemia can cause unexplained bruising, usually because blood does not clot properly.If you often develop severe and unexplained bruising, you should see your doctor to rule out such disorders, especially if they start to appear suddenly.
4. Diabetes . People with diabetes may develop dark age spots, often in areas where the skin is in contact with other parts of the body. These spots may be mistaken for bruising, but they are actually caused by insulin resistance.
5. Excessive stress during training .Excessive muscle tension, such as lifting heavy weights, can rupture blood vessels and cause bruising. Bruises can also cause microscopic tears in muscle tissue. In addition, if you play sports or vigorous exercise, you may experience bumps and minor injuries that cause bruising, but you do not remember about them.
6. Certain drugs . Medicines such as aspirin, anticoagulants, and antiplatelet drugs reduce blood clotting and increase the likelihood of bruising.And medications such as aspirin, prednisone, prednisone, oral contraceptives, and others can also weaken blood vessels, increasing the likelihood of bruising.
7. Heredity . If you have close relatives who bruise easily, then you may well be prone to bruising, too (although there are usually steps you can take to avoid this potential genetic tendency).
8. Pale skin .Pale skin does not mean bruising – it just makes any bruising more visible than darker skinned people.
9. Sun damage . Although the body needs sun exposure to make vitamin D (and get additional benefits), excessive sun exposure, especially when it causes burns, can cause the skin to lose its pliability and resilience. This, in turn, makes bruising easier and more visible.

90,000 Dark circles under the eyes: where are they and what to do with them

• Jason J. Goldman
• BBC Future

8 crescent 2016

Photo by Getty

Dark circles under the eyes are not only indicative of lack of sleep , the researchers say.

The benefits of nearly hairless faces are obvious. Lack of facial hair means fewer parasites, and exposed skin allows sweat to perform its cooling function more effectively.

However, despite the fact that the “naked” face facilitates easier communication, since we can convey our emotions and feelings through facial expressions. It also unmistakably tells us when we are tired or feeling bad.

In most cases, the appearance of bags and dark circles under the eyes does not indicate any serious health problem. But in a 2007 article published in the Journal of Cosmetic Dermatology, Brazilian researcher Fernanda Maganin Freitag notes that “although dark circles under the eyes are usually within the physiological range, most patients worry about their appearance and believe that they significantly impair the quality of life.” …

Skin conditions that can cause emotional stress are worth investigating, even if they do not pose a threat to health.

Author of the photo, Getty

Pidpis to the photo,

The reason for bags and dark circles under the eyes is unlikely to be in lack of sleep

“Dark circles” or “bags under the eyes” are certainly not medical terms. They are used for a relatively wide range of phenomena that have similar external signs. The clinical term is “periorbital hyperpigmentation,” and since this problem has never been a priority among dermatologists, little is known about it.

We know, for example, that the skin under the eyes is especially thin and therefore transparent. As a result, the blood vessels underneath become more visible and the skin tone darker.

“When someone complains about dark circles under the eyes, I have to see that person,” explains Hayley Goldbach, staff physician at the Department of Dermatology at the University of California, Los Angeles. face, vessels under the skin “.

To clarify this issue, the doctor pulls the skin in this area a little. If its appearance deteriorates, the darkening is caused by the peculiarities of the vascular system. But if the skin looks better, then the problem may lie in its lethargy.

Author of the photo, Getty

Signs to the photo,

With age, the layer of adipose tissue under the skin surface decreases, and the lacrimal groove becomes more expressive

The area between the nose, eyes and cheeks dermatologists call the lacrimal groove, as tears flow down it when we cry.“With age, the layer of fatty tissue under the skin’s surface decreases and the lacrimal groove becomes more pronounced,” explains Goldbach. This creates a kind of optical illusion. The shadow on the skin in these areas is caused by light reflection on the contours of the face.

Skin tone under the eyes can also indicate the cause of dark circles. If it is bluish with a pink or purple tinge, blood vessels are the cause of the darkening. And if it is dominated by brownish shades, this indicates an excess of melanin in the skin, although this is perhaps one of the rarest causes of dark circles.

But the most common explanation, Goldbach notes, is the structural features of the face due to the loss of subcutaneous fat during aging, which makes the face look tired.

This does not explain, however, why bags temporarily appear under the eyes when we do not get enough sleep.

“Another cause of bags under the eyes is swelling after sleep,” says Mr. Goldbach. Salty food may be the cause. If you eat fries before bed, bags under your eyes are almost guaranteed in the morning, but this has nothing to do with fatigue.

It is also believed that dark circles can be exacerbated by ultraviolet radiation, as well as stress, alcohol and smoking. Although dermatologist Rashmi Sarkar, in a 2016 article published in the Journal of Clinical and Aesthetic Dermatology, writes that none of these reasons are scientifically substantiated.

Empirical evidence also suggests that darkening of the skin under the eyes, at least temporarily, may be due to allergies, as patients begin to rub their eyes or have increased tearing.

Since most of the time dark circles are temporary, and because most dermatologists consider it to be an aesthetic problem, there is a lack of scientific evidence to treat this problem.

The cosmetic services market offers skin whitening creams, chemical peels and even laser therapy. The acids used in these preparations are obtained from mushrooms and pear tree sap extracts.

Author of the photo, Getty

Pidpis to photo,

Salty food at night is one of the reasons

Another method is various injections under the skin that act as fillers.And of course – plastic surgery. One researcher, for example, gave subcutaneous injections of carbon dioxide once a week for two months and even achieved some results.

Creams with vitamin C are sometimes also used. Some dermatologists resort to rather original methods, although their effectiveness has not been proven at all – these are sunscreens and UV-coated glasses.

Dermatologist Rashmi Sarkar, however, stresses that “even a slight improvement in the patient’s appearance can significantly improve the quality of his life.”

However, until scientists discover new ways to combat dark circles under the eyes, you can simply change your attitude towards them and admit that they give our face a more thoughtful expression.

A short guide to rheumatism – Venäjän kielinen reuma-aapinen

A short guide to rheumatism

in Russian

Translation of information on rheumatic diseases was made from the page:

Suomen Reumaliitto Ry

http: // www.reumaliitto.fi/reuma-aapinen/reumataudit/

1. FIBROMYALGIA, 2. PADAGRA, 3. CHILD RHEUMATISM, 4. LYMBORELLIOSIS, 5. SYSTEMIC DISEASE OF THE CONNECTIVE TISSUE, 6. JOINT RHESIS II, 9. JOINT HYPERMOBILITY, 10. OSTEOPOROSIS, 11. RHEUMATIC POLYMIALGIA, 12. POLYMYOSITIS, 13. REACTIVE ARTHRITIS AND REITER’S SYNDROME, 14. SPINE RHEUMATISM AND BEKHTEREV’S DISEASE 15. HEREDITAL DISEASE OF CONNECTIVE TISSUE 16. SHEGRIN’S SYNDROME 17. SERONEGATIVE SPONDYLO 18.SYSTEMIC LUPUS ERYTEMATOSUS (SLE) 19. SYSTEMIC SCLEROSIS (SYSTEMIC SCLERODERMIA) 20. VASCULITIS

1. FIBROMYALGIA (MUSCLE RHEUMATISM)

Fibro means connective tissue, and myalgia means pain in muscles. Fibromyalgia causes pain in muscles, connective and extra-articular soft tissues. In addition to pain in the musculoskeletal system, patients suffer from various sleep disorders: shallow sleep, frequent awakenings at night, a feeling of weakness and physical exhaustion in the morning.In addition, they have different types of mental and neurological symptoms, which can be very varied.

More often middle-aged and elderly women suffer from the disease. Fibromyalgia is estimated to occur in 2 to 5% of the population, and is rare in children and young people.

Causes

The causes of fibromyalgia are still not entirely clear. The onset of symptoms is influenced by many factors, due to which the disease develops in the form of various changes on the part of the central nervous system (CNS).In many patients, symptoms occur in conjunction with infection, trauma, or other painful situations. Sometimes local pains turn into general pain sensitivity. Some patients suffer from joint hypermobility; in others, social or mental problems are added to the symptoms. Other comorbidities are common in patients with fibromyalgia.

One of the causes of fibromyalgia is long-term stress, which causes bad mood and feelings of depression.Stress can be caused by repetitive and prolonged external stimuli: work, feelings of dissatisfaction, rush, movement, noise, human relations, money problems, or unemployment. Fibromyalgia patients show the same hormonal changes as people suffering from long-term stress. It remains to be seen whether stress or depression and anxiety is the cause of fibromyalgia, rather than the cause of fibromyalgia.

Another cause of illness is lack of sleep or poor quality sleep.During deep sleep, the pituitary gland produces growth hormone, which has an anabolic (tissue-strengthening) effect. If there is a lack of deep sleep, no growth hormone is released. In patients, a decrease in the release of growth hormone was confirmed. At the same time, symptoms similar to fibromyalgia were identified in laboratory conditions, when normal sleep was simply disturbed in the studied people.

Stress, sleep disturbances and other causes affecting hormone secretion disorders can affect the central nervous system in such a way that pain increases.Patients often experience personal and social pressure that manifests itself in the form of physical symptoms, often in the form of pain.

Symptoms

The most important symptom of fibromyalgia is prolonged pain in different parts of the body, the nature of which is influenced by various external stimuli. Patients describe pains: pinching, burning, cutting, aching, deep, exhausting, monotonous. The pain is exacerbated by cold, moisture, drafts and mental stress. In the sauna, the pain decreases, but after the sauna, it intensifies again.

For patients with fibromyalgia, fatigue, fatigue, weakness, edema and a feeling of stiffness are also characteristic. In addition to the pain of the musculoskeletal system, headaches, abdominal pain, pain during menstruation and when urinating may occur. Many patients experience joint swelling, although the doctor does not diagnose this. Patients get tired quickly with exertion. And almost all patients complain of sleep deprivation.

Diagnosis

Diagnosis of fibromyalgia is based on patient complaints and medical clinical research.To confirm the disease, a large group of other diseases are taken into account, which also cause pain symptoms. Other diseases do not rule out the possibility of fibromyalgia.

In a conversation with a patient, the doctor pays special attention to both the nature of pain in different situations and the quality of sleep. During a medical examination, a painful reaction is noted in known sensitive points on the body. Some parts of the body are very painful. For fibromyalgia, there are no changes in blood tests.

If necessary, conduct additional research to rule out other illnesses that cause fatigue and pain, such as anemia, thyroid dysfunction, muscle aches, or menopause symptoms. Joint hypermobility also requires examination.

Often, people with fibromyalgia have co-morbid conditions, which can be, for example, inflammation of the intestines, bladder, endometriosis, headaches, signs of fatigue and depression. Especially in the elderly, fibromyalgia can occur concurrently with coronary artery disease, diabetes, joint damage, and articular rheumatism.This is called secondary fibromyalgia.

Treatment

Fibromyalgia does not have a single treatment that is suitable for everyone and brings results. the causes of the disease are different. The patient’s own opinion on the results of treatment is very important.

Planning, implementation and monitoring of treatment outcomes is a basic prerequisite for close and trusting collaboration between patient and doctor. It is important to stop further unnecessary additional research, which in the worst case leads to unnecessary surgery.The best way to treat a patient with fibromyalgia is a polyclinic doctor who is well aware of his problems.

Learning about fibromyalgia is the foundation of treatment. If possible, at an early stage, the patient should undergo a rehabilitation course designed for patients with fibromyalgia. Usually it is possible to combine it with work. Group training gives good results. The courses help to reduce the fatigue associated with the disease, support self-medication and training. Avoiding stress and improving mood with warm baths, massage and other physical therapy, as well as group discussion and psychological support, are the only treatment lines.For some, hardening of the body (swimming in an ice hole, cold chambers) and a gradual increase in physical activity are suitable.

Physical education should be administered carefully. Suitable sports: walking, pole walking, aqua aerobics, cycling, dancing and skiing. Physical activity is aimed at activating the body’s own defense mechanisms that relieve pain.

There is no specific drug for the treatment of fibromyalgia yet. Medications that improve sleep and mood, such as amitriptyline, can be tried as drug treatments.Treatment should be started in small doses to reduce side effects. The benefits of such treatment are observed only after a few weeks. There is little effect from conventional painkillers, sometimes paracetamol helps. The benefits of medication should outweigh the side effects. For some patients, medications that affect the central nervous system are suitable for relieving pain of nervous origin. If fibromyalgia is associated with prolonged insomnia, depression, or other psychiatric symptoms, the patient needs psychiatric help.

Prognosis

The prognosis is favorable, although there is no improving treatment. The symptoms of fibromyalgia persist for years and decades, but damage to organs or tissues of the body does not occur and the disease is quite compatible with life. Many retire early for other reasons. At present, officials dealing with pension issues do not consider fibromyalgia to be a cause of disability and retirement.

2. PADAGRA (Greek podos – leg, Greek agra – seizure, literally “foot in a trap”)

Padagra is more common among middle-aged men.In Finland, padagroy affects about 30,000 people. The onset of the disease may be due to a change in life habits and an increase in alcohol consumption, small doses of aspirin and diuretics.

Padagra is a disease caused by disorders of purine metabolism, leading to an increase in the level of uric acid (urates) in the blood and their deposition in tissues, articular cartilage, epiphyses of bones, periarticular tissues, kidneys and other organs. An increase in uric acid levels (hyperurecaemia) can cause kidney failure.

