Ankylosis is a difficulty in moving the joints, which can even, in extreme cases, lead to their complete immobility. More a symptom than a disease in itself, it is found, in particular, in the case of rheumatism, in the form of osteoarthritis, and can also be the sequel of a fracture, or even be caused by an infection, as in the case of certain arthritis.

In addition, it can be caused by autoimmune diseases, such as rheumatoid arthritis, or as a result of inflammation, such as ankylosing spondylitis, which affects the spine.

All joints are potentially affected. The risk of ankylosis following a fracture can be prevented through rehabilitation. Regular physical activity is a good way to guard against the risk of ankylosis.

Definition of ankylosis

Ankylosis can potentially affect all joints: it is defined as a decrease or deprivation of the mobility of a joint. It corresponds to a stiffness which can be total or partial, and temporary or permanent.

The joint is the point of contact between two bones, a bone and a cartilage, or a bone and a tooth. It is also very often made up of fibrous tissue, ligaments and tendons. Tendons are bands of tough fibrous tissue that connect muscles to bones, ligaments connect bones to other bones at joints, and contain more elastic fibers than tendons. Sometimes there is also synovial tissue lining the joints, such as those in the elbow and knee.

In general, a joint is mobile (except those of the teeth): ankylosis therefore hinders its mobility as soon as this joint is affected.

Ankylosis is most often linked either to osteoarthritis, a disease of the joint caused by erosion of the cartilage, or to arthritis, which is more an inflammation of the joint. In some cases, it is the consequence of neurological damage resulting in muscle deficit.

Causes of ankylosis

The possible causes of ankylosis are as follows:

• rheumatic causes : they are linked to the wear and tear of the cartilage in the joint, also called osteoarthritis. 
• infectious causes : Infections can be the cause of arthritis, for example Lyme arthritis (caused by infection with the bacteria Borrelia burgdorfori). In addition, sepsis can also generate ankylosis, causing infectious arthritis, when a microbe spreads through the blood and the germs spread in the body, and in particular in the joint. Tuberculosis can also be the cause of ankylosis in the spine, in the back, by affecting the discs between the vertebrae.
• traumatic causes : Following a fracture, the joints may present with ankylosis, especially in the event of poor reduction of the fracture.
• immunological causes : this is the case with autoimmune diseases, especially rheumatoid arthritis. In this pathology, there is a Rheumatoid Factor (RF), which can be dosed, it does not cause joint damage directly but induces the inflammatory reaction of the organism. This, via an auto-immune type mechanism, will then cause the destruction of the joint. 
• In addition, ankylosis of the spine, another autoimmune disease, is the natural evolution of an inflammatory disease affecting the spine, called ankylosing spondylitis. It causes a loss of elasticity in the spine.
• Among the other autoimmune diseases causing ankylosis, we find Horton’s disease, pseudo-rhizomelic arthritis (PPR), or lupus. Autoimmune diseases, by producing auto-antibodies directed against the body, and in particular connective tissue (the tissue that binds the different organs and tissues of the body together), will also affect the connective tissue present in the joints .
• In addition, a heterotopic ossification, or the production of extra-osseous soft tissue, can also be a cause of ankylosis, in the elbow for example.

Diagnosis of ankylosis

Ankylosis can be diagnosed by the doctor, or even an osteopath, who can refer to a rheumatologist.

This diagnosis can be made on the basis of medical imaging, radiological data confirming clinical data, and also sometimes via certain laboratory tests. For example, the bioassay of RF, or Rheumatoid Factor, will help in the diagnosis of rheumatoid arthritis (however, RF can be present in other conditions as well).

• Clinical examination: the doctor measures the deflection, that is to say the amplitude of the movement, by comparison with the other side. Inflammation will be seen by swelling, redness, heat, and very severe pain. An ankylosis of muscular or neurological origin will be detected by the retraction of the muscles: the palpation of the muscle makes it possible to identify a hard stop or a soft stop, the softer or softer stop being a sign of a muscular or neurological problem.
• Radiological examination: ankylosis may or may not be seen on imaging, depending on its cause (a muscular or neurological origin will not be seen on an x-ray). In the case of osteoarthritis, a reduction in the thickness of the cartilage may be observed. It is also possible to visualize a denser bone, or a bone-on-bone friction, or even a deformation of a swollen joint. With each new pain of osteoarthritis, an x-ray is necessary.
• Biological assessment: it can help determine the origin of ankylosis, as in the case of an infectious cause, where the inflammatory assessment will be disturbed. Regarding autoimmune diseases, the workup will detect autoimmune antibodies.

The people concerned

Older people are more at risk of ankylosis, age and aging being an important factor in the development of osteoarthritis. Regarding arthritis, women are more affected than men, and Caucasians more concerned than other ethnic groups, such as Asians. But with the current rhythms of life, and the development of obesity, all populations now tend to be affected. Autoimmune diseases more often affect young women.

Risk factors

Rheumatoid arthritis, a major risk factor for ankylosis linked to an autoimmune disease, mainly affects women. Lack of physical activity is a risk factor for ankylosis, as are obesity and high blood pressure. There is also a genetic risk factor, especially if cases of arthritis of the autoimmune type exist in the family.

