Symptoms

Stiff joints


Stiff joints are symptoms that range from mild functional impairments to complete joint stiffness. In principle, joint stiffness can occur in all joints, but the functional restriction in those who are exposed to particularly high loads in everyday life can be observed increasingly. These include above all the large joints, such as the knee joint, hip joint, shoulders and elbows. Since with many forms of joint stiffness there is a permanent deterioration in joint function without therapeutic countermeasures, medical help should be sought as soon as possible in the case of stiff joints.

Definition

The colloquial term "stiff joints" describes restrictions on the ability to move in the joints, which can range from minimal functional impairment to extremely painful complete joint stiffness. In the medical community, the stiff joints can be described in so-called contractures, which describe a functional impairment of the joint due to impairment of the surrounding tissue structures (ligaments, muscles, tendons, fascia), and which directly differentiate joint stiffness due to damage in the joint. The latter can also be due to damage to the bone, for example. In both cases the active mobility of the joints is restricted and under certain circumstances the joints cannot be moved passively or only with pain to the usual extent.

Symptoms of stiff joints

Stiffness of the joints is a far-reaching symptom, the symptoms of which range from minimal movement impairments to complete fixation of the joints. The complaints are often associated with pain, which occurs especially when moving or exercising. Sometimes, however, there is pain in the joint area even when at rest. In various joint diseases, the joints also appear red and overheated.

Depending on the joints affected, the degree of joint stiffness and the causes of the complaints, impairments of varying degrees can be seen in the everyday life of the patients. For example, in the case of joint stiffness in the hip joint, those affected are often considerably restricted in their overall mobility, which massively complicates their everyday life. Climbing stairs is often hardly possible and even going to the toilet can be painful complications. A detailed description of the symptoms, including the accompanying symptoms, is then given in connection with the explanations on the causes of joint stiffness.

Causes of stiff joints

The possible triggers of stiff joints are extremely complex and include congenital diseases as well as acute joint diseases and sometimes even psychogenic factors. The following detailed description of the individual causes of joint stiffness shows the wide range of potential triggers to be considered in the context of the diagnosis. The joint diseases (arthropathies), which can result in joint stiffness, are roughly divided into infectious arthropathies, inflammatory polyarthropathies, non-inflammatory arthrosis diseases and other joint diseases.

Infections as the cause of joint stiffness

If bacteria get into the joint via open wounds (for example during an operation) or via the bloodstream and settle here, there is a risk of purulent bacterial arthritis, which is associated with a strong inflammatory reaction in the joint area. If superficial joints are affected, they are often red, swollen and overheated. Patients experience permanent joint pain, which increases with movement or stress. Often, those affected tend to be careful because of the pain. The mobility of the joint is increasingly restricted in the course of purulent arthritis and there is no therapeutic care, irreversible damage to the joint structures threatens. After a relatively short time, the destruction of the articular cartilage begins. At worst, the bacterial infection can become life-threatening blood poisoning (sepsis).

General infectious diseases can also affect the joints and cause arthritis with corresponding joint stiffness. A possible cause is, for example, a meningococcal infection in which further symptoms such as high fever, chills, body aches, nausea and vomiting or even impaired consciousness can occur. Other infectious diseases such as rubella, mumps, tuberculosis, borreliosis, typhoid or gonorrhea can also cause arthritis.

The respective accompanying symptoms are extremely different for the various infectious diseases and the stiff joints are by no means a leading symptom. Those affected often show significant further complaints and the joint problems are more of a by-product. An essential indicator of most infectious diseases is accompanying fever. Should the body temperature be increased in addition to the joint stiffness, a doctor should therefore be consulted in any case. It is not uncommon for symptoms to appear in the joints only after an infectious disease has been overcome. These are called reactive arthritis.

Inflammatory polyarthropathies

Inflammatory processes often develop in the joints even without the presence of infection, the most common form being rheumatoid or chronic polyarthritis. Typically, not only individual joints are affected here.

At the beginning of the relapsing disease, the symptoms manifest themselves as pain in the finger and toe joints. In addition to the pain, there is often pronounced joint stiffness, especially in the morning after getting up. In addition there are non-specific general symptoms such as chronic fatigue, fatigue and increased night sweats. During the flare-ups, the joints are significantly swollen and overheated. As a rule, the symptoms appear symmetrically on both halves of the body, i.e. the same joints are affected on the left hand as on the right. On the right foot, the same as on the left.

In the long term, the joints are destroyed by rheumatoid polyarthritis and those affected show complete joint rigidity with fixed incorrect posture. Also in the late stage of the disease there is an increasing loss of muscles. In the end, many patients can no longer carry out even the simplest everyday tasks with their hands. The less frequently observed transition from chronic polyarthritis to the larger joints also leads to an increasing loss of function here. Depending on which joints are affected, knee pain, hip pain or ankle pain can occur as an accompanying symptom.