Against the background of padagra, there may be disorders in the activity of enzymes, which are inherited. The cause of the disease can be malnutrition, overeating, alcohol consumption, especially beer, obesity, diabetes mellitus, high levels of blood fats and arterial hypertension. Padagra can also develop as a side disease when taking diuretics and aspirin. Sometimes padagra manifests itself together with renal failure or blood disorders.

Symptoms

The first symptom of padagra is acute inflammation in the joint of the big toe.Later, other joints become inflamed – the knees, the cervical spine and the joints of the fingers. Padagra causes permanent joint changes and crystallization of uric acid in soft tissues (tophus), kidney diseases can join them. Nowadays, padagra very rarely leads to disability.

Symptoms appear more often with stress on the inflamed joint or with alcohol and purine-containing foods. The joint becomes hot, red and very painful. The picture of the disease is not always typical.Within a week, the inflammation goes away on its own, but with treatment – faster.

Diagnostics

When diagnosing a padagra, the doctor identifies typical symptoms and changes in the patient’s diet. The diagnosis is confirmed by examining the joint fluid, in which urate crystals are visible under a microscope. In patients with padagra, uric acid levels are usually high. On the other hand, they can be high in healthy people. Low rates also do not exclude the possibility of contracting padagra.During research, it is important to check the functioning of the kidneys in order to exclude disruption of their activity.

Treatment

As a treatment for an acute attack of padagra, cold, pain relievers and anti-inflammatory drugs, and rest are used. Intensive treatment for an acute attack of padagra is intra-articular administration of cortisone.

The most important element of treatment is the balance of medication intake, lifestyle and especially the patient’s nutrition. When planning treatment, it is also necessary to consult a dietitian.Moderate weight loss can be maintained with proper nutrition, if necessary.

The diet should be followed after the first attack of padagra. The diet prohibits foods that produce uric acid and can significantly reduce the intake of essential drugs.

But sometimes diet alone is not enough to cure. Then, after the third attack of padagra, drug treatment is started, which reduces the synthesis of uric acid in the blood. In such cases, allopurinol is effective.Treatment with allopurinol can only be started after confirmation of the diagnosis of padagra. Its side effect can be liver dysfunction and changes in the blood picture, therefore, treatment is carried out under the supervision of blood tests. If there were no seizures during the year against the background of treatment, you can stop taking the drug.

Prognosis

With proper treatment, the prognosis for padagr is good, but if for some reason it is impossible to use allopurinol, problems may arise. Failure to follow the diet can also be the reason for the failure of treatment.

Diet

Padagra sufferers need to have a list of various foods that contain purine. It can be found in pharmacies and on the internet. Below is a brief overview of the most important foods.

Foods containing quite a lot of purine are completely prohibited:

fish

meat

peas, beans, soybeans, mushrooms, asparagus

Other harmful substances:

all alcoholic beverages (prevent the excretion of uric acid), especially beer

aspirin-containing antipyretic drugs

Approved foods containing a small amount of purine:

cereals

dairy products

eggs, fats, sugar

fruits, almost all vegetables, potatoes

coffee, tea, cocoa, spices

and fish

3.CHILD RHEUMATISM

Children’s rheumatism is an inflammation of the joints that occurs for unknown reasons in children under 16 years of age, and which lasts more than six weeks. The definition of the disease is conditional, because the causes of its occurrence are unknown, the same symptoms of the disease can occur after 16 years. Children who become ill later retain their original diagnosis.

Children’s rheumatism is currently divided into seven subtypes. For all types, the name is used for childhood rheumatism or juvenile idiopathic arthritis.Every year in Finland, 100-150 children fall ill, half of whom are under 5 years old.

Causes

The cause is unknown. Perhaps there are several of them, and hereditary factors increase the risk of getting some form of rheumatism. Children’s rheumatism is not directly inherited, and does not behave like an infectious disease. Children’s rheumatism includes childhood diseases (oligoarthritis) or forms similar to diseases of adults (articular rheumatism, articular psoriasis, spinal rheumatism).

Symptoms

Usually the first symptom of childhood rheumatism is morning joint stiffness, which parents immediately notice. Inflexibility can manifest itself either in all or only in diseased joints. Children limp or protect their joints due to pain. They may also have trouble sleeping. However, young children may not always be able to describe pain in words. Often, pain is manifested by a bad mood and the protection of a sore joint. Sometimes the knee or other joint swells so much that it is easy to notice.Fever and slight skin inflammation on the body are the initial symptoms of childhood rheumatism.

The course of the disease

The complexity of childhood rheumatism in its variability. The disease drags on and eats away at the cartilage of the joints, bones and ligaments of the joints. As a result, the joints swell and their work is limited. Currently, complete ossification of the joints does not occur. Inflammation of the eyes can go unnoticed, up to complete loss of vision.

Developmental delays may also appear in patients with childhood rheumatism.Growth can be slowed down by severe illness or high-dose cortisone treatment. Overgrowth of bones begins in a swollen joint, for example, in the lower jaw, legs, ankles, wrists, and toes. Especially in the knees, this can be manifested by an asymmetrical limb length or its incorrect position. If left untreated, childhood rheumatism can cause life-threatening heart inflammation and kidney disease.

Diagnostics

The main symptom of childhood rheumatism is swelling of one or more joints, lasting over six weeks.The child feels tired, cries, he may have a skin rash and fever. Blood inflammation and CRP levels may be elevated. When making a diagnosis, rheumatic factor and the presence of antibodies in the blood are also examined. If the blood test for antibodies is positive, then with a high probability we are talking about childhood rheumatism or systemic connective tissue disease. Since heredity is an important factor, it is necessary to find out from the parents whether there were joint diseases or psoriasis in the family.

Treatment

Pediatric rheumatism is diagnosed and monitored in university hospitals and the Heinola rheumatology hospital by a specialist doctor. Treatment and rehabilitation of patients is carried out in the children’s department of the rheumatological hospital.

The goal of the treatment is to reduce symptoms and normalize the parameters of inflammation in the blood (ESR, CRP), which are achieved through the selection of individual drug treatment and exercise therapy in everyday life. In difficult cases, more serious treatment is required.

Usually, an integrated approach is used in the treatment of childhood rheumatism. Thanks to the use of strong medicines, the results are faster and the treatment time can be shortened.

Pediatric rheumatism is treated with the same medicines as adults. With long-term treatment, methotrexate is used – a drug that affects cell growth. Currently, childhood rheumatism can be treated with biological TNF – alpha drugs. Supportive therapy – cortisone drugs.

Treatment of childhood rheumatism is aimed at ensuring the normal growth of the child. Correct positioning of the limbs can be assisted by applying splints and splints. In young patients, the growth of the lower jaw and teeth is monitored and the eyes are regularly examined. The physiotherapist develops individual programs to maintain joint mobility and strengthen muscles. The rehabilitation program includes providing conditions for the child to receive primary education.

Forecast

Modern methods of treatment significantly improve the prognosis of childhood rheumatism.Lifetime disability and premature mortality are rare. Amyloidosis (a violation of the body’s protein metabolism) no longer occurs. The majority of patients are able to lead a normal working life with the help of treatment.

Classification of childhood rheumatism

Ordinary children’s rheumatism

Ø fever, skin inflammation, inflammation of the lymph nodes, symptoms of internal diseases

Oligoarthritis (inflammation of rare joints)

Ø from 1 to 4 diseased joints

Seronegative polyarthritis

Seronegative polyarthritis 9000 Ø no rheumatic factor in the blood, 5 or more joint pains

Adult-type articular rheumatism

Ø “seropositive polyarthritis”

Ø rheumatic factor present in the blood, 5 or more joint pains

Articular psoriasis

Ø cutaneous psoriasis and inflammation of the joints

Ø pronounced psoriatic changes in the nails without skin symptoms, sausage-like inflammation of the fingers and toes, psoriasis in the next of kin

Rheumatism of the spine

Ø “arthritis joining enthesitis” enthesitis (damage to the ligamentous apparatus).If only one of these symptoms is present, then there should also be two more of the following: pain in the sacrum and lower back, positive HLA-B27 antigen, rheumatism of the spine in one of the close relatives, eye inflammation, boy over 8 years old.

Other forms of the disease

Ø childhood rheumatism, which is not included in other groups

4. LYMBORELLIOSIS (Lyme disease or tick-borne borreliosis)

Lyme disease is an infectious disease transmitted through a tick bite.The causative agent Borrelia burgdorferi is a bacterium belonging to the spirochete class. Lyme disease has no connection with childhood rheumatism or rheumatic diseases.

In Finland, natural foci of Lyme disease are found mainly on islands and coastlines, although ticks also live throughout the country, including Lapland. But not all ticks carry the Borrelia bacteria. On average, the bite of only one tick in 50-100 cases causes disease. Every year in Finland, about 3000 people get sick from tick bites, and 10-20% of them – Lyme disease.The disease can manifest itself as a rapidly passing skin inflammation.

Prevention

Lyme disease can be prevented by avoiding tick bites. Ticks settle in humid places where children often play, so their skin should be examined in the evenings. This also applies to adults living in natural foci. Ticks are removed from the skin, for example, with tick-borne tweezers purchased from a pharmacy. The best way to remove it is to grab the tick as close to the skin as possible and gently pull it out in a circular motion.

Symptoms

Most tick bites are asymptomatic. If a person is bitten by a tick, it must be quickly removed from the skin, because it can carry the Borrelia bacteria. In this case, reddening of the skin appears around the bite after a few days, which spreads in a circle from the site of the bite (erythema annulus). Bacteria that enter the body can cause a cold-like illness, which is combined with fever, fatigue and muscle pain. This is the initial stage of Lyme disease, and antibiotics are used to treat it.

Course of the disease

If untreated, the disease can manifest itself in different parts of the body months or even years after infection. These can be symptoms of damage to the musculoskeletal system (muscle pain and stiffness), edema of one or more joints, in severe cases – symptoms of CNS damage: facial paralysis and paralysis of various nerves, meningitis, neurological pain symptoms. Prolonged muscle pain resembles complex fibromyalgia. In disease caused by a Borrelia bacterium, chronic inflammation of the skin, eyes and heart muscle can be observed.

Diagnosis

The initial phase of Lyme disease is confirmed by inflammation of the skin around the tick bite, which does not appear in later stages. The only symptom may be, for example, swelling of the knee joints. At this stage, the doctor tries to rule out other illnesses and confirm borelliasis with blood tests. The study of the results of laboratory tests sometimes requires an examination in the infectious diseases department of the district hospital. In the diagnosis, information about previous tick bites, for example, a month ago, is very helpful.

Treatment

A simple tick bite does not require any treatment. If inflammation spreads around the bite, you should see a doctor immediately. After an obvious bite, antibiotics are prescribed for two weeks to treat borelial skin inflammation. The infection responds well to treatment and late symptoms do not appear. If the initial phase is left untreated, and the patient develops true Lyme disease, then long-term and debilitating antibiotic treatment is required, which is most often carried out in a hospital setting.

Prognosis

As a rule, patients are cured of Lyme disease. In this disease, the inflammation of the joints is benign and does not lead to their destruction, but the pain can last a long time. In young children, the disease is more severe. For years, persistent symptoms of CNS inflammation are rare. They may mimic the symptoms of fibromyalgia.

5. SYSTEMIC DISEASE OF THE CONNECTING TISSUE

In patients with systemic disease of the connective tissue, symptoms of many rheumatic diseases are observed.They may resemble systemic sclerosis, an autoimmune disease, or polymyositis and joint inflammation. Many diseases can begin with symptoms similar to systemic connective tissue disease, which need to be clarified later. Most of the patients are women over 40 years of age.

Causes

The causes are unknown, but the occurrence of the disease is influenced by heredity.

Symptoms

Usually the disease begins with general symptoms such as fatigue, fever, muscle and joint pain.Almost all patients have Raynaud’s symptom (blanching of the fingers). The hands may swell so that the fingers take on the shape of sausages. The skin of the hands becomes denser and later atrophies. The patient may have skin inflammation and swelling in the joints, similar to articular rheumatism.

Course of the disease

The disease usually either disappears or turns into some overt disease – articular rheumatism, systemic sclerosis, immune disease or polymyositis. The disease causes changes in internal organs such as the lungs, heart and kidneys.

Diagnostics

Diagnostics is carried out on the basis of the patient’s history and blood tests.

Treatment

Treatment is individualized according to the patient’s symptoms. As a treatment, cortisone drugs and antirheumatic drugs methotrexate, hydroxyclorokine are used. If the patient has pale fingers, a vasoconstrictor such as nifedepine is recommended, but it is best to keep the hands warm.

Forecast

Symptoms of the manifestation of the disease can last for years.The prognosis depends on the direction of the development of the disease. If the disease does not affect the internal organs, the prognosis is favorable.

6. PSORIASIS OF THE JOINTS (psoriatic arthritis)

Psoriasis (squamous lichen) is a chronic dermatosis characterized by scaly skin rashes. Approximately 2% of the Finnish population suffers from psoriasis. Of these, only 10% have joint inflammation. Half of those with complex cutaneous psoriasis also have joint psoriasis. It occurs in both women and men.Sometimes the picture of the disease is similar to psoriasis of the joints and is diagnosed in patients who do not have skin inflammation. The disease is inherited.

Causes

The causes of psoriasis are unknown, and it has not been investigated why patients with skin diseases often exhibit joint symptoms. In psoriasis, the regulation of the body’s immunological defenses is disrupted, and skin inflammations appear, for example, after infection, with skin lesions or after burns.

Psoriasis is a hereditary disease.If both parents have psoriasis, the child’s risk of developing the disease is about 50%. If only one – the risk of developing the disease is reduced to 20%. Joint psoriasis is much less common.

