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There is no known cure for fibromyalgia. Therefore, the goal of treatment is successful symptom management. Treatment usually requires a combination of therapies, exercise, and lifestyle adjustments. Adequate rest is essential in the treatment of fibromyalgia. The diet should include a large variety of fruits and vegetables, which provide the body with trace elements and minerals that are necessary for healthy muscles. Avoidance of stimulating foods or drinks (such as coffee) and medications like decongestants prior to bedtime is advised. A patient’s clear understanding of his or her role in the recovery process is imperative for successful management of this condition.

Treatments found to be helpful include heat and occasionally cold compress applications. A regular stretching program is often useful. Aerobic activities focusing on increasing the heart rate are the preferred forms of exercise over most other forms of exertion. Exercise programs need to include good warm-up and cool-down sessions, with special attention given to avoiding exercises causing joint pain. Hydrotherapy exercises (exercises in a pool or tub) may be useful in providing a low impact exercise environment while soothing muscle and joint pain.

Massage therapy can be helpful, especially when a family member is instructed on specific massage techniques to manage episodes of increased symptoms. Short sessions are most helpful as repetitious movement can aggravate the condition. Specific attention to mental health, including psychological consultation, may also be important, since depression may precede or accompany fibromyalgia. Relaxation exercises, yoga, aromatherapy, guided imagery, and other relaxation therapies can be useful in easing stress and promoting overall well-being. Acupuncture can be very helpful for symptom relief and in easing the general condition.

Herbalists and aromatherapists may recommend tub soaks or compresses with lavender (Lavandula angustifolia), chamomile (Chamaemelum nobilis), or juniper (Juniperus communis) to soothe muscle and joint pain.

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If a nonsurgical treatment is recommended, you should avoid activities that cause discomfort. You should avoid competitive sports for 6 to 8 weeks. Your doctor may suggest stretching exercises or swimming instead as a means of physical therapy.

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If signs of osteochondritis dissecans are seen on X-rays of one joint, you’ll have X-rays of the other joint to compare them. After this, you may have an MRI (magnetic resonance imaging) or a CT (computerized tomography) done. These tests can show whether the loose piece is still in place or whether it has moved into the joint space. If the loose piece is unstable, you might need surgery to remove it or secure it. If the loose piece is stable you may not need surgery, but you may need other kinds of treatment, such as resting the affected joint, bracing the joint when playing sports and treating pain and inflammation with ibuprofen.

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The symptoms of osteochondritis dissecans include:

* Swelling of the affected joint
* Decreased joint movement, such as not being able to fully extend your arm or your leg
* Pain, especially after activity
* Stiffness after resting
* A joint that “sticks” or “locks”
* A clicking sound when you move the joint

These are all clues that you may have osteochondritis dissecans. Your doctor will check you to be sure the joint is stable and check for extra fluid in the joint. Your doctor will consider the possible causes of joint pain, such as fractures, sprains and osteochondritis dissecans. If osteochondritis dissecans is suspected, your doctor will order X-rays to check all sides of the joint.

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In osteochondritis dissecans, a loose piece of bone and cartilage separates from the end of the bone because of a loss of blood supply. The loose piece may stay in place or fall into the joint space, making the joint unstable. This causes pain and feelings that the joint “sticks” or is “giving way.” These loose pieces are sometimes called “joint mice.” Osteochondritis dissecans usually affects the knees and elbows.

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Goal of the treatment is to protect the affected joints afrom repeated injury and the stresses of weight-bearing. This is usually done with orthosis wearing.

Progression of the disease is usually delayed with conservative management. Surgical measures are directed toward stabilization of the joint by arthrodesis. In the feet, bony prominences may be excised to facilitate shoe wear.

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In a normal limb, the injured joint is protected from further trauma by pain. In the absence of pain and proprioceptive sensation, however, the joint continues to be active and is repeatedly injured.

Synovial effusion and hemarthrosis are aggravated and, together with the abnormal stresses on the joint, cause extreme stretching and weakening of the capsule and supportive ligaments.

Local hyperemia causes bone atrophy and resorption.

Cartilage destruction, bone erosion, and minute fractures soon follow. Reparative response results in the formation of callus and metaplastic changes in surrounding traumatized soft tissues. With repeated injury, the joint becomes totally disorganized, subluxation ensues, and severe degenerative changes take place.

The affected joints are boggy, tense, swollen, nontender, and have an excessively abnormal range of motion on clinical examinaion. The local triad of swelling, instability, and absence of pain is nearly always suggestive of Charcot joint.

Radiographic Findings

The joint will show varying degrees of destructive and hypertrophic changes. There is loss of articular cartilage, fragmentation and absorption of subchondral bone, and osseous proliferation of the articular margins.

The bone overgrowth may be enormous, bizarre in configuration, and so great as to surround the joint as a spongy mass. The periarticular soft tissues are thickened and contain scattered calcifications.

Pathologic fractures involving the articular surface are common, as are irregular loose bodies within the joint.

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* Congenital insensitivity to pain
* Peripheral nerve injuries
* Diabetic neuropathy
* Chronic diseases of the spinal cord that lead to sensory disturbances of the limbs.

In myelomeningocele, absence of pain sensation is associated with flaccid paralysis and marked limitation of physical activity; thus, owing to associated severe osteoporosis, the bone and joint changes present a different picture.

The joints involved vary with the different etiologic conditions.

In congenital insensitivity to pain and diabetic neuropathy, the destructive changes occur primarily in the tarsal and metatarsal joints, less commonly in the ankle, and rarely in the knee.

In syringomyelia, the joints involved are those of the shoulder and elbow. In tabes dorsalis, the knee, hip, ankle, and thoracolumbar spine are frequent sites of the disease.

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This condition was described by Charcot, in 1868. He described it as a bizarre destruction of the knee joints with indolent swelling and instability in patients of tabes dorsalis. He proposed that the disease resulted from traumatization of a joint deprived of sensation.

Later Steindler classified the condition into the condition into the destructive, atrophic and hypertrophic proliferative forms.

Charcot-like changes in joints are seen in patients who have absence or depression of pain and proprioceptive sensation and who take part in extended continuous physical activity.

As a consequence their joints sustain repeated trauma.

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The menisci in the knee joint are required for

* Compensation of incongruity between the femur and tibia
* In the distribution of joint pressure
* Shock absorber, for stabilization of the knee, in provision of rotation, in spreading of synovial fluid, and in nutrition of articular cartilage.

An intact meniscus transmits 70 to 90 percent of the total load across the knee joint. Therefore, it is desirable to preserve the meniscus whenever possible.

A conservative nonoperative method of management is recommended In the treatment of discoid meniscus  if pain and functional disability are minimal.

SIlent discoid menisci  require no treatment. however, they should be kept under observation.

Conservative measures

* Immobilization of the knee
* Restriction of physical activity
* Progressive exercises for the quadriceps.

Operative Measures

If the knee locking persists their is functional disability or pain partial or complete excision of the discoid meniscus is indicated.

Diagnostic arthroscopy is carried out to know the pathologic changes and the type of discoid meniscus.

Partial resection of the discoid meniscus is preferred when it is of the complete or incomplete type with minimal tearing and slight degeneration

Excision of the entire meniscus is performed when it is of the Wrisberg type  or when it is torn and there is marked degenerations.

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