Upper arms shorter than forearms, calves shorter than thighs

Introduction Patients with Kashin-Beck disease can develop short limb deformities, short stature, generally upper arm is significantly shorter than the forearm, calf is significantly shorter than the thigh, and the trunk is close to normal.

Cause

The cause of Kashin-Beck disease is still unknown. It was suspected to be caused by chronic poisoning of the mouth, but it was not confirmed. Most people think it may be related to pathogenic mold in the grain. Animal experiments have found that the pathological changes in the bones of animals fed with cereals with pathogenic molds are very similar to those of large joint diseases. The pathogenic mold may be Fusarium, but it has not been fully confirmed.

an examination

Related inspection

Serum selenium (Se) blood routine

Clinical manifestation

If it occurs in adolescence, due to the early ossification of the epiphyseal plate, the developmental disorder appears as a dwarf type. It has short stature, large joints, and limited pain and activity. It has the earliest incidence of ankle joints, followed by finger joints, knees, elbows, wrists, toe joints and hips. Because of the inconsistent speed of the tarsal plate, the lower extremities often have knee varus, knee valgus or hip varus deformity. The fingers are short and small, and the feet are flat. The younger the age, the heavier the deformity.

If it occurs in the later stages of adolescence, the deformity is not obvious. Mainly manifested as symptoms of osteoarthritis, joint swelling, a small amount of fluid, a sense of friction during exercise, and sometimes with interlocking symptoms, and sometimes can be detected in the joints with free body. There are many cases of lower extremity in adults, and it is very inconvenient to walk because of swelling of the knees and knees.

X-ray films are very similar to osteoarthritis, with ankle joint lesions being the most serious. In the early stage, the joint space is widened, severely irregular, and there are free bodies in the joint. Then the cortical bone density of the articular surface increases and the gap tends to be narrow. Significant bones and lips appear at the edges of the joints. There are often subchondral cystic changes. Often the talus is squashed, the bone is dense, and the shape is flat, just like ischemic necrosis. Thereafter, both the scapular and subtalar joints can develop bone and lip, increase in bone density, and cyst formation under the cartilage. The patellofemoral joints of the knee joint can also be uneven, the edges are many bone lips, the joint ends are thick, and there are free bodies in the joints. After a long time, the joint collapsed. There is a similar change in the hip joint. The femoral head is avascular necrosis and may have a hip varus deformity. In the fingers, the joints are thick, the joint surface is uneven, the joint space is narrow, the bone density is increased, and the phalanx is short.

The diagnosis should be based on:

Epidemiology

2. Clinical manifestations

Typical manifestations are pygmy, increased bone ends, limited joint movement, and pain. The earlier the onset age, the more obvious the joint deformation and gnome, the symptoms of adult patients are generally lighter, often limited to joints.

3. Imaging performance

The disease is a systemic, multifocal, cartilage-necrotic disease that occurs during bone development. The resulting bone and joint damage will last for life, and the X-ray signs are summarized as follows:

1. The edge of the metaphysis is blurred or uneven, wavy or jagged. If the lesion continues to develop, the edge of the numb end may be fragmented. At this point, the joints are not significantly deformed.

2. Characterized by the beginning of fusion between the epiphysis and the backbone. The epiphysis begins to fuse from the central part and gradually expands to the edge. The epiphysis itself is also damaged, segmented, and irregular, and may be completely absorbed. The metaphysis can be in the form of a cup-shaped depression, and the bone marrow is embedded therein to heal early and stop development.

3. Cognac is completely integrated, the longitudinal development of the bone stops, and the diseased bone becomes shorter and thicker. Because the fusion of the cognac is different sooner or later, the phalanx can be uneven, the bone ends are wide and deformed, and the joints are coarse.

4. If the young people are infected after the metaphysis is cured, the clinical symptoms are more common and serious. The joint has damage to the bone end, which can affect the entire joint, which is characterized by a large bone joint deformity, which may be accompanied by a short backbone.

5. The series of signs seen in Kashin-Beck disease are repairs and secondary changes after cartilage necrosis. Only after repairing the tissue, especially the bone shape, can the lesion develop to abate, stabilize or deform.

Differential diagnosis

Calf or forearm gap syndrome: is a clinical manifestation of the compartmental compartment syndrome. The fascial space syndrome is a common and common disease of limbs. Once it occurs, it needs to be treated correctly in time. Otherwise, the dysfunction of the vestibule is serious.

The forearm has a pronation deformity: the forearm has a pronation deformity, and the pronation is a clinical manifestation of the radial nerve injury during exercise. The phrenic nerve is close to the diaphysis in the lower third of the humerus, where the phrenic nerve is vulnerable to injury.

Forearm shortening: is the clinical manifestation of the diagnosis of supracondylar fracture of the humerus. The supracondylar fracture of the humerus refers to a fracture above the medial and lateral iliac crest.

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