Symptoms

There are 4 different forms of joint psoriasis. The most common form is inflammation of several joints with symptoms of sharpening of the first phalanges of the fingers of the extremities, which can manifest themselves on their own. Another form of the disease is less common, usually inflammation of a large joint.It can only be inflammation of one knee without other joint symptoms. A disease resembling spinal rheumatism is rare.

With articular psoriasis, the heel or the Achilles tendon swell, sometimes a finger or toe swells in the form of a sausage (dactylitis, sausage-like toe). Symptoms of sharpening of the phalangeal joints of the fingers are manifested in conjunction with psoriatic changes in the nails.

Course of the disease

In a patient with psoriasis, joint disease develops over time.Often cutaneous psoriasis is only confirmed if a person seeks a doctor for joint symptoms or nail changes. Usually, joint symptoms appear at the age of 30-50, although the skin inflammation in this case has already lasted for many years. Articular psoriasis also occurs in children, but it is quite rare.

Diagnosis

Psoriasis of the joints can be suspected if the patient has cutaneous psoriasis and inflammation of one or more joints. The skin inflammation can be quite extensive or limited to the nails only.Sometimes it appears on the scalp as scaly patches.

In case of joint psoriasis, blood tests do not show increased indicators of inflammation (ESR, CRP) and rheumatic factor, as in articular rheumatism.

X-ray in the joints showed the same erosive changes as in articular rheumatism. In patients, the pointed phalanges of the joints of the fingers are eaten away. Mutilating, disfiguring arthritis caused by the destruction of the bone tissue of the phalanges of the fingers is quite rare.

Treatment

Timely treatment of skin manifestations of the disease and sunlight also relieve joint symptoms. Strengthening the physical condition of joints and muscles is suitable as an initial treatment. For more help, you can contact the hospital’s rehabilitation department.

Paracetamol or anti-inflammatory and pain relievers are used to relieve pain symptoms. If the inflammation of the joints is prolonged or if the X-ray shows changes in the joints, the same medications are used as treatment as in the initial treatment of articular rheumatism.Methotrexate is effective for skin inflammations and is better suited for treating articular psoriasis than for treating articular rheumatism. A similar new generation drug is leflunomide. For mild articular psoriasis, sulfasalicylates should be tried first to eliminate articular symptoms. Cyclosporine is suitable for the treatment of both complex skin inflammations and for the treatment of joint inflammation. Cortisone injections are used to treat swollen joints. With mutating, disfiguring arthritis, arthroplasty or endoprosthetics are performed.

Complex articular and cutaneous psoriasis can also be treated with biological rheumatic drugs. Currently, TNFα inhibitors (blockers) are used in Finland: infliximab, adalimumab, etanercept. They quickly relieve inflammation. The patient can inject adalimumab and etanercept himself. Infliximab is administered to the patient by intravenous drip in a hospital.

Forecast

On average, joint psoriasis is a milder disease than joint rheumatism. The long-term prognosis is often very good.Treatment of complex diseases that cause changes in the joints should be carried out as soon as possible. Medical therapy in the initial stage of the disease is more effective. If left untreated, psoriasis of the joints can lead to disability, destruction of the joints, or stiffness of the spine.

7. JOINT RHEUMATISM

Joint rheumatism (rheumatoid arthritis, arthritis rheumatoides) is a common inflammatory disease of the joints. Every year 1,700 Finns fall ill with it, usually women 60-70 years old, less often young men.There are approximately 35,000 people with articular rheumatism in Finland.

Causes

The causes of articular rheumatism are unknown, but it is part of the so-called autoimmune diseases, in which the body’s immunological defense is directed against its own tissues. Articular rheumatism is not a hereditary disease, and susceptibility to it is weakly inherited. Smoking, the postpartum period, all kinds of infections, mental factors and joint injuries contribute to the occurrence of articular rheumatism.There are no clear links between nutrition and the onset of the disease, but during treatment, attention should be paid to a healthy diet.

At first, changes in the body can begin not in the joints, but in other places. With inflammation, the articular membrane thickens, new blood vessels grow in it, and inflammatory cells circulate in the tissues. Active inflammatory cells release immune complexes (interleukins, prostaglandins, Tnf-alpha) into the environment that cause inflammation in the body: fatigue, fever, increased blood counts and CRP.

Inflamed tissue grows and expands over the surface of the articular cartilage and bones. It gradually eats away at healthy cartilage, bones and joint ligaments. In this regard, the structure of the joint is destroyed, and its work is disrupted.

Symptoms

Articular rheumatism begins with mild joint pain that manifests itself in the morning as soreness and stiffness in the fingers or toes. A visible symptom is joint edema, which occurs with an increase in the amount of articular fluid and a thickening of the articular membrane.With severe inflammation, the joint turns red and becomes hot. The swelling begins most often in the fingers and wrists. Articular rheumatism is usually a symmetrical disease of the joints of the fingers and toes, but it can spread to all joints of the limbs, as well as to the jaw joints and the cervical spine. It usually does not appear in the first phalanges of the fingers and the lower back. In the initial stage, the disease causes a deterioration in the general condition, a feeling of malaise, fatigue and joint stiffness in the morning.

Course of the disease

If the body’s resistance overcomes the disease, the symptoms of articular rheumatism disappear at all or do not appear for a long time.Most often, articular rheumatism is a disease that lasts for decades. Cartilage erosion begins within a few months from the onset of the disease. Over the years, erosion expands and covers more joints.

Most of all, patients suffer from damage to the large joints of the extremities (hip, knee, shoulder joint) and the cervical spine. The movement of the joints becomes difficult, but patients suffer much more pain. The pain is manifested by increased sensitivity of the joints, however, in the initial stage it is not very significant.

With prolonged articular rheumatism, symptoms also appear in other organs. Prolonged inflammation dries out tissues: the skin becomes thinner, muscles die off, bones break, and blood hemoglobin decreases. Dryness of the mucous membranes of the eyes, mouth and genitals comes from Schengren’s syndrome. Friction can cause rheumatic bumps to grow in the elbows, fingers and toes. Blanching of the fingers or Raynaud’s symptom is a signal of vascular disease. Pleurisy and rheumatic nodes develop in the lungs, and sometimes serious pulmonary changes occur.Amyloidosis (impaired protein metabolism) occurs as a result of prolonged active inflammation, but kidney damage caused by it is currently rare.

Diagnosis

At the onset of the disease, articular rheumatism is difficult to diagnose. If articular rheumatism is suspected, the patient is referred to a specialist doctor. Symptoms of the disease are obvious swelling of the joints, especially fingers and wrists, sensitivity of the ball of the foot, increased blood inflammation (ESR, CRP) and rheumatic factor.Articular rheumatism is assessed according to seven criteria. If four of the seven criteria are met, the patient is diagnosed with articular rheumatism, and active treatment should be started as early as possible.

Symptoms of immunological disorders are confirmed by rheumatic factor in the blood, and sometimes antibodies. The rheumatic factor was detected not in all patients with articular rheumatism. It can also be found in people with other diseases or in perfectly healthy people. Therefore, the diagnosis of articular rheumatism is radically independent of the presence of a rheumatic factor.

Classification of articular rheumatism:

morning stiffness of the joints for at least one hour

swelling of at least three joints

swelling of the arm joint

symmetric swelling of the joint

rheumatic cones rheumatic cones rheumatic factor

lesions in the joints visible on x-ray

Treatment

Treatment of articular rheumatism should be multifaceted. It is important for patients with chronic diseases to know more about the disease and the possibilities of its treatment.

The course of articular rheumatism does not allow it to be influenced by other means than drugs. Sometimes surgery and physical therapy are required to prevent disability. Effective drug treatment is especially important in the early stages and when joint destruction progresses.

At the initial stage, the treatment includes, first of all, drugs that slow down the course of the disease. In the complex treatment of articular rheumatism, methotrexate, sulfasalicylate, hydroxyclorokine, gold preparations, leflunomide and cyclosporine are used; biological drugs can be tried.Despite the side effects, the benefits they bring are much greater than the harm. Treatment started early is more effective.

Most patients require pain relievers (paracetamol, anti-inflammatory drugs). They do not inhibit the development of the disease, but good pain relief improves the quality of life. Cortisone medications are used as supportive therapy to relieve pain as well as keep joints working. Cortisone injections directly into the joint temporarily relieve swelling and significantly improve mobility.The attending physician should have the cortisone syringes needed by the patient ready.

Surgical treatment can be used to remove inflamed tissues not susceptible to drugs from a joint or from a tendon, as well as to correct an already damaged joint. Often, an artificial joint can prevent the development of a disability.

Physiotherapy is used to treat pain and keep the joints moving through special exercises. In the active phase, it is necessary to maintain the mobility of the joints and the physical condition of the muscles.

A specialist doctor teaches gentle movement skills. Various splints are used to reduce joint pain and prevent joint misalignment.

Rehabilitation supports work and physical activity. In rehabilitation courses, immediately after the detection of the disease, patients receive information about the disease and its impact on daily life. Sufficient attention should be paid to the professional rehabilitation of the working population and youth. KELA organizes rehabilitation in especially difficult cases.

Forecast

At the initial stage of articular rheumatism, it is rather difficult to make a prognosis. Therefore, even mild symptoms of articular rheumatism should be taken seriously. Currently, most of the patients are living a normal life, starting a family and retaining their ability to work. Although there is an improving treatment, articular rheumatism progresses for decades and destroys the joints, but there is no threat of complete loss of motor activity.

8. JOINT RHEUMATISM II

Arthrosis or osteoarthritis is a common disease of the joints.It is associated with an increase in the average age of the population. Almost every pensioner has osteoarthritis, but only some of them cause significant harm to health. Due to the inability of older people to move independently, society incurs significant costs. To preserve the motor ability of the elderly, thousands of hip and knee replacements are performed in Finland every year.

More often arthrosis manifests itself in the interdigital joints of the foot, the first metatarsophalangeal joint of the hand, in the joints of the spine, but arthrosis of the hip and knee joints brings the greatest harm to health.

Causes

The occurrence of arthrosis of large joints is promoted by old age, hard work, sports with stress on the joints, obesity, injuries and inflammations of the joints, heredity. A big problem is weight gain, which causes and always complicates most of the knee arthrosis. Arthrosis of the toes and hand is, for the most part, a hereditary disease.

Symptoms

At the initial stage of arthrosis, the most important symptom is pain, which intensifies when starting to move after rest (starting pain).The primary pain arises when going down the stairs, later on, pain when going up is added to it. With the development of the disease, the amplitude of motion of the joint decreases. The knees are turned to the sides, and bow-legged appears. In the fingers, in the place of the joints, bone cones grow. The uneven cartilaginous surfaces of the joints crunch when moving.

Osteoarthritis worsens gradually over the years. Problems depend on the affected joint. Arthrosis of the spine leads to the formation of bone spurs and compression of the nerves coming out of the spinal cord, as a result of which the back pain passes into the legs (sciatica).Osteoarthritis of the hip and knee joints complicates movement and can cause severe pain.

Course of the disease

At the onset of arthrosis, the smooth cartilage covering the surface of the joint begins to decompose. The body reacts to this by overgrowing the bone tissue of the cartilage. The joints become firm and in contact with each other, and their range of motion decreases. Usually the joint takes a forced position. Gradually, the inner surface covering the articular membrane of the damaged joint becomes irritated and inflamed.Fluid builds up in the joint and may turn red. The joint becomes inflamed and arthrosis progresses.

Diagnosis

The doctor makes a diagnosis of arthrosis based on symptoms and X-rays. However, multiple arthrosis can be mistakenly treated like gout or articular rheumatism. A blood test does not diagnose arthrosis.

Treatment

Arthrosis cannot be cured. First of all, paracetamol and, if necessary, anti-inflammatory drugs are used as anesthesia.Some are helped by glucosamine. Anti-rheumatic gel ointments containing anti-inflammatory drugs help with arthrosis of the fingers. Your doctor may inject cortisone medications into irritated and swollen joints. Arthrosis of the knees can be treated with hyaluronate injections. Complex and painful arthrosis of the hip and knee joints is treated by surgery.

Too much stress on sore joints should be avoided. A wand or rollator and high-legged chairs make everyday life easier.You should also stop carrying heavy loads.

Weight management is an important part of treatment because excess weight, first of all, loads the joints. Joint performance is supported by movement, and muscle condition is maintained by regular physiotherapy exercises. Exercise is needed to straighten the hip and knee joints. To straighten your knees, you can exercise while sitting on a chair. If pain is felt, straightening movements can be done while lying on your back, with a pillow under your knees. A cold compress in the acute phase soothes sore and painful joints.In the calm phase of the disease, warming the joints brings a sense of relief. When treating arthrosis of the fingers, regular exercise keeps them mobile.

Forecast

Most patients are coping well with their illness. More painful are diseases that begin at a young age and in several joints at the same time. Osteoarthritis causes a deterioration in normal life. The increase in the overweight of the population is the reason for the occurrence of arthrosis in the future. Joint replacement surgery can avoid the patient’s disability.

9. JOINT HYPERMOBILITY

Joint hypermobility is a set of symptoms in which the joints have an abnormally wide range of motion. Joint hypermobility is especially pronounced in children and young women. It is rare in the elderly. Some occupations (musician, acrobat) benefit from a wide range of joint motion, but it can be harmful to the joints.

Causes

The weakening or tension of the articular ligaments in people is different.Probably, there are differences in the structure of the binding protein, collagen, and connective tissue. Joint hypermobility is often hereditary. It is difficult to distinguish it from Ehlers-Danlos syndrome (skin hyperelasticity).

