Achy Breaky Joint Issues

Have you been ignoring the discomfort in your knees when you walk down the stairs or go for your evening jog?

Our joints well-oiled mechanisms that keep our limbs moving and functioning as they should. Like all mechanisms, they can experience wear and tear over time, resulting in intense pain.

Sore and swollen joints are the hallmark condition of Osteoarthritis or OA – the most common form of arthritis that primarily affects our knees, and other weight-bearing joints such as the hips and spine.

A degenerative joint disease, OA is characterised by the progressive loss of cartilage, which eventually leads to the smooth surface of the cartilage becoming rough and causing irritation to the joint. In advanced stages of the disease, the cartilage wears out completely, exposing the underlying bones, causing them to rub against each other.

According to the National Center for Biotechnology Information (NCBI), more than 10% of the U.S. adult population had clinical OA in 2005, and in 2009, OA was the fourth most common cause of hospitalization. About 90% of the American population is said to have some features of OA in their weight-bearing joints by the age of 40.

OA is common in Asia, though early awareness is still lacking. In Malaysia, it is estimated that about 20% of the population will have OA by the age of 60. Derived from Greek words osteo, arthro and it is which mean bone, joint and inflammation respectively Osteoarthritis can also affect the non-weight bearing joints like the shoulder, elbow, wrist and fingers. The early features of OA are pain, swelling and stiffness of the joint that can last for days or up to weeks. Over time, these episodes will become more frequent, last longer and the symptoms become more intense.

These are two types of OA – primary, without any predisposing cause; or secondary, caused by underlying conditions such as previous joint injuries or trauma. Regardless of type, if left unattended, OA can result in continuous pain even while resting, as well as loss of mobility and deformity of the joint.

Not just the old folks

While arthritis and joint ailments are typically linked to older people, trends indicate that there has been a spike in incidents of OA among the younger population (in their 40s or below) around the world.
High-impact physical activities, such as running, hiking and playing traditional field sports on hard-court surfaces such as futsal, can increase the risk of developing OA. However, you may not need to hang up your boots just yet.

“Ironically, the majority of knee replacements I do for end-stage arthritis are for those who have never exercised a single day in their lives; while there are septuagenarians running marathons without a hint of arthritis in their knees,” says Dr. Siva Kumar Ariaretnam, Consultant Orthopaedic Surgeon at Sime Darby Medical Centre Ara Damansara and Sime Darby Medical Centre ParkCity, the two new hospitals under the SIme Darby Healthcare Group.

“Weight-bearing exercise is a necessary component of any exercise regime. Doing low impact exercises like swimming and cycling alone are great for cardiovascular well-being, but can hinder adequate bone mineralization leading to brittle bones. So, often a balanced exercise regime with a good mix of low and high impact exercises is advised,” he adds.

According to Dr. Siva,obesity and heavy manual labour are also known aggravating factors for knee OA. However, primary OA is often congenital (predisposed based on family history). This is where early detection plays a role in delaying or preventing the need for surgery altogether.

“Often there are foot abnormalities that contribute to OA of the knee and even the spine. These, if recognised and corrected early with the use of simple and inexpensive foot orthotics, can go a long way in protection your joints. Muscle imbalances in the knee can also be corrected with simple everyday exercises that can be done while sitting at your desk or standing.”

Even for those beyond the early to moderate stages of OA, all is not lost, assures Dr. Siva.

Besides proper footwear and insoles, the correct use of supplements can help a great deal in protection your joints. Knee braces have also been used successfully for years for sports and manual labour, in an attempt to avoid or delay surgery.

He also cautions against the vast majority of untested, and in some cases harmful, herbal remedies in the market, instead recommends clinically-proven traditional anti-inflammatory remedies that are derived from staple Asian Kitchen condiments, which actually work.

There are also various “biologic therapies” that can be administered as injections into the knee in the advanced stage, which help alleviate the pain and in some instances heal the damaged tissues in the knee.
However, once OA has reached an advanced stage surgery becomes a necessity.

Minimally Invasive surgery

The good news is – unlike 20 years ago, today’s technological and medical advances have opened up various minimally-invasive surgical options that do not impede one’s ability to continue working or maintaining a robust and active lifestyles afterward, making it a viable option for patients of any age.

An emerging technology that has taken the world by storm is Patient Specific Instruments (PSI). Using a CT or MRI scan of the joint, a cutting jig that is custom-made to the patient is fabricated, which fits the exposed knee like a piece of a puzzle.

