Subchondral sclerosis of articular surfaces and endplates. Sclerosis of the articular surfaces what is it Subchondral sclerosis of the articular surfaces of the costal notches of the sternum
Subchondral sclerosis develops as a result of a violation of the trophism of the articular surfaces of the bones and their excessive proliferation. This causes the development of pain in the patient, which increases with movement, as well as severe deformities of the limbs or the spinal column. You can get rid of the disease with an integrated approach to treatment with the elimination of the main cause of the pathology.
Etiology and pathogenesis
Subchondral sclerosis of the articular surfaces can be caused by the effect on the human body of factors such as:
- burdened heredity;
- going in for sports;
- a history of trauma;
- overweight;
- professional activity, which is associated with a constant load on one muscle group;
- osteoporosis;
- insufficient intake of vitamins and minerals;
- hormonal disruptions;
- degenerative-dystrophic bone pathologies;
- autoimmune diseases;
- stress;
- violation of tissue trophism;
- a focus of chronic infection in the body;
- inflammation of the joints.
Excess weight puts additional stress on joints and ligaments. As a result of malnutrition of the subchondral bone tissue, its growth occurs. The increase in volume occurs due to scarring, when this area of the bone also ceases to function. As a result of osteosclerosis, the work of the joints is also disrupted, since subchondral cells partially provide nutrition for the cartilage in the joint. They act as an intermediate link between bone and collagen formations in the joint. A large volume of subchondral tissue is contained on the articular side of the vertebral bodies in the sacroiliac spine and in the symphysis.
Sclerosis of the processes of the shoulder joint of the right hand causes significant discomfort and impaired functional activity in the patient.
How to recognize?
In the advanced stages of the disease, degenerative changes in the joint are pronounced. Symptoms of the disease depend on how severe osteosclerosis and degenerative changes in bone tissue are:
- Moderate subchondral sclerosis is characterized by a narrowing of the joint space. In this case, the patient develops pain of insignificant intensity and limitation of the amplitude of active joint movements.
- At grade 2 of the lesion, the thickening of the epiphyses of the bones is more significant, and the sclerosis is uneven, and a moderately pronounced deformation of the adjacent articulating surfaces also appears.
- Severe subchondral osteosclerosis is very dangerous and causes the formation of bone growths, which are called osteophytes. This often occurs in the knee and ankle area.
- The severe stage is characterized by significant deformation of the joints, as a result of which the motor function is impaired, leading to the patient's disability.
The pathological process can form in the area of the endplates, which causes subchondral sclerosis of the cervical spine with damage to the facet articular surfaces. If the disease develops in the thoracic region, then severe scoliosis occurs with pinching of the nerve roots. Developed subchondral sclerosis of the hip joint is more often caused by rheumatoid arthritis and provokes significant pain when walking.
Methods for the diagnosis of subchondral sclerosis
Compaction of bone tissue is clearly visible on an X-ray. It is most often possible to detect pathology with the help of an X-ray examination. Subchondral fibrosis of the articular surface looks like a linear area of bone compaction. It is especially noticeable in the area of the acetabulum. A traumatologist can suspect a pathology during an external examination of the patient. In addition, the patient is recommended to undergo magnetic resonance imaging and computed tomography in order to more accurately identify the problem. To exclude concomitant pathology, a general blood and urine test is indicated.
What is the treatment?
The treatment of the problem is based on the elimination of the cause of subchondral sclerosis. More often it means changing the place of work and living conditions of the patient. At the same time, it is very important to change the diet, get rid of bad habits, and, in case of insufficient physical activity, start therapeutic exercises. All this can significantly slow down the development of pathology, and sometimes completely stop it. When the disease is severe, the patient needs surgical correction. It consists in the elimination of pathological growths of subchondral tissue and osteophytes. This is especially true if the sclerosis is localized in the area of the tibia, since in this area it significantly complicates the walking process.
Traditional therapies can only be used in combination with traditional medicine.
