Synovitis Health Dictionary

Surgical removal of the synovium (see SYNOVIAL MEMBRANE) to treat troublesome SYNOVITIS. The operation is not normally done until other treatments have failed.... synovectomy

Dracontiasis, or dracunculiasis, is a nematode infection caused by Dracunculus medinensis (guinea-worm). The major clinical problem is secondary infection of the worm track, causing CELLULITIS, SYNOVITIS, epididymo-ORCHITIS, periarticular FIBROSIS, and ARTHRITIS; TETANUS is a potentially lethal complication. CHEMOTHERAPY is unsatisfactory and the time-honoured method of extracting the female adult by winding it around a matchstick remains in use. Surgical treatment may be necessary. Ultimate prevention consists of removing Cyclops spp. from drinking water.... dracontiasis

‘Rheumatism’ is the colloquial term for nonspeci?c musculoskeletal symptoms arising in the joints, ligaments, tendons and muscles. ‘Arthritis’ describes a pathological musculoskeletal disorder. Most common are sprains of ligaments, strains of tendons and muscles,

BURSITIS, TENDINITIS and non-speci?c back pain (see BACKACHE).

Osteoarthritis (OA) rarely starts before 40, but by the age of 80 affects 80 per cent of the population. There are structural and functional changes in the articular cartilage, as well as changes in the collagenous matrix of tendons and ligaments. OA is not purely ‘wear and tear’; various sub-groups have a genetic component. Early OA may be precipitated by localised alteration in anatomy, such as a fracture or infection of a joint. Reactive new bone growth typically occurs, causing sclerosis (hardening) beneath the joint, and osteophytes – outgrowths of bone – are characteristic at the margins of the joint. The most common sites are the ?rst metatarsal (great toe), spinal facet joints, the knee, the base of the thumb and the terminal ?nger joints (Heberden’s nodes).

OA has a slow but variable course, with periods of pain and low-grade in?ammation. Acute in?ammation, common in the knee, may result from release of pyrophosphate crystals, causing pseudo-gout.

Urate gout results from crystallisation of URIC ACID in joints, against a background of hyperuricaemia. This high concentration of uric acid in the blood may result from genetic and environmental factors, such as excess dietary purines, alcohol or diuretic drugs.

In?ammatory arthritis is less common than OA, but potentially much more serious. Several types exist, including: SPONDYLARTHRITIS This affects younger men, chie?y involving spinal and leg joints. This may lead to in?ammation and eventual ossi?cation of the enthesis – that is, where the ligaments and tendons are inserted into the bone around joints. This may be associated with disorders in other parts of the body: skin in?ammation (PSORIASIS), bowel and genito-urinary in?ammation, sometimes resulting in infection of the organs (such as dysentery). The syndromes most clearly delineated are ankylosing spondylitis (see SPINE AND SPINAL CORD, DISEASES AND INJURIES OF), psoriatic or colitic spondylitis, and REITER’S SYNDROME. The diagnosis is made clinically and radiologically; no association has been found with autoantibodies (see AUTOANTIBODY). A particularly clear gene locus, HLA B27, has been identi?ed in ankylosing spondylitis. Psoriasis can be associated with a characteristic peripheral arthritis.

Systemic autoimmune rheumatic diseases (see AUTOIMMUNE DISORDERS). RHEUMATOID ARTHRITIS (RA) – see also main entry. The most common of these diseases. Acute in?ammation causes lymphoid synovitis, leading to erosion of the cartilage, associated joints and soft tissues. Fibrosis follows, causing deformity. Autoantibodies are common, particularly Rheumatoid Factor. A common complication of RA is Sjögren’s syndrome, when in?ammation of the mucosal glands may result in a dry mouth and eyes. SYSTEMIC LUPUS ERYTHEMATOSUS (SLE) and various overlap syndromes occur, such as systemic sclerosis and dermatomyositis. Autoantibodies against nuclear proteins such as DNA lead to deposits of immune complexes and VASCULITIS in various tissues, such as kidney, brain, skin and lungs. This may lead to various symptoms, and sometimes even to organ failure.

