Osteoarthritis:  Joint pain
From Diagnosis to Treatment

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Osteoarthritis is perhaps one of the most common reasons for joint pain. It can affect both weight-bearing and not weight-bearing joints.  Weightbearing joints include your hip joint or knee and ankle.  Other joints that there are non weightbearing also can be affected by osteoarthritis.  It is considered a degenerative condition and aging is a big factor.  Other factors that can accelerate the process include excessive weight, work injuries, fractures, and previous meniscal  and ligamentous injuries.

Joints are supported by tendons and ligaments.  Sometimes the pain is not coming from the joint itself but it is coming from supporting tendons, ligaments, and bursa.  Your doctor should be able to differentiate between joint related pain and soft tissue that they surround the joint.


Symptoms:
Swelling, pain, stiffness in the morning, pain with weightbearing including walking and standing for lower extremities and movement of the arm for the upper extremity joints are common presentation. If the osteoarthritis is involving your spine, motion of the spine can be painful. In small joints of hands and feet, moving the toes and fingers, gripping something with the hands, making a fist can be painful in those particular joints.


Work-up:
X-rays are often sufficient for diagnosis of osteoarthritis.  Sometimes to differentiate joint pain from other causes of pain within the joint, an MRI may be indicated.  For soft tissue pain around the joints including issues with the tendon and bursa, ultrasound can be helpful.

 

Treatment:

Your doctor may recommend a variety of treatments to you.  Most of the time, conservative care is recommended.  Conservative care includes physical therapy for strengthening the muscles around the joint, improvement of range of motion, reducing inflammation of the joint, and overall improvement of function.  Physical therapist will work with you to improve the utility of the joint.

If the physical therapy is not effective, you may combine this with medication which includes

 

In terms of medications Tylenol, and some of the NSAIDs can help the pain . Risk assessment to be done between physicians and patients regarding potential side effects of any medication you take. Opioid medications are generally not recommended, although if you have joint replacement surgery, for the first 10 days, you may be prescribed such medications..

Steroid Injections:
Injections into the joints can be effective to relieve pain most common injection a steroid injection into the particular joint.  X-ray or ultrasound should be used to direct the needle within the joint space.  If effective, this could be treated from time to time although frequent injections of steroid or anesthetic can deteriorate the structure of the joint.

In some cases, viscosupplementation can be recommended.  This is most commonly done in the knee joint but have been tried for other joints as well.    Read More

Regenerative Treatment  (PRP or B-MAC) 

Most recent musculoskeletal trend is to pursue regenerative treatments.  Often PRP and bone marrow aspirate are considered.  Some patients undergo prolotherapy.  The goal of the regenerative treatments to spare patients from steroid, reduced inflammation of the joint, improve the flexibility, and ultimately, regenerate tissues that they have degenerated.  There are lots of studies to be done on these but over the past few years, these options have shown some promise.  Insurance do not cover these treatment.    Read More 

Surgeries:
For end-stage joint disease, surgery is recommended.  Often this would be a joint replacement surgery.  Not every joint can be replaced but many joints can be an orthopedic surgeons are skilled to do so.  Recovery can be 2 to 6 months depending on the joint replaced.  Outcomes are generally good.

 

Examples of arthritic joints that we treat includes:

1.  Hip osteoarthritis 

2.  Knee osteoarthritis (tibiofibular joint, patellofemoral)

3   Ankle osteoarthritis

4.  Shoulder osteoarthritis (AC joint or glenohumeral) 

5   Elbow osteoarthritis

6   Wrist osteoarthritis

7   Fingers and toes osteoarthritis

8.  Spine Osteoarthritis