Medications
NSAIDs can help relieve pain and inflammation. With a slight severity of the disease, drug therapy is carried out. Its purpose is to eliminate pain and significant inflammation in the area where adjacent articular surfaces are sclerosed or the end plates of the spine have been damaged. To do this, use non-steroidal anti-inflammatory drugs: "Diclofenac" and "Indomethacin", which are often used in the form of intramuscular injections or ointments for external use.
With their ineffectiveness, the use of hormonal drugs is shown. The necessary means for the treatment to be effective are multivitamin complexes with a high content of B vitamins and chondroprotectors. In the case of a bacterial infection, broad-spectrum antibiotics are used.
Subchondral sclerosis of the hip joint is a degenerative process in the head of the femur that develops in deforming arthrosis.
What is subchondral sclerosis?
Sclerosis is the replacement of any normally functioning tissue with connective tissue that cannot perform the required functions. With subchondral sclerosis, the pathological process occurs in the so-called endplate. It is located under the articular cartilage and represents the peripheral portion of the pineal gland - the head of the femur.
The development of subchondar sclerosis is provoked by dystrophic changes in cartilage: a decrease in its thickness, a decrease in elasticity, and the appearance of roughness. In this regard, the amortization capacity of the cartilaginous tissue deteriorates, due to which the pineal gland underneath it experiences heavy loads. This leads to impaired calcium metabolism and deterioration of blood circulation in the bone tissue, as well as to the subsequent necrosis of its areas. Dividing osteocytes are replaced by actively dividing connective tissue cells.
Why is this condition dangerous?
Subchondral sclerosis is accompanied by the appearance of osteophytes - pathological growths on the surface of the damaged bone. Their size and number are increasing, which seriously limits the range of motion in the joint, up to contracture - its complete immobility. 
In addition, the formation of "bone spurs" is accompanied by increased painful sensations. This forces the person to spare the limb when walking.
As it progresses, this pathological process leads to deformation of the articular surfaces of the bones, which is fraught with destabilization of the joint, the development of subluxations, dislocations and pathological fractures.
Impaired mobility of the hip joint in the long term leads to destabilization of the spinal column when walking. This becomes a predisposing factor for the development of curvature of the spine, which, in turn, is one of the causes of osteochondrosis.
What are the causes of subchondral sclerosis of the hip joint?
This condition is not considered an independent disease, it is a pathological process that develops most often with degenerative-dystrophic joint disease - arthrosis. Accordingly, the causes of subchondral sclerosis of the hip joint can be as follows:
- injuries that have not been healed properly (fractures of the pelvis or femoral head, dislocations);
- metabolic disorders (for example, diabetes mellitus);
- endocrine diseases;
- infectious inflammation of the joint;
- rheumatoid arthritis;
- joint inflammation with systemic lupus erythematosus or psoriasis;
- dysplasia - a congenital pathological feature leading to joint dysfunction;
- Perthes disease - aseptic (non-infectious) necrosis of the femoral head.
Particular attention should be paid to the presence of factors predisposing to the development of arthrosis and subchondral sclerosis. They are:
- elderly age;
- poor nutrition;
- smoking;
- overweight;
- hypodynamia;
- heavy physical activity;
- systematic hypothermia.
- postmenopausal period;
- osteoporosis.
What are the signs of subchondral sclerosis?
Symptoms of such a pathological condition are signs of arthrosis of the hip joint (coxarthrosis), namely, its second and third stages, since it is at these stages of the disease that sclerosis begins and osteophytes are formed: 
- Joint pains are characteristic, which can occur at night, when walking, standing and sitting for a long time.
- There is stiffness, stiffness of the joint immediately after waking up, which passes after some time.
- Over time, the limitation of walking distance progresses, it becomes more and more difficult to overcome certain distances.
- Lameness occurs, ultimately leading to a pathological type of movement.
- It becomes necessary to use additional support - a cane or crutch.