Infective arthritis includes: SEPTIC ARTHRITIS An uncommon but potentially fatal disease if not diagnosed and treated early with approriate antibiotics. Common causes are TUBERCLE bacilli and staphylococci (see STAPHYLOCOCCUS). Particularly at risk are the elderly and the immunologically vulnerable, such as those under treatment for cancer, or on CORTICOSTEROIDS or IMMUNOSUPPRESSANT drugs. RHEUMATIC FEVER Now rare in western countries. Resulting from an immunological reaction to a streptococcal infection, it is characterised by migratory arthritis, rash and cardiac involvement.

Other infections which may be associated with arthritis include rubella (German measles), parvovirus and LYME DISEASE.

Treatment Septic arthritis is the only type that can be cured using antibiotics, while the principles of treatment for the others are similar: to reduce risk factors (such as hyperuricaemia); to suppress in?ammation; to improve function with physiotherapy; and, in the event of joint failure, to perform surgical arthroplasty. NON-STEROIDAL ANTI-INFLAMMATORY DRUGS (NSAIDS) include aspirin, paracetamol and many recently developed ones, such as the proprionic acid derivatives IBUPROFEN and naproxen, along with other drugs that have similar properties such as PIROXICAM. They all carry a risk of toxicity, such as renal dysfunction, or gastrointestinal irritation with haemorrhage. Stronger suppression of in?ammation requires corticosteroids and CYTOTOXIC drugs such as azathioprine or cyclophosphamide. Recent research promises more speci?c and less toxic anti-in?ammatory drugs, such as the monoclonal antibodies like in?iximab. An important treatment for some osteoarthritic joints is surgical replacement of the joints.... joints, diseases of

Synovitis. Treat as for gout.

Potato Poultice. 1 part potato juice to 3-4 parts hot water, applied on suitable material. Cover with protective. ... big toe joint, inflammation

A membrane that lines the capsule surrounding a movable joint.

The synovium also forms a sheath for certain tendons of the hands and feet.

The membrane secretes synovial fluid, which lubricates the joint or tendon.

The synovium can become inflamed; in a joint this is known as synovitis, in a tendon sheath it is known as tenosynovitis.... synovium

(transient synovitis of the hip) a self-limiting condition, affecting children between 3 and 10 years of age, due to inflammation of the synovium of the hip joint capsule. It is a common cause of sudden hip pain and limping in young children. Treatment is with NSAIDs and by limiting weight bearing. It usually resolves in 7–10 days, although in some cases symptoms may persist for several weeks.... irritable hip

The joint formed by the FEMUR, TIBIA and patella (knee-cap). It belongs to the class of hinge-joints, although movements are much more complex than the simple motion of a hinge, the condyles of the femur partly rolling, partly sliding over the ?at surfaces on the upper end of the tibia, and the acts of straightening and of bending the limb being ?nished and begun, respectively, by a certain amount of rotation. The cavity of the joint is very intricate: it consists really of three joints fused into one, but separated in part by ligaments and folds of the synovial membrane. The ligaments which bind the bones together are extremely strong, and include the popliteal and the collateral ligaments, a very strong patellar ligament uniting the patella to the front of the tibia, two CRUCIATE LIGAMENTS in the interior of the joint, and two ?brocartilages which are interposed between the surfaces of tibia and femur at their edge. All these structures give to the knee-joint great strength, so that it is seldom dislocated. The cruciate ligaments, although strong, sometimes rupture or stretch under severe physical stress such as contact sports or athletics. Surgical repair may be required, followed by prolonged physiotherapy.

