Ankylosing spondylities

It is sero-negative progressive inflammatory arthrities of the spine.it also may involve hip and shoulder joint.

Ankylosing Spondylities

Actiology:
Males are more affected than the female
Age: 16-40 years

Cause: unknown

Investigation:
HLA-B 27 positive

Pathology: 
Ist affected the sacroilliac joint then in lumber spine from lumber joint runs to thoracic, then cervical the hip and shoulder then pain in spread
spinal-hip-shoulder joint

Pathological change

Climical feature:

1. Lumber backache
2. Pain and stiffness,after rest and early morning
3. Sacroilliac joint tender to force  extendedmovement.
4. Stiffness back, progressive rigidity
5. Loss of lumber curvature
6. Progressive thoracic khyphosis
7. Forward extended head

8. Decrease chest expansion
9. Flextion contracture of hip and shoulder.
10 .Achilies tendinities


X-ray shown:

1. Sacro-illiac erosion lateral fusion
2. Arthrities change in apophyseal joint
3. Ligamentus ossification
4. Squaring of vertebral bodies
5. New bone  growth between two vertebrae.


Problem:

1. Low back pain.
2. Vertebral joint stiffness
3. Muscular pain and contracture
4. Decrease chest expansion
5. Respiratory complication
6. Spinal deformity
7. Tendinities and tendo-achilies
8. Muscle power decrease


Sensory Complication:

1. Chest infection
2. Atlanto-axial subluxation
3. Possible spinal cord damage
4. Heart disease
5. Decrease hight
6. Loss of mobility

Management:

1.To reduce pain sacro-illiac joint

• apply ice
• ultra-sound
• back extension

Lumber region:

• Apply heat
• Grade I mobilization
• IRR 
• SWD
• Ultra-sound

Vertebral joint stiffness:

• Heat compression
• Accessory movement of lumber spine
• Rotatioal movement
• Posterior to anterior
• Back extension in lying to repeatation

To reduce muscle pain:

• Messege transversely

To reduce contracture:

• Back flextion, patient in prone lying place pillow under the abdomen.

Chest complication:

• Lateral costal breathing exercise.

Respiratory complication:
.
1. Deep breathing:apical,lateral costal, abdominal
2. Hulfing/FET
3. Coughing:at least 5times with rest
4. Lordosis-back extension
5. Kyphosis-back extension place towel under lumbrg region.
6. Tendinities-at firest hot compression,GTFM,DTFM message
7. Muscle power decrease-all kind of strengthening exercise
8. Lower limb-static cycle,swimming


Advise:

1. Advice daily activiting
2. Avoid heavy weight lifting
3. Patient will continue his/her home exercise.

















 mobility