Such symptoms indicate a long course of pathological processes and the presence of irreversible changes. Therefore, one should not wait for the onset of subchondral sclerosis; it is necessary to consult a doctor at the initial stage of the development of arthrosis, when discomfort occurs regularly in the joint when walking, and a crunch is periodically heard.
How is subchondral sclerosis diagnosed?
In order to detect changes, the doctor prescribes. With arthrosis, the pictures show:
- narrowing of the joint space;
- the presence of bone cusps of various sizes - osteophytes;
- thickening of the shadow under the endplate and in some areas of the femoral head (directly a sign of subchondral sclerosis);
- the appearance in the area of the head of the bone oval enlightenment with clear contours - bone cysts.
At later stages, impression occurs - crushing of the end plate, which in the image is manifested by the inconsistency of the articular surfaces of the bones with each other.
An ultrasound or magnetic resonance imaging can be done as an additional examination. These methods make it possible to assess the condition of the joint capsule, its ligaments, menisci (when it comes to the pathology of the knee joint), the surrounding soft tissues, to clarify the localization and size of cysts and osteophytes, to assess the degree of subchondral sclerosis.
In order to choose the most appropriate treatment tactics, it is important for the doctor to know what causes led to the development of arthrosis and sclerosis. To this end, he can prescribe various blood tests that will help identify inflammatory processes, metabolic and endocrine disorders, the presence of rheumatoid factor and signs of other conditions.
Treatment and prevention
Elimination of subchondral sclerosis occurs during the treatment of arthrosis.
If possible, the doctor tries to carry out etiotropic therapy, which is aimed at eliminating the root cause of the disease.
For this, various medications are used: antibiotics, non-steroidal anti-inflammatory drugs, corticosteroids. In addition, chondroprotectors are used as a drug treatment, which contribute to the restoration of cartilage tissue.
Physiotherapeutic treatment plays an important role, it includes the performance of special exercises in water, massage, ultrasound therapy, warming up, stimulation with electric current. In addition, it is important to carefully dose the stress on the joint. Excessive activity will lead to the progression of subchondral sclerosis, as well as physical inactivity, accompanied by atrophy of muscles and ligaments. Of great importance in the treatment of arthrosis is the correct implementation of physiotherapy exercises.
and subchondral sclerosis involves the elimination of predisposing factors. This means that it is necessary to give up bad habits, ensure the intake of all the necessary nutrients into the body, get rid of excess weight, and do physical education. Such measures will help maintain normal nutrition of the cartilage tissue and relieve some of the load from the joint by training the muscles.
Separately, it should be said about the timely detection and elimination of congenital hip dysplasia in children. It is possible to eliminate such a feature without any consequences conservatively, but only on condition that treatment is started at an early age. As the child grows up, irreversible changes occur in the joint, which in the future become the cause of arthrosis and subchondral sclerosis. It is usually possible to eliminate dysplasia with late diagnosis only promptly. Consultation with a pediatrician is required if a child has a clear asymmetry of skin folds (there are more folds on one leg) and a shortening of one leg.
The unpleasant sensation of discomfort, accompanied by joint pain, is familiar to many people, especially the elderly. It happens that due to serious physical exertion, such manifestations are of a periodic, short-term nature. In such cases, you can cope with them yourself with the help of various pain relievers. But when joint problems develop into a serious illness, a person is forced to see a doctor.
Among the variety of diseases affecting the joints, such ailment as subchondral sclerosis of the articular surfaces deserves special attention. With this pathology, degenerative processes develop in the cartilage or bone tissue. As a result, the articular surface undergoes serious changes. By and large, subchondral sclerosis cannot be considered an independent disease. It is rather an X-ray symptom, indicating that the cause of this ailment is other pathologies of a degenerative-dystrophic nature occurring in the body. Therefore, it is rather difficult to get rid of subchondral sclerosis without treatment of the underlying disease.