“PSI reduces about 9 steps and an average of 19 minutes of surgery, without compromising the outcome. It can be performed significantly faster and more accurately than conventional surgery, providing greater overall benefits to the patients,” explains Dr. Siva, who successfully performed the first case of United States Food and Drug Administration (US-FDA) approved PSI surgery in Southeast Asia, right here in Malaysia, more than two years ago.

Its benefits are seemingly endless. PSI technology addresses many of the issues of conventional surgery and of CAS (Computer Assisted Surgery), and avoids the added risk of infection, fractures and vascular injuries.

“In addition, PSI allows minimally invasive surgery to be performed, reducing the cuts in the muscles and tendons that move the knee. This enables a majority of patients to bend their knee even as they are being wheeled out of the operating room, and walk within 6 hours of surgery with little or no pain!

This in turn reduces the risk of deep-vein thrombosis and its associated pulmonary embolism, which are rare but potentially fatal complications of surgery associated with delayed mobilization,” he adds

Better than cure

Before we resign ourselves to the fact that our joints will one day wear out, let us first look at some precautionary measures to keep Osteorthritis at arm’s length.

For Example, maintaining an ideal body mass index (BMI) and ensuring that you are not overweight or obese, is important in preventing stress on your joints.

A healthy lifestyle is also important, but exercises should be tailored according to age and physical fitness. Ensuring you do the appropriate exercises, including weight-bearing exercises, is as important as ensuring that you exercise regularly.

Dr. Siva adds that those who do experience aches and pains in their joints more than once, or for a prolonged period, should not delay in seeking their doctors’s opinion at once.

Identifying the early signs or symptoms of OA is important to ensure that we obtain necessary and immediate attention. Some common symptoms may include:

- Pain in a joint during or after use, or after a period of inactivity.
- Tenderness in the joint, especially when waking up in the morning or after a period of inactivity
- Loss of flexibility and difficulty using the joint
- Grating sensation when using the joint
- Bone spurs, which appears as hard lumps, that have formed around the affected joint
- Welling (effusion) in the affected joints, in some cases.

This article was contributed to Tab A Doctor by,
Dr Siva Kumar, Orthopaedic Surgeon, Sime Darby Medical Centre

Osteoarthritis

Osteoarthritis is a degenerative joint disease, classified under mechanical degradation of joints and joints tissue. Symptoms of a person with osteoarthritis will include pain within the affected joint, stiffness, 'locking' of the knee and tenderness to the touch. When cartilage wears off due to wear and tear, the bone surfaces becomes more vulnerable to physical trauma (as the cartilages serve as 'shock absorbers'). This in turn

causes pain, and the patient will limit the movement of the joint, which causes muscle atrophy and ligamental laxity.

Treatments involves a mix of exercise therapy, lifestyle changes and modifications, and painkillers to lessen or manage the pain. If the pain experienced becomes overpowering, patients who have less risk often undergo joint replacement surgery such as hip replacement, knee replacement of the joint with osteoarthritis.

Osteoarthritis is a very common form of arthritis, and a big cause of long term impairment and disability.

Signs And Symptoms

Symptoms include pains (aching, pulling, burning) in joint and surrounding joint structures, loss of mobility and function, as well as decreased use. Sometimes movements will cause a cracking noise (known as crepitus), and accompanied by muscle spasms. Our patients also will often complain that the differences in weather e.g. moving from a cold room to a hot room or vice versa will result in a cramping ache.

OA often affects mobile and more weight bearing joints, such as the mobile hands, or the larger weight bearing hips and knees. As it progresses, the joints enlarge, becoming increasingly more painful and decreasing in mobility, as the day progresses. This distinguishes it from its related cousin,rheumatoid arthritis, that often gets better as time goes by.

In smaller joints such as the joints of the hands and fingers, Heberden's nodes can form on the end finger joint, and Bouchard's nodules can form on the joints just after the knuckles (refer to the picture by Drahreg01). They are not always painful, but they do restrict the movement of the fingers.

Causes Of Osteoarthritis

There are two types of OA classified: primary and secondary. Primary OA is the chronic degenerative disorder that is related by is not primarily caused by aging (some people in their 80+ or 90+ have no OA at all). Over time, the cartilages in our joints shrink, and becomes less resilient.

Secondary OA is caused by a variety of factors, but ends up with the same pathological results as of the primary OA. Some of the causes are listed here:
1. Joint disorders.
2. Diabetes mellitus.
3. Any/all forms of inflammatory/arthritic diseases.
4. Direct trauma.
5. Joint infections.
6. Ligamental laxity or instability.
7. Obesity.
8. Other syndromes such as marfan's syndrom and wilson's disease.

Treatments

A combination of treatment approaches and modalities for a more effective outcomes are recommended. Lifestyle changes and modification such as adopting a more active lifestyle of healthy eating, exercise and weightloss), coupled with painkillers are some of the long term solutions.
Physical therapy helps to improve function, increase strength and mobility, decrease pain and delay the need for surgery. The exercise therapy that is prescribed by physiotherapists is documented to be more effective than that of a pure pharmaceutical approach. Some of the targeting areas include balance training, gait correction re-training, and functional mobilization. Hand therapists often prescribe custom-made splints to prevent aggravation and deformities.

This article was contributed to Tab A Doctor by,
Ms Louise Yow, Physiotherapy, UrbanRehab Pte Ltd, Physiotherapy & Rehabilitation Specialists

Knees and Arthritis

"I couldn't even sleep at night because of the pain in my knees," said Sally, sharing about her osteoarthritis of the knees at AAOS.org. As a hostess in a restaurant and an active person who loved biking, tennis, walking, gardening and traveling, Sally found that her osteoarthritis had a negative impact on her life.

Sally's condition affected both knees, making it impossible for her to walk, especially up and down the stairs. The constant pain left her hunched over and limping. No longer able to exercise, she gained weight and her overall health began to deteriorate.

Osteoarthritis (OA) is a degenerative joint disease often found in the hands, knees, hips, feet and spine, according to the AAOS article. It is one of the most common forms of arthritis and occurs when the cartilage that cushions the ends of the bones breaks down, resulting in a bone-on-bone contact and significant pain, loss of movement and deformity. Besides physical limitations, OA can also cause financial strain to the sufferer as treatments can be expensive, and for some patients with this condition, they may no longer be able to work.

Symptoms

Common symptoms of OA according to an article at Pain-Research.org:

• Joint pain and swelling
• Early morning stiffness
• Warmth around a joint
• Redness of the skin around a joint
• Reduced ability to move the joint
• Unexplained weight loss, fever, or weakness that occurs with joint pain

Diagnosis

Diagnosing arthritis according to the Pain Research article includes:

A physical examination may show fluid being collected around the joint known as effusion, and the affected joints may indicate limited range of motion, being painful or difficult to move in some directions. In certain forms of arthritis, for example rheumatoid arthritis, the joints may become deformed if the disease continues for too long without treatment.

Diagnostic tests vary depending on the suspected cause, and may include blood or urine tests, as well as joint X-rays. In septic arthritis or inflammation of a joint due to a bacterial or fungal infection, fluid may be removed from the joint with a needle and examined for the presence of infection.

Medication and Treatment

Many over-the-counter medications include common anti-inflammatory drugs like:

• Aspirin
• Ibuprofen
• Naproxen

Such drugs may be used to effectively control pain and inflammation in arthritis, as described in another article at Pain-Research.org. However, these drugs need to be used with care as they have possible side effects of causing damage to the stomach lining and the kidneys.

Glucosamine and chondroitin which are known to provide naturally-occurring nutrient for forming the building blocks of cartilage may be recommended. These are available at health food stores or supermarkets without a prescription. Early studies indicate that these compounds are quite safe and may improve symptoms relating to arthritis.

Injections of liquid cortisone directly into the joint may temporarily help to relieve pain and swelling. However, it should be noted that repeated frequent injections into the same joint can damage the joint and have undesirable side effects.

If nonsurgical treatment fails to give relief, a surgery for arthritis by an orthopedist may be considered. This is the advice given in an article on arthritis treatments at Pain-Research.org. The orthopedist and patient will choose the type of surgery by taking into account the type of arthritis, its severity, and the patient's physical condition.

Surgical procedures include:

• Removal of the diseased or damaged joint lining
• Realignment of the joints
• Total joint replacement
• Fusion of the bone ends of a joint to prevent joint motion and relieve joint pain

For professional help with osteoarthritis and joint degeneration, please consult a doctor or an orthopedic specialist.

What Causes Joint to Wear Out?

by Singapore Health

Knee Osteoarthritis and Physiotherapy Management

by Singapore Health