If the cervical spine is affected as a result of the disease, the spinal cord may be compressed. Chronic polyarthritis can also spread to the organs and thus, for example, cause vascular inflammation, pericarditis, peritonitis, endocraditis or pneumonia with corresponding symptoms.

Inflammatory polyarthropathies also include so-called juvenile arthritis, which describes a joint inflammation that occurs for no apparent reason in childhood. The affected children look battered, tearful and avoid moving. They may also adopt a protective posture due to the pain, which in turn can lead to contractures in the long run. Sometimes the growth of the joint-forming bones is impaired. Those affected also occasionally have an irregular, itchy rash. Accompanying swellings of the lymph nodes, liver and spleen are typical of juvenile arthritis. In the worst case, the disease leads to irreversible growth impairments and organ damage to the children.

Gout, the metabolic disease, also leads to painful inflammation of the joints, whereby the deposition of uric acid crystals in the joint area is considered to be the main trigger. Basically, all joints can be affected by gout, but usually the symptoms show up in the area of ​​the toe, hand and finger joints. In addition to the typical joint complaints, general symptoms such as fever or headache can be observed as an accompanying symptom of an acute gout attack. Other diseases, such as chondrocalcinosis, are also associated with crystalline deposits in the joints and corresponding joint complaints.

Other possible causes of inflammatory polyarthropathy include the so-called hip runny nose (coxitis fugax) and diseases such as an underactive thyroid (hypothyroidism), an overactive thyroid (hyperthyroidism) or a congenital sickle cell anemia.

Diabetes mellitus can also trigger so-called neuropathic arthropathy in the long term. Sarcoidosis (also called connective tissue disease, also known as Boeck's disease) rarely leads to inflammatory processes in the joint area and corresponding joint stiffness. This applies in a similar form to special forms of the so-called amyloidoses (pathological protein deposits in the space between the cells). Numerous other factors can be considered as triggers of the non-infectious joint complaints, whereby a complete list at this point would go beyond the scope. As a rule, stiff joints associated with inflammatory processes can be attributed to one of the causes mentioned.

Osteoarthritis as a cause

Osteoarthritis refers to wear and tear on the joints, which in the long term can lead to considerable functional impairment or even complete loss of function of the affected joints. The cause is usually incorrect loading in the joint area, which leads to increased signs of wear and tear on the cartilage tissue or the joint-forming bones. The cause of the incorrect loading is usually a so-called dysplasia, i.e. a malposition in the joint area. This can be innate or, for example, due to an accident. Hip dysplasia should be mentioned as an example of congenital dysplasia, which is one of the most common causes of the relatively widespread osteoarthritis of the hip.

Osteoarthritis usually develops over a longer period of time, with pain occurring during exercise being a typical symptom in the early stages. As the disease progresses, swelling and deformation of the joints, as well as increasing joint stiffness, may occur. Also typical are the joint noises that can be observed during movement. Joint wear generally increases with age. Accordingly, most osteoarthritis patients are already at an advanced age. Years of incorrect loading in the joint area show their consequences here. However, acute injuries, for example in the context of an accident, can also lead to premature wear of the joints. This so-called post-traumatic arthrosis sometimes also affects people of younger ages. Another possible trigger for arthrosis is the intake of certain antibiotics and anticoagulants, which can lead to permanent damage to the cartilage tissue and to a decrease in bone density.

With all forms of osteoarthritis, the wear and tear on the joints usually extends over a long period of time before the affected person complains of stiff joints or other complaints. Therefore, the irreversible damage to the joint in osteoarthritis is often well advanced before medical help is sought. A complete restoration of the joint function is thus in many cases significantly more difficult or impossible.

Congenital joint stiffness

From birth, some people suffer from the so-called arthrogryposis multiplex congenita (AMC), a special form of joint stiffness. The typical malformations of the disease usually occur between the eighth and eleventh week of pregnancy. The severity of the disease can vary significantly. While some children only show adhesions of individual joints, others have numerous joints and other organs malformed. The muscles, tendons and fasciae in the joint area are also affected by the growth impairment, which further restricts the ability to move. The children are born with conspicuous contractures and deformities of the joints. The joints in the arm and leg area are increasingly affected. Shoulder joints, elbows, wrists and individual finger joints, but also the hip and knee joints are particularly often changed in the course of the disease. The causes of the disease are still largely unknown, although AMC is one of the more widespread growth problems in newborns.