In subchondral sclerosis, due to inflammation, trauma or aging of the body, the connective tissue of the joint is affected. As a result, bone density increases, and it grows. Such a pathological process leads to the fact that irregularities appear on the articular surface, bone outgrowths - osteophytes - are formed. The appearance of such irregularities increases friction, which is the cause of pain. With an incorrect diagnosis, untimely treatment, further growth of outgrowths can block the joint and completely immobilize it.
According to the observations of doctors, subchondral sclerosis most often develops against the background of such degenerative-dystrophic diseases as arthrosis and. Of course, the causes of their occurrence and symptoms are somewhat different, but arthrosis and osteochondrosis have one common feature: the development of these diseases, as a rule, always leads to the formation of osteophytes. Only with arthrosis, osteophytes are formed along the edges of the joints, and in the presence of osteochondrosis, bone outgrowths appear along the edge of the vertebrae.
Unfortunately, such formations, which characterize subchondral sclerosis, cannot be completely cured. With the help of drug therapy, you can only stop the further progression of the disease and prevent the formation of new bone growths. Moreover, doctors involved in the treatment of this pathology rarely resort to surgical intervention, since even an operation is not able to radically change the situation.
Distinguish between primary and secondary forms of development of subchondral sclerosis. In the primary form, pathological changes in the articular surface occur in a healthy joint. Pain syndrome occurs due to the load on the musculoskeletal system, and subsides during rest. In the secondary form of the disease, an already damaged joint is affected after arthritis or an injury. In most cases, subchondral sclerosis affects the ankle, knee, and hip joints. The most dangerous consequences of this pathology are the formation of bone spurs and complete immobility.
Doctors note that the treatment process for subchondral sclerosis takes a long time and requires a lot of effort. In the case of severe pain, the patient is prescribed non-steroidal anti-inflammatory drugs and analgesics. The patient needs to regularly perform special exercises to improve blood circulation in the affected joints and flexibility of movement. In addition to the main measures of influence, hardware physiotherapy, acupuncture helps, a semi-bed or orthopedic regime is possible.
One of the important conditions for the treatment of subchondral sclerosis of the articular surfaces is the limitation of physical activity. To reduce the likelihood of progression of the disease, it is necessary to monitor your own weight, since each extra kilogram significantly increases the load on the joint. Therefore, at the same time with therapeutic measures, a dietary diet should be observed.
It is well known that joint pain is an inevitable manifestation of the aging of the body. Timely visits to doctors, maintaining a healthy lifestyle will help to identify a dangerous disease at an early stage. You should not wait for the dangerous consequences that subchondral sclerosis often leads to. Take care of yourself!
Subchondral sclerosis of the endplates is a disease of the bone system of a degenerative-dystrophic nature, which manifests itself in deformation and reactive growth of the subchondral bone.
Although this condition is not considered an independent disease, its presence indicates the development of arthritis, arthrosis, osteochondrosis and other conditions that, without treatment, can lead to disability.
Causes
The articular surfaces of the bones (the rounded ends that form the joint) are covered with subchondral tissue, which is fused with bone on one side and with cartilage on the other.
The subchondral bone contains a huge number of blood vessels and nerves, which is why this tissue is so important: cartilage, not having its own blood supply, receives all the nutrients it needs from the underlying tissue.
But such "mutual assistance" of tissues is feasible only if the subchondral bone is healthy. If the processes of blood supply in it are disturbed, this tissue gradually becomes denser, deformed, and instead of providing food for the cartilage, it begins to destroy it.
The reasons for the development of pathology in the subchondral bone may be the following circumstances:
- prolonged inflammatory and / or degenerative process in the joint (arthrosis, rheumatoid arthritis, osteochondrosis, etc.);
- excessive loads on a joint or a group of joints (professional sports, physical activity without observing safety requirements, heavy physical activity without preliminary preparation of muscles and joints, etc.);
- overweight, in which the hip, knee, ankle joints, as well as the spine must withstand a weight for which they are not designed;
- autoimmune diseases, metabolic disorders.