Symptoms

Joint hypermobility is not necessarily harmful. A common symptom is pain that is localized in the joints (hip, knee, shoulder, wrist) or back. Common pain conditions are easily interpreted as fibromyalgia, one of the causes of which may be hypermobility of a joint.In complex forms of the disease, the joints can easily twist. Hernia, varicose veins, impaired venous circulation, prolapse of the uterus and urinary problems can also join the complex of symptoms. Hypermobility can lead to arthrosis.

Diagnostics

Joint hypermobility is determined using the Beighton scale. If a person has five criteria out of eleven, the joints are considered hyper-movable.

Beighton scale

passive dorsiflexion of the little finger more than 90 ° (left and right hand)

passive adduction of the thumb to the flexor surface of the forearm (left and right hand)

hyperextension of the elbow joints more than 10 ° (left and right arm) )

overextension of the knees more than 10 ° (left and right legs)

bending forward without bending the knees, with palms touching the floor

Treatment

The patient should be aware of the origin of the symptoms.There is no complete cure, but symptoms can be alleviated with joint and muscle exercise therapy. Activities that increase the risks and lead to a wide range of motion of the joints and dislocations should be discontinued. Conventional pain relievers relieve pain. Joint hypermobility should be considered when choosing a profession.

Forecast

With age, the range of motion of the joints decreases. This improves the long-term prognosis.

10.OSTEOPOROSIS

Osteoporosis is a progressive decrease in bone density, leading to a decrease in bone strength and an increase in the likelihood of fracture. After age 30, bone density begins to slowly decrease. Older people are at increased risk of bone fractures from falls. In Finland, more than 400,000 people suffer from osteoporosis, most of whom are women over 50 years of age.

Causes

Age-related decrease in bone density is a normal physiological process.But a sharp decrease in bone density leads to osteoporosis. Osteoporosis is more common in women than in men. The risk of disease in women increases during menopause, when the production of female sex hormones (estrogens) decreases, which regulate bone metabolism and prevent osteoporosis. A short period of puberty (late onset and early end of menstruation) is also a cause of osteoporosis.

A lean physique, lack of exercise, vitamin D (sunlight) and / or calcium, smoking, excessive salt intake, bowel disease, rheumatism, diabetes, kidney disease, and certain medications (cortisone, antiepileptic drugs) increase the risk of osteoporosis.Overweight, although it is a dangerous disease, to some extent protects against osteoporosis. The predisposition to osteoporosis is hereditary.

Symptoms

Osteoporosis is asymptomatic. Problems arise with bone fractures, the most common of which are vertebral fractures. In this case, height decreases and posture changes. Fractures of the femoral neck are considered complex. Over the past 15 years, the number of upper femoral neck fractures has doubled in Finland.Although fractures caused by osteoporosis are treated with surgery, the quality of life of older people is impaired.

Diagnosis

An experienced doctor can quickly diagnose an elderly person by measuring their height. If over the years the growth has decreased by more than 5 centimeters, and the posture has become stooped, the diagnosis is correct.

Bone density can be measured. The measurement is made based on an analysis of the bones of the back and upper thigh bone.

Hospitals and private clinics have devices for examining osteoporosis.Based on international criteria, women are diagnosed with a bone density below 2.5 units. standard deviation than at a young age. For men, the border is 3 units. standard deviation.

A conventional bone X-ray can be used to assess the initial stage of osteoporosis. The X-ray shows a fracture of the bones of the spine. Density is measured by ultrasound examination of the calcaneus, but in this way it is impossible to establish the exact location of the fracture.

Prevention

Osteoporosis can be prevented. Young girls need to increase bone density and build bone mass that protects against possible fractures as they age.

Prevent osteoporosis:

Ÿ Constantly move

Ÿ Lose weight carefully and avoid a sharp drop in weight

Ÿ Go outdoors more often, so you get vitamin D

Ÿ Diet should include milk and cheese, forest fish

Ÿ Do not smoke

Ÿ Consume a limited amount of salt

Ÿ Brew tea, which contains Florid, which strengthens bones

Ÿ Women over 40 are recommended to be tested for the presence of estrogen

Ÿ In the dark, people over 50 For years it is recommended to take vitamin D and calcium

Ÿ Falling is especially dangerous in old age, therefore it is recommended to wear special clothing protecting bones.

Treatment

Osteoporosis is difficult to treat because bone is slowly renewing itself. Cortisone treatment is given to people who have had fractures and their bone density is constantly decreasing.

Treatment provides for adequate vitamin D and calcium intake. The daily intake of calcium is 800 mg, it is contained, for example, in three glasses of milk or kefir. Cheese and other dairy products are also good sources of calcium.

Vitamin D is obtained by a person under the sun, as well as from food, for example, fish and mushrooms are rich in vitamin D.People over 70 are advised to take 15 micrograms of vitamin D daily (600 units). This amount is difficult to obtain from food, which is why it is prescribed for older people in the form of dietary supplements.

The drug treatment of osteoporosis is constantly evolving. Treatment is lengthy and quite expensive. An important drug group is bisphosphonates (alendronate, etidronate, residronate and ibandronic acid). Currently, the dosage of drugs is calculated so that they need to be taken no more than once a week or month.Medicines come in the form of a nasal spray. Also, women can take drugs containing the hormone estrogen or drugs that act in the same way (raloxifene). In difficult cases, strontium and teriparatide are used.

11. RHEUMATIC POLYMIALGIA

Polymealgia is a fairly common disease that causes muscle pain. Poly means a lot, myalgia means muscle pain.

Causes

The causes of the disease are not clear, but a viral infection can provoke the disease.Most often, women get sick with polymyalgia after 50 years.

Symptoms

Symptoms of the disease appear rather slowly. Pain and numbness (stiffness) appear in the muscles of the neck, shoulders, lower back and hips. Muscles become tender and sore when moved and touched. Swelling of the joints is rare. Due to the appearance of muscle and joint pain, it is difficult to get up in the morning. The patient may also have fatigue and fever. In the blood test, the indicators of inflammation are increased, so a previously healthy and vigorous person feels seriously ill.

Often arterial inflammation joins the muscular form of rheumatism. Inflammation of the temporal artery causes pain in the temples or cheeks, such as when chewing food. An inflamed artery can sometimes be seen in the temple area, it is tense and enlarged. There may be no pulse in the artery. It is important to detect temporal artery inflammation (temporal artery) in time, because a branch of the temporal artery goes to the base of the eyes. Obstruction of the temporal artery can lead to loss of vision.

Diagnosis

The doctor makes a diagnosis based on the symptoms of the disease, the patient’s age, pain, general condition and blood test. Elderly people are prescribed other types of examinations. If an inflammation of the temporal artery is suspected, the patient is referred to the Central Hospital for examination.

Treatment

For the treatment of polymyalgia, cortisone preparations are prescribed. Treatment lasts at least a year and the dose of cortisone is gradually reduced based on observations of the course of the disease, symptoms, and blood counts.Other drugs are also used for treatment, such as methotrexate. Inflammation of the temporal artery is treated in a hospital.

Forecast

The forecast of polymyalgia is good. With the right approach to treatment, in a few years health returns to almost all sick people.

12. POLYMYOSITIS

Polymyositis is a fairly rare inflammatory muscle disease that manifests itself both with rheumatism and an independent disease of the connective tissue.Also, the disease includes cutaneous and inclusive myositis.

Approximately 20 people fall ill every year in Finland. Adults are more likely to get sick, but the cutaneous form of myositis is also found in children.

Causes

The causes of myositis are unknown, but obviously, we are talking about a dysfunction of the autoimmune system, as in other systemic diseases of the connective tissues. Muscle inflammation can present with mild articular rheumatism, Shegrin’s disease, or SLE symptoms.The cutaneous form of myositis can occur in the presence of cancer.

Symptoms

An important symptom of polymyositis is muscle weakness. Symptoms usually develop slowly, and pain first appears in the thigh, hip, and shoulder muscles. Difficulty getting up and raising arms up. Patients also have difficulty swallowing food. With the cutaneous form of myositis, symptoms appear on the skin of the hands and face. Inclusive myositis manifests itself more slowly than other forms of myositis.In children, after inflammation, calcium is deposited in the scar tissue. The inflammation causes fatigue, weight loss, and fever.

Diagnosis

The diagnosis of myositis is based on a blood test. A biopsy is also done. If necessary, electroneuromyography (ENMG) and magnetic resonance imaging are done. Elderly people, if necessary, undergo additional examination.

Treatment

Treatment begins in the hospital with fairly high doses of cortisone.If cortisone treatment is not enough, methotrexate is given. In difficult cases, new biological rheumatic drugs are prescribed.

Treatment lasts for years, so it is important to keep your muscles in shape.

Prevention

Previously, myositis was a dangerous disease, but now it can be completely cured of it.

13. REACTIVE ARTHRITIS AND REITER’S SYNDROME

Infectious diseases of the intestines, urinary tract or sexually transmitted infections can cause inflammation of the joints.In the future, this leads to reactive inflammation of the joints (arthritis), that is, the body’s immunological response to infection. In Reiter’s syndrome, patients may have inflammation of the mucous membrane of the eyes, skin or mouth, genitals, or urinary tract.

Causes

The lining of the joint reacts with inflammation to bacteria-infections. The body makes antibodies (immune response) against itself. Reactive joint inflammation begins, for example, with chlamydia, salmonella, or a common bowel disorder.There is a high risk of intestinal infections in large tourist centers in hot countries.

The disease has a hereditary predisposition. HLA-B27 antigen was found in most of the patients. Reactive arthritis mainly affects young people.

Symptoms

Symptoms of reactive arthritis begin one week after an intestinal or venereal infection and are manifested by pain and swelling of the joints. The initial infection usually goes away. The disease is manifested by inflammation of several joints.Usually the lower limbs are affected more often than the upper ones. Also, the sacrum and ilium become painful.

Reactive arthritis and Reiter’s syndrome cause flaky redness of the skin on the feet, toes and on the genital mucosa (balanitis). Also, patients may have redness of the mucous membrane of the eyes or inflammation of the ureters. Fever and fatigue are common symptoms. A blood test indicates the presence of an infection in the body.

Diagnosis

Reactive arthritis is easy to diagnose if the patient has recently had a venereal or intestinal infection.Sometimes there are few or no symptoms of infection. Then the causes of infection are found out by culture or blood test for antibodies. Sometimes it becomes necessary to exclude other diseases, such as incipient articular rheumatism.

An ECG is also done because there is a risk of heart inflammation.

Treatment

An infection that causes joint inflammation is treated with antibiotics. Chlamydia treatment is also prescribed. Anti-inflammatory drugs, pain relievers, and sometimes cortisone-containing drugs are given as injections into the affected joint or as pills.Swollen joints should not be overloaded, but supportive exercise is not contraindicated.

Cold treatments such as an ice pack can also be used to relieve inflammation and pain.

If during several months the inflammation of the joints does not go away, then rheumatic drugs are prescribed, one of them is sulfasalacin.

Re-inflammation can be avoided by safe sexual intercourse, good hygiene and good nutrition.

Prophylaxis

Reactive arthritis usually heals in a few months, but joint pain can last for a long time.After a sexually transmitted infection, the disease is more difficult to treat than after an intestinal infection. Individuals with the HLA-B 27 antigen are at increased risk of re-disease.

In some patients, reactive arthritis turns into a chronic form of rheumatism, spondylatropathy (ankylosing spondylitis), for example, with rheumatism of the spine.

14. RHEUMATISM OF THE SPINE AND BEKHTEREV’S DISEASE

Rheumatism of the spine is a long-term inflammatory disease of the spine, sometimes manifested in the joints of the extremities.In addition, it can cause inflammation in the attachment points of the tendons and in the eyes. Sometimes the inflammation can be in the heart or on the walls of the aorta. Spinal rheumatism refers to spondylatropathy.

Rheumatism of the spine occurs equally often in both men and women, but in men the disease is more serious. Most of the patients in the hospital are men. Almost all women with spinal rheumatism are unaware of their illness. Heredity is a risk factor.In Finland, about 10,000 patients with rheumatism of the spine need treatment. But according to statistics, patients with rheumatism of the spine can make up one percent of the total population.

Causes

The causes of the disease are unknown, but infectious diseases are one of the factors. Spinal rheumatism may appear after suffering from reactive arthritis. In 95% of patients with rheumatism of the spine, the hereditary antigen HLA-B27 was found.

Symptoms

A young man who begins to wake up at night with pain in the lumbar region is a typical patient.The pain can radiate to the back of the thigh. Your back won’t bend in the morning, but a little exercise will ease the pain. In half of the patients, the joints of the arms and legs also become inflamed, the knees, legs and hips swell. Sometimes the disease begins with swelling of the joints of the hands and feet, less often with eye inflammation. Quite often, the disease is accompanied by chest pain.

Symptoms of rheumatism of the spine may be short-lived. Sometimes the disease manifests itself again after a while. There are pains in the spine when bending forward.Bone bridges grow between the vertebrae. Posture changes and the flexibility of the spine decreases. The joints of the arms and legs are also affected. The joints of the hips, knees and shoulders are especially affected.

At the next stage of the disease, some patients develop eye inflammation – iritis. One or two out of a hundred patients with rheumatism of the spine subsequently develop inflammation of the heart.