A troublesome condition often found in the knee – and common among athletes, footballers and other energetic sportspeople – consists of the loosening of one of the ?bro-cartilages lying at the head of the tibia, especially of that on the inner side of the joint. The cartilage may either be loosened from its attachment and tend to slip beyond the edges of the bones, or it may become folded on itself. In either case, it tends to cause locking of the joint when sudden movements are made. This causes temporary inability to use the joint until the cartilage is replaced by forcible straightening, and the accident is apt to be followed by an attack of synovitis, which may last some weeks, causing lameness with pain and tenderness especially felt at a point on the inner side of the knee. This condition can be relieved by an operation

– sometimes by keyhole surgery (see MINIMALLY INVASIVE SURGERY (MIS)) – to remove the loose portion of the cartilage. Patients whose knees are severely affected by osteoarthritis or rheumatoid arthritis which cause pain and sti?ness can now have the joint replaced with an arti?cial one. (See also ARTHROPLASTY; JOINTS, DISEASES OF.)... knee

Despite major e?orts, it has proved impossible to produce a single clear de?nition of osteoarthritis and this probably reffects the muddled nature of a concept which will need replacing. Unfortunately, there is confusion because the term is also used to cover joint pain that appears to have a mechanical basis in the absence of clinical or radiographic evidence of CARTILAGE loss.

The primary problem is seen as a change in structure of cartilage and BONE, rather than an in?ammatory SYNOVITIS. Osteoarthritis usually implies a loss of the central load-bearing area of articular hyaline cartilage, with outgrowth of cartilage at the articular margin and subsequent ossi?cation to form bony outgrowths known as OSTEOPHYTES. Osteophytes form with increasing age, whether or not there is signi?cant cartilage loss, and in the elderly may lead to local frictional symptoms, and in the spine, to nerve compression.

The condition has a wide range of causes, of which some, like dysplasia and trauma, are known and others have yet to be identi?ed. The main clinical problems occur in the hip and knee. The cartilage loss in the hip usually occurs in the sixth or seventh decade. It may affect both hips in fairly rapid succession, or only one hip; such patients often have no problems in other joints. Cartilage loss in the knee occurs from the ?fth decade onwards and is often associated with cartilage loss in small joints in the hand and elsewhere. Cartilage loss in the distal interphalangeal joints of the hand is associated with the formation of bony swellings known as Heberden’s nodes.

Treatment Management is largely directed at maintaining activity, with physical and social support as necessary. ANALGESICS may be of some value, particularly in the management of night pain. NON-STEROIDAL ANTIINFLAMMATORY DRUGS (NSAIDS) may help patients with early-morning sti?ness and may also reduce pain on movement and night pain. Their bene?t, however, tends to be less marked than in RHEUMATOID ARTHRITIS and their long-term usage has considerable toxicity problems. Advanced cartilage loss is best treated by joint replacement. Hip- and knee-joint replacements – with a wide variety of arti?cial joints – are now common surgical procedures which greatly improve the mobility of affected individuals. (See ARTHROPLASTY.)

People with arthritis and their relatives can obtain help and advice from Arthritis Care.... osteoarthritis

n. joint pain and swelling, resembling gout, caused by crystals of calcium pyrophosphate in the synovial membrane and fluid (see synovitis). It commonly affects the knee. X-rays may show signs of *chondrocalcinosis. Treatments include NSAIDs and colchicine. Pseudogout is one manifestation of *calcium pyrophosphate deposition disease.... pseudogout

(peritendinitis) n. inflammation of a tendon sheath, producing pain, swelling, and an audible creaking on movement. It may result from a bacterial infection or occur as part of a rheumatic disease causing *synovitis.... tenosynovitis

An aseptic (that is, not involving infection) ARTHRITIS secondary to an episode of infection elsewhere in the body. It often occurs in association with ENTERITIS caused by salmonella (see FOOD POISONING) and certain SHIGELLA strains, and in both YERSINEA and CAMPYLOBACTER enteritis. Non-gonococcal urethritis, usually due to CHLAMYDIA, is another cause of reactive arthritis; Reiter’s syndrome is a particularly ?orid form, characterised by mucocutaneous and ocular lesions.

The SYNOVITIS usually starts acutely and is frequently asymmetrical, with the knees and ankles most commonly affected. Often there are in?ammatory lesions of tendon sheaths and entheses (bone and muscle functions) such as plantar fasciitis (see FASCIITIS). The severity and duration of the acute episode are extremely variable. Individuals with the histocompatibility antigen HLA B27 are particularly prone to severe attacks.... reactive arthritis

A chronic in?ammation of the synovial lining (see SYNOVIAL MEMBRANE) of several joints, tendon sheaths or bursae which is not due to SEPSIS or a reaction to URIC ACID crystals. It is distinguished from other patterns of in?ammatory arthritis by the symmetrical involvement of a large number of peripheral joints; by the common blood-?nding of rheumatoid factor antibody; by the presence of bony erosions around joints; and, in a few, by the presence of subcutaneous nodules with necrobiotic (decaying) centres.

Causes There is a major immunogenetic predisposition to rheumatoid arthritis in people carrying the HLA-DR4 antigen (see HLA SYSTEM). Other minor immunogenetic factors have also been implicated. In addition, there is a degree of familial clustering which suggests other unidenti?ed genetic factors. Genetic factors cannot alone explain aetiology, and environmental and chance factors must be important, but these have yet to be identi?ed.

Epidemiology Rheumatoid arthritis more commonly occurs in women from the age of 30 onwards, the sex ratio being approximately 4:1. Typical rheumatoid arthritis may occur in adolescence, but in childhood chronic SYNOVITIS usually takes one of a number of di?erent patterns, classi?ed under juvenile chronic arthritis.

Pathology The primary lesion is an in?ammation of the synovial membrane of joints. The synovial ?uid becomes diluted with in?ammatory exudate: if this persists for months it leads to progressive destruction of articular CARTILAGE and BONE. Cartilage is replaced by in?ammatory tissue known as pannus; a similar tissue invades bone to form erosions. Synovitis also affects tendon sheaths, and may lead to adhesion ?brosis or attrition and rupture of tendons. Subcutaneous and other bursae may be involved. Necrobiotic nodules also occur at sites outside synovium, including the subcutaneous tissues, the lungs, the pericardium and the pleura.

Clinical features Rheumatoid arthritis varies from the very mild to the severely disabling. Many mild cases probably go undiagnosed. At least 50 per cent of patients continue to lead a reasonably normal life; around 25 per cent are signi?cantly disabled in terms of work and leisure activities; and a minority become markedly disabled and are limited in their independence. There is often an early acute phase, followed by substantial remission, but in other patients gradual step-wise deterioration may occur, with progressive involvement of an increasing number of joints.

The diagnosis of rheumatoid arthritis is largely based on clinical symptoms and signs. Approximately 70 per cent of patients have rheumatoid factor ANTIBODIES in the SERUM but, because of the large number of false positives and false negatives, this test has very little value in clinical practice. It may be a useful pointer to a worse prognosis in early cases if the level is high. X-RAYS may help in diagnosing early cases and are particularly helpful when considering surgery or possible complications such as pathological fracture. Patients commonly develop ANAEMIA, which may be partly due to gastrointestinal blood loss from antiin?ammatory drug treatment (see below).

Treatment involves physical, pharmacological, and surgical measures, together with psychological and social support tailored to the individual patient’s needs. Regular activity should be maintained. Resting of certain joints such as the wrist with splints may be helpful at night or to assist prolonged manual activities. Sound footwear is important. Early use of antirheumatic drugs reduces long-term disability. Drug treatment includes simple ANALGESICS, NON-STEROIDAL ANTI-INFLAMMATORY DRUGS (NSAIDS), and slow-acting drugs including GOLD SALTS (in the form of SODIUM AUROTHIOMALATE), PENICILLAMINE, SULFASALAZINE, METHOTREXATE and AZATHIOPRINE.

The non-steroidal agents are largely e?ective in reducing pain and early-morning sti?ness, and have no e?ect on the chronic in?ammatory process. It is important, especially in the elderly, to explain to patients the adverse effects of NSAIDs, the dosage of which can be cut by prescribing paracetamol at the same time. Combinations of anti-rheumatic drugs seem better than single agents. The slow-acting drugs take approximately three months to act but have a more global e?ect on chronic in?ammation, with a greater reduction in swelling and an associated fall in erythrocyte sedimentation rate (ESR) and rise in the level of HAEMOGLOBIN. Local CORTICOSTEROIDS are useful, given into individual joints. Systemic corticosteroids carry serious problems if continued long term, but may be useful under special circumstances. Much research is currently going on into the use of tumour necrosis factor antagonists such as INFLIXIMAB and etanercept, but their precise role remains uncertain.... rheumatoid arthritis

 Pyogenic. Bacterial infection may invade the body via mouth, nose or other mucous membranes. By the bloodstream it can be borne to almost any body tissues; joints of the shoulders, knees and hips. Immediate attention is necessary to avoid tissue destruction. Two virulent types are tuberculosis and gonorrhoea.

Infective arthritis may be associated with German Measles against which conventional antibiotics may be of little value. Infective organisms include: streptococcus, E. coli, staphylococcus, or others. May follow surgical operation, steroid therapy, rheumatoid arthritis or diabetes.

Symptoms. Joint hot, feverish, enlarged and painful.

Differential diagnosis: distinguish from gout and synovitis. Herbal treatment must needs be persevered with for 3 to 6 months, even longer. Good nursing is necessary. Natural life-style. Bedrest.

Treatment. For all microbial infections include Echinacea. (Hyde)

Teas. Nettles. Red Clover. Yarrow. 2 teaspoons to each cup boiling water; infuse 15 minutes. 1 cup 3-4 times daily.

Tablets/capsules. Devil’s Claw, Alfalfa, Echinacea, Horsetail.

Alternative formulae:– Powders. Echinacea 2; Burdock 1; Devil’s Claw 1; Guaiacum quarter. Mix. Dose: 750mg (three 00 capsules or half a teaspoon). Thrice daily.

Liquid Extracts. Echinacea 2; Juniper half; Black Cohosh half; Guaiacum quarter. Mix. Dose: 30-60 drops. Thrice daily.

Tinctures. Dandelion 2; Echinacea 2; Poke root half; Peppermint quarter. mix. Dose: 1-2 teaspoons. Thrice daily.

Above powders, liquid extracts and tinctures – effects are enhanced when each dose is taken in half-1 cup Fennel tea; otherwise, to be taken in water.

Topical. Analgesic cream. Comfrey poultice, Comfrey ointment. Tea Tree oil, Castor oil packs.

Diet. High Vitamin C foods. Dandelion coffee. ... arthritis, infective

Wild vine. Bryonia alba L. French: Bryone blanche. German: Zaunru?be. Spanish: Brionia. Italian: Briona bianca. Contains cucurbitacins. Sliced dried root.

Action: diaphoretic, expectorant, powerful hydragogue, emetic, cathartic, anti-tumour, anti-rheumatic. Externally: as a rubefacient. Internal use, practitioner only.

Uses: Rheumatism worse from movement, rheumatic fever, acute arthritis. Heart disorder following rheumatic fever. For absorption of serous fluid as in pleurisy. Congested bronchi and lungs. Synovitis, malaria and zymotic diseases.

Combinations: With Black Cohosh for muscular pain. Also for tenderness of the spinal vertebre (an important indication). With Poke root for inflammation of the breast or testicles.

Preparations: Owing to difficulty of the layman to dispense accurately dosage of powder or decoction, use is best confined to liquid extract or tincture; small doses frequently repeated; large doses avoided. Liquid Extract: 10 drops in 4oz water; dose 1 teaspoon every half hour.

