Joint Pain - Lehigh Valley Health Network

Your Guide to

Joint Pain

SYMPTOMS

OF JOINT PAIN

YOU AND YOUR JOINTS

Because the condition develops slowly, many people

You were born with the best joints you¡¯ll ever have.

do not experience symptoms until several years after

That¡¯s why the nonsurgical orthopedic specialists

cartilage breakdown begins.

and fellowship-trained surgeons at Lehigh Valley

The following are the most common symptoms of

Health Network (LVHN) Orthopedics will use the latest

osteoarthritis. However each person may experience

therapies ¨C from rehabilitation to nutritional counseling

symptoms differently:

and steroid injections ¨C to help extend the life of your

? Joint pain, swelling and stiffness, especially

natural joints.

The sooner you engage with one of our orthopedic

experts at LVHN, the more options you¡¯ll have to treat

your joint pain. If your natural joints have completely

worn out, total joint replacement surgery can restore

comfort, mobility and quality of life. However, there

after use

? Joint discomfort before or during a change

in the weather

? Bony lumps on the fingers

? Limited joint movement and loss of flexibility

are many nonsurgical options that can help relieve

? Joint stiffness, especially after sleeping or inactivity

joint pain. We want to partner with you to explore all

? Grinding of joints when moved (in more advanced

of your options to find a treatment plan that meets

stages of osteoarthritis) as the cartilage wears away

your individual needs.

Once symptoms develop, they generally are the

worst during the first year of the disease. Pain often

is described as a deep ache and is confined to the

affected joint.

In most cases, pain increases with use of the joint

and subsides with rest. However, as the disease

progresses, pain may become persistent.

Osteoarthritis may cause pain at night that interferes

with sleep.

If you overuse the affected joints and do not receive

treatment, the joints¡¯ cartilage may wear down

completely. When this happens, bone may rub

COMMON SYMPTOMS OF HIP, KNEE,

SHOULDER AND WRIST PAIN

The most common cause of joint pain in people age

55 and older is osteoarthritis (degeneration of joint

cartilage and the underlying bone). Osteoarthritis

symptoms usually develop slowly over many years.

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against bone, causing severe pain, inflammation and

joint damage.

Arthritis symptoms may resemble other medical

conditions or problems. Always consult your

physician for a diagnosis.

COMMON TREATMENTS

FOR JOINT PAIN

At Lehigh Valley Health Network¡¯s

or cross-country skiing. Cross-

gels and sprays that are applied

Center for Orthopedics, we specialize

training programs involving low-

to the skin. Many over-the-counter

in diagnosing, treating and preventing

impact activities are recommended.

(OTC) pain relievers may temporarily

problems of the bones, joints,

? Strengthening exercises to build

help reduce the pain caused by

muscles, tendons and ligaments.

supporting muscles so they can

osteoarthritis.

Our experienced orthopedic

absorb stress on joints and keep

? Corticosteroids: Corticosteroids,

surgeons are recognized as some

them stable.

such as prednisone (e.g., Deltasone?)

Heat therapy: Applying a hot pack

and methylprednisolone (Medrol?),

to affected joints may help reduce

are occasionally used to reduce

pain, relax muscles and increase

inflammation and pain and slow joint

blood flow to the joint. It also may

damage caused by osteoarthritis.

be an effective treatment before

? Cortisone injections into the joint:

exercise. Many people also get relief

This will begin to reduce pain and

from heat patches, ointments like

swelling in a day or two and may

Icy-Hot, taking a hot bath or sitting in

work for months.

a hot tub.

Synthetic joint fluid: Injections of

Medication: Osteoarthritis is most

synthetic joint fluid (Synvisc, Hylagan)

often managed with medications that

can improve motion in the knee.

reduce pain and inflammation.

Weight loss: Maintaining a healthy

? Nonsteroidal anti-inflammatory

weight is the best thing you can do

drugs (NSAIDs): NSAIDs have been

for arthritis. It keeps added pressure

used to relieve pain and inflammation

off the joints. Being only 10 pounds

caused by osteoarthritis.

overweight increases the pressure on

? Pain relievers: Prescription

your knees by 30 to 60 pounds with

pain relievers, including tramadol

each step.

of the finest in the nation, pioneering

new technologies so you can regain

movement and a life without pain.

