Osteochondrosis: how does it manifest itself?

It is a heterogeneous group of lesions not necessarily related to each other, but which share some common characteristics and whose symptoms may vary from patient to patient.

The prognosis is generally good, so much so that sometimes the problem resolves before it is even diagnosed, but in cases where treatments are not effective you may even have to use prostheses to cope with its side effects. We are talking about osteochondrosis, the most common form of repeated strain injury in childhood.

What is osteochondrosis

More than a pathology, osteochondrosis should be considered a syndrome.

From a practical point of view it is a disorder of the development of ossification centers (the aggregates of cells from which the process of bone formation begins) of the immature skeleton, which can undergo a process of recalcification.

At its roots there may be different causes, some of which have not yet been identified.

According to current knowledge, both the patient’s genetic predisposition and environmental factors could come into play, such as predisposition to thrombotic events, acute or repeated trauma, embolisms, copper deficiencies and mechanical factors.

Infections can also trigger or enhance the development of osteochondrosis; Their effect may be direct or associated with an autoimmune mechanism.

The definition of osteochondrosis is also complicated by the fact that this term is used to indicate problems affecting different areas of the skeleton.

Today “osteochondrosis” means in fact a heterogeneous group of lesions (see in the table some examples) not necessarily related to each other, but which share some common characteristics, such as the fact of preferentially affecting the immature skeleton, of involving the same structure (ie the epiphyses, the rounded ends of the long bones) and the presence of ossification centers that appear fragmented, collapsed, hardened and reossified on radiographs.

However, they can have different causes. Blount’s disease, for example, is known to be an inherited condition. Perthes’ disease, on the other hand, is known to come into play a combination of genetic and environmental factors: exposure to smoke can promote its appearance due to the presence of a particular variant of the gene for beta fibrinogen.

Syndrome Localization
Preiser syndrome Carpal scaphoid
Kienböck disease Crescent-shaped
Buschke’s disease Medial cuneiform
Köhler disease Kneecap
Mouchet’s disease Astragalus
Legg-Calvé-Perthes disease Vertebral body
Buchman’s disease Iliac crest
Pierson syndrome Pubic symphysis
Freiberg disease Second metatarsal

Even today, not all experts agree on the inclusion of certain syndromes or diseases in the group of osteochondrosis.

According to some, for example, osteochondritis dissecans would be an osteochondrosis despite being a disorder that also affects in adulthood.

What triggers osteochondrosis?

The doubts are not limited to the classification, but it remains to clarify also the initial event that can trigger the appearance of the problem.

According to current knowledge, it would be the interruption of blood flow to the ossification center of the epiphysis and the consequent degeneration of the latter, a process known as “ischemic necrosis”.

Because of this phenomenon the cartilage cells present in the epiphysis would begin to proliferate in an uncontrolled way; Depending on the affected area, other secondary problems may appear, such as fragmentation and collapse of the ossification center.

The disorder can affect one or more epiphyses at the same time; The underlying process seems to be the same, but the syndrome can manifest itself differently depending on the stresses to which the epiphysis has been subjected.

How osteochondrosis manifests itself

The symptomatology of osteochondrosis varies depending on the patients; Both the bone involved and the stage reached by the syndrome come into play.

Typically, in the early stages, you are dealing with localized pain; those struggling with Osgood-Schlatter disease, for example, may experience pain when kneeling.

Other signs and symptoms that may depend on any of these syndromes include localized soreness, difficulty moving joints, swelling, walking problems, and sometimes fluid buildup in the joints.

The association of pain with fever, generalized malaise, weight loss, localized redness should instead make us suspect problems other than osteochondrosis.

In most cases, however, osteochondrosis is asymptomatic and you end up at the doctor only when it has already progressed to advanced stages; for this reason it is important not to underestimate non-specific osteoarticular pain that children and young people may suffer during growth shots: the risks that are run include growth alterations and deformations, which can for example appear in the advanced stages of Blount’s disease, Scheuermann syndrome and Legg-Calvé-Perthes disease.

The latter can initially manifest itself with limping gait, reduced hip mobility and pain in the hips, thighs and knees; Over the years, in addition to necrotization and progressive deformation of the femoral head, there can also be enlargement of the femoral neck and other deformations that can cause the early appearance of osteoarthritis.

Among the diagnostic tests, radiography generally reveals the presence of osteochondrosis.

An MRI or bone scan could allow early diagnosis, but often the absence of symptoms limits its use.

Osteochondrosis: how to cure it

The long-term consequences of osteochondrosis depend on the effectiveness of regeneration and repair processes.

As mentioned, given that even partial healing can lead to the appearance of chronic disorders, the situation should not be underestimated.

In the event that the problem is localized at the joint level, treatments are aimed at eliminating pain and allowing movement; More generally, the main goal of the treatment of all forms of osteochondrosis is to reduce the symptoms and their duration.

The therapy aims to:

  • protect the affected area and prevent further trauma
  • prevent the appearance of secondary deformities
  • promote ressification
  • reduce the transmission of mechanical stress to the bone during the reossification process
  • remove fragments that have become moving bodies
  • compensate for repaired bone deformities.

It is often possible to solve the problem totally or at least partially without having to resort to surgery; When the joints are not involved, protection alone may be enough to heal.

However, in cases where treatment has not been effective, surgery may be necessary.

In addition, in some cases surgery is the most suitable solution to relieve some symptoms or reduce a disability.

The pain can be relieved with cold treatments and with the intake of painkillers; Antibiotics, once commonly used in case of osteochondrosis, are no longer recommended today.

To avoid further trauma it is necessary to keep the affected part at rest, paying particular attention during sports; For this reason, any type of sports activity that involves physical contact should be avoided.

To prevent the appearance of secondary deformities and reduce mechanical stress on the affected part, the use of braces or traction devices could be recommended, while to promote reflexification it is sometimes recommended to take calcium-based supplements and multivitamins with trace elements; However, for the moment there is no definitive scientific evidence of their effectiveness.

Finally, in some cases a physiotherapy program may be useful.

What exercises to do for osteochondrosis

The best exercises in case of osteochondrosis depend on the type of syndrome you are dealing with.

In the case of Osgood-Schlatter disease – the most common form of osteochondrosis – physiotherapy programs are aimed at strengthening the quadriceps and posterior tendon of the knee; By performing appropriate exercises and progressively increasing the load, it is also possible to resume practicing sport.

The approach is similar when the osteochondrosis you are dealing with is Sinding-Larsen-Johansson disease, a problem that can occur in adolescent athletes, in whom it is typically associated with pain in the front of the knee during physical activity that increases with jumping.

In the case of Sever’s disease, however, physiotherapy is aimed at strengthening the gastrocnemius muscle and improving ankle dorsiflexion.

In case of Scheuermann syndrome it is important to reduce activities involving repetitive push-ups and physiotherapy programs should aim to reduce stiffness and strengthen the abdominal and spinal muscles.

Joycelyn Elders is the author and creator of EmpowerEssence, a health and wellness blog. Elders is a respected public health advocate and pediatrician dedicated to promoting general health and well-being.

The blog covers a wide range of topics related to health and wellness, with articles organized into several categories.

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