Tincture: dose; 2 teaspoons every half hour (acute) cases; thrice daily (chronic).

External. Tincture used as a lotion.

Note: Not used in pregnancy, lactation or in presence of piles. ... bryony, white

Compression of the median nerve between the transverse carpal ligament and the carpal bone. May cause damage to the sensory and motor nerves and manifest as teno-synovitis or ganglion. Affects chiefly middle-aged women.

Symptoms. Numbness or tingling in first three fingers which feel ‘clumsy’. Worse at night. Muscle wasting of palm of the hand.

Diagnostic sign: the ‘flick’ sign – shaking or ‘flicking’ of the wrist when pain is worse and which is believed to mechanically untether the nerve and promote return of venous blood. (J. Neural Neurosurgery and Psychiatry, 1984, 47, 873)

Differential diagnosis: compression of seventh cervical spinal nerve root (osteopathic lesion) has tingling of the hands when standing or from exaggerated neck movements.

Treatment. Reduction of spasm with peripheral relaxants (antispasmodics). Also: local injection of corticosteroid or surgical division of the transverse carpal ligament.

Alternatives:– Tea. Equal parts. Chamomile, Hops, Valerian. 1 heaped teaspoon to each cup boiling water; infuse 15 minutes. 1 cup 2-3 times daily.

Tablets/capsules. Cramp bark. St John’s Wort. Wild Yam. Lobelia. Prickly Ash. Passion flower. Black Cohosh. Hawthorn.

Powders. Formula. Cramp bark 1; Guaiacum half; Black Cohosh half; Pinch Cayenne. Dose: 500mg (two 00 capsules or one-third teaspoon) 2-3 times daily.

Bromelain, quarter to half a teaspoon between meals.

Turmeric. Quarter to half a teaspoon between meals.

Tinctures. Formula: Cramp bark 1; Lobelia half; Black Cohosh half. Few drops Tincture Capsicum. Mix. 1 teaspoon in water when necessary. To reduce blood pressure, add half part Mistletoe.

Practitioner. For pain. Tincture Gelsemium BPC 1963 5-15 drops when necessary.

Topical. Rhus tox ointment. Camphorated oil.

Lotion: Tincture Lobelia 20; Tincture Capsicum 1.

Supplements. Condition responsive to Vitamin B6 and B-complex. Some authorities conclude that CTS is a primary deficiency of Vitamin B6, dose: 50-200mg daily.

General. Yoga, to control pain. Attention to kidneys. Diuretics may be required. Cold packs or packet of peas from the refrigerator to site of pain for 15 minutes daily. ... carpal tunnel syndrome (cts)

The hinge joint formed where the lower end of the humerus meets the upper ends of the radius and ulna. The elbow is stabilized by ligaments at the front, back, and sides. It enables the arm to be bent and straightened, and the forearm to be rotated through almost 180 degrees around its long axis without more than very slight movement of the upper arm.

Disorders of the elbow include arthritis and injuries to the joint and its surrounding muscles, tendons, and ligaments. Repetitive strain on the tendons of the muscles of the forearm, where they attach to the elbow, can result in an inflammation that is known as epicondylitis. There are 2 principle types of epicondylitis: tennis elbow and golfer’s elbow. Alternatively, a sprain of the ligaments may occur. Olecranon bursitis develops over the tip of the elbow in response to local irritation. Strain on the joint can produce an effusion or traumatic synovitis. A fall on to the hand or on to the elbow can cause a fracture or dislocation.elderly, care of the Appropriate care to help minimize physical and mental deterioration in the elderly. For example, failing vision and hearing are often regarded as inevitable in old age, but removal of a cataract or use of a hearing-aid can often improve quality of life. Isolation or inactivity leads to depression in some elderly people. Attending a day-care centre can provide social contact and introduce new interests.