Diagnosis

Due to the fact that back pain is common, the diagnosis of rheumatism of the spine is very easy to miss.At the initial stage of the disease, the flexibility of the spine remains in good shape, but over time, the back grows numb and the flexibility of the spine deteriorates. Sometimes the diagnosis of rheumatism of the spine can be made only five or even ten years after the first symptoms of the disease appear.

The disease is confirmed by an X-ray of the sacral spine, which shows inflammatory changes. In the early stages, you can take a magnetic image. Later, bone bridges (syndesmophytes) are visible between the vertebrae.The blood test shows high levels of inflammation and low hemoglobin. In some cases, the blood test may be normal. There is no rheumatic factor in the blood. A test for the presence of the HLA-B27 antigen is prescribed.

Treatment

Exercise is important in the treatment of back rheumatism. Rheumatism affects the spine and a forward bend is formed. By exercising daily, you can maintain good posture and flexibility in the spine. Straighten your back at least once a day.This can be done by approaching a wall, pressing your heels, buttocks and shoulders against it. The chest can be kept in good condition by taking deep breaths and exhales. It is advisable to direct the patient to physical education and explain what needs to be done to keep the body in good shape. Classes with a professional instructor are especially important for young patients.

For mild forms of the disease, pain relievers and anti-inflammatory drugs are prescribed. Sulfasalacin is prescribed to prevent the development of the disease in the spine.Other medications are also prescribed. For example, new biological antirheumatic drugs that are effective in treating rheumatism. If rheumatism affects the joints of the hips and knees, then the patients undergo joint replacement surgery.

Pain and redness of the eyes can be a sign of inflammation, for this it is recommended to consult an ophthalmologist.

Prevention

Good treatment is prevention. Spinal rheumatism is not cured, but it can be prevented.The acute period of the disease rarely occurs in people over 40 years of age. Most people retain their working ability, and only a small proportion of those who fall ill are disabled.

15. HEREDITARY DISEASE OF CONNECTING TISSUE

Connective tissue connects all tissues in the body, it consists of cells, fibers, water and intercellular substance. Connective tissue fibers are proteins or proteins, the structure of which is inherited from the father and mother. If there was an error in the genes of the parents, then in the new, born gene there will also be an error, which will lead to the appearance of the disease.

Collagen is a protein in the body. They are tough fibers that can withstand stretching. Tendons, ligaments and muscle membranes are formed from collagen, and collagen is also found in other tissues. There are many types of collagen. Collagen I is found in bone tissue, collagen II in cartilage tissue.

Elastin are fibers that stretch like rubber. Elastic fibers wrap around fibrillins like fishnet tights wrap around a woman’s leg. In all protein fibers, hereditary diseases caused by an error in genes can manifest.

Ehlers-Danlos Syndrome (EDS)

There are about 1000 patients with EDS in Finland.

Causes

The cause of the disease is heredity. If the parents of a child are sick with Ehlers-Danlos syndrome, then the probability of the child’s illness increases by 50%. But it is possible that the affected gene of one of the parents will never lead to the disease. If the genes are affected in both parents, then the child’s chance of getting sick is one in four. Ehlers-Danlos Syndrome is a group of inherited connective tissue disorders that affect the skin, joints and blood vessels, causing them to stretch.With this syndrome, there are disorders in the structure of collagen.

Symptoms

Symptoms of the disease are varied: easily damaged elastic skin, hyper-movable joints, varicose veins, hernias, ruptured blood vessel walls, inflammation of the gums and tooth loss. Symptoms depend on the type of disease.

Courses for EDS patients are organized at the Apila Rehabilitation Center, where people with this disease are helped to cope with their difficulties and problems: pain, joint flexibility, dental problems, muscle weakness, bruising and bleeding, slow wound healing and scarring, problems bowel dislocation, fatigue and swelling.In women, miscarriage prevention.

Types of EDS-syndrome

Currently, EDS-syndrome is divided into different forms of the disease.

Hypermobility – hypermobility (formerly type III)

The main symptom of the hypermobile type is increased mobility in large and small joints, sometimes dislocations and pain. The skin is stretchy and velvety. The disease can manifest itself in relatives.

Classic form EDS (earlier forms I and II)

In the classic form of the disease in patients, the skin is soft and velvety, pronounced elasticity of the skin, a tendency to damage with minor trauma, as well as the formation of bruises or hematomas, scars, subcutaneous pseudotumors, increased mobility in large and small joints, frequent varicose veins.Patients also have inguinal and diaphragmatic hernias, bruising, muscle weakness, hemorrhoids, and gum disease. The disease is hereditary.

Vascular form (formerly form IV)

In patients, this form of the disease is manifested by joint hypermobility. Vessels are easily damaged because the vascular walls are weak, which is vasculitis, that is, inflammation of the vascular walls.

The skin of these people is thin, transparent with translucent vessels. Bruises easily.

EDS kyphoscoliosis (formerly type VI)

Kyphoscoliosis is a rare disease, but the affected gene is currently being investigated. This disease affects about 60 people on Earth. They have severe muscle weakness, which leads to incorrect posture of the spine – scoliosis. In some cases, there may be increased eye vulnerability and corneal thinning.

Arthrochalasia type EDS (formerly types VII A and VII B)

In a rare form of arthrochalasia type EDS, there are strong changes in connective tissues that weaken joints, make the skin easily damaged, lead to inflammation of the joints, brittle bones and orthopedic problems.About 30 people are sick on Earth.

Dermatosparaxis EDS (formerly type VII C)

Severe skin vulnerability and its increased elasticity. One gets the impression that there is a lot of skin. Scars and hernias are common. Pregnant women are at risk of premature birth due to the weak membrane of the fetus.

Treatment

It is impossible to change the gene and eliminate the cause of the disease. Treatment is aimed at reducing symptoms and preventing them from worsening.

It is important to determine the cause of the disease and provide the patient with complete information about the disease. Knowing about the nature of the disease, the patient himself plans his life so that the disease does not affect her. When choosing a profession, young people should take their illness into account.

For joint pain, paracetamol and anti-inflammatory drugs can be taken. For large joint lesions, joint implantation operations are performed.

Before surgery, EDS patients need to tell the surgeon about their illness in order to avoid complications during wound healing.

EDS patients can benefit from a variety of tools in their daily life. By avoiding dangerous situations, you can keep your joints intact. Supportive elastic bandages can be worn around the joints. Muscles need to be strengthened. The skin should be moisturized with creams. It is recommended to wear supportive tights and golf to prevent varicose veins. Regular visits to the dentist can help prevent dental problems.

Patients themselves know how important it is to receive information about the nature of the disease.A calm life, rest and relaxation, as well as the support of loved ones help to overcome life’s difficulties. It is necessary to avoid sudden movements, use tight bandages for joints, regularly take medication, eat right, try Reiki treatment, yoga, zonotherapy and lymphomassage. Try to do everything that you can and can do.

Other damage to the structure of collagen

Stickler syndrome is a fairly common disease that is caused by a violation of the structure of type II collagen.The disease is often mild. Stickler’s syndrome is a complex of hereditary abnormalities of the eyes and joints. The first symptoms appear in childhood: congenital severe myopia, often blindness, cataracts, secondary glaucoma, chronic uveitis, keratopathy, wrinkling of the eyeball develop in the blind eye. Joints become hyper-flexible, painful, and prone to fracture. In some cases, violations in the structure of the face are noted: a small chin, split jaws.

Connective tissue dysplasia (MED) is caused by a structural disorder of type IX collagen. These abnormalities in the structure of articular cartilage lead to growth retardation and joint destruction.

Imperfect osteogenesis is a bone disease caused by a type I collagen mutation that can cause fetal death while still in the uterus. In a mild form of the disease, bones are weak and break easily. In addition, there may be problems in the connective membrane of the eyes, hearing problems and deafness.

Other genetic problems of protein fibers

Williams syndrome is a syndrome that occurs as a consequence of the chromosomal abnormality of elastin. Elastin and collagen form a fibrous protein, with the help of which the walls of blood vessels, lungs and other organs are able to stretch. This disease affects one child in 20,000. They develop problems in the cardiovascular system. The aorta and pulmonary artery is narrowed already in childhood, later there are problems with blood pressure. Children are born small, feeding problems, colic appear.Also, there are changes in the structure of the teeth (large gaps between the teeth), weak muscles, hypermobility of the joints. In adults, the joints are less mobile.

Marfan syndrome is caused by a change in fibrillin type I. Fibrillin is a fibrous protein.

In connective tissue, it forms a protective mesh around elastin. In addition to the characteristic changes in the organs of the musculoskeletal system (elongated bones of the skeleton, hypermobility of the joints), pathology is observed in the organs of vision and the cardiovascular system.

16. SHEGRIN’S SYNDROME

Shegrin’s syndrome is a systemic autoimmune disease characterized by dryness of the mucous membranes of the eyes, mouth and genitals caused by damage to the lacrimal, salivary and gonads. Most often, women are ill. Shegrin’s syndrome affects people over 50 years of age. There is no reliable information about the disease, but according to experts, 3-4% of adults suffer from Shegrin’s syndrome.

Causes

Autoimmune disorders, in which the immune system opposes its own tissues, are considered the basis of the mechanisms of the development of the disease.The syndrome can develop independently (primaarinen) or together with other rheumatic autoimmune diseases, in particular, articular rheumatism (sekundaarinen). One of the causes of the disease is considered to be a change in sex hormones, because most of the sick are women.

Symptoms

With Shegrin’s syndrome, dryness of the mucous membranes appears. The first signs of the disease are irritation and dryness in the eyes. There is a dry mouth and difficulty in swallowing food, there is a need to drink food.The voice sits down. Due to the decrease in salivation, caries forms on the teeth and the gums become inflamed. Inflammation of the salivary glands may occur. Dry skin causes itching. Dry nose and dry cough appear. In women, dryness of the mucous membranes of the genitals appears. Disorders of the glands of the stomach and intestines cause malabsorption of iron and vitamin B12.

In Shegrin’s syndrome, fatigue appears, joint pain resembles fibromyalgia, skin irritation and fever appear. Possible kidney disease, swelling of the lymphatic glands and disorders of the nervous system.

With Shegrin’s syndrome, the risk of cancer of the lymphatic glands (lymphoma) increases. With severe edema of the lymphatic and salivary glands, it becomes necessary to examine them.

Diagnosis

Shegrin’s syndrome is determined by the dryness of the mucous membranes typical of this disease. Tear production is measured by the Schirmer test, which examines the rate at which absorbent paper becomes wet behind the lower eyelid. The secretion of salivary fluid is measured by the collection of saliva. Microscopic examination of the lips indicates the presence of an inflammatory process.Indicators of inflammation in the blood are elevated. Almost all patients have rheumatic factor of Shegrin’s syndrome and antibodies in their blood.

In the elderly, dryness of the mucous membranes is an age-related indicator and is not a symptom of Shegrin’s disease.

Treatment

If rheumatism of the joints or another disease of rheumatism is included in the secondary Shegrin’s syndrome, then it is treated in the usual way. Dysfunction of the glands in Shegrin’s syndrome is incurable, but moisturizing can alleviate dry mucous membranes.

Moisturizing eye drops and safety glasses prevent dry eyes. The indoor air should not be very dry. Moisturizing drops are instilled regularly at regular intervals. The use of xylitol chewing gum, as well as medications such as pilocarpine and bromhexidine, increase saliva production. It is necessary to monitor the condition of the teeth. Fungal infections of the mouth and genitals need to be treated with antifungal medications. The female genitals are treated with special moisturizers.

Primary Shegrin’s syndrome is treated with low doses of cortisone. In difficult cases, methotrexate and other newer rheumatic drugs are prescribed.

Prevention

Shegrin’s syndrome is not cured. Treatment slows the progression of the disease, but you need to learn to live with the disease. Disability caused by illness is rare. Prevention is more influenced by the nature of the course of the primary disease or rheumatism than dryness of the mucous membranes.

17. SERONEGATIVE SPONDYLOARTHRITIS

Spondyloarthritis defines a group of diseases, the exact diagnosis can not always be determined.We are talking about seronegative rheumatism of the spine, with spondyloarthritis there is no rheumatic factor in the blood, but there is a tendency to cause inflammation in the joints of the spine.

Spondyloarthritis includes:

rheumatism of the spine (Spondylarthritis ancylopoetica, ankylosing spondylitis)

reactive inflammation of the joints and Reiter’s disease

ulcerative inflammation of the colon and Cronin’s disease

part of psoriasis 9000 diseases can cause inflammation in the joints of the limbs and spine.A feature of these diseases is inflammation of the intermediate joint between the sacral and iliac bones (sacroilitis). During examination, the hereditary antigen HLA-B27 is found in patients. Usually these diseases develop at a young age, inflammation of the eyes (iritis), heart and aortic walls appear. All symptoms are rare at the same time. At the beginning of the disease, inflammation of the joints brings problems and pains, but later they can disappear even without treatment.

Spondyloarthritis manifests itself like other rheumatic diseases.Perhaps the cause is a previous intestinal or venereal infection, as with reactive inflammation of the joints. The hereditary factor is of great importance.

Finns live in cold climates and the presence of the HLA-B27 antigen is quite common. 15% of Finns have the HLA-B27 antigen, while only 8% of Central Europeans, 1% of Japanese, and even less of South American Indians. People with the HLA-B27 antigen in their bodies have a hundred times higher risk of developing spondyloarthritis than others.

Spondyloarthritis is a long-term disease, but it rarely causes disability. In mild forms of the disease, the patient is treated with small doses of drugs. In difficult cases, biological rheumatic drugs are prescribed.