ARTHRITIS

Arthritis (osteoarthritis) and other

rheumatic conditions can be very

painful, sometimes even keeping

you from doing certain activities.

Our goal is to help eliminate joint pain

and stiffness, improve joint movement

and restore comfort, allowing you to

return to your normal life.

Treatment for osteoarthritis may

include:

Physical and occupational

therapy: Physical and occupational

therapy may help to reduce joint

pain, improve joint flexibility when

performing daily activities and reduce

joint strain.

Exercise: Exercise is part of any

weight control program, and it¡¯s

critical for people with arthritis. You¡¯ll

feel better if you keep those achy

joints moving, and strengthening your

muscles helps support the joints.

An effective exercise program

consists of these three types of

exercises:

? Range-of-motion exercises to

keep muscles and joints flexible.

(Ultram?), have been used to reduce

pain caused by osteoarthritis.

? Opiates: Narcotic pain

relievers, such as acetaminophen/

codeine (Tylenol with Codeine?),

hydrocodone/acetaminophen

(Lorcet?, Lortab? or Vicodin?),

or oxycodone (OxyContin? or

BURSITIS

Bursitis is an inflammation of the

fluid-filled pads (bursae) that act as

cushions at the joints. Bursitis occurs

most often at joints that perform

frequent repetitive motion.

Bursitis treatment depends on

Roxicodone?), may be prescribed to

whether or not it involves infection.

treat severe arthritis pain. However,

For aseptic bursitis, where no

they do not reduce swelling.

infection is present, your health care

? Selective COX-2 inhibitors:

provider may prescribe the following

Celecoxib (Celebrex ) has been

treatments:

?

taken by mouth to reduce pain

? Anti-inflammatory and pain

? Aerobic exercises to promote

and inflammation caused by

medications, such as ibuprofen or

cardiovascular conditioning, overall

osteoarthritis.

aspirin to alleviate pain and swelling

? Topical pain relievers: Topical pain

? Avoiding the activity that led

relievers are creams, ointments,

to pain

fitness and help manage weight.

The exercises should be low-impact,

such as walking, swimming, bicycling

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? Using ice for the first 48 hours after

ACTIVITY MODIFICATION

? Myofascial release ¨C a gentle form of

an activity causing pain. Apply the

If your health care provider gives you

stretching and compression designed

ice wrapped in a towel for 15 to 20

the OK, begin exercising to strengthen

to release the uneven tightness in

minutes, three to four times a day. After

the muscles around the sore joint within

injured tissue that surrounds the body¡¯s

a couple of days, use moist heat before

a day or two. Start with a long warm-up

organs, muscles and bones

physical activity and ice after activity if

to minimize shock to the tissues, and

? Muscle energy techniques ¨C a

recommended by your doctor.

then try lifting light weights or working

variety of manual techniques designed

? Elevating the injury to reduce swelling

with an elastic exercise band. Go easy

to increase range of motion, relieve

? Injection of cortisone into the injured

at first, and build as your strength

spasticity and reduce pain

bursa to ease pain and swelling

increases.

? Ultrasound and electrotherapy ¨C

? Gentle exercise at home to improve

blood flow to the joint and the bursa

and to increase the range of motion

? Chiropractic treatment

REHABILITATION

Whether you are recovering from

an injury or surgery, LVHN offers

personalized rehabilitation care. Our

For septic bursitis, bursitis with an

network has board-certified therapists

infection, treatment may include:

and specializes in numerous therapies,

? Antibiotic medications

including treatment for unique and

? Repeated removal of the inflamed

less common conditions. With nearly

fluid using a thin needle

? Surgical drainage and removal of the

infected bursa sac if necessary

four dozen convenient locations, our

outpatient rehabilitation sites are just

minutes away.

All our rehabilitation programs are

TENDONITIS

tailored to meet your unique lifestyle

Whether you suffer a tendon injury from

needs and challenges. Our goal is to

playing sports, experience pain from

help you return to your regular routine

arthritis or break a bone, our orthopedic

as quickly and safely as possible. Our

surgeons can help. Our goal is to

rehabilitation team offers a wide range

eliminate your pain and restore your

of programs, including physical therapy,

comfort. Our experience allows us to do

occupational therapy, hand therapy,

that quickly and safely.

orthopedic therapy, pre- and post-

Your treatment for tendonitis may

include R.I.C.E. treatment for pain

relief: Rest the joint, apply ice packs,

compress the area with an elastic

bandage to reduce soreness and

inflammation, and keep the joint

elevated.

