Joint Pain Common But Most Causes Can Easily Be Treated

Joint pain is one of the most common new complaints that patients present to their primary care physician. There can be a myriad of reasons for joints to hurt most of which are easily treated. The joints of our body are composed of numerous tissues including cartilage, tendons, bone, bursas, ligaments and the lining of the joint called the synovium. Any one of or several of these structures can become inflamed, worn out or injured, and this can lead to significant pain and disability from joint pain.

Inflammation in and around our joints is fairly common. This can be related to a specific injury and the natural inflammatory response that occurs during healing. Or it can be abnormal inflammation that occurs because of over use or poor joint mechanics that leads to over stressing of the tissues which respond by initiating the inflammatory pathway. Tendonitis is a common inflammatory problem that typically results not from inflammation of the tendon itself, but actually occurs when the lining or sheath of the tendon becomes inflamed. This is common around the shoulder and in the hands.

On the other hand when tendons start to age they can begin to break down which can lead to a problem called tendinopathy. Tendinopathy can lead to pain and dysfunction but unlike tendonitis we do not see the inflammation present in the tissues. This has been seen in several different processes that we once thought were tendonitis’ such as rotator cuff tendonitis, Achilles tendonitis, tennis elbow and many others. What we find in these situations is degenerative tissue that is unhealthy and not able to stand up to the normal loads required of the tissue and it therefore becomes painful. What we do not see when we look at these tissues under the microscope is inflammatory cells. Another common inflammatory process that can lead to joint pain is inflammation of the lining of the joint or the synovium. When this occurs the joint often will produce excessive joint fluid making the joint more swollen and adding to the pain. Rheumatoid arthritis (RA) is a fairly common diagnosis and one of the major issues with RA is exuberant synovitis. This leads to chronically painful, swollen joints and if present for too long may lead to progressive deterioration of the cartilage and joint. There are other diagnoses that can lead to synovitis as well but the common thread amongst the diseases is painful and swollen joints.

The loss of the normal joint cartilage, called hyaline cartilage, which is the smooth cartilage caps on the ends of the bones inside of the joints, is arthritis. Arthritis can occur because of excessive inflammation such as in RA, from previous trauma, from infections or most commonly because it has worn out over time. When the cartilage just wears out we term this osteoarthritis which affects millions of people every year. One in four adult Americans will develop some form of arthritis in their lifetime. Unfortunately at this time we do not have a cure for osteoarthritis but we do have treatments that can improve pain and quality of life and keep patients doing what they want.

Joint pains can often be treated with simple rest, anti-inflammatory medications, and rest. Many conditions require nothing more than this simple formula to get better. But if after a few days to a few weeks the symptoms have not resolved it is reasonable to see your doctor for a more thorough evaluation. Physical therapy and even unsupervised exercise has been shown to be very effective in preventing and improving chronic joint pains. Some key points to an exercise program are to be sure to warm up and cool down, have realistic goals early on, talk to your doctor about your plan (especially if you have heart or lung disease), expect some pain and soreness early on but follow the two hour rule. The two hour rule is: your pain two hours after exercise should be no worse than it was prior to starting your exercise activity. It is sometimes helpful to start with a trainer or therapist and gradually work toward an independent exercise program that you can do on your own at home.

When therapy and exercise do not work other more invasive measures may be necessary. This can include over the counter pain medications and anti-inflammatory medications, joint injections and maybe surgery. In tendonitis and other inflammatory problems using medications to decrease the inflammation can be very effective. A “steroid” or “cortisone” injection is really nothing more than a strong local anti-inflammatory that can be placed in a joint or around inflamed tissue. A special group of medications called DMARDs or disease modifying anti-rheumatologic drugs are used in the treatment of certain diseases that we call inflammatory arthritis. These drugs hold the promise of not only helping with the symptoms, but actually preventing the progressive joint destruction, which has historically lead to the crippling pain and progressive joint deformities seen in many of these diseases.

When medications and injections no longer work, surgery is an option in many cases. This can range from simple clean up operations and debridement or removal of inflamed tissue to repair or reconstruction of torn ligaments to the replacement of part or the entire joint. The level of surgery required to treat these conditions relates to the severity of the disease at hand. In severe arthritis a simple clean up may provide short term relief or it may not provide any relief at all and only puts patients at risk for complications.

On the other hand an inflamed joint may not need a joint replacement if the inflammation can be managed with medications or injections. The decision to move forward with surgery requires careful consideration to ensure the risks are outweighed by the benefit, that patients are healthy enough to tolerate the surgery, and that there is a good prognosis for a meaningful and hopefully long term recovery. If you have had persistently painful joints you may want to talk to your health care provider about treatment options.

Are you living with joint pain? Do you have hip, knee or shoulder pain? Join us on Thursday, Oct. 9 from 5:30 to 7 p.m. at Marcus Daly Memorial Hospital in Conference Room B/C and participate in this free interactive class. Get helpful tips on the right kind of exercise to reduce joint pain and increase your pain threshold, learn about the source of your pain and explore options for bringing movement back into your life.

Questions and or comments regarding this week’s health column please contact Jeremiah Clinton, MD at Bitterroot Orthopedics and Sports Medicine, a service of Marcus Daly Memorial Hospital, 1200 Westwood Drive, Hamilton, MT 59840. Working together to build a healthier community!

Source: http://ravallirepublic.com/lifestyles/health-med-fit/article_e14611fe-4e8e-11e4-becf-b7ca9a3f08bc.html

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