18. SYSTEMIC LUPUS ERYTEMATOSUS (SLE)

Systemic lupus erytematosus (SLE) is a systemic autoimmune disease of the connective tissue. The body produces antibodies, which, instead of protecting, on the contrary, attack the connective tissues of the body.Symptoms of the disease appear in different parts of the body. There are about 2,000 SLE cases in Finland, 90% of whom are women. Half of them are under the age of 30. In older people, the disease is mild.

Causes

The causes of the disease are unknown. In women in adulthood, sex hormones affect the disease. Heredity also affects the disease. Certain medications (hydralazine, procainamide), chemicals, and ultraviolet light increase the risk of SLE.

Symptoms

Common symptoms of SLE disease are fatigue, weight loss and fever. Skin rashes appear on exposed parts of the body, caused by exposure to sunlight. A red butterfly-shaped rash appears on the face around the nose. Joint pain and inflammation, hair loss, mouth ulcers, kidney disease, inflammation of the membranes of the lungs and heart, and neurological diseases. Pain or rheumatic inflammation in the joints is manifested in almost all patients, skin rashes – in a fairly large part of the sick, and kidney disease – in almost half.The joints are not destroyed, but they can become deformed. The symptoms of the disease are manifested differently in different people. More often, the disease is mild and does not affect the patient’s lifestyle. It is quite difficult to identify the form of the disease.

Diagnosis

The diagnosis of the disease is made on the basis of symptoms and laboratory tests. There are 11 criteria for disease. If 4 or more criteria are manifested in the disease, then the diagnosis of systemic lupus erytematosus is correct.The calculation of the criteria is more theoretical. In the analysis of blood, the indicators of inflammation increase, but as with other diseases of rheumatism, the CRP is not increased. Almost all patients have antibodies in their blood. By the quantity and quality of antibodies, the stage of the disease and the result of treatment can be assessed. Leukocytes and platelets may be lowered. Anemia is possible.

Treatment

Mild cases of SLE do not require treatment. The sick person takes care of himself, avoiding the sun’s rays and using protective creams.It is enough to get by with weak drugs, for example, small doses of cortisone and hydroxychloroquine. In difficult cases, the patient is given large doses of cortisone.

Pregnancy can cause problems. It is recommended to consult a rheumatologist about the observation and treatment of SLE disease during pregnancy. Infections can also cause complications. It is imperative to find out the reason for the rise in temperature in order to know whether it is caused by an infection or an exacerbation of SLE disease.Treatment is directed at the affected organ. Almost always resembles treatment for osteoporosis.

Prevention

Prevention of systemic lupus erytematosus is constantly evolving. The disease is dangerous for people with serious diseases of the kidneys, lungs or central nervous system. With age, the disease subsides. SLE- drug-induced illness resolves with drug withdrawal.

SLE criteria:

1. Red butterfly rash on nose and cheeks

2.Scaly redness on the skin

3. Redness of the skin under the influence of sunlight

4. Ulcers in the mouth

5. Inflammation of the joints

6. Inflammation of the membranes of the lungs and heart

7. Kidney diseases

8. Neurological symptoms ( or psychosis)

9. Blood changes (anemia, decrease in leukocytes or platelets)

10.Immune changes in the blood (DNA, false positive cardiolipini test)

11. Antibodies

19. SYSTEM SCLEROSIS (SYSTEMIC SCLERODERMIA)

Systemic sclerosis is a rheumatic disease of the connective tissues. One of the forms of the disease is scleroderma (sclero is hard, dermis is skin). With this disease, the skin becomes rough. Also, the connective tissue of internal organs is scarred, but this symptom is rare. In Finland, 20-50 people fall ill every year, most of them are women.Children rarely get sick.

Causes

The cause of systemic sclerosis is unknown, but many chemicals can cause the disease. For example, in 1981 in Spain there was a wave of this disease caused by low-quality vegetable oil. A substandard tryptophan marketed as a natural product caused a second epidemic at the end of the same decade. Also, coal and silica dust, vinyl chloride, triclorothylene and other chemicals can cause disease. Silicone implants are one of the suspected causes.In most patients, the causes of the disease are unknown.

Symptoms

The disease begins with circulatory disorders of the fingers and toes. Raynaud’s symptom appears when the vessels contract so strongly that the fingers turn white at a cool ambient temperature. Skin changes appear on the fingers. The skin of the fingers swells and hardens. Skin wrinkles and folds disappear. Over the years, the skin becomes thin and taut, sometimes calcium is deposited in the skin. Symptoms can spread throughout the body, and the skin becomes denser and deformed.The muscles of the face become immobile and the mouth contracts. The dilated subcutaneous vessels are visible.

Scleroderma can affect not only the skin, but also the internal organs. If the esophagus is affected, there are problems with swallowing. With damage to the lungs, kidneys and intestines, serious health problems appear. These diseases also include such unusual forms of the disease as eosinophilic faskitis. When the inflammation subsides, the skin will scar and resemble an orange peel.

A common form of systemic sclerosis is CREST (from calcinosis – skin hardening), Raynaud’s symptom, esophagus (scarring of the esophagus), sclerodactyly and telagniectasia, that is, dilation of the subcutaneous vessels.

Diagnosis

The diagnosis is based on the picture of the disease. Indicators of rheumatism and antibodies are found in the patient’s blood. CREST detects the antibodies characteristic of this disease.

Treatment

Treatment of systemic sclerosis is difficult because there is not enough effective medicine. The patient needs to protect the skin from the cold. Stop smoking. Vasodilators (nifedipine) are prescribed. Moisturizers are used to prevent dry skin.To maintain the mobility of the fingers, it is necessary to do gymnastics for the hands.

Rheumatic drugs are being tested, but their effect remains negligible. Penisillamine and cyclosporine are widely used. When treating internal organs, symptomatic medications are prescribed.

Prevention

An important role in the prevention of systemic sclerosis is to limit the disease to the cutaneous stage, when other organs are not yet affected. Over time, the skin softens and the disease becomes mild.But damage to the lungs and kidneys remains a serious disease.

20. VASCULITIS

Vasculitis is an inflammation of the walls of blood vessels. The consequences of vasculitis depend on the number of affected vessels and sites of inflammation. In severe cases, vasculitis causes blood circulation problems. This leads to bleeding or tissue death.

Vasculitis is classified based on the size of the vessels involved. Vasculitis affects the temporal artery, cutaneous vasculitis, small blood vessels. With temporal arteritis, large and multinucleated cells are visible in the wall of the temporal artery under a microscope, due to which the disease has received its second name – giant cell arteritis.

Vasculitis is often manifested by rare diseases such as polyarteritis nodosa. As well as Shenlein-Genoch purpura, Churg-Strauss syndrome, Kawasaki disease, Wegener’s granulomatosis, and Takayashi’s arteritis.

Causes

The causes of the disease can be infections, tissue damage, foreign substances that cause immune reactions in the body. The mechanism of the appearance of vasculitis has not been determined. Heredity matters too. Vasculitis can be either an independent disease or belong to a group of rheumatisms such as articular rheumatism or SLE disease.

Symptoms

Vasculitis is characterized by fever and weight loss. Due to vascular diseases, skin rashes of various types appear. Typical symptoms of the disease are muscle and joint pain, disturbances in the peripheral nervous system, nosebleeds, coughing up blood, blood in the urine, and abdominal pain.

Features

Half of the patients diagnosed with vasculitis and temporal arteritis show symptoms of polymyalgia. Symptoms of arteritis include headaches in the temporal region and pain in the cheekbones when chewing.With the disease, there is a risk of ocular artery blockage and loss of vision, so treatment should be started as soon as possible. Mostly elderly people get sick.

Takayashi’s disease affects the aorta and the blood vessels emanating from it. The main symptom of the disease is circulatory disorders. The diagnosis is difficult. Mostly young women get sick.

Polyarteritis nodosa is a rare condition in which inflammatory plaques form on the walls of the arteries.It manifests itself in young people. There are serious changes in the internal organs, the diagnosis is clarified during the operation.

The initial symptoms of Wegener’s granulomatosis are upper airway disturbances, sinus inflammation, nasal congestion and nosebleeds. There may also be otitis media and deafness, impaired vision. Complex forms include kidney and lung damage. Some forms of the disease are rather mild. ANCA antibodies are present in the blood.

With secondary vasculitis in combination with other autoimmune diseases, symptoms begin with lesions of small skin vessels. Wounds and necrosis form on the skin of the legs or arms.

Diagnosis

Diagnosis is based on symptoms and skin biopsy. X-rays of the blood vessels (angiography) reveal vasculitis. Also, the diagnosis is based on laboratory tests. CRH increased.

Treatment

Treatment is aimed at eliminating the cause of vasculitis.First, the inflammation of the blood vessels is removed with drugs. After its termination, the underlying disease is treated more effectively. Cortisone is prescribed. Cytostatic agents are often used along with it. In critical situations, large doses of cortisone are prescribed. Biological medicinal products give good results.

Prevention

The prognosis of vasculitis improves with the development of treatment methods. In a large proportion of patients, symptoms improve. Although sometimes the disease can become severe.Extensive lesions of internal organs give a poor prognosis of the disease and urgent hospitalization.

© 2016 Lappeenrannan reumayhdistys ry.

Chronic Fatigue Syndrome | Family Doctor

Loss of strength, weakness, lethargy, rapid fatigability, powerlessness, “woke up and already tired”, drowsiness, “I do not feel rested after a full sleep”, decreased concentration, memory impairment, etc. A significant proportion of people who seek advice from an endocrinologist or doctors of other specialties experience these or similar symptoms.The latter are not specific, since they can be in a number of diseases and painful conditions.

Let’s figure out which common endocrine diseases can cause symptoms of chronic fatigue.

With a decrease in thyroid function (hypothyroidism):

loss of strength is often combined with dry skin, hair loss, swelling of the face, hands and lower extremities, constipation, chilliness, memory impairment; in women – with menstrual irregularities.

With an excess of thyroid hormones in the blood (thyrotoxicosis):

weakness and increased fatigue are accompanied by constant heart palpitations, increased excitability and sweating, tremors of the hands and / or body, sleep disturbances, weight loss with increased appetite, in some cases with bulging, pain and redness of the eyeballs.

With elevated blood glucose (type 1 diabetes):

patients complain of thirst, frequent urination, dry mouth, itchy skin, changes in visual acuity, weight loss with increased appetite.In type 2 diabetes, such symptoms occur much less frequently, since they develop only with pronounced decompensation of carbohydrate metabolism several years after the manifestation of the disease. With a moderate increase in blood glucose, in most cases, there are no symptoms.

Disorders of phosphorus-calcium metabolism

Disorders of phosphorus-calcium metabolism can be suspected in persons with general and muscle weakness, bone pain, low mood, with complaints of thirst, frequent urination, vomiting and diarrhea (not due to other reasons), urolithiasis, frequent recurrence of gastric ulcer and duodenal ulcers, low-traumatic (occurring with minimal trauma) fractures, muscle cramps, with chronic kidney disease, long-term use of glucocorticosteroids, with low or no insolation, including people who are completely covered by clothes for religious or national reasons or who do not leave home.

Testosterone deficiency

Testosterone deficiency in men is also often accompanied by rapid fatigue, mood lability with a tendency to depression, decreased sex drive, memory impairment, hot flashes, increased sweating, palpitations, decreased muscle mass, and sleep disorders.

Adrenal insufficiency

In adrenal insufficiency, asthenia is always accompanied by weight loss, decreased appetite, and orthostatic hypotension (darkening of the eyes and / or dizziness when standing up).In addition, there may be cravings for salty foods and darkening of skin folds and postoperative sutures.

Hypercortisolism

Hypercortisolism (excess production of cortisol by the adrenal glands) is characterized by muscle weakness in the arms and legs, weight gain with predominantly fat deposition on the trunk with relatively thin limbs, the appearance of bright purple, wide (usually more than 1 cm wide) stretch marks on the skin, increased blood pressure , disorders of carbohydrate metabolism (impaired tolerance to carbohydrates or type 2 diabetes), impaired sexual function, a decrease in the body’s resistance to infections.

If you have noted a combination of asthenic symptoms with the above manifestations, contact an endocrinologist. A specialist will help eliminate endocrine disorders and normalize hormone levels, if necessary.

For the prevention of endocrine diseases, consume iodized salt with food, consume dairy products daily, maintain a normal and stable weight, sleep well (at least 7-8 hours a day), engage in aerobic physical activity, walk in the fresh air, take preventive doses of vitamin D.

You can sign up for a consultation with an endocrinologist and get all the answers you are interested in on the diagnosis of endocrine diseases by phone in Moscow +7 (495) 775 75 66

Information prepared for you:

Grechkina Alla Pavlovna – endocrinologist. Conducts a reception in the building of the clinic on Ozerkovskaya.

90,000 recommendations, answers to questions, how to improve well-being

After the operation to install the implants, it is very important to follow all the doctor’s recommendations.First, so that rehabilitation is simple and with a quick return to the usual rhythm of life. Secondly, to reduce possible complications to a minimum.

The first 2-3 days after dental implantation

You just came home from your implant surgery. We are sure that you are feeling well, but you feel a slight general weakness caused by the operation and the general psychological stress, as well as numbness caused by the use of anesthesia and excessive pressure on the nerves.It will pass on its own in 5-6 hours (the maximum will persist locally and pointwise for a week).

“In the first days after the operation, we recommend staying within the reach of the dentist – no need to go out of town or on a business trip in order to get timely medical help if the condition worsens”.

Bespalov Roman Dmitrievich,
maxillofacial surgeon, implantologist,
work experience over 25 years make an appointment

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Nutritional rules

The main requirement is the minimum load on the implants both on the first day and in the next 2-3 days. The following nutritional rules must be observed:

General rules of what you can eat and drink

• refuse food within the first three hours,
• in 3 hours you can eat: give preference to soft and warm food (ideal is warm soups, yoghurts),
• for the next three days, hot and cold food, drinks are prohibited,
• Eliminate spicy and sour foods from the diet,
• it is necessary to chew food on the side of the dentition where there are no seams,
• Your diet should be varied – make sure the foods you eat contain all the nutrients you need, especially calcium,
• no alcoholic drinks or smoking,
• it is not advisable to drink coffee and black tea, it is better to give preference to herbal tea or dried fruit / fruit compote,
• Do not eat solid food, excessively cold or hot drinks,
• it is important to drink as much water as possible (up to 1.5-2 liters).

Do not give up meals – gradually introduce all foods into the diet. Remember that your body needs strength and energy to recover. The diet should be of high quality and as useful as possible.

Sample menu – what should be the diet in the first 2-3 days after surgery

• soft cottage cheese, various yoghurts, baby food can be purchased in jars – give preference to meat products and vegetables. In the first 2 days, if you do not have dentures installed immediately, your diet will consist exclusively of liquid and puree food,
• Cook yourself some broth.It can also be regular soup, but it’s best to use a blender before eating. On the first day, you can afford grated boiled vegetables. All food should be warm – not hot or cold,
• from drinking – water is a priority, but you can afford warm herbal tea, especially one that acts on the nervous system as a sedative. Be sure to buy a straw – if stitches are applied, you are better off eating that way.

Can I drink alcohol after implant placement?

To the question “is it possible to drink alcoholic beverages after implantation”, our answer is categorical.NO. Check out our reasons why we strongly discourage drinking alcohol after implant placement:

1. bone tissue is destroyed, gums heal poorly,
2. fusel oil, which is contained in alcohol, slows down the healing process and causes inflammation of the gums, increases the risk of complications – hematoma, purulent inflammation, peri-implantitis and implant rejection,
3. antibiotics are prescribed, which means alcohol is prohibited – the combination can be life-threatening,
4. inadequate actions and impossibility of hygiene, because when a person is in strong alcoholic intoxication, he cannot control his actions,
5. the appetite rises – you can damage the implants,
6. your immunity stops working in a complete system,
7. you forget that you need to visit a doctor: such situations arise in those situations if the patient drinks alcohol for a long period of time.A shift in the visit to the doctor by 1-2 days (after a month after the installation of implants) is allowed. But in the first week, doctor visits must be strictly day-to-day,
8. you may lose your warranty.

Please do not read the Internet and do not study the stories of people who wrote that “they drank alcohol after installing implants or removing a tooth and nothing happened.” Much depends on the amount of alcohol consumed, the nature of the surgery, its complexity, your state of health and the prescribed medications.If it worked for others, this does not mean that you will not have complications either.

Read more about the negative effects of alcohol on the body in our separate article.

Alcohol intake should not interfere with a full life and the preservation of the result of expensive treatment!

Hygiene rules

• do not touch the area of ​​sutures and installed implants with your hands or tongue,
• in the first 3-4 days, limit yourself to oral baths (just hold the solution / water in the mouth), after which you can gently rinse,
• for 3-5 days, that is, after reducing the inflammatory process and edema, you must start using a toothbrush.Recommended hardness of the bristles – soft or ultra soft, so as not to damage the gingival tissue and the area of ​​sutures,

Inject

• toothpaste at the same time as you start using the brush: Parodontax, R.O.C.S. or RasYan Herbal Clove toothpaste (example, herbal, clove). These pastes allow effective prevention of gum inflammation,
• starting from 2-3 weeks after installing the implants, after each meal, use an irrigator (for a start – at 1-2 speeds, that is, the minimum), in the end, rinse your mouth with water or an antibacterial rinse.

After the implant treatment, be sure to buy a new toothbrush. Do not use the old one – it contains a huge amount of microbes and bacteria that can lead to the development of an inflammatory process.

Drug treatment

Do not forget about cold compresses to reduce the likelihood of developing edema – apply ice, a piece of meat or frozen vegetables to your cheek, a container or ice pack wrapped in 2-3 layers of thin cloth.The duration of the compress is 5-10 minutes, the breaks are 3-5 minutes. The number of approaches is 7-10 times, approximately for 1.5-2 hours. Compresses should be started immediately upon returning home after surgery; they can also be repeated periodically during the first day.

Your doctor has prescribed pain medications for you. Monitor your condition – if necessary, you can take a pill at night or after you no longer feel the effect of anesthesia, that is, pain appears.

The list of prescriptions for each patient is individual and is indicated in the recommendations issued by the doctor. But in any case, you will be prescribed ointments to be applied to the area of ​​sutures, antibiotics (taken for at least 7 days, as prescribed by a doctor), antihistamines to reduce tissue swelling, drugs with a high content of vitamins C and P in the body (to improve the condition of the gums ), antiseptic agents for oral baths (do not rinse in the first 3 days – just keep the solution in the mouth).

Postoperative lifestyle: general guidelines

• avoid physical exertion, do not lift weights – you must stop performing sports exercises in the next month after the implantation,
• avoid hypothermia and overheating – it is recommended to refuse to visit baths, saunas, swimming pools, swimming in the sea / lake also for 1 month,
• quit smoking (if possible) and drinking alcoholic beverages,
• in the first 3-5 days it is worth giving up flights,
• if the implantation of the upper jaw was carried out, including with the procedure of sinus lifting (displacement of the maxillary sinus), it is necessary to cough, sneeze and blow your nose very carefully – without opening your mouth or puffing out your cheeks (after bone augmentation, any pressure drops and overloads are prohibited).

Advice for smokers

If you smoke, then during the first 3-4 days (or before the removal of stitches, if they were imposed) try to stop smoking completely. If you cannot, then reduce the number of cigarettes to the maximum, and after smoking make a bath of “Chlorhexidine” or “Miramistin”. While osseointegration (implant engraftment) is taking place, minimize the number of cigarettes per day, switch to electronic substitutes with a reduced content of tar and carcinogens.

Prohibited with dental implants

• use an electric toothbrush, as vibration and excessive pressure during brushing, especially in the first months after implantation, can lead to impaired fixation of the implants,
• , you shouldn’t also use dental floss, especially if only a few implants were installed instead of living teeth. After implantation, the gums become less sensitive and when using the thread, you may not feel when it is time to stop – this can damage the tissues, which will lead to the fact that bacteria will enter the area around the installed implants.And this is already fraught with their possible rejection,
• to carry out hygienic cleaning in any dentistry – it is very important that the hygienist knows how and understands how to carry out the procedure in the presence of dental implants,
• Eating too hard foods: the denture can be damaged if you bite off hard objects with your teeth, gnaw on pencils or crack nuts. It, of course, can be restored, but it is better not to allow such situations to develop.

You will forget about dental problems for the rest of your life!

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When to see a doctor

Contact your healthcare professional if you experience any of the following symptoms:

• pain that does not decrease / increase 3 days after surgery,
• numbness persists for 2 days after the operation, does not go away a week after implantation and only intensifies, spreads throughout the face,
• a sharp increase in facial edema for 2-3 days or after he was already asleep,
• a sharp increase in body temperature or it does not fall on 3-4 days after the operation,
• when pressing on the implants, unpleasant sensations, sharp pain occur,
• the seams are open,
• redness of the gums and bleeding that does not stop after 2-3 hours,
• discomfort and sharp pain when pressing on the area of ​​installed implants 7 days after installation,
• pain after fixation of the prosthesis, teeth do not close, it is impossible to chew even soft food,
• the prosthesis became mobile, a part of the teeth were chipped.

Frequently Asked Questions and Answers

Don’t worry, it is perfectly normal for you to feel some discomfort. But be sure to pay attention to the signals that your body sends. If in doubt, contact support to see if your symptoms are normal. Be attentive to your teeth and the body as a whole – remember that the implants, the entire jaw system and you yourself need some time for rehabilitation.

Postoperative consequences and complications

This section deals with the most popular questions about conditions that arise during or in the first days after the installation of implants.Please note that it is very important to distinguish between the concepts of “consequences” (this is the norm, since tissue injury occurs during the operation) and “complications” (are a pathological condition that requires immediate medical attention).

You need to understand the difference between concepts such as sedation and general anesthesia. General anesthesia is a complete blackout and immersion of the patient into sleep. As a rule, it is carried out by inhalation. Breathing is provided by a ventilator.Therefore, when using general anesthesia, the patient does not hear or feel anything.

Sedation can be xenon (superficial, in fact – to calm and saturate the cells of the body with oxygen), as well as intravenous. In the second case, certain anesthetics are injected into the body (selected individually), their dosage is calculated based on the patient’s weight, his state of health, as well as the duration of the procedure. If necessary, the drug can be re-administered during the operation.Local anesthesia is used at the same time.

The Smile-at-Once clinic has an agreement with a specialized and licensed service of professional anesthesiologists. The reanimobile and the medical team are certified within the framework of the regulations and are an ambulance substation. Therefore, treatment under general anesthesia and intravenous sedation is carried out under the strict supervision of specialized specialists.

The difference between sedation and general anesthesia is that the patient retains the ability to breathe on his own, there are no involuntary reflexes of the respiratory tract (coughing, swallowing), unlike anesthesia, the patient is conscious and can, if necessary, follow the doctor’s instructions.

Since sedation uses more gentle drugs (as opposed to general anesthesia), the patient does not fall asleep, but relaxes. The action is individual: someone falls asleep for several hours, someone plunges into a state of complete relaxation. If you belong to the second type, then everything that happens in the oral cavity, you will really feel. But all procedures are painless, since high-quality local anesthesia is used. And the sensations remain at the level of “moving the instruments” in the oral cavity.

This is a normal process caused by tissue trauma during implant placement. The edema reaches its peak on the 3rd day, after which it should gradually subside. If the situation is the opposite, be sure to see a doctor. To reduce swelling, you need to apply a cold compress for the first two hours, if necessary, repeat the course throughout the day.

If the bleeding is minor, then there is nothing to worry about. You can stop it by attaching a piece of sterile gauze to the wound and closing your jaw tightly.Remember not to rinse your mouth, move your jaw actively, chew, suck and swallow with force – all this can increase bleeding.

If, 3-5 hours after the operation, the bleeding not only does not decrease, but also increases, you need to consult a doctor.

Accidental bleeding is normal up to 7 days after surgery, but usually go away within 2-3 days. We strongly recommend sleeping in a horizontal position right away with pillows on the sides of your head.If required, make for yourself a comfortable tilt angle of up to 30 degrees.

It is important to sleep strictly on your back, but if you accidentally turned your face on its side in a dream and were in this position for a long time, then due to the squeezing of the tissues, bleeding is possible, and depending on the load, even profuse. The main thing is that it stops within 1-2 hours after you have taken an upright position. If the bleeding is persistent, be sure to contact patient support for an unscheduled examination by your doctor.

Similar sensations occur due to increased blood flow to the head. In this situation, try sleeping in a semi-sitting position (tilt up to 30 degrees) – use an extra pillow or put it under the mattress, increasing the inclination of the berth. Thus, the head will be at a higher level in relation to the body and the discomfort will subside. But it is advisable to fix the head so as not to throw it on its side.

Hematomas are a consequence of vascular injury during the installation of implants.They quite often appear after the installation of two-piece structures, as well as after zygomatic implants – they appear approximately 2-3 days after the operation. You have absolutely nothing to worry about – the color of the bruises will change as the tissues begin to heal. In the fight against swelling and bruising, various gels for resolving bruises, for example, “Badyaga Forte”, will help you.

This is also a completely normal condition caused by a long stay in the dentist’s chair and the lack of natural mucous membrane wetting.For the first two to three days, use petroleum jelly or lanolin cream to relieve dry lips. Regular balm may not be enough – you need the most oily and moisturizing cream. Also make sure you are drinking enough fluids.

Saliva is a very important biological medium for organs and tissues of the oral cavity. It contains many enzymes that contribute to normal digestion and the formation of healthy microflora in the oral cavity. The therapeutic norm is the production of saliva fluid in an amount of 2 ml in ten minutes.In the case of implantation, especially during the period when the denture has not yet been installed, the patient may complain of hyperactivation of the secretory function of the salivary glands already when 5 ml is produced. This is a normal reaction to tissue injury from implantation, especially if the operation was performed to restore a full dentition.

But increased salivation is also possible as a result of damage to the lingual nerve. Its symptoms are pain when swallowing, change or complete loss of taste, numbness of the tongue and its biting, burning, salivation.If the integrity of the nerve is not violated, but compression on the nerve is observed or its sheath is damaged, then the discomfort is restored within 7 days to 4 months. Otherwise, more time may be required for rehabilitation, and in case of extensive damage to the integrity of the nerve bundle, microsurgical interventions.

Disruptions in the functioning of the endocrine system is another common prerequisite for hypersalivation. Thyroid problems are usually to blame. Diabetes mellitus or changes in hormonal levels during menopause or puberty can also provoke a symptom.

Numbness is caused by compression of the trigeminal nerve, its stretching, or injury – complete or partial transection. In the case of stretching or compression without violating the integrity of the trigeminal nerve, sensations pass rather quickly – up to 7 days as blood circulation in the bone tissue improves. But if there was a partial damage to the fibers of the nerve bundle, then the rehabilitation process can take from 14 days to 6 months. Reinstallation of implants may be required in cases of severe trauma, since the body of the implant interferes with the restoration of axons (processes) in the nerve bundles.

