Explore detailed information about a range of joint problems and treatments, including medications, surgery, physiotherapy and rehabilitation. Reading this will help you understand more about your own condition. There is also a glossary with explanations of many medical terms used in orthopaedics. You can find out even more by following the links page to other related websites, journals or professional medical associations.
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Author: DAVID P JOHNSON MB ChB FRCS FRCS. MD
Consultant Orthopaedic Surgeon
The human body is able to move because the bones are connected to one another by way of a series of joints which, in themselves, are very specialized structures. In the limbs the bones are connected by ‘synovial’ joints. To form these joints the ends of the bones are widened out to reduce the pressure across the articular cartilage capping the ends of the bones. This cartilage is firm and smooth and is lubricated by a special fluid which helps to ensure effortless and painless movement. The whole structure is contained within a fibrous capsule and held together by a series of ligaments.
The synovial joints of the body generally serve people well, allowing them to continue their physical activities unimpeded for the whole of their life. Nevertheless in some people some of their joints become injured or ‘wear out’, leading to a degenerative arthritis. In these instances the smooth, glistening, cartilage of the joint is destroyed, leaving the underlying bone exposed. Bare bone is not designed to rub together and, on doing so, causes pain. In addition, the damaged cartilage releases a series of breakdown products which cause an inflammation in the surrounding tissues and, often, an effusion of fluid within the joint. This arthritis of the joint then results in it becoming swollen, stiff and painful, which in turn limits the ability of the affected individual to perform many of the activities which he, or she, used to undertake freely and consequently leads to a great deal of frustration and despair.
No joint is immune from the condition but the weight bearing joints in the legs, namely the hips and the knees, take the greatest strain and are most commonly affected. Very often the cause for the arthritis is not immediately obvious. Sometimes the condition is found within a family. Arthritis can also be associated with a previous injury to the limb; to the presence of a generalized condition such as Rheumatoid arthritis, Gout, Psoriasis, Ankylosing spondylitis; to a previous infection within the joint; or to some form of localized vascular problem within the bone such as Avascular Necrosis.
There is usually little a person can do to prevent the onset of arthritis of a joint. Nevertheless, if a joint is affected the sufferer can take some measures to help himself or herself and make themselves more comfortable:
Taking analgesic tablets and other ‘pain killers’ can help. The joint is inflamed and taking tablets which have an additional ‘anti-inflammatory’ element is often of great benefit. Although some of these preparations can have side effect your general practitioner or physician will be able to advise which is the most suitable preparation for you.
Support for the affected joint can be of assistance. A localized soft support or bandage around the joint can help, even if this only keeps it warm. If the affected joint is in the leg a walking stick or crutch which reduces the weight of the body passing through it can often allow the person to get about relatively comfortably. In some cases splinting of the joint, especially in the upper limbs, is helpful.
Excessive weight puts a large strain across the joints, especially those in the legs. Bringing the body’s mass to normal levels has produced a remarkable reduction in pain and allowed much greater movement in some individuals. A Dietician will advise on methods whereby this may be achieved.
Maintain movement of the joint. One of the major problems which people have with an arthritic joint is the stiffness which occurs. For this regular exercises are often beneficial. The assistance of a Physiotherapist is often of great help in this respect.
A further measure is to modify your activities in order to accommodate to the diminished function which an arthritic joint can cause. You may need to plan your activities to ensure that your actions and joint movements are efficient and not wasteful of energy. Obtain an aid to function, such as a grasping stick or a long handled shoe horn frequently makes life easier by replacing lost functions, such as picking up or manipulating items, which would otherwise be very difficult to undertake because of the arthritis. The advice and assistance of an Orthotist or Occupational therapist in this respect should be sought.
Physically disabling arthritis of a joint is a very distressing condition for any individual. The support of like afflicted people, with whom one can discuss the condition and its various modalities of treatment, can be invaluable. There is often a local support group whom you can contact by way of meetings or telephone, whom your doctor or social worker may know of, or you can contact organizations with web sites on the internet such as www.arthritis.org or www.allaboutarthritis.com for more information and possible assistance.
One of the changes which happens in an arthritic joint, which may possibly be the result or the cause of its degeneration, is a change in the consistency of the synovial fluid which is responsible for lubricating the joint. Intra-articular injections of polymers of Hyaluronic acid, a substance which is present in normal joints, has been shown to ameliorate the disease, albeit for a limited time, in some instances.
Despite the measures outlined above, the condition sometimes continues to deteriorate. In this situation the options become somewhat limited. Surgery, by reducing pain and improving the movement of the joint, can bring about a revolutionary change in the individual’s quality of life, it is not, however, without its ‘cost’. Every surgical procedure has its possible complications and, even if the operation is conducted with the greatest of care and ability, it cannot be fully guaranteed to succeed. If you are contemplating surgery you should therefore discuss the procedure with your surgeon and satisfy yourself, in your own mind, that the benefits which may result from the operation outweigh the complications which can ensue
DAVID P JOHNSON MB ChB FRCS FRCS. MD
Consultant Orthopaedic Surgeon
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