MEDICATION

Your health care provider may

recommend taking over-the-counter

nonsteroidal anti-inflammatory drugs

(NSAIDs), such as aspirin or ibuprofen,

which also may help inflamed soft

tissue.

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surgical care, and sports rehabilitation.

CHIROPRACTIC

TREATMENT

LVHN offers a variety of chiropractic

services for conditions of the bones,

joints and spine. Some of those

services include:

? Mobilization techniques ¨C

manual therapy used to manage

musculoskeletal dysfunction

? Instrument adjusting ¨C the use of

technology to apply gentle, precise

adjustments

use of sound waves and electrical

nerve stimulation to treat a variety of

chiropractic conditions

? Exercise recommendations

? Nutritional counseling

JOINT SURGERY

When arthritis, tendonitis or bursitis

is advanced, surgical treatment may

be necessary. Surgery may include

cleaning out the joint via a procedure

called arthroscopic debridement; an

osteotomy, which straightens the

bones; or joint replacement surgery.

Our surgeons offer the latest in joint

replacement technology to improve

the wear and fixation of hip and knee

replacements. This includes using new

plastics and metals called alternative

bearing implants. These implants

wear better and last longer. We also

offer techniques to reduce the size

of incisions and resulting scars, and

administer anti-inflammatory and antinausea drugs before, during and after

surgery to help you get active right

away and speed your recovery.

QUICK FACTS

ABOUT JOINT REPLACEMENT SURGERY

Q How do I know if I need joint replacement surgery?

A If you have a sore knee or hip, it¡¯s a question

you might be asking. Your first step is learning from

a health care provider exactly what¡¯s causing the pain.

Your provider will order diagnostic tests to rule out

any other causes of pain.

If tests reveal you have osteoarthritis ¨C the wearing

down of the cartilage that covers the joints ¨C your

quality of life will determine when and if you need

replacement. As a general rule, if your pain is regularly

causing you to lose sleep and hurting your work or

daily functions, it¡¯s probably time for surgery.

Before surgery, your doctor may first recommend

nonsurgical options such as pain medication, physical

therapy, cortisone and synthetic joint fluid injections,

and weight loss and other lifestyle changes.

Q  Am I too old (or too young) for surgery?

A Your overall health means much more than your

age when it comes to successful recovery from surgery.

At one time surgeons only did joint replacements for

older people. Today knee and hip replacements last

longer, so younger people can have the surgery with

the understanding they may need a second one in

their lifetime.

Q  What happens during joint replacement surgery?

A During a joint replacement surgery, your

orthopedic surgeon will remove part or all of your

damaged joint and replace it with a new one,

restoring comfort and mobility.

Before the surgery you¡¯ll be given anesthesia so you

won¡¯t feel the pain. Depending on the joint being

replaced, your surgery might last two hours or fewer.

Q  What happens after joint replacement surgery?

A After surgery, you¡¯ll be moved to a special

recovery room until the anesthesia wears off. Then

you¡¯ll be moved to a room where you¡¯ll stay for a few

days for the rest of your recovery.

If you undergo hip or knee surgery, your care team

will have you out of bed and walking the same day

as the surgery. Rehabilitation therapy will begin in

your hospital room following surgery. You¡¯ll continue

physical therapy to gently strengthen the muscles

around your new joint and help you regain mobility.

Q  How long will recovery take?

A Most joint replacement surgery patients return

home in just two days and can ride an exercise bike

at therapy within two weeks. It¡¯s a far cry from the

early days of joint replacement, when patients were

hospitalized for up to two weeks. And often any

immediate post-surgery pain pales in comparison

to the pain of walking with an arthritic knee or

hip. Once you recover, you can essentially return to

normal activities. You may even be able to do more

than you could prior to surgery.

Q  Both of my knees are bad. Should I get them

both done at once?

A If you are young and healthy, a bilateral knee

replacement (both knees at once) may be the answer.

If you are age 70 or older, or if you have significant

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health issues, having the procedures separately may

be a better answer. The final determination should be

made with your doctor.

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