Joint asymmetry is observed in traumatic injuries, developmental abnormalities, inflammatory and degenerative joint pathologies. Sometimes it occurs as a reaction of the body to diseases of other organs and systems. It can be caused by edema, fluid accumulation, changes in the configuration of solid structures, atrophy, fibrosis of the periarticular soft tissues. The cause of the asymmetry is found out according to the survey, external examination, radiography, ultrasound, other imaging and laboratory methods. Before diagnosis, it is sometimes possible to take painkillers and anti-inflammatory drugs.
Causes of joint assymetry
Accumulation of fluid
Accumulation of blood or inflammatory fluid is accompanied by many diseases and injuries. Hemarthrosis occurs more often in the first days after traumatic injury. Synovitis forms 1-2 weeks after injury, is formed against the background of acute inflammatory pathologies, exacerbation of chronic degenerative, inflammatory processes. The asymmetry is clearly noticeable, often pronounced. The joint becomes spherical, its contours are smoothed. The patient complains of a feeling of bursting. Palpation reveals a fluctuation.
The symptom is detected with the following traumatic injuries:
- Bruise. The violation of symmetry is caused by swelling of soft tissues, disappears within 1-2 weeks. Movements are limited due to pain, the function of the limb is preserved.
- Dislocation. Asymmetry occurs due to a gross violation of the configuration, gradually aggravated by progressive edema. The pain is intense, there are no movements, springy resistance is detected when trying to move. The function of the limb is lost.
- Fracture. The cause of the symptom is significant edema, sometimes – displacement of fragments with intra-articular or periarticular fracture. Movements are practically absent due to pain, limb functions are sharply limited, crepitation, pathological mobility are possible.
- Ligament damage. The asymmetry is caused by edema, more pronounced in the projection of the injured ligament. The support is limited, the movements are painful, especially when trying to move the leg or arm in the direction opposite to the damaged ligament.
The cause of asymmetry after severe injuries is often deformations caused by inaccurate comparison of fragments, excessive formation of bone corns, and the growth of scar tissue. In the outcome, it is possible to increase the volume of the injured joint, shortening or curvature of the limb, due to which paired joints look asymmetrical, contracture or ankylosis, in which the joint loses not only mobility, but also its original configuration.
Asymmetry in arthrotic changes is explained by the proliferation of bone tissue, concomitant changes in the surrounding soft tissue structures. It can develop with the defeat of any joint of the upper or lower extremity, but it is most visually noticeable with unilateral involvement of the knee or ankle. The symptom is most often detected in patients with post-traumatic arthrosis, since the paired joint remains intact.
Another possible cause is the development of non-traumatic arthrosis due to overload of one limb or a faster progression of the process on the one hand. In pathology of non-traumatic genesis in older people, the symptom is often absent, since the joints are deformed equally or almost equally against the background of symmetrical arthrosis.
Asymmetry is characteristic of some aseptic arthritis (except rheumatoid), due to inflammatory edema:
- Psoriatic arthritis. One of the variants of the course of the disease is asymmetric mono- or oligoarthritis. Skin symptoms, as a rule, precede articular manifestations.
- Gouty. In a typical course, 1 metatarsophalangeal joint is affected. It is characterized by an acute onset with intense pain, pronounced edema, hyperemia of the skin. Sometimes the cause of asymmetry is the involvement of one large joint or oligoarthritis.
- Reactive. Asymmetric joint edema appears within a month after the development of intestinal or urogenital infection, can be combined with urethritis, conjunctival lesions, lymphadenitis, skin manifestations.
Obvious joint asymmetry is determined in nonspecific infectious arthritis. The disease begins acutely. Pronounced edema, severe pain, general and local hyperthermia, fever are detected. The joint is sharply swollen, the skin above it is red, sometimes with a purple tinge. Due to the involvement of surrounding tissues, the symptom is most pronounced in panarthritis. Specific arthritis is characterized by less noticeable asymmetry:
- Tuberculous. Affects one large joint, proceeds chronically. Symmetry violations increase gradually over several months in parallel with an increase in edema.
- Gonococcal. The course is acute or subacute, the knee, ankle, elbow joints are more often affected. Articular symptoms are combined with rashes on the skin, sometimes with pain, pathological discharge from the urethra.
- Brucellosis. Arthritis is observed mainly in the chronic course of the disease, it can capture several joints, be symmetrical or asymmetric. Over time, destruction progresses, deformations form.
Arthropathies on the background of infections
An asymmetric lesion can develop against the background of infectious diseases and pathological conditions caused by them:
- Reiter’s syndrome. Occurs with chlamydia, less often – with salmonellosis, dysentery, yersiniosis, enterocolitis. Asymmetric arthritis manifests 1-1.5 months after the appearance of signs of the underlying pathology, is the leading symptom, combined with damage to the eyes, genitourinary system.
- Meningococcal infection. Symmetry violations are detected in the second week from the onset of the disease. One knee suffers, asymmetric oligoarthritis is less common.
- Chickenpox. The asymmetry is short-term, due to swelling of one or more joints.
