Understanding joint pain
JOINT pain is common in society and it may affect an individual’s quality of life. A burning or throbbing pain and stiffness are usually associated with joint pain. Weight-bearing joints such as the hips, knees and ankles usually worsen with activity. Certain diseases may also cause joint pains in the hands, feet or spine.
According to Dr Ruzaimi Md Yusoff, consultant orthopaedic surgeon at MSU Medical Centre, “There are several identified risk factors with regards to joint pain. Previous injuries to a joint, overuse of a particular joint, history of arthritis, being overweight and ageing are among the common associated risk factors associated.”
Symptoms of joint pain range from mild to disabling with some requiring urgent attention and immediate consultation with medical practitioners. Symptoms include:
l Swelling
l Stiff or enlarged joint
l Numbness
l Noisy joints, or clicking, grinding or snapping sounds when moving the joint
l Painful movement
l Difficulty bending or straightening the joint
l Loss of motion
l A red and hot and swollen joint
The most common causes of joint pain are: l Osteoarthritis – commonly seen in orthopaedic practice and usually resulting from degeneration (wear and tear) or trauma
l Rheumatoid arthritis – a chronic disease that causes painful swelling of a joint. It usually affects the hands and wrists.
l Gout – painful joints caused by elevated uric acid levels in the body which then causes crystal deposits in the joint. It commonly affects metatarsophalangeal joint of the big toe.
l Bursitis – usually found in the hip, knee, elbow or shoulder and is usually caused by overuse. l Viral infection l Trauma such as fractures/dislocations. l Tendinitis – an inflammation of the tendons and usually seen in the elbow, heel and shoulders caused by overuse.
Management of osteoarthritis
Clinical and radiographic methods of diagnosing osteoarthritis are:
l Plain radiography – a cost-effective imaging method that can depict joint-space loss as well as subchondral bony sclerosis and cyst formation.
l Magnetic resonance imaging (MRI) – used when additional pathology amenable to surgical repair is suspected. Pathology that can be seen on MRI includes joint narrowing, subchondral osseous changes, and osteophytes. Unlike radiography, MRI can display articular cartilage and other joint tissues (e.g., meniscus, tendon, muscle or effusion).
l Computed tomography (CT) may be used in the diagnosis of secondary causes of osteoarthritis such as malalignment of the patellofemoral joint or of the foot and ankle joints.
l Ultrasonography is being investigated as a tool for monitoring cartilage degeneration, and it can be used for guided injections of joints not easily accessed without imaging.
Lifestyle modification, particularly exercise and weight reduction, is a core component in the management of osteoarthritis. Optimally, patients should receive a combination of nonpharmacologic and pharmacologic treatment.
Nonpharmacologic interventions include: l Patient education l Home treatments such as applying a heat pad or ice on the affected area. l Weight loss to decrease joints strain. l Exercise such as walking, swimming or other low-impact aerobic exercises. Those participating in strenuous workouts or sports may need to scale down or begin a lowimpact workout routine. Gentle stretching exercises will also help.
l Physical or occupational therapy, along with a balanced fitness programme.
l Support in certain joints (e.g., knee, hip) – aids such as a brace, cane or orthotic device in the shoe can help support the joint to allow ease of movement.
Pharmacologic agents used in the treatment of osteoarthritis include:
l Paracetamol
l Nonsteroidal anti-inflammatory drugs (NSAIDS)
l Calcium channel blocker/cox-2 inhibitor combination
l Intra-articular corticosteroids
l Intra-articular sodium hyaluronate
l Opioids
l Muscle relaxants l Nutraceuticals (e.g., glucosamine/ chondroitin sulphate).
Surgical procedures for osteoarthritis may be considered if the osteoarthritis fails to respond to a medical management plan.
l Arthroscopy is indicated for removal of meniscal tears and loose bodies; less predictable arthroscopic procedures include debridement of loose articular cartilage with a microfracture technique and cartilaginous implants in areas of eburnated subchondral bone.
l Osteotomy is used in active patients younger than 60 years who have a misaligned hip or knee joint and want to continue with reasonable physical activity.
l Arthroplasty is performed if all other modalities are ineffective and osteotomy is not appropriate or if a patient cannot perform activities of daily living despite maximal therapy.
Prevention of osteoarthritis include:
l Regular low-impact exercise such as strength training and stretching which can help slow down the progression of osteoarthritis. Exercise is important in maintaining healthy joints, relieving stiffness and increasing muscle and bone strength Quadriceps-strengthening exercises are recommended for patients with osteoarthritis of the knees, except for those with pronounced valgus or varus deformity at the knees.
l Maintaining an ideal body weight. Overweight patients who have early signs of osteoarthritis or who are at high risk should be encouraged to lose weight. Losing weight can help to reduce pain and increase joint motions.
l Resting, as overuse of the joints will increase the risk of developing osteoarthritis. Therefore, if the joint becomes swollen or painful, it should not be used for 12 to 24 hours to reduce the risk of developing osteoarthritis in the future.
l Occupational risks – jobs that require repetitive kneeling, twisting, lifting and walking may have impact on joints. It is important to work according to the designated standard operating procedures to maintain healthy joints.