According to research data, damage to the trigeminal nerve during dental implantation occurs in no more than 3% of patients, while only 1.7% are diagnosed with permanent neuropathy, which requires microsurgical correction of the situation.

In our clinic, before the operation, a thorough computer planning of the implant placement is carried out, after which surgical templates are printed to protect the patient and the doctor from incorrect implant placement. Immediately, or the next day after the operation, a control computed tomography is performed, at which the control commission (consultation of doctors), in accordance with international quality assessment protocols, compares the placement of implants with the original plan and makes a conclusion about the success of the operation, or makes recommendations to the attending physician about the need to take additional measures.

We draw your attention to the fact that it makes no sense for the doctor and the clinic to hide the fact of damage to the trigeminal nerve, he will still reveal himself – this is the first thing. Secondly, even if this happened, the consequences are eliminated by correctly selected therapy and joint work of the doctor and patient.

Yes, if damage occurs, then the patient will have to undergo a fairly long period of rehabilitation (up to 6 months), but in difficult clinical situations of complete absence of teeth and poor quality of bone tissue, the doctor works in very limited conditions, therefore, unfortunately, there are some consequences , but not threatening life and health dysfunction, it is not always possible to avoid.

Do not confuse nerve damage and compression on it that occurs in the bone as a result of edema after the installation of implants close to the nerve endings. The compression goes away with the swelling and numbness is normal in this situation.

Most often, such symptoms typically appear 2-3 days after multiple implantation, they are a normal reaction of tissue injury when the implants are screwed in and damage to the intraosseous capillaries. Improvements will be noticeable almost immediately after the installation of the prosthesis on the implants and the activation of the chewing load, and with it the restoration and blood circulation in the bone.

The first phase is soft tissue healing. It takes about a week. After this stage, you will feel much better. If the installation of implants was carried out in a minimally invasive way – by means of a protocol, then rehabilitation takes only 2-3 days. The second phase is osseointegration, that is, the direct engraftment of the implant in the bone tissue. It takes from 3 months to six months, in difficult situations up to 8-12 months – at this time, the bone is actively growing around the implants, strengthening their position.

Antibacterial drugs are prescribed for major surgical intervention in order to reduce the risks of developing inflammatory processes. In addition, they are mandatory for those patients whose implantation was carried out against the background of periodontitis or before the installation of the implants, inflammatory processes in the tissues of the periodontium, periodontium (cysts, granulomas, etc.) were diagnosed. In other cases, you can limit yourself to vitamins, local anti-inflammatory drugs and antihistamines.

If you received bone grafting or RPF-membrane, if the doctor used healing drugs (for example, “Alvostat”), you should not panic – discharge from the wound in such situations is normal. Still, we recommend that you contact support and discuss the nature of the discharge with your doctor.

This is a fairly rare phenomenon, the main reasons for which are excessive stress on the operated area, frequent contact with the tongue with the tongue, and non-observance of hygiene rules.As a rule, we use resorbable sutures (they dissolve on their own) – these sutures do not need to be removed. But in any case, after installing the implants, you will still visit the implantologist in the coming days – the attending physician will monitor your condition.

An increase in body temperature up to 39 ° in the first 3 days is a completely normal reaction of the body to external influences and the ingress of a foreign body (in this case, an implant). It should not cause concern – in this way our body accelerates all processes of tissue repair.But if the temperature subsided, you felt good, and then there was a sharp rise to 38-39 °, you should immediately consult a doctor.

Drinking or not drinking antipyretics – you must decide for yourself, based on your own health. Monitor your condition as each person tolerates heat differently.

Prosthetic issues

In case of implantation carried out according to the protocols of immediate loading, the prostheses are installed immediately – within 3-4 days maximum.At first, you will experience some discomfort – and this is completely normal, because before the treatment you lived without teeth for a long time, your bite has changed. Now it just takes a while for both you and your jaw system to get used to the changes.

Read more questions and answers about dental implantation in our separate selection of Frequently Asked Questions.

Checklist: general list of what to prepare after implantation

Prepare a sleeping place in advance, stock up on interesting films or your favorite music – they will help you to get distracted on the first day after surgery and not focus on every sensation.The body has suffered stress and tissues begin to rehabilitate – discomfort is normal.

90,000 KNEE INJURIES IN CHILDREN: WHAT IS THE DANGER, HOW TO AVOID, WHERE AND HOW TO TREAT … G.N. Speranskogo Elena G. Pligina.

The knee joint is the largest in the human body and the most prone to injury. Almost every child has fallen down and broke a knee at least once in their life, but if the fall is more serious, the child can get injured in the knee joint.

What diagnosis can be given to a child who has a knee injury?

“Hemarthrosis of the knee joint” – in fact, is not a diagnosis, but indicates damage to the internal structures of the knee joint.This can be a rupture of the joint capsule, cruciate ligaments, meniscus, dislocation, subluxation of the patella, trauma to the articular cartilage, damage to the fat body and other injuries.

“Post-traumatic synovitis of the knee joint” – a disease in which there is an inflammation of the inner membrane covering the joint cavity. This is also a preliminary diagnosis, which indicates a problem in the joint. The main complaints of a patient with this diagnosis are knee pain and impaired mobility.Synovitis often develops as a complication of an injury that has not received timely treatment.

What are the symptoms of a serious knee injury?

Edema of soft tissues in the joint area, joint increase in volume;

Severe pain when moving the joint, especially when trying to step on the leg;

Limitation of joint mobility (the patient cannot bend the leg).

What to do?

It is best to immediately call an ambulance: this is the easiest and most reliable way to transport a patient to the hospital, limiting the mobility of the joint.In addition, emergency doctors will definitely give your child a safe pain reliever.

While waiting for an ambulance, provide the affected joint with complete rest: do not ask the child to move his leg, do not let him get up and step on the sore leg. All this can increase pain and worsen the condition of the joint. Wait calmly for the doctor to arrive. To reduce pain and swelling of the joint, apply a cold compress or ice wrapped in tight cloth to the joint.

How is it treated?

Several years ago, a child with hemarthrosis of the knee almost always required diagnostic knee surgery.Today, surgery can be replaced by timely CT and MRI of the joint; joint operations are performed only for certain indications.

At the moment, operations on the knee joint are performed using the minimally invasive endoscopic method (arthroscopy) – using high-tech equipment. In this case, two or more small incisions of 5 mm each are made: through one incision, optics are inserted into the joint cavity, others are intended for the introduction of endoscopic instruments. Arthroscopy is carried out with a constant flow of fluid (0.9% NaCl solution – a liquid inert for the human body), which allows for a complete sanitation of the joint – washing from blood, clots, fragments of the damaged synovial membrane.

Recovery after surgery and the course of treatment takes from several weeks to several months, depending on the nature of the injury. Rehabilitation after arthroscopy begins the next day after the operation and is carried out during the entire period of the child’s stay in the hospital. For further rehabilitation treatment, children are hospitalized in the clinic 2 weeks – 1 month after discharge (depending on the type of operation performed) for transfer to the suburban orthopedic department – (branch) of St.Vladimir. In the first hours after the operation in the children’s hospital named after G.N. Speransky, the first rehabilitation actions are carried out, later the children undergo a full course of rehabilitation at the hospital.

And if time is lost?

There is a group of patients who, for some reason, “missed” the injury and did not receive proper treatment on time. This is a serious situation, since the prolonged existence of undiagnosed injuries of functionally significant internal structures of the knee joint (menisci, ligaments, cartilage) inevitably leads to degenerative changes in the articular cartilage and the development of early osteoarthritis – a disease that significantly impairs the quality of life of the child, limits his mobility and even leads to disability.

Fortunately, even such patients can be helped. At the Center for Arthrology and Rehabilitation of Children with Diseases and Injuries of the Joints at the Children’s City Clinical Hospital No. 9 named after G.N. Speransky, children are operated on and treated even with the consequences of chronic joint injuries. But, of course, treatment will give the greatest effect if you turn to specialists as soon as possible. If you suspect that the child has injured a joint – knee, elbow, … – immediately contact the Center for consultation.

How to avoid childhood knee injury?

Most often, knee injuries occur during sports: hockey, basketball, roller skating, football.Children who are involved in high-performance sports from an early age are at risk: they spend more time in training and are very devoted to the game, forgetting about caution.

With great care, you need to put children on alpine skiing and especially snowboarding: these sports involve a heavy load on the knee joints (descent from the mountain is always done on bent legs, which in itself is not entirely natural). There is no need to give up skiing and snowboarding, but you should always use protective equipment and not overload the joints with excessive stress.

Also at risk are children who have joint hypermobility from an early age. In itself, this is not a pathology, but heavy physical activity is contraindicated in such children and often leads to degenerative diseases of the knee joint. Such children are very attractive to coaches, especially gymnastics, figure skating: the peculiarities of their connective tissue in high-performance sports becomes an advantage. However, despite the fact that such children can really make progress, you need to treat physical activity with great care: excessive stress can provoke degenerative joint disease.So, one of the diseases that threatens children with joint hypermobility is osteochondritis dissecans. Fortunately, the child’s body has high regenerative capabilities, and with proper and timely treatment, it is possible to completely cure an incipient dangerous disease.

How to protect joints from injury? General rules for all sports.

Always wear knee protectors during all sports, especially contact sports.

Do not allow your child to play active sports if he is unwell, dizzy or has other conditions that do not allow him to control his movements.

Monitor the load level. If your child is involved in active sports, visit an orthopedic doctor regularly.

Before sending your child to the sports section, consult an orthopedic doctor.

If a child, starting to play sports, began to often complain of pain in the joints, immediately seek the advice of a specialist: early treatment increases the likelihood of a complete recovery.

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Septoplasty – correction of the curvature of the nasal septum

Curvature of the nasal septum is a very common phenomenon; few people have this septum ideally shaped. For most people, this feature does not cause any problems, but in some cases it can significantly impair the quality of life.

Possible consequences of the curvature of the nasal septum are problems with nasal breathing up to its complete absence, frequent respiratory diseases, nosebleeds, polyps, chronic sinusitis or otitis media, snoring, which worries both the person and his loved ones. All these are medical indications for septoplasty, surgery to correct the curvature of the nasal septum. If you have experienced such symptoms, we may be able to help you.

The nasal septum is located in the middle of the nose, it divides it into two halves and is a plate of bone and cartilage tissue.This partition is not integral, it consists of several parts, each of which can be damaged for one reason or another. There are three main groups of causes of the curvature of the nasal septum.

• Physiology. Uneven growth of the constituents of the septum and those parts of the skull with which it comes in contact can also lead to its curvature.
• Injuries. This includes not only nose fractures, even an accidental light blow to the nose during childhood can slightly dislodge the components of the septum, as a result of which they may begin to develop abnormally.
• Compensatory reasons. This group includes curvatures caused by external factors such as tumors or polyps.

As a result of the influence of certain factors, spikes or growths of bone tissue may appear on the septum, and it can also be deformed in one direction or another – c-shaped and s-shaped curvatures of the nasal septum are distinguished. Often, patients who combine several types of deformities at once turn to doctors.

What affects the curvature of the nasal septum and why is septoplasty of the nose needed

If the deformation of the septum is strong, the nasal passages become narrower, which means that less oxygen enters the body through them. In addition, the air does not pass correctly inside the nose, the mucous membrane dries up and works worse – and now a person complains of chronic rhinitis. And since the auditory tubes, and the oral cavity, and even the lacrimal canals are connected with the nasal cavity, corresponding diseases can also occur.Persistent lingering rhinitis, frequent mucous nasal discharge, and breathing discomfort are just some of the signs of a deviated nasal septum. Adults may complain of headaches, constant or chronic fatigue, and a lack of energy due to the lack of oxygen in the tissues caused by the curvature.

The most effective way to treat a curvature of the nasal septum is surgery. Scientifically, it is called “submucosal resection of the nasal septum”, and for short – “septoplasty” (from the word septum – septum).During this operation, the curved septum is leveled, the person begins to breathe fully, he feels much better.

Curvature of the nasal septum: treatment and surgery

So, you have discovered one or more of the symptoms described earlier and came to the otolaryngologist. What can you expect?

Your nose will be examined completely, the condition of the mucous membrane, the severity and degree of curvature of the septum, the presence of polyps, bullae, and enlargement of the turbinates will be assessed.In some cases, an additional examination will be required – computed tomography.

If it is confirmed that the cause of your breathing problems is precisely the curvature of the nasal septum, and if you have no contraindications (for example, cancer or diseases that affect blood clotting), the doctor will suggest you surgery. During the operation, under the control of an endoscope, the fragments of the septum that interfere with your breathing will be corrected and returned to their place.The operation takes an average of 40 minutes to 1.5 hours and is performed under local anesthesia as the safest and most well-tolerated method of pain relief. Laser correction of the structures of the nose is carried out according to the indications.

As a result of the intervention:

• nasal breathing is restored,
• the sense of smell is restored,
• headaches go away,
• the quality of life improves, the patient begins to breathe “full”.

In children, during the surgical treatment of a deviated nasal septum, a sparing version of septoplasty is used

Septoplasty of the nasal septum: the advantages of our clinic

Patients often delay the decision on the operation, fearing the forthcoming intervention to correct the nasal septum; in addition, it is quite difficult to choose from a large number of clinics and doctors in them. To make a decision in our favor, we will list the main advantages of the clinic:

1. Extensive experience and high qualifications of our ENT doctors.