Joint Pain


Joint Pain Treatment in Alaska

A joint is the space where bones of the skeleton make contact, allowing for movement and providing support to the bony structures. For example, the elbow, knee, hip, shoulder and ankle are all joints. The anatomy of a joint includes muscles for movement, tendons to attach muscle to bone, ligaments connecting bone to bone, cartilage to lubricate and absorb shock, and a synovial sac surrounding the joint, providing protection and lubrication.

Joint pain is commonly reported, occurring in about one-third of adults. Many factors can result in joint pain, including physical injury or an inflammatory disease process such as arthritis. Joint pain occurs more often with age, and can interrupt the ability to perform physical activity. It ranges from mild to severe, and can be acute or chronic in duration.

Pathology

Joint pain may be caused by physical injury to the joint tissues. A few common injuries are:

  • Sprain, especially to the ankle, typically caused by a twisting motion damaging the tendons in the joint.
  • Strain, an injury to the muscles or tendons, the result of overstretching.
  • Torn meniscus, a common injury from contact sports affecting cartilage of the knee.
  • Torn Anterior Cruciate Ligament (ACL), an injury to the knee, which is common in sports such as basketball, football, soccer and gymnastics, where a sudden pivot or change in direction tears the ligament.
  • Tennis elbow, an overuse injury, which can result in chronic tendonitis.

Inflammatory conditions may also result in joint pain:

  • Osteoarthritis, caused by wear and tear on the joint over years of physical activity, which damages the cartilage, resulting in swelling, pain and stiffness in the joint.
  • Rheumatoid arthritis, an autoimmune disorder which causes chronic inflammation of the joints (and other tissues of the body).
  • Bursitis, inflammation of the bursa, a fluid filled sac in the joint. This injury is caused by overuse or acute trauma and commonly affects the elbow, shoulder, hip and knee.
  • Gout, a type of arthritis caused by a buildup of uric acid in the blood, which crystalizes in the joint.

Diagnosis

Joint pain may be associated with swelling, warmth and tenderness to the touch. Movement or weight-bearing activity may aggravate the pain. Individuals who experience persistent joint pain for more than a week should be examined by a physician. The exam will include questions regarding the history of joint pain and how activity affects the pain. X-rays or other imaging studies, such as MRI, may be ordered to visualize the muscles, tendons, ligaments, and bones of the affected area. The physician will assess the affected joint by touch, and determine the patient’s range of motion. Blood tests may be used to detect systemic inflammatory disorders such as rheumatoid arthritis or gout.

Treatment

Joint pain treatment depends on the cause. If the pain is the result of a physical injury, treatment begins with supportive care, known as PRICE:

  • Protect the joint by stabilizing it with a flexible wrap or brace.
  • Rest the joint, refraining from activity, giving the body a chance to heal.
  • Ice the joint for 15 minutes, multiple times a day.
  • Compress the joint with an elastic wrap to minimize swelling and give support.
  • Elevate the joint above the level of the heart to reduce swelling.

After a period of rest, physical therapy may help provide stability to the joint by strengthening the surrounding muscles. The physical therapist may use ultrasound, electrical nerve stimulation, heat or cold therapy, or manipulated exercises to increase range of motion.

The doctor may recommend overweight patients perform exercise and diet changes to lose weight, which may relieve stress on the joints and joint pain. Medications may be prescribed to treat inflammation of the joints associated with injury or arthritis.

Patients suffering from moderate joint pain with swelling may be given an over-the-counter prescription for nonsteroidal anti-inflammatory drugs (NSAIDS):

  • Aspirin
  • Ibuprofen
  • Naproxen Sodium (Aleve)

A Cox-2 inhibitor, such as Celebrex, may be prescribed by the physician and dispensed by the pharmacy. Tylenol is effective in treating pain without swelling. If these medications are not effective, the doctor may prescribe muscle relaxants to relieve muscle spasms or opioids for severe pain.

Topical creams may provide relief of joint pain. Capsaicin, the chemical present in chili peppers, triggers the release of endorphins and blocks transmission of pain signals. Methyl salicylate (found in Bengay) is also effective in relieving pain when rubbed on the sore joint.

Patients with joint pain that is not relieved by oral or topical medications may be treated with a steroid injection to the affected joint every three months. These injections are most effective for patients with arthritis or other joint disease. Fluid may also be removed from the joint with a needle to relieve swelling. Hyaluronan, a synthetic joint fluid, may be injected to treat osteoarthritis.

Alternative treatments for joint pain include glucosamine or chondroitin supplements, which are taken orally and come in tablet, capsule, powder and liquid forms. These supplements have no significant side effects and are made from components of cartilage. Though these supplements may not work for everyone, they may be effective in building cartilage to cushion the joints.

Joint pain is often effectively treated with noninvasive interventions like rest, over the counter medications and physical therapy. The most important factor in recovery is avoiding re-injury to the joint and getting back to a normal, active lifestyle.

Resources

  1. The Center for Orthopaedics and Sports Medicine. (April 3, 2003). What is a Joint? Retrieved from http://www.arthroscopy.com/sp12001.htm
  2. William C. Shiel Jr., M.D, FACP, FACR. Joint Pain. Retrieved from http://www.emedicinehealth.com/joint_pain/article_em.htm
  3. WebMD. Joint Pain. Retrieved from http://www.webmd.com/pain-management/guide/joint-pain