Osteoarthritis is the most common form of degenerative joint disease, and is a leading cause of disability in people over 50 years of age. It is can be a very debilitating form of arthritis in that it tends to affect the load-bearing joints, especially the hips and knees, that are crucial for normal movement.
Osteoarthritis occurs when the cartilage cushioning the joints breaks down and causes the bones to rub together, inducing a change in shape. Osteoarthritis is found most frequently in people over age 50, although it can occur at any age. It most commonly affects joints in the knees, hips, shoulders, elbows, ankles, and hands. There are currently close to 10 million Americans living with osteoarthritis .Explore in-depth symptoms and treatments articles for:
For many, osteoarthritis pain may become markedly worse over time or with specific activities. Characteristic signs and symptoms of osteoarthritis include:
While osteoarthritis pain is usually felt in the affected joint, for some patients the pain may be referred to other areas of the body. For example, hip osteoarthritis may lead to knee pain, or spinal osteoarthritis may affect nerves that cause pain, numbness or other symptoms in the part of the body that the nerve leads to.
When the hips or knees are affected, walking can be a significant source of pain, and accommodating pain may induce a limp. Pain can be felt in areas outside the damaged joints, including the buttocks, groin, or thigh and may vary in severity from a dull ache to a sharp pain.
Osteoarthritis pain is caused by a wearing down of the cartilage that serves as a protective shock absorber between the joints. Cartilage is important for minimizing the impact of everyday activities on the joints, but the intensive use also means that it is subject to high levels of wear and tear.
There is no single known cause of osteoarthritis, but several risk factors can serve as strong indicators for the disease when present. Patients are at greater risk of developing osteoarthritis if they have one or more of the following factors.
Having a risk factor for osteoarthritis does not guarantee that the condition will develop. But the presence of a combination of risk factors produces the highest likelihood that a given person will develop the disease.
diagnosis of osteo artritis-
Osteoarthritis of the major joints is most effectively diagnosed through a combination of medical history, physical examination, and various lab tests including imaging studies such as X-ray. A primary care physician can diagnose most cases, but depending on perceived severity a patient may be referred to a specialist, such as a physiatrist or orthopedic surgeon, for further evaluation.
Medical histories can often be the most useful tool for physicians in diagnosing osteoarthritis. Practitioners will look for family history of the disease as well as the presence of various risk factors to indicate the need for further testing. A careful review of the patient’s symptoms is important to obtaining an accurate diagnosis.
A physical examination will usually follow the medical history as the physician looks for physical signs of the disease. These include swelling and tenderness of the joints, loss of movement in specific joints, or visible joint damage such as bony growths in the surrounding area. The patient may also be asked to perform a variety of physical tasks so the physician can evaluate range of motion and general joint mobility.
Laboratory tests are used to help confirm a suspected diagnosis of osteoarthritis if the diagnosis is otherwise in doubt.
The above combination of medical history, physical exam, and possibly diagnostic testing, all inform the diagnosis of osteoarthritis.
The most effective step toward controlling the symptoms of osteoarthritis is obtaining an early diagnosis and starting treatment as soon as possible. Non-surgical treatments are often sufficient for the management of physical symptoms and the preservation of daily functioning.
Osteoarthritis treatment programs typically include a combination of medication and exercise therapy.
Drug therapy is used to manage physical symptoms, with a focus on relieving pain and slowing progression of the disease. Some commonly used medications include:
Physical therapy provides targeted exercises that help maintain the ability to perform everyday tasks such as walking, bathing, and dressing. Although rest is an important part of the healing process, it is important to keep up with moderate levels of activity to strengthen the muscles surrounding the damaged joint. Stronger muscles provide greater stability for the joint, which in turn helps reduce stress on the joint.
Occupational therapy may also be recommended to demonstrate appropriate modifications for everyday activities that may be causing pain.
Steroid injections are often performed if pain is moderate to severe and especially if the pain symptoms limit the patient’s ability to participate with exercises. When combined with physical therapy, steroid injections can offer a very important “window of opportunity” during which the patient may more fully participate with therapy because the pain is resolved or at least better controlled. By allowing the patient to participate with therapy, the patient may stretch and strengthen important muscles around the affected joint(s) and thereby decrease the load experienced by the joint(s) so that the inflammation and pain do not return
In general, patients receive cortisone injections for one of two reasons: to treat a condition or to provide information for an accurate diagnosis.
Cortisone to treat joint pain
A cortisone injection typically relieves inflammation and pain for between 6 weeks and 6 months. The pain may return after that time or it may not, depending on the person, the condition being treated, and follow-up care.
Temporary pain relief allows the patient to:
Almost all types of arthritis are chronic, and a cortisone injection is just one part of a larger treat Cortisone to Diagnose Pain
When the underlying cause of pain is uncertain, a doctor may recommend a cortisone shot to help narrow the list of possible diagnoses. This procedure is common in the hip and shoulder joints.
