Ankylosing spondylitis- Causes & Symptoms

Ankylosing spondylitis
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Ankylosing spondylitis

•  It is chronic progressive, inflammatory autoimmune disorder of sacroiliac joints and axial skeletal.

 

Etiology

  • Idiopathic
  • Hereditary
  • Presence of HlA gene
  • Ulcerative colitis

 

Pathology

  • Sacrolilac spine is 1st involved
  • It is then followed by lumbar spine,hip,knee and manubriosternal joint.
  • It is characterized by synovitis, arthritis leading to cartilage destruction and bony erosion.
  • Later it leads to Bony ankylosis making the spine permanently stiff.

 

Clinical feature

  • Back pain
  • Early morning stiffness
  • Stiff spine
  • Spasm of sacroiliac muscles
  • Tenderness over sacroiliac joint
  • Chest expansion is diminished to less than 5 cms due to involvement of costovertebral joints.
  • In later stages, cervical spine become rigid.
  • Flexion deformity of spine and knee and hip while atlanoaxial it in hyperextension
  • Extraarticular manifestation
  • -Acute iritis
  • Aotic valve incompetence
  • Pulmonary complication
  • Osteoporosis
  • Dislocation of atlantoaxial joints
  • Fracture of cervical spine

 

Special test

i. Localized tenderness in PSIS

ii. Straight leg raising test

• Patient is asked to lift the legs with knee in extended. This is cause pain in sacroiliac joints.

 

iii. Sacroiliac compression

• Direct side side compression of pelvic causes pain in sacroiliac joint.

 

iv. Pump handle test

• Patient lies supine on table with full flexion of hips and knee on affected side.

• The affected hip and knee is brought close to the opposite shoulder.

• This cause pain on affected side.

 

v. Fleche’s test

• Cervical spine involvement can be tested by asking the patient  to touch the wall with the back of head without raising his chin.

 

i. Gaenshen’ s test

• The opposite side hip and knee is flexed to fix the pelvis.

• Affected hip is hyperextended over the edge of table.

• This will exert a rotational strain on sacroiliac joint causing pain

 

ii. Chest measurment

• Chest expansion is diminished to less than 5 cms.

• Reduction in vitak capacity

 

viii. Xray

• Hazziness and erosion of SI joint

• Bamboo spine appearance

• Osteophytes formation

• Squaring of vertebral bodies

 

xiii. Deformities can be measured in ankylosing spondylitis by spondylometer

 

xiv pulmonary function test

 

Physiotherapy management

1. To relieve pain

  • Hot packs
  • SWD
  • Massage
  • TENS
  • Progessive relaxation techniques

 

2. To reduce spasm

  • Hydrocollateral packs
  • Ultrasound for micromassage
  • Sustain passive stretching of quadriceps, sacrospinalis, neck and spine muscles.
  • Hydrotherapy

 

3. To improve spinal mobility

  • Flexion, extension and rotational exercise of spine.
  • Continuous or intermittent traction to widen IV space
  • Medicine ball exercise
  • Trunk rotation (side to side, forwards, backwards)
  • Reaching activites in sitting and standing
  • Spinal mobilization techniques

 

4. Use of splints and braces

  • HKAFO, AKO, KAFO  to prevent hip and knee flexion deformity.
  • Spinal casts or frames
  • Static/dynamic splints
  • Soft  cervical collars to prevent cervical flexion deformity
  • Butterfly pillow to support the neck
  • Lumbar corsets and lumbar belts to reduce excessive mobility
  • Kypho – thoracolumbosacral orthosis

 

5. Postural correction and ergonomics

  • Postural stability exercise done in front of mirror
  • Visual and biofeedback
  • Maintain an upright position in sitting and standing
  • Chin should be tucked in
  • Prone lying to prevent hip flexion and kyphotic deformites
  • Hip should be in hyperextension in prone by using pillow support
  • Shoulder bracing exercise
  • Avoid stopping posture
  • Sleep on a firm mattress

 

6. Chest physiotherapy

  • Deep breathing exercises to improve vital capacity
  • Incentive Spirometry
  • Segmental i.e posterobasal expansion exercise
  • Ventilatory muscle training
  • Pursed lip breathing to prevent dyspnea
  • Coughing  and huffing technique
  • Chest mobility exercises
  • IPPB
  • Flutter

 

7. Strengthening exercises

  • Muscle power can be imoroved by progressive resisted exercises
  • Pulley, weight, dumbells, spring resistance tubes can be used
  • Spine, hip, knee, joint are mainly concentrated
  • Cervical isometrics can be given

 

8. Functioning training

  • Teaching ADL
  • Gait training
  • Group therapy
  • Swimming
  • Aerobics exercises
  • Recreational exercises

 

9. Psychological support

 

10. Parent and family eduction

 


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