Osteoarthritis

Osteoarthritis is a middle age plus disorder that is the result of an earlier traumatic incident or just chronic degeneration from a lifetime's wear and tear. Specifically, these conditions result in degeneration of the articular cartilage resulting in bone on bone contact, a painful and debilitating consequence. Injuries earlier to either bones in the knee joint or to the meniscus or ligaments can foment these arthritic reactions. Some people just have genetic predispositions to arthritis.

Developing slowly over years, the main symptoms of osteoarthritis include pain, swelling, and stiffening of the knee joint. The pain increases over the years. Initially, the knee can abide exercise, although stiffness sets in after a few minutes rest. Overtime, the problem accelerates as pain can be observed with simple daily activities. In the late stages, the pain can interfere with and be unrelenting.

The source of pain with osteoarthritis is somewhat conjectural, since articular cartilage covering the joint has no nerve supply. Theories of pain etiology include inflammation in the lining of the joint, called the synovium. Additionally, the condition could emanate from small fractures in the bone under the cartilage called the subchondral bone. Pressure from blood in the area and stretching and aggravation of the nerve endings over bone spurs are other possible sources of pain.

X-rays are effective in diagnosis of cases of osteoarthritis, except in the early stages where it can elude detection. An MRI may be called for to insure knee pain is not the result of torn meniscus or patellar-femoral problems. Finally, if confusion still exists, the use of arthroscopy can isolate the problem. Arthroscopy involves a small fiber optic camera inserted into the knee joint through a small incision, no more than 0.5 of an inch.

The first treatment objective is to mitigate the pain. Anti-inflammatories (tylenol, ibuprofin, or aspirin) can help. Cortisone injection (anti-inflammatories injected into the joint) can help control inflammation. Repeated injection however can have the counterintuitive effect of actually speeding degenerative effects. Additionally, infection is always a risk with injections.

In the early stages, moist heat, ultrasound, can stimulate blood flow and override pain sensations. Joint mobilization is useful because it provides nutrition and lubrication to the joint surfaces. Activity also overrides transmission of pain to the brain. Transsubcutaneous nerve stimulation (TENS) which use tolerable electrical impulses can serve to block pain. Capsaicin is a topical cream that has provided a measure of relief. Range of motion exercises help to keep the joint surfaces healthy. Swimming, yoga, or just regular stretching, and biking are healthy options. Weight lifting can provide strengthen and protect the joint with strengthened muscles acting as shock absorbers. Being conscientious in a multi-pronged approach is its own reward.

Good shoes, perhaps fitted with orthotics, with exercise of softer surfaces can provide stimulation with destruction. Exercise, strengthening, stretching, and management of swelling will continue as part of a concerted program to mitigate symptom of osteoarthritis as it progresses.