The Crewellier joint is located in the region of the first cervical vertebra and is formed by the posterior surface of the atlas arch and its tooth-like process. The first 2 vertebrae of the spine have a special structure. 1 vertebra (C1 or Atlas) has a ring-shaped shape and its lateral sections are larger than the front and rear. These sections with the occipital bone form a joint. 2 cervical vertebra or axial (C2) resembles a ring shape. Its lateral surfaces are also thicker, and in front of it there is a “tooth” - a process that protrudes upward and resembles the phalanx of the finger. Slipping this tooth on the inner surface of the atlas and forms the Crewellier joint. As a result, the ring in front has ligaments, and the back of the tooth has its transverse ligament with the vertebra. The back ring of the Atlanta, as it were, “sags”, because it is not connected to anything.
All joint surfaces of the Crewellier joint are normally covered with a capsule with folds, due to which the head can move: turns to the side, rotation of the head and oscillatory movements of the head.
Joint function
The joint performs rotational movements in a different range - flexion, extension, swinging to the sides. In addition, the anatomical location of the Crewellier joint allows the support of the head. It has a constant load.
The size of the crevice of the Crewellier joint normally ranges from 1.8 to 2.2 mm, which makes head movements possible. If there are deviations from the norm, then there are distortions and dysfunctions during rotation.
The most common joint pathologies
The most common disease is the arthrosis of the Crewellier joint. Any person during his active life receives many minor injuries that, after 20 years, can begin to manifest themselves. This refers to arthrosis.
In women, arthrosis appears 2.5 times more often. By the age of 50, every 3 people have articular changes, and at the age of 60 - in everyone, regardless of gender. To prevent this, like old age, is impossible.
The symptom of the Crewell may also occur - this is a subluxation of the Crewellier joint. It was first described by a French doctor. It occurs due to weakness of the cervical ligaments and muscles, abnormal development of the C2 tooth, the presence of a gap between the tooth and the C2 body. A symptom can develop with Down syndrome, Morkio disease, rheumatoid polyarthritis. This is not an independent pathology.
In addition, the disease often occurs in children:
- when landing on a head or face;
- head bang;
- headstand or somersaults.
Its danger is that the blood supply and the passage of impulses in this area are disturbed due to compression. The result is muscle hypotension, paresthesia occurs, and the sensitivity of the fingers decreases, paresis of the extremities join and unilateral paralysis can develop.
Asymmetry of the lateral cracks in the joint of the Crewellier is a rotational subluxation of the atlas, in which not only damage to the vertebra occurs, but also the development of degenerative changes in it. In this case, the vertebra is shifted to the side. This phenomenon occurs in 31% of all neck injuries. An incorrect position of the vertebra can cause compression of the spinal cord, and head movements become impossible.
The causes of arthrosis
Osteoarthritis of the joint of Crewell is provoked by external and internal factors:
- previous injuries of the cervical vertebral column;
- genetic predisposition;
- infections and inflammations in the body;
- endocrinopathies (thyroid pathology, diabetes);
- congenital malformations of the cervical zone;
- age after 50 years with wear and tear of the body;
- osteoporosis;
- hard work in the form of lifting weights with a load on the neck;
- obesity as an excessive load;
- physical inactivity and muscle weakness;
- liver diseases in which joint nutrition is impaired.
The mechanism of development of arthrosis
Arthrosis is a non-inflammatory chronic pathology of the joints with premature wear of the intraarticular intervertebral cartilage (disk).
If arthritis is acute and for a short time, arthrosis begins after 20 years and increases throughout life. For a long time does not manifest itself. With it, degenerative-dystrophic changes in the joints occur. Cartilage tissue is erased and cracks appear in it due to narrowing of the intervertebral space.
The composition of the nourishing intraarticular fluid changes through the cracks, and proteoglycans, substances necessary to maintain cartilage elasticity, gradually leak out of the joint.
With the loss of the full value of the cartilage, friction of the bones against each other occurs, which, with the slightest movement, gives severe pain. Together, all this leads to pinching of the spinal nerves, etc. - a vicious circle.
Types of cervical arthrosis
Spondylosis is called arthrosis of the entire spine, and the arthrosis of the joint of the Crewell of the cervical spine is considered uncovertebral. There is also circus vertebral arthrosis, it is associated with the wear of cartilage. It is characterized by headaches and dizziness.
Any arthrosis can be:
- Primary or idiopathic is age-related.
- Secondary - does not depend on age and develops as a result of trauma, existing diseases, dysplasia or inflammation, etc.
- Deforming - with the classical development of degeneration processes, which causes changes in the shape of the joints, disrupts their functions and is manifested by severe pain.
Osteoarthritis of the joint Crewellier is a type of deforming arthrosis.
It is characteristic of the elderly, as the cartilage tissue loses its natural elasticity, the synovial fluid decreases in volume. Growths (osteophytes) with it are formed on the posterolateral surfaces.
Over time, osteophytes infringe on the nerve roots and neuritis can develop. Without treatment at an early stage, the pathology progresses quickly and becomes irreversible.
Stages of arthrosis
There are 4 stages of arthrosis in total:
- Degeneration is just beginning. There are no symptoms. Initial changes in the articular membrane and ligaments are noted.