Risk factors
Risk factors that contribute to the development of joint diseases and, as a result, subchondral sclerosis include:
- insufficient or excessive physical activity;
- frequent injuries to the joints and back;
- hereditary predisposition to metabolic disorders or articular diseases.
Symptoms
Subchondral sclerosis differs in several stages, each of which has different manifestations:
- Stage I (initial) - the growth of bone tissue (osteophytes) is detected only at the edges of the joint;
- Stage II (moderate) - the image shows osteophytes, the articular part of the bone has a lighter shade, and the articular space is narrowed;
- Stage III - the joint space is significantly narrowed, bone growths are large enough and capable of disrupting the motor activity of the joint due to friction;
- Stage IV - osteophytes are very large, the articular surfaces of the bones are severely deformed, the joint is not capable of full flexion or extension.
Unfortunately, this pathology is most often detected at later stages, when surgical intervention is necessary to maintain the patient's activity.
Most often, large joints and the spine are subject to changes in the subchondral bone.
But in addition to the listed X-ray signs, with this pathology, the following subjective symptoms are observed:
- Subchondral sclerosis of the endplates of the spine is manifested by insufficient mobility of the cervical, thoracic, lumbar spine (depending on the location of the pathology), dull pain when trying to bend forward or backward, acute pain may occur when the body is turned back. In the later stages, osteophytes can damage the blood and nerve highways of the spine and, as a result, the pathology goes into the area of neurological ailments:
- a feeling of numbness in the limbs;
- noise and ringing in the ears;
- dizziness;
- decrease in visual acuity and hearing;
- violations of coordination of movements, etc. - In the knee and elbow joints, the extension process is disrupted - when trying to bend a limb, a person, as a rule, experiences only discomfort, and pain begins to be felt at the moment of extension.
- Sclerosis of the subchondral tissues in the hip joint leads to sharp or aching pain in the pelvis and lower back. In the later stages, dysfunctions of the genitourinary organs and intestines may develop.
Important: subchondral sclerosis in the spine can manifest itself with symptoms such as chest pain, heart palpitations, a feeling of insufficient filling of the lungs when inhaling, and impaired renal function.
If the examination did not reveal any systemic diseases, it is necessary to be diagnosed by a vertebrologist, neuropathologist or orthopedist.
Complications
The most common complication of subchondral sclerosis is excessive growth of the bone tissue of the joint, as a result of which there is increased friction of the articular surfaces and, as a result, a new cycle of inflammation.
But in the absence of treatment, complications do not end with the compaction and proliferation of tissues. As the articular surfaces thicken and go beyond the anatomical limits of the joint, inflammation of the tendons, muscles, blood vessels, and subcutaneous tissue may develop.
In severe cases, the process can transform into purulent or necrotic - with the formation of pus and its penetration through the bloodstream into other organs, or with the death of tissues.
Treatment
Since subchondral sclerosis of the articular surfaces is not an independent ailment, but only an X-ray sign by which the underlying disease can be identified, treatment is prescribed and carried out according to the following plan:
Treatment of the underlying disease
Depending on what caused the compaction and proliferation of subchondral tissue, drug treatment is prescribed. It may include anti-inflammatory, antibacterial, antihistamines, hormonal, pain relievers and other groups of drugs.
Important: detecting the destruction of subchondral tissues on an X-ray is not a reason to start treatment with drugs that are recommended by someone who had the same symptoms. Only a complete examination and understanding of the causes of this condition allows for adequate treatment.
With significant joint deformities, surgery may be required to restore joint function. In modern medicine, various techniques are used - from arthroscopy to partial or complete joint replacement, each of which is indicated depending on the objective examination data and the degree of joint destruction.
Physical activity
Changes in the structure of subchondral tissue, revealed during X-ray examination, indicate a long-term pathological process in the joint.