Ankylosis, in itself a symptom, results in difficulty in moving a joint, or even in its complete immobility. Among its other signs, frequently occur:

• stiffness;
• body aches, even at rest;
• symptoms of inflammation, such as redness, swelling, a feeling of heat around the joint.
• pains.

Thus, the inflammation of a joint is very painful, because this inflammatory reaction causes swelling: in fact, the fluid which increases within the joint serves to defend itself against germs, the number of white blood cells is therefore increased, resulting in increased joint volume. The inability to move the joint, called ankylosis, will therefore come from both the pain and the swelling. Because when the joint is swollen, it loses range of motion. The fibers, tendons and muscles, then have less possibility of moving, of sliding.

Professor Samantha Demaille, physical medicine and rehabilitation doctor at the Espoir center, in the North, specifies: “The whole game of rehabilitation will be to drain the effusion as quickly as possible, and to allow the ligament of the joint to move normally.«.

Main conventional treatments:

• The treatment recommended as part of the treatment of ankylosis is physiotherapy, which can help restore mobility of the joint. But sometimes ankylosis turns out to be irreversible.
• Analgesics (or pain relievers) are aimed at relieving pain.
• Immunomodulators (also called immunosuppressants) will be used in cases of ankylosis caused by an autoimmune disease.
• Anti-inflammatory drugs (corticosteroids) will help decrease inflammation.
• Hyaluronic acid injection: this type of injection, three times a year, acts as a protective gel, much like an oil, on damaged cartilage, also making it less painful.
• Prostheses: when the ankylosis is complete, for example in very severe osteoarthritis, for which the cartilage is destroyed, the bones can go so far as to fuse together, leading to immobility, and intense pain. Treatment may then consist of replacing the joint, using a knee or hip prosthesis.

Principle of the treatment of ankylosis in rehabilitation:

Rehabilitation, in the treatment of ankylosis, will first aim to relieve a painful joint, therefore by prescribing, depending on the cause of the ankylosis, drugs to fight against inflammation, against infection, or others.

At the outset, the joint must be left immobilized, at rest. This immobilized joint will not prevent the start of the actual rehabilitation, by working the muscles without moving the joint. “For example, physiotherapists can offer the patient to contract the muscles, to do isometric muscle strengthening, in which the muscle works and the joint does not move“, Explains Professor Samantha Demaille. She adds : “This prevents the muscle from losing strength, and allows the body not to be absorbed, to retain muscle volume. In addition, the body keeps the memory of movement. So when the joint gets back into motion, it will do so naturally.«

Heat can also be delivered to certain joints, for example by means of a hot water bottle. This heat will help reduce inflammation, and therefore relieve pain.

Then, little by little, the rehabilitation will consist in moving the joint again, by making it work on increasingly large amplitudes, in order to put it back in motion, gradually and painlessly.

Among the herbal treatments:

• The hay flower (drug name: Graminis flos), which is a therapy for degenerative diseases, and various forms of arthritis.
• The essence of cajeput, combined with other oils such as peppermint, clove oil, menthol and camphor can be used against muscle and joint pain associated with rheumatoid diseases, and also against l osteoarthritis.
• In addition, the essence of cajeput can also be combined with other plants to fight against arthritis and osteoarthritis: St. John’s wort, aloe, myrrh gum, calendula flower, rosemary leaf, the arnica flower, the balsam of Peru, in the form of homeopathic preparation.
• For chronic degenerative arthritis, nasturtium or Nasturtium seeds can be used (Tropaeolum forwards) combined with dandelion roots and grass, kawa-kawa roots, Bryonia roots, mountain bay leaves, swamp ledon, bittersweet stems, rhododendron leaves.
• For osteoarthritis, again: white mustard seeds.
• For arthritis, also white mustard seeds, or even mistletoe grass.
• In addition, a very good treatment to fight against inflammation is to combine harpagophytum with St. John’s Wort, an effective remedy both against inflammation and very good analgesic, made from mother tincture. They are good long-term pain relief treatments, especially since they are not aggressive.

The list is not exhaustive, however be careful to always have medical advice when using herbal treatments.

• The best prevention of ankylosis after a fracture is rehabilitation. It is therefore essential to exercise the muscles under the casts. Maintaining the muscles will facilitate the mobilization of the joint.
• When ankylosis begins, rehabilitation, which is carried out mainly with physiotherapists, will aim to restore the initial movement of the joint, and to prevent at best a fall of greater amplitude. However, if the cartilage is damaged, it will not be possible to return to the initial state.
• In the case of a neurological problem, the muscles, which usually cause the movement of the joint, no longer do so, and the joint becomes stiff: it will thus be necessary to exercise hemiplegic people, in particular, to maintain the flexibility of the joint. their joints.

Regular physical activity, in general, combined with a healthy lifestyle, is a good way to prevent ankylosis. Controlling blood pressure, as well as a healthy, balanced diet and weight maintenance are all preventative factors against arthritis.

It is therefore essential to walk regularly, but also to treat all infections, in order to avoid sepsis. You have to take care of your joints, and respect a painful joint by letting the pain pass. Ultimately, as Professor Demaille points out, “you have to move so as not to rust«.