Sometimes joint asymmetry is detected in vasculitis, metabolic, endocrine pathologies:
- Hydroxyapatite arthropathy. The symptom is observed with monoarthritis, synovitis on the background of chronic polyarthritis. In 75% of patients, the shoulder suffers, lesions of the wrist or knee joint, hand joints are less common.
- Diabetic arthropathy. It is more often diagnosed in young women with type 1 diabetes mellitus. Unilateral lesion of the joints of the foot is revealed, less often – the knee or ankle. Even less often, the upper limbs are involved.
- Hyperparathyroidism. The occurrence of acute mono- or polyarthritis is typical.
- Nodular periarteritis. Accompanied by migrating arthritis of large joints.
The appearance of the symptom is due to impaired development of the joints themselves or a difference in the length of the limbs with underdevelopment of bones. The most common pathology is hip dysplasia, congenital hip dislocation is less common. Other possible causes of asymmetry include:
- congenital dislocation of the lower leg;
- varus and valgus deformities of the hip or knee;
- underdevelopment of the femur, tibia;
- congenital myopia;
- gigantism of the limb segment.
Asymmetry of the wrist joint can occur with hygromas of the hand, the posterior surface of the knee – with Baker’s cyst. Sometimes a violation of symmetry is provoked by diseases of the bursitis, ligaments and tendons: bursitis, enthesopathies, tendinitis, tendovaginitis.
In addition, the increasing deformation is detected in oncological diseases. In patients with benign tumors, asymmetry increases gradually, in patients with malignant neoplasms, the joint is deformed for several months. The rapid (in a few days) progression of asymmetry in neoplasia indicates the addition of inflammation or the development of synovitis.
The cause of non-traumatic asymmetry is determined by rheumatologists. Trauma patients are examined by traumatologists. According to the indications, consultations of a phthisiologist, an endocrinologist, an infectious disease specialist are prescribed. The doctor conducts a survey, examines the joints, compares their size and configuration, determines the volume of movements, identifies local hyperemia and hyperthermia, fluid in the joint cavity. The survey plan is drawn up taking into account the data obtained, may include the following procedures:
- Radiography. It is produced in two projections. If necessary, images of two symmetrical joints are taken. On radiographs, marginal growths, narrowing of the articular gap, zones of osteolysis or destruction are visible.
- Ultrasound of the joint. Informative in the study of soft-tissue structures. Confirms the presence of fluid, detects signs of inflammation, hemorrhage, calcification zones.
- CT and MRI of the joint. They are assigned to clarify the data obtained during basic research. They allow you to accurately determine the localization, nature and size of the pathological focus, choose the most effective scheme of conservative therapy, plan the tactics of surgical intervention.
- Puncture of the joint. It is carried out with asymmetry due to fluid accumulation. Effusion is studied by microbiological, immunological or cytological examination.
- Arthroscopy. It is indicated for suspected tumors, tuberculosis, autoimmune pathology. It is made for a detailed study of intra-articular structures, additional diagnostic (biopsy sampling) and therapeutic measures.
- Laboratory tests. In the course of laboratory studies, signs of inflammation are detected, markers of autoimmune and oncological diseases are detected, pathogens of infectious diseases are identified.
Assistance at the pre-hospital stage
Victims with traumatic injuries need to ensure the immobilization of the limb. To reduce edema, cold should be applied, an analgesic can be given to reduce the severity of the pain syndrome. In other cases, rest is shown. With slightly pronounced local symptoms, anti-inflammatory and painkillers can be used for a short time. If symptoms persist or worsen, violations of the general condition, it is necessary to consult a doctor.
Patients with injuries are shown the reduction of dislocations, the reposition of fractures, the imposition of a plaster cast or skeletal traction. With hemarthrosis and synovitis, joint punctures are performed. The scheme of conservative treatment of diseases and traumatic injuries may include:
- Protective mode. The level of physical activity, the amount of motor limitations, the need to use additional means (crutches, canes) are determined taking into account the peculiarities of pathology.
- NSAIDs. Reduce pain and inflammation. They are prescribed in the form of injections, tablets, topical agents.
- Antibiotics. They are indicated for the infectious nature of the disease. The drug is selected taking into account the sensitivity of the pathogen.
- Chondroprotectors. They provide nutrition and restoration of cartilage, are used in the form of general medications or are injected into the joint cavity.
- Hormonal agents. They are injected into the joint or periarticular tissues to quickly eliminate swelling, pain and inflammation.
- Cytostatics. They are necessary for malignant tumors, and can be supplemented with radiation therapy.
- Physical therapy. For non-tumor diseases, UHF, medicinal electrophoresis, magnetotherapy, acupuncture, massage, and other techniques can be recommended.
In pathologies with joint asymmetry, the following operations are performed:
- Injuries: osteosynthesis of periarticular and intraarticular fractures, open reduction of dislocations, suture and ligament plasty.
- Post-traumatic deformities: arthroplasty, arthrodesis, endoprosthetics.
- Infectious arthritis: arthrotomy, removal of altered tissues in tuberculosis, reconstructive surgery in the long term.
- Developmental anomalies: corrective osteotomy, limb elongation using compression-distraction devices, bone-plastic interventions.
- Volumetric formations: removal of Baker’s cyst, excision of hygroma, removal of benign tumor, bone resection, amputation in malignant neoplasia.