膝　関節水腫

Knee Joint edema

膝に水がたまり、以前に整形外科で水を抜いてもらったことがある。再び、膝に水が溜まり、膝の関節水腫の症状で来院。膝関節は関節包で守られていて、その包みの中には、骨同士が衝突しないように潤滑剤として、関節液という液体が入っています。これは関節を覆う包み、袋の内面についている滑膜という組織で産生や、吸収をされて、滑液量の調整を行っています。その量は1-3mlのごく少量です。関節水腫は、滑膜が関節液の正常範囲を超えて大量に産生してしまい、関節内に溜まってしまった状態です。今回の症例では、スポーツ事故や怪我をしていない状態で、膝に水が溜まるようになったので、変形性関節症が疑われます。関節は骨と骨のジョイント部分であり、継ぎ目でもあります。骨の表面部分には軟骨という、神経がなく痛みを感じない組織で、包まれるように覆われています。この軟骨が年齢とともに、すり減り、最終的には骨が関節の表面にでてしまうの が変形性関節症です。軟骨がすり減って薄くなった状態では、歩行などのちょっとした荷重でも、その刺激は骨に伝わり神経が豊富な骨は痛みとして感知します。その際、人によっては、滑膜に炎症を伴い、関節液を大量に産生してしまうわけです。この状 態だと、関節を覆う包みこむ袋である、関節包は膨張してしまい、それが袋の神経を刺激してさらに別の痛みも引き起こします。また、関節水腫があると、膝関節自体が安定しません。今症例でも、関節に水が溜まると、痛みで歩きづらさがでて、大腿に負荷をかけてしまうせいで、膝のお皿の上（膝蓋骨）の上部付近に付着する、大腿四頭筋に硬さがありました。鍼灸治療としては、血行を促進して、痛みの発痛物質を流し、炎症を軽減させ、疼痛緩和を図り、硬くなった大腿四頭筋の柔軟性を取り戻し、運動療法で膝周りの筋肉を鍛えて、膝関節を安定させていきます。

He had water in his knee and had previously had it drained by an orthopedic surgeon. Again, he came to the clinic with water in his knee and symptoms of joint edema of the knee. The knee joint is protected by a joint capsule, which contains a fluid called joint fluid as a lubricant to keep the bones from colliding with each other. This fluid is produced and absorbed by the synovial membrane on the inner surface of the capsule, which covers the joint, and regulates the amount of synovial fluid. The amount of synovial fluid is very small (1-3 ml). In joint edema, the synovial membrane produces a large amount of synovial fluid that exceeds the normal range of joint fluid and accumulates in the joint. In the present case, osteoarthritis is suspected because the water has accumulated in the knee in the absence of a sports accident or injury. Joints are joints and seams between bones. The surface of the bone is encased in cartilage, a tissue that has no nerves and causes no pain. Osteoarthritis occurs when this cartilage wears away with age, and the bone eventually comes to the surface of the joint. As the cartilage wears away and thins, even the slightest load, such as walking, is transmitted to the bone, which is rich in nerves, and the bone senses it as pain. In some people, this is accompanied by inflammation of the synovial membrane, resulting in the production of large amounts of joint fluid. In this condition, the joint capsule, the enveloping bag that covers the joint, swells, which irritates the nerves in the bag and causes additional pain. In addition, the knee joint itself is not stable when there is joint edema. In the present case, there was also stiffness in the quadriceps muscle, which attaches near the top of the knee plate (patella), because the water in the joint makes it difficult to walk because of the pain and puts pressure on the thigh. Acupuncture treatment was used to stimulate blood circulation, flush out pain-producing substances, reduce inflammation, alleviate pain, restore flexibility to the stiffened quadriceps muscle, and strengthen the muscles around the knee with exercise therapy to stabilize the knee joint.