Other causes of stiff joints

In addition to the factors mentioned so far, numerous other triggers of joint stiffness come into consideration. For example, restricted movement of the joints can also be observed in connection with neurogenic diseases such as polio. Sometimes the contraction of the outer skin layers, for example due to scarring after a burn, leads to stiffening in the joint area. If the vision is shortened, this can also result in a contracture. The same applies to the shrinking or contraction of fascia, for example after an injury or prolonged immobilization. So-called psychogenic contractures are also known in the professional world, in which those affected, for example due to a traumatic event, consciously or subconsciously do not move a joint. If you are bedridden, incorrect positioning of the immobile patient can also cause a contract in the long term.

Diagnosis

Based on the description of the symptoms and the externally visible changes (redness, swelling, overheating, deformation), the cause of the stiff joints can usually already be clearly narrowed down. Some simple movement exercises can provide further important clues. Many forms of contractures can be identified relatively clearly in this way. Ultrasound examinations reveal pathological changes in the joint area, such as purulent arthritis. Blood tests or evidence of increased inflammation levels in the blood can also be used to confirm the diagnosis. Imaging methods such as X-rays, computer tomography and magnetic resonance imaging may also be necessary for the diagnosis (for example, in the case of arthrosis).

A minimally invasive arthroscopy is available as a further examination method in the case of suspected joint damage, in which an endoscope allows a view inside the joints. This not only ensures the diagnosis, but also minor therapeutic interventions can already be carried out during the examination respectively. This so-called therapeutic arthroscopy is used relatively frequently today.

Treatment

The treatment of joint stiffness must always be geared to the respective causes of the symptoms and can therefore vary significantly. For example, while bacterial arthritis is often treated with antibiotics, medication for osteoarthritis promises little relief. Instead, physiotherapy is of particular importance here, which is not helpful in most forms of arthritis. Purulent arthritis often requires surgery to avoid permanent destruction of the affected joints and the development of life-threatening blood poisoning. Surgery can also be used to restore joint function in osteoarthritis patients. In case of doubt, a prosthesis, such as an artificial hip joint, is implanted. Sometimes, however, the joint function can already be restored using the minimally invasive method of arthroscopy.

When treating contractures, physiotherapy is the first choice of treatment options. The stiff joints should be restored to their original ability to move through active and passive movement exercises. Accompanying massages and heat therapies can be used. Special splints and bandages are used to prevent contracture from occurring in everyday life. From the field of naturopathy, the manual procedures such as osteopathy or Rolfing are particularly suitable for the treatment of contractures. Acupuncture is not infrequently used here. This is also often used in the naturopathic treatment of arthritis. If the measures mentioned have no effect, surgery for removing the contracture often remains the last option, as is the case with arthritis.

In the case of inflammatory joint complaints, naturopathy often relies on regulation in the acid-base balance or the reduction of any acidity that may be present, since a connection with the inflammatory processes in the organism is suspected here. Various medicinal plants are also used, which, depending on the suspected cause of joint stiffness, for example to stimulate metabolic functions (e.g. nettle or dandelion tea), promote blood circulation (e.g. rosemary, mustard seeds, ginger, juniper, St. John's wort) or inhibit inflammation ( for example arnica, willow bark, incense, camphor). Pain-relieving medicinal plants such as the devil's claw or goldenrod are also used for various joint diseases. In general, the herbal medicine treatment of stiff joints should be geared to the causes as much as the entire therapy for joint stiffness.

Author and source information

This text corresponds to the specifications of the medical literature, medical guidelines and current studies and has been checked by medical doctors.

Dipl. Geogr. Fabian Peters

Swell:

  • Alexandra Villa-Forte: Clarification in patients with joint symptoms, MSD Manual, (accessed October 8, 2019), MSD
  • Apostolos Kontzias: Neurogenic Arthropathy, MSD Manual, (accessed October 8, 2019), MSD
  • Michael Hammer: Rheumatoid Arthritis (chronic polyarthritis), Deutsche Rheuma-Liga Bundesverband e.V., (accessed October 8, 2019), rheuma-liga.de
  • M. Schneider et al .: Interdisciplinary Guideline for Management of Early Rheumatoid Arthritis, German Society for Rheumatology e.V., (accessed October 8, 2019), DGRH
  • Apostolos Kontzias: Osteoarthritis, MSD Manual, (accessed October 8, 2019), MSD
  • Angela Zink, Kirsten Minden, Sabine M. List: Inflammatory Rheumatic Diseases, Robert Koch Institute in cooperation with the Federal Statistical Office, Issue 49, May 2010, (accessed October 8, 2019), rki
  • Nikolaus Wülker et al .: Pocket textbook on orthopedics and trauma surgery, Thieme Verlag, 3rd edition, 2015


Video: What causes Joint Stiffness? (January 2022).