What are Joint Problems?

Your musculoskeletal system is constructed of bones, muscles, and joints. The bones attach to each other at a joint, where strong tissues called tendons and ligaments help connect the bones. On the ends of each bone, is a lining of smooth, protective cartilage and soft tissues (synovial membranes), that produce a liquid (synovial fluid). Thanks to the cartilage and synovial membranes, your bones are cushioned and lubricated so that they will not rub against each other. Joints are beautifully designed to let you move your body, and support your weight, as you go through life.

But, as you get older, your cartilage may start to deteriorate from the normal wear and tear of the passing years. The protective membranes and fluids in your joints begin to dry up. These changes may cause the bones to rub against each other painfully. You may also notice that some joints have changed shape, especially in your fingers or toes. You may feel stiff in the morning, or have aches and pains in some joints that never bothered you before. The joint may even become swollen, and warm to the touch. These problems are common in seniors. Usually, they are minor annoyances, but sometimes joint pain and deformities can make it very hard to function, and eventually, may lead to surgery or joint replacement.

The Most Common Types of Joint Problems

Arthritis (or osteoarthritis) is the most common type of joint problem in older people. It usually affects the knees, hips, hands, spine, or sometimes shoulders.

Rheumatoid arthritis is the second most common type of chronic arthritis.  It is caused by an auto-immune reaction, in which your body’s immune system, mistakenly attacks joint tissues. Generally, it involves the joints in your fingers, wrists, elbows, knees, ankles, and toes.

Other types of arthritis include gout or pseudogout. Sometimes, there is a mechanical problem in the joint, such as torn cartilage, that causes pain or limits movement in the joint.

Types of joint problems that affect the soft tissues like muscles, tendons, and ligaments include:

• Tendonitis
• Bursitis
• Fibromyalgia

Who Manages Joint Problems?

Many joint problems can be managed by your primary care provider. Others may be handled by:

• A physical therapist (healthcare professional who helps you maintain, restore, or improve physical function due to injury, disease, or disability).
• An occupational therapist (healthcare professional who helps you maintain, restore, or improve upper extremity function, and the ability to perform activities of daily living).
• An orthopaedic (doctor specialising in the treatment of the musculoskeletal system).
• A physiatrist (doctor specialising in rehabilitation medicine).
• A rheumatologist (doctor who specialises in the treatment of the joints and connecting tissues).

History and Examination

Once a medical history is taken, your healthcare provider will do a physical examination. This will include:

• a search for the source of the pain – whether it is within or outside a joint or referred from another location in your body (e.g., hip pain that comes from your back)
• an evaluation of the affected area – particularly looking for signs of inflammation (redness, swelling, tenderness or pain, warmth, persistent stiffness, enlargement, or deformity)
• assessment of which joints, and how many, are involved
• a range of motion test
• a check of joint stability
• a test of your ability to walk a short distance, and get in and out of a chair
• evaluation of certain diagnostic movements, noting how painful, impaired, or stiff the motion is, and whether there is pain; mainly when the examiner moves your joint (more likely in arthritis), or more likely if you move it yourself (probably a muscle or soft tissue disorder).

Your healthcare provider may also want to order additional tests.

Lab Tests

These may include blood, urine, and testing of the fluid extracted from the affected joint.

Imaging Tests

These will give a view of joint damage, and include x-rays, computed tomography (CT) scan, magnetic resonance imaging (MRI), ultrasound, and arthroscopy.

Care and Treatment

Effective treatment of your condition will probably involve a combination of medications and non-drug therapies. Physical activity is particularly important in many types of joint problems, especially in arthritis.

Medications

The following types of medication are used to treat joint problems:

• Pain medications, Nonsteroidal anti-inflammatory drugs (NSAIDs), Topical medications, Anti-immune system medications such as DMARDs, Corticosteroids, Antidepressants, and Muscle relaxants.

Non-drug Treatments

Exercise

Exercise strengthens weakened muscles and moves the joints. This will help improve function, and reduce your pain. The earlier you get started, the better. Depending on your diagnosis, therapy may have to be done for a few weeks, or even many months. Exercise programs should be individually designed for you, at the correct intensity by a physical therapist. These can include:

• Walking
• Swimming/ Aqua therapy (especially good for arthritis of the hip)
• Individualised exercises to do at home, including stretching and resistance training
• Yoga and tai chi (programmes that use stretching, slow movements, and balance).

Other ways you can reduce symptoms and improve function:

• Lose weight.
• Apply heating pads or ice packs a couple of times a day (maximum of 20 minutes for each application). Make sure that the heating pad is not burning the skin.
• Wear splints or braces if recommended by your healthcare provider.
• Use aids or devices (such as a cane or modified shoes), to help you keep your weight off an affected hip, knee, or other weight-bearing joint.
• Rest: stop or modify any repeated movements that may cause or worsen your condition.

Additional therapies include:

• Ultrasound (gentle sound-wave vibrations) to soothe tissues and improve blood flow
• Massage
• Transcutaneous electrical nerve stimulation (TENS), to soothe muscles and nerves and block pain sensations.

Surgery

For some people, physiotherapy and pain medicines are not enough. Depending on your general health and your specific disability, your doctor may suggest surgery and referral to an orthopaedic surgeon, after carefully weighing risks and benefits.

Your feet mirror your general health . . . cherish them!