- Fatigue and pain are intermittent, only during exertion, pass at rest. Movements become more constrained, the crevice of the joint is narrowed, the destruction of cartilage is already underway, and growths begin to appear on the edges of the vertebrae.
- The growths are clear. In the vertebrae, an inflammatory reaction develops with a malfunction of the ligaments, deformation occurs. The joint may be immobilized.
- The growths increase even more. The process becomes irreversible - ankylosis.
Symptoms of osteoarthritis of the joint
In the initial stage, there are no manifestations. Sharp, but short-term pains may occur with different regularities, they pass as quickly as they appear. This occurs when abrupt turns of the head or lifting weights from a jerk. The disks have already grown and at the moment of movement they touch the ligaments.
The stage is reversible, and in just 2 weeks of treatment. Otherwise, the pathology progresses, the pains become longer and already occur with small loads. Also, a person begins to react to the weather: in wet weather, with hypothermia, pain always occurs.
It becomes difficult to work with your hands and move your head freely, as before, it is no longer possible. To reduce pain, a person moves less, protecting himself, but this gives the opposite effect.
Due to the lack of activity, blood supply in the affected segment decreases, subluxations periodically occur. In the later stages, the pain is less intense, but already constant, even at rest. Head turns begin to be accompanied by a crunch. The pain goes down to other parts of the spine.
In the last stages, paresthesias become frequent - numbness and tingling in the cervical spine. Sleep is disturbed due to pain.
Due to compression of the roots of the nerves and partly even of the spinal cord, frequent dizziness, paroxysmal cephalgia, pain at the base of the head, hypertension, nausea occur, the balance of the body can be disturbed and the gait becomes unsteady. Also, the patient may notice redness and swelling on the back of the neck in the upper part. There is often noise in the ears. Vision decreases. It ends with ankylosis.
Diagnostic research methods
Difficult early detection of the disease due to the absence of symptoms and changes in the x-ray. Diagnostics includes:
- visual inspection;
- palpation examination and collection of detailed history;
- X-ray of the joint Crewellier - an x-ray of the neck in different projections;
- Ultrasound
- MRI
- angiography;
- tomography;
- blood and urine tests as needed.
Disease treatment
Only complex treatment is justified:
- drug treatment (taking pills, injections, ointments, gels);
- physiotherapy;
- diet and exercise therapy;
- elimination of causes;
- surgical intervention (rarely).
In any case, the treatment of arthrosis is a long process that requires patience.
Orthopedics
Its task is to gently stretch the cervical spine to reduce the load on the intraarticular cartilage. To do this, use the wearing of an orthopedic collar of Shants. It does not treat arthrosis, but alleviates the symptoms.
Drug treatment
First step:
- The use of NSAIDs: "Ibuprofen", "Nimesulide", "Diclofenac" - relieve pain and remove inflammation.
- Muscle relaxants that relax the muscles and remove their spasm.
- Chondroprotectors - to strengthen cartilage, which includes chondroitin sulfate and glucosamine - substances that restore cartilage.
- In advanced cases, intra-articular administration of drugs is practiced - these are primarily GCS (corticosteroids) - Hydrocortisone, Diprospan, Dexamethasone. After removing the inflammation, hyaluronic acid is introduced there, which acts as a lubricant and reduces the rough friction of the articular surfaces, eliminates pain, increases mobility and causes the synthesis of its hyaluronate.
- Since the blood flow is disturbed, warming ointments can correct the situation: Bischofite, Capsicam, Dimexidum. All of them improve blood flow and relieve pain.
The second stage is aimed at improving metabolic processes:
- Reception of "Riboxinum" within 2 weeks or ATP in / muscle.
- To improve the microcirculation process - Actovegin, Trental, Curantil for a month.
- As antioxidants - vitamin and mineral complexes with selenium, vitamins E, C.
Physiotherapy and exercise therapy
The exercises are mostly simple - rotations and oscillatory movements of the head. They are carried out only during the period of remission.
From physiotherapy are shown:
- magnetotherapy;
- ;
- phonophoresis;
- microwave therapy;
- abdominal decompression.
Well unloads the spine and heals swimming and water aerobics.
Surgical intervention
In advanced cases, when there are already growths on the vertebrae, there is no effect from conservative treatment, surgical methods are used. With the help of surgery, osteophytes are removed, the affected joint is replaced with an implant. To relieve pain, thermal destruction of nerve endings in the affected joint can be used - denervation.
During surgery, the spinal disc is restored. Neck and head movements resume, and the pain goes away.
Diet
Diet implies the following:
- refusal of smoked meats, refractory fats and the transition to vegetable oils;
- refusal of fried foods and preservation, seasonings;
- reduction of salt, alcohol and soda;
- the exception of muffin and sweets;
- more cereals, fresh vegetables and fruits, greens;
- water regime - at least 2.5 liters of clean water per day.
Preventive measures
These include diet, an active lifestyle, gymnastics, the correct lifting of weights and the distribution of loads on the spine. A regular massage after heavy loads, weight normalization is indicated. It is necessary to eliminate other provocative factors and stop existing chronic pathologies.