Aging & Health A to Z

Joint Problems

Care & Treatment

Effective treatment of your condition will probably involve a combination of medