Vim & Vigor - Spring 2020 - UVA - 23

Finding Relief

In certain circumstances, it's
best to wait on X-rays and MRIs.
"For some patients, imaging
can just add to the confusion,"
Konstant says. Besides imaging,
he uses physical therapy exercises
to conduct a thorough evaluation
of the joint before developing
a diagnosis.
Also, the American College of
Physicians has found that conducting imaging including MRI
and CT for pain in the lower back
(which includes the sacroiliac
joints) is not associated with better
patient outcomes.

PHOTO BY GETTY IMAGES

Understanding the
Hips and Knees

When it comes to joint pain, hips
and knees tend to take the spotlight
because they are more commonly
affected by osteoarthritis.
In 2014, nearly 15 million people
reported arthritis-related joint pain,
an increase from 10 million in 2002,
according to data from the Centers
for Disease Control and Prevention.
Arthritis presents with stiffness, aches
and difficulty switching positions

or moving, says Sean Dingle, MD, a
fellow of the American Association
of Orthopaedic Surgeons. "It's fairly
easy to differentiate an arthritic kind
of pain" from joint pain caused by an
injury, he says. (Rheumatoid arthritis
can cause similar symptoms but is
an autoimmune disorder that can
develop at any age.)
Hip pain also can result from
bursitis or hip abductor tears, which
often hurt on the outside of the hip.
Another common cause is femoroacetabular impingement, a condition in
which extra bone grows alongside the
hip joint. As for the knees, buildup of
synovial fluid that lubricates the knee
joint, meniscus or cartilage tears, tendinitis and bursitis from overuse are
especially common causes of pain.
When the joint in a nonarthritic knee
is causing pain, you may also experience some locking and catching as
you use the knee, Dingle says.
Since hips and knees support
a significant percentage of body
weight, the extra stress from carrying your body weight means it's possible to experience joint pain even
in your younger years, he adds.

Joint pain is
considered
severe when
a person
rates it a 7
on a scale
of 0 (no
pain) to 10
(unbearable
pain)
Source: Centers
for Disease
Control and
Prevention

For people with joint pain, conservative measures are often the first
line of treatment. Start with overthe-counter medications such as
NSAIDs that can decrease inflammation, pain and stiffness. Make
an appointment with your doctor if
symptoms are getting worse or not
resolving after a few days.
In some cases, cortisone injections
can help with joint inflammation.
While some newer experimental
injectable options such as plateletrich plasma and stem cells are
increasingly offered to patients,
there is only anecdotal evidence that
these may work, Dingle says.
Don't discount time as a healing
factor, Konstant adds. Sometimes
pain can spontaneously resolve on
its own, even after several years.
For instance, frozen shoulder (also
called adhesive capsulitis), which
is common with women in middle
age because of a tightened joint
capsule (the sac that envelops the
end of the bones), often resolves on
its own.
But even though some joint pain
can go away without serious intervention, don't wait to see a doctor.
Especially for younger people, joint
pain signals an increased risk of
arthritis later in life, so getting an
early diagnosis is critical, Bhatia
says. For instance, hip pain that
comes from increased friction
within the joint can ultimately
make that joint prone to arthritisrelated inflammation.
"Hip impingement is usually a
precursor to hip arthritis later in
life," he says.
For older people living with
arthritis, working with your doctor to create a road map for how
to maintain your joints through
an exercise regimen is key, Dingle
says. "As a general rule, arthritic
joints like some activity, but don't
overdo it." *
VIM & VIGOR SPRING 2020

Vim & Vigor - Spring 2020 - UVA

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