Unlike traumatic and acute inflammatory conditions, chronic pathologies require stimulating procedures. This allows you to normalize metabolic processes in the tissues of the joint or, at least, prevent the deterioration of the situation. Therefore, physical therapy is one of the best ways to slow down the destruction of the joint and restore its functions in case of subchondral sclerosis.
It is logical to assume that the visit to the doctor, as a result of which subchondral sclerosis was identified, was due to pain and discomfort. Therefore, physical education can be a real challenge for a person suffering from joint pain.
Be sure to tell your doctor if after exercise therapy your health worsens, and joint pain becomes stronger. Your doctor will prescribe you a less intensive course of exercise therapy, or temporarily replace it with massage and physiotherapy.
Manual and physiotherapy
Massage, acupuncture, heat, radiation and wave procedures serve the same purpose as exercise therapy - to accelerate metabolic processes and blood circulation in tissues with subchondral sclerosis.
In addition, electrophoresis can be prescribed with the use of medicinal applications (chondroprotectors, pain relievers, anti-inflammatory drugs), and mud baths will make it possible to replenish the deficiency of minerals.
Subchondral sclerosis of the articular surfaces is the process of death of healthy cells of the joints and their subsequent replacement with connective tissue. It is more of an X-ray term than an individual disease. Often, subchondral sclerosis becomes a sign of advanced osteoarthritis.
Reasons for the development of subchondral sclerosis
The subnerral ball is the layer of tissue that adjoins the cartilage. Unfortunately, with age, it can harden and grow. This is due to the fact that the blood supply to the subchondral layer is disrupted due to atherosclerosis or other vascular pathologies. Due to the violation of blood flow to the subchondral layer, the structure of the cartilage is disrupted. This is one of the pathogenetic mechanisms of osteochondrosis and the appearance of osteophytes.
The free process develops with age. The elasticity of the structures that surround the joint is lost, cartilage is destroyed and sclerosis is formed. Subchondral sclerosis and osteophyte manifestation is a diffuse phenomenon, most often spread over the spine. Large growths provoke pain during movement.
Subchondral sclerosis and osteosclerosis can develop for such reasons:
- degenerative processes in the joints (osteoarthritis);
- constant, uneven physical activity on the joints;
- excess weight;
- diabetes mellitus and atherosclerosis of the lower extremities;
- autoimmune pathologies.
Subchondral sclerosis often affects the hip joints of patients over 50 years of age. This is a symmetrical process, accompanied by morning stiffness and pain during physical exertion.
Subchondral sclerosis of the joints of the lower extremities is accompanied by intermittent claudication, soreness at the end of the working day.
Subchondral sclerosis treatment
Unfortunately, subchondral sclerosis is untreated in 80% of cases. You can only stop the progression of pathology. It is not known until the end which of the factors influences the development of the disease and it is impossible to cure it with one pill.
But if you do not engage in treatment at all, this will lead to immobility of the limb or spine. Over time, ankylosis will develop against the background of subchondral sclerosis.
What drugs are prescribed for a patient with osteosclerosis:
- Pain relievers and anti-inflammatory drugs from the NSAID group (Diclofenac, Meloxicam, Celecoxib).
- Chondroprotectors. The funds have unproven effectiveness, therefore they are used only as an auxiliary method.
- B vitamins. Relevant for vitamin deficiency, polyneuropathies. Combined drugs are prescribed (Milgamma, Kombilipen).
With severe pain in the joints, the patient needs to do novocaine blockade. They are performed by a vertebrologist or neurologist. 
It is possible to connect a course of physiotherapeutic methods in the treatment of osteosclerosis:
- magnetic waves;
- phonophoresis and electrophoresis;
- paraffin and mud applications.
The extreme degree of joint immobility is stopped by a surgical method - endoprosthetics.
It is important to engage in dosed physical activity or exercise therapy.
Basic rules for a patient with osteosclerosis, which should be followed at home:
- monitor body weight by body mass index;
- do not injure bones and joints;
- engage in dosed physical activity;
- avoid infectious diseases and inflammation of the joints.
