Category: Painful Conditions

Osteoarthritis is a disorder affecting our joints; causing pain and gradual deterioration of function. Every joint is composed of two bones with a gap between them. Lining the bone on either side of the gap is a smooth material called cartilage that allows the joint to move freely. In the gap between the two cartilage surfaces is joint fluid. Around the joint is a capsule called the synovium. It contains the joint fluid. Overlying the synovium are ligaments and muscles keeping the joint intact and the bones in place.

In osteoarthritis there is a progressive loss of the smooth cartilage, exposing the rough bone underneath. The bone will compensate by increasing its growth. This causes spur formation where the ligaments and capsule attach to the bone. This combination of exposed bone and spurs make the joint stiff and painful. The causes of osteoarthritis are:

• Joint overuse
• Obesity
• Fractures
• Trauma to the soft tissues (cartilage)
• Genetics

Diagnosis

The primary symptom of osteoarthritis is joint pain and stiffness. Sometimes the pain can be directed to some other area of the body that has a nerve connection with the joint. Patients with osteoarthritis of the hip may actually feel pain in their groin or knee. Patients with osteoarthritis of the spine may feel pain in the hip. If these symptoms are present, the doctor will order an X-ray, test the joint fluid and order blood tests to make sure there is no other disease present.

Treatment

Treatment of osteoarthritis should include medications, strength training, weight loss, minimal joint impact and surgical replacement of certain joints when necessary. Strength training is extremely important in patients with osteoarthritis. Avoiding physical activity causes the muscles around the joint to decrease in size or atrophy. As the muscles atrophy, the joint becomes less stable and that can have a negative effect on osteoarthritis. It is important to keep our body weight at ideal levels. Excessive body weight puts additional stress on the joint causing more pain. Using a walker or cane can make the joint feel better.

Your doctor may prescribe certain medications. There are over 17 different drugs, called non-steroidal anti-inflammatory agents (NSAID) that are useful in the treatment of osteoarthritis. These drugs include medications such as ibuprofen, aspirin and Naprosyn. It is important to realize these drugs have significant side effects such as ulcer formation, water retention, increased blood pressure and increased stress on the kidneys and liver. Your doctor will want to monitor your response to these drugs very closely.

Depending on the location of the arthritis, injections can sometimes be given into the joint or adjacent nerve to help relieve the pain associated with a sudden flare up. The injection may require the use of an X-ray machine for accurate placement. If the injection is painful to administer, a light intravenous sedative such as Valium can be used to make the procedure comfortable. In some patients the joint function deteriorates so badly that surgery is the best option. Surgery is commonly used to replace the joints of the knees, hips and fingers. Other joint replacement surgeries such as the shoulder are being developed and with time may be as successful as hip and knee replacement.

It is important to remember to stay very active despite the osteoarthritis. Non-impact exercises such as bicycling and swimming are ideal. Strength training is very beneficial when done appropriately.

Prevention

• Maintain ideal body weight
• Low-impact activities
• Proper strength training

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Arthritis is inflammation of one or more joints. A joint is the area where two bones meet. There are over 100 different types of arthritis. When the cartilage that cushions between bones wears down the result can be the bones rubbing together causing irritation, swelling and stiffness at the joint. The most common type of Arthritis is Osteoarthritis.

Osteoarthritis is a disorder affecting our joints; causing pain and gradual deterioration of function. Every joint is composed of two bones with a gap between them.  Lining the bone on either side of the gap is a smooth material called cartilage that allows the joint to move freely. In the gap between the two cartilage surfaces is joint fluid. Around the joint is a capsule called the synovium. It contains the joint fluid. Overlying the synovium are ligaments and muscles keeping the joint intact and the bones in place. 

In osteoarthritis there is a progressive loss of the smooth cartilage, exposing the rough bone underneath. The bone will compensate by increasing its growth. This causes spur formation where the ligaments and capsule attach to the bone. This combination of exposed bone and spurs make the joint stiff and painful.

Causes

• Joint overuse
• Obesity
• Fractures
• Trauma to the soft tissues (cartilage)
• Genetics

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Spinal arthritis is a very common disorder affecting millions of Americans. When it occurs in the neck it is called cervical spinal arthritis. When it involves the low back it is called lumbar spinal arthritis. It begins to affect many people in their 30’s. By the age of 40, 50% of people will have evidence of spinal arthritis on an X-ray or CT scan. By the age of 50, that number rises to 100 percent.

Arthritis begins as a low-grade inflammation of the soft tissues surrounding the joints. The joints are composed of a delicate tissue called articular cartilage. It is a very smooth surface and allows the two bones composing the joint to glide over one another easily. Around the articular cartilage is a capsule of soft tissue called synovium. This capsule contains the joint fluid that lubricates the articular cartilage. Inflammation first begins in the capsules. Because the capsules are composed of soft tissue, they cannot be visualized on x-ray. As the arthritis progresses, the surface of the joints becomes pitted and gradually deteriorates. As the articular cartilage erodes, the bones underneath respond to the stress by forming spurs. This erosion and spur formation is a later finding that can be viewed on X-rays.