For example, a doctor may recommend a cortisone injection for a patient with persistent, undiagnosed hip pain.
If a diagnosis is still uncertain following a diagnostic injection, the doctor may recommend an MRI or other detailed imaging study.
Of course, an injection meant to aid in diagnosis can be useful for treatment, and vice versa. However, a doctor and patient should take time to discuss the primary purpose of the cortisone injection before it is administered. During this conversation a doctor should let the patient know what part of the joint is being targeted, what are reasonable expectations regarding pain relief, and if follow-up treatment will involve medications, physical therapy, or lifestyle changes.
Cortisone refers to a category of man-made steroids that mimic the effects of cortisol, a hormone that naturally occurs in the body. Both cortisone and cortisol are types of corticosteroids.
It is important to note that these types of steroids differ from anabolic steroids (e.g. testosterone) that are used to enhance athletic performance. Both types of steroids share similar chemical structures but play different roles in the body.
A person usually receives a cortisone injection to help reduce pain-causing inflammation. Once this inflammation is reduced, the person can participate in physical therapy (which is essential for treatment in most situations). However, cortisone, like all medications, can have side effects.
Most notably, cortisone is known to break down tissues, such as articular cartilage in the joint.1,2Cartilage is crucial to joint health, acting as a shock absorber and reducing friction between bones when a person moves. Therefore, most physicians will refuse to administer repeated cortisone injections into the same joint over a short period of time, simply because too much cortisone can cause more harm than good.
Cortisone injections allow doctors to deliver potent medicine directly to sites of inflammation with minimal side effects. Depending on the patient and the condition being treated, a successful cortisone injection can suppress localized inflammation for anywhere from 6 weeks to 6 months.
While cortisone injections can be an important tool in treating joint inflammation and pain, they do have limitations. Many of these limitations are described A Cortisone Injection Is Part of a Larger Treatment Plan
Cortisone injections typically provide temporary relief. Most patients seeking better, long-term relief are advised to participate in physical therapy to stretch and strengthen their joints, muscles, and other soft tissues. Patients may also be advised to lose weight or make other lifestyle changes, such as changing footwear. These steps can improve a joint’s biomechanics and possibly decrease or eliminate the need for additional cortisone shots.
Patients who do have repeated cortisone shots may notice that the period of pain relief becomes shorter and shorter over time. This is not necessarily because the patient has built up a tolerance to the medication but because the joint is degrading. Again, physical therapy, weight loss, and changes in day-to-day lifestyle can help slow down or stop joint degradation.
It may take a few days for the benefits of the cortisone medication to take full effect. During this time, patients are usually told to rest and cut back on normal activities. Once the joint pain is relieved, a well-intentioned patient may be tempted to jump right into an exercise routine. However, in order to avoid injuries or possibly making the condition worse, a doctor typically advises a patient to resume normal activities gradually and add intensity over time.
Repeated Injections Can Affect Soft Tissue
Too many injections over a short period of time can cause damage to the tendons, ligaments, and articular cartilage at the injection site. For this reason:
In fact, the Achilles and patella tendons are particularly prone to injury post-injection, even if an injection is directed near, rather than in, the tendon. For this reason, doctors avoid cortisone injections for Achilles and patella tendinopathies.
Below is a step-by-step description of a typical cortisone injection procedure. An injection may be administered so that medication is delivered directly into the joint capsule or near the joint capsule, depending on the condition being treated.
During viscosupplementation a small amount of hyaluronic acid, often just 2 mL, is injected directly into a joint capsule.
A healthy knee joint has up to 4 mL of joint fluid within the joint capsule.1,2 Hyaluronic acid is a key component of the joint fluid. It gives the joint fluid its viscous, slippery quality, which does the following:
Joints affected by osteoarthritis typically have a lower concentration of hyaluronic acid in their joint fluid than healthy joints, and therefore less protection against joint friction and impact. Experts believe this further accelerates the joint degeneration process, setting in place a vicious cycle.
As its name implies, viscosupplementation artificially supplements the joint fluid’s natural viscosity. By injecting a man-made hyaluronan into the knee, doctors hope to temporarily lubricate the knee joint, thereby decreasing pain improving function and perhaps even slowing the degeneration process.
The United States FDA has approved viscosupplementation for treating knee arthritis only, but treating hip osteoarthritis or other joints with viscosupplementation is permitted. Some doctors have found some patients respond to viscosupplementation for the hip, shoulder and ankle, but there is relatively little published research regarding its efficacy.
Using viscosupplementation for a joint other than the knee is considered an “off label” use of the injectable fluid. Insurance companies may consider the procedure “experimental” and not cover the cost, so patients should check with their insurance companies if considering viscosupplementation for hips or other joints.