DISEASES OF THE JOINTS (ARTICULATIONS)

DISORDERS

Bursitis-inflammation of the fluid filled pad between tendon and bone (i.e., the bursa).

            Causes: infection; trauma; overuse.

             Contraindications/indications: avoid deep work on affected areas (in acute cases, massage can increase inflammation); use caution around all painful areas.

Tendinitis-inflammation of a tendon.

            Causes: infection; trauma; overuse.

            Contraindications/indications: avoid any areas that have acute inflammation.

Osteoarthritis-most commonly degenerative joint disease; progressive, unsymmetrical deterioration and breakdown of articular cartilage, mainly in weight-bearing joints; loose bodies may develop in the joint space and react with the synovial membrane to cause pain; bone spurs may develop as a result of damage of the joint capsule; no known way of arresting osteoarthritis once it has had an effect; treatment includes weight loss, reduced activity, and replacement of the affected joint.

            Cause: "wear and tear" on the joint, leading to death of chondrocytes and subsequent thinning and degeneration of articular cartilage.

            Contraindications/indications: avoid areas of inflammation; be cautious of possible bone spurs.

Rheumatoid arthritis-severe form of chronic synovitis; stiffness and pain result from thickening synovium and projection of synovium into the joint; inflammation of the smaller joints of the hands, wrists, ankles, and feet is very common and symmetrical (affects both sides of the body equally); may also affect the heart, lungs, and skin; signs include ulnar deviation of the fingers and radial deviation of the wrist.

            Cause: autoimmune reaction, usually initiated by an infection.

            Contraindications/indications: avoid affected joints when an acute and inflamed stage; paraffin bath is the medical treatment of choice.

Gout-a metabolic disorder involving the development of tophi (masses of uric acid crystals with macrophages and scar tissue cells) in and around joints and the ear lobes; 75% of attacks involve the great toe, but other joints often become involved affected joints are inflamed, red, and very tender; acute episodes can subside within 3 to 10 days.

            Cause: 90% of cases are of unknown cause in which the body is not able to excrete enough urea in the urine; predisposing factors include high alcohol intake, excessive red meat in diet, and obesity.

            Contraindications/indications: avoid affected joints when in an acute and inflamed stage; refer to doctor.

Osgood-Schlatter disease- partial separation (avulsion) of the tibial tuberosity from the tibial shaft resulting in inflammation on the bone and connective tissue of the anterior knee; usually occurs in male children 10 to 16 years of age (i.e., during puberty); calcification of the tibial tuberosity is incomplete, making it more easily fractured; symptoms include pain when kneeling, running, climbing stairs, or riding a bicycle and disappear at approximately 18 years of age; usually necessitates bracing or at least decreased activity levels for an extended period.

            Cause:  "growth spurt," causing the bone to grow faster than the muscle and tendon.

            Contraindications/indications: avoid affected area.

Chondromalacia patellae-softening and deterioration of the articular cartilage on the posterior patella; pain usually experienced when forcefully extending the knee.

            Causes: instability of the knee; substantial misalignment of the patella on the femur; overuse; chronic substantial of the patella.

            Contraindications/indications:  obtain advice and approval from the client's doctor before performing bodywork because of potential damage (particularly in acute cases); massage to and stretching of the quadriceps would be beneficial and could relieve pain.

Temporomandibular joint dysfunction (TMJ dysfunction or TMD)-any kind of abnormal functioning of the poromandibular joint.

            Causes: trauma (often from motor vehicle accidents); poor posture; overuse from bruxism (teeth grinding).

            Contraindications/indications: condition can change the position of the jaw, causing natural teeth, dentures, or bridges to fit together improperly; massage can relax muscles and relieve symptoms; work with dentist or physician, if necessary.

Degenerative disk disease-deterioration of the intervertebral disks in the spinal column; 80% of damage occurs in the posterior half of the disk; repetitive movements causing fissuring in the annulus fibrosis, which allows the nucleus pulposus to migrate into the fissure, reducing the potential for the annulus to heal; increased pressure in the outer annulus may cause pain or paresthsia in the back or trunk (nerves are present in the outer third of annulus), or the pain may refer to the lower extremities; nuclear migration also leads to protrusion of the disk into the intervertbral foramen, which puts pressure on the nerve root, causing weakness and pain in the lower extremities.

            Causes: poor posture; repetitive movements of the spine such as flexion combined with rotation when carrying or lifting heavy objects; low tension for long periods can cause the same amount of damage as high tension for short periods.

            Contraindications/indications: do not massage painful areas; consult with client's doctor.