Diagnosis

Patients with spinal arthritis will develop pain in the neck or low back. That pain can spread to the arms or legs as the inflammation from the joints begins to affect the spinal nerves next to the joints. The pain may be worse in the morning because the joint stiffens during the night. As the day progresses, the joint gradually loosens up and symptoms get better. As the pain progresses, the patient will frequently go to the doctor to see what is wrong. The doctor will conduct a history and physical exam and may order blood tests and X-rays to confirm the diagnosis. The most sensitive test is the CT scan. This is capable of picking up arthritis at a relatively early stage. However, in most symptomatic patients, a simple X-ray will suffice.

Treatment

Many patients can find meaningful relief with a combination of therapies. The initial approach to early arthritis should involve a modest exercise program to keep the joints flexible; usually non-weight bearing exercises such as water aerobics to put the spine through a gentle range of motion and to enhance its flexibility. As arthritis progresses, medications such as aspirin may be necessary. There are now over 17 different types of compounds resembling aspirin on the market. These include drugs like Motrin or Naprosyn. Many patients with spinal arthritis find excellent relief with these anti-inflammatories, however there are some troublesome side effects such as stomach ulcer formation, high blood pressure, and deterioration of the liver or kidneys. Patients on these drugs have to be monitored by their doctor with blood tests taken at least once a year.

If gentle exercises and oral medications fail to control the discomfort, the patient can try a back or neck brace to inhibit the joint’s movement and to allow it to rest for a short period of time. Wearing a brace long term is controversial because it will cause weakening of the spinal muscles, which can worsen symptoms.

In severe cases of spinal arthritis, the patient may be a candidate for nerve block techniques. With nerve blocks, anti-inflammatory medications are injected directly into the joints or nerves. Once the inflammation decreases, the pain decreases. These steroid drugs are generally given as a short series of injections, usually two or three, over a period of weeks. If the patient gets relief lasting at least a few months, the drugs can be used again if the symptoms recur.

It is important to realize spinal surgery cannot relieve the pain of spinal arthritis. Even if a surgeon removes an arthritic joint, the tendency to form arthritis is still present in all the other elements of the spine so the pain will continue. Only if there is pressure being placed on the nerve by a single spur, can surgery be beneficial. The surgeon can remove the spur, alleviating the pressure and pain associated with nerve compression. Nonetheless, the tendency to form arthritis still remains and another spur may develop in a matter of years.

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Osteoarthritis is a gradual deterioration of the spinal column that occurs in everybody by the time they are 50 years of age. Fortunately, the majority of the people are not symptomatic from the arthritis. In contrast, however, for reasons we do not yet know, some patients may suffer severely. The deterioration causes a low-grade inflammation in the joints of the spinal column.

Each joint is composed of two surfaces of cartilage that are normally very smooth and lubricated by joint fluid. Normal joints move smoothly, similar to two pieces of glass with a little bit of water in between them. Gradual calcium build-up gets deposited into the soft tissue around the joints causing inflammation and the soft tissues to become very hard. This hardening is called spur formation because a small mound of bone develops. The spinal joint is very close to the nerve and is susceptible to this bony spur putting pressure on the nerve, causing significant pain in association with the arthritis.

Diagnosis

Patients with spur disease of the spine will have symptoms related to their arthritis such as pain in the neck or low back as well as pain secondary to nerve root irritation where the spinal cord starts to branch out. This will usually cause radiating pain down the arm or leg. A simple spine X-ray is usually adequate for diagnosis of spinal spurs. Spurs that are just forming can sometimes be diagnosed earlier with a CAT scan.

Treatment

There are essentially five treatment strategies for nerve irritation secondary to spurs.

1. Medications. A combination of anti-inflammatory drugs and mild narcotics can be used to reduce pain.
2. Physical therapy. Sometimes patients with  spurs  may  benefit  from  mild traction, which reduces pressure on the nerve. In addition, keeping the joint from moving with a soft collar can help.
3. Epidural injection.  During an epidural injection, medications are placed close to the nerve to relieve the inflammation associated with the arthritis.  These injections consist of  anti-inflammatory cortisone type  steroids. They are usually given as a series of two to four injections over a period of weeks. Relief will usually begin within 72 hours and can last for many months.
4. Surgery.  During surgery the spur is removed, relieving the pressure on the nerve.  Unfortunately, the tendency to form arthritis still remains.  The spur can regrow and pain may recur.
5. Transcutaneous electrical nerve stimulator, also known as a TENS unit.  This device is worn externally and delivers a mild electrical stimulation over the nerve, interfering with the conduction of pain.  While the TENS unit does not change the underlying condition, it can definitely reduce symptoms while it is being worn.

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