Many elderly people are cared for by family members. Voluntary agencies can often provide domestic help to ease the strain on carers. Sheltered housing allows independence while providing assistance when needed. Elderly people who have dementia or physical disability usually require supervision in a residential care or hospital setting. (See also geriatric medicine.)... elbow

Soreness of the nipple caused by clothing rubbing against it, usually during sports such as jogging or long-distance running. Both men and women can be affected. Prevention is by applying petroleum jelly to the nipple before prolonged running.

joint The junction between 2 or more bones. Many joints are highly mobile, while others are fixed or allow only a small amount of movement.

Joints in the skull are fixed joints firmly secured by fibrous tissue. The bone surfaces of mobile joints are coated with smooth cartilage to reduce friction. The joint is sealed within a tough fibrous capsule lined with synovial membrane (see synovium), which produces a lubricating fluid. Each joint is surrounded by strong ligaments that support it and prevent excessive movement. Movement is controlled by muscles that are attached to bone by tendons on either side of the joint. Most mobile joints have at least one bursa nearby, which cushions a pressure point.

There are several types of mobile joint. The hinge joint is the simplest, allowing bending and straightening, as in the fingers. The knee and elbow joints are modified hinge joints that allow some rotation as well. Pivot joints, such as the joint between the 1st and 2nd vertebrae (see vertebra), allow rotation only. Ellipsoidal joints, such as the wrist, allow all types of movement except pivotal. Ball-and-socket joints include the hip and shoulder joints. These allow the widest range of movement (backwards or forwards, sideways, and rotation).

Common joint injuries include sprains, damage to the cartilage, torn ligaments, and tearing of the joint capsule.

Joint dislocation is usually caused by injury but is occasionally congenital.

A less severe injury may cause subluxation (partial dislocation).

Rarely, the bone ends are fractured, which may cause bleeding into the joint (haemarthrosis) or effusion (build-up of fluid in a joint) due to synovitis (inflammation of the joint lining).

Joints are commonly affected by arthritis.

Bursitis may occur as a result of local irritation or strain.... jogger’s nipple

Inflammation of the vulva and vagina. Vulvovaginitis is often provoked as a result of the infections candidiasis or trichomoniasis. (See also vaginitis; vulvitis.)

walking Movement of the body by lifting the feet alternately and bringing 1 foot into contact with the ground before the other starts to leave it. A person’s gait is determined by body shape, size, and posture. The age at which children first walk varies enormously.

Walking is controlled by nerve signals from the brain’s motor cortex (see cerebrum), basal ganglia, and cerebellum that travel via the spinal cord to the muscles. Abnormal gait may be caused by joint stiffness, muscle weakness (sometimes due to conditions such as poliomyelitis or muscular dystrophy), or skeletal abnormalities (see, for example, talipes; hip, congenital dislocation of; scoliosis; bone tumour; arthritis). Children may develop knock-knee or bowleg; synovitis of the hip and Perthes’ disease are also common. Adolescents may develop a painful limp due to a slipped epiphysis (see femoral epiphysis, slipped) or to fracture or disease of the tibia, fibula or femur.

Abnormal gait may also be the result of neurological disorders such as stroke (commonly resulting in hemiplegia), parkinsonism, peripheral neuritis, multiple sclerosis, various forms of myelitis, and chorea.

Ménière’s disease may cause severe loss of balance and instability.... vulvovaginitis

n. a bone disease characterized by a decrease in bone mineral density and bone mass, resulting in bones that are liable to fracture. Infection, injury, and *synovitis can cause localized osteoporosis of adjacent bone. Generalized osteoporosis is common in older people, and in women it often follows the menopause. It is also a feature of *Cushing’s syndrome and prolonged steroid therapy. Osteoporosis can be detected by *quantitative digital radiography, ultrasound, and *DEXA scans. A diet with adequate calcium, together with exercise, are preventative, and several drugs, including *bisphosphonates, parathyroid hormone (PTH), and *denosumab, can be used to reduce the risk of fracture.... osteoporosis