Joint Pain - Lehigh Valley Health Network

Joint Pain Your Guide to

SYMPTOMS OF JOINT PAIN

YOU AND YOUR JOINTS You were born with the best joints you'll ever have. That's why the nonsurgical orthopedic specialists and fellowship-trained surgeons at Lehigh Valley Health Network (LVHN) Orthopedics will use the latest therapies ? from rehabilitation to nutritional counseling and steroid injections ? to help extend the life of your 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 are many nonsurgical options that can help relieve joint pain. We want to partner with you to explore all of your options to find a treatment plan that meets your individual needs.

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.

Because the condition develops slowly, many people do not experience symptoms until several years after cartilage breakdown begins.

The following are the most common symptoms of osteoarthritis. However each person may experience symptoms differently:

Joint pain, swelling and stiffness, especially after use

Joint discomfort before or during a change in the weather

Bony lumps on the fingers

Limited joint movement and loss of flexibility

Joint stiffness, especially after sleeping or inactivity

Grinding of joints when moved (in more advanced stages of osteoarthritis) as the cartilage wears away

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 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.

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COMMON TREATMENTS FOR JOINT PAIN

At Lehigh Valley Health Network's Center for Orthopedics, we specialize in diagnosing, treating and preventing problems of the bones, joints, muscles, tendons and ligaments. Our experienced orthopedic surgeons are recognized as some 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.

Aerobic exercises to promote cardiovascular conditioning, overall fitness and help manage weight. The exercises should be low-impact, such as walking, swimming, bicycling

or cross-country skiing. Crosstraining programs involving lowimpact activities are recommended.

Strengthening exercises to build supporting muscles so they can absorb stress on joints and keep them stable.

Heat therapy: Applying a hot pack to affected joints may help reduce pain, relax muscles and increase blood flow to the joint. It also may be an effective treatment before exercise. Many people also get relief from heat patches, ointments like Icy-Hot, taking a hot bath or sitting in a hot tub.

Medication: Osteoarthritis is most often managed with medications that reduce pain and inflammation.

Nonsteroidal anti-inflammatory drugs (NSAIDs): NSAIDs have been used to relieve pain and inflammation caused by osteoarthritis.

Pain relievers: Prescription pain relievers, including tramadol (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 Roxicodone?), may be prescribed to treat severe arthritis pain. However, they do not reduce swelling.

Selective COX-2 inhibitors: Celecoxib (Celebrex?) has been taken by mouth to reduce pain and inflammation caused by osteoarthritis.

Topical pain relievers: Topical pain relievers are creams, ointments,

gels and sprays that are applied to the skin. Many over-the-counter (OTC) pain relievers may temporarily help reduce the pain caused by osteoarthritis.

Corticosteroids: Corticosteroids, such as prednisone (e.g., Deltasone?) and methylprednisolone (Medrol?), are occasionally used to reduce inflammation and pain and slow joint damage caused by osteoarthritis.

Cortisone injections into the joint: This will begin to reduce pain and swelling in a day or two and may work for months.

Synthetic joint fluid: Injections of synthetic joint fluid (Synvisc, Hylagan) can improve motion in the knee.

Weight loss: Maintaining a healthy weight is the best thing you can do for arthritis. It keeps added pressure off the joints. Being only 10 pounds overweight increases the pressure on your knees by 30 to 60 pounds with each step.

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 whether or not it involves infection.

For aseptic bursitis, where no infection is present, your health care provider may prescribe the following treatments:

Anti-inflammatory and pain medications, such as ibuprofen or aspirin to alleviate pain and swelling

Avoiding the activity that led to pain

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 Using ice for the first 48 hours after an activity causing pain. Apply the ice wrapped in a towel for 15 to 20 minutes, three to four times a day. After a couple of days, use moist heat before physical activity and ice after activity if recommended by your doctor. Elevating the injury to reduce swelling Injection of cortisone into the injured bursa to ease pain and swelling Gentle exercise at home to improve blood flow to the joint and the bursa and to increase the range of motion Chiropractic treatment For septic bursitis, bursitis with an infection, treatment may include: Antibiotic medications Repeated removal of the inflamed fluid using a thin needle Surgical drainage and removal of the infected bursa sac if necessary

TENDONITIS Whether you suffer a tendon injury from playing sports, experience pain from arthritis or break a bone, our orthopedic surgeons can help. Our goal is to eliminate your pain and restore your comfort. Our experience allows us to do that quickly and safely. 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.

ACTIVITY MODIFICATION

If your health care provider gives you the OK, begin exercising to strengthen the muscles around the sore joint within a day or two. Start with a long warm-up to minimize shock to the tissues, and then try lifting light weights or working with an elastic exercise band. Go easy at first, and build as your strength increases.

REHABILITATION

Whether you are recovering from an injury or surgery, LVHN offers personalized rehabilitation care. Our network has board-certified therapists and specializes in numerous therapies, including treatment for unique and less common conditions. With nearly four dozen convenient locations, our outpatient rehabilitation sites are just minutes away.

All our rehabilitation programs are tailored to meet your unique lifestyle needs and challenges. Our goal is to help you return to your regular routine as quickly and safely as possible. Our rehabilitation team offers a wide range of programs, including physical therapy, occupational therapy, hand therapy, orthopedic therapy, pre- and postsurgical 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 ? manual therapy used to manage musculoskeletal dysfunction

Instrument adjusting ? the use of technology to apply gentle, precise adjustments

Myofascial release ? a gentle form of stretching and compression designed to release the uneven tightness in injured tissue that surrounds the body's organs, muscles and bones

Muscle energy techniques ? a variety of manual techniques designed to increase range of motion, relieve spasticity and reduce pain

Ultrasound and electrotherapy ? 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.

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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 ? the wearing down of the cartilage that covers the joints ? 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.

Q How long will recovery take?

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.

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

health issues, having the procedures separately may be a better answer. The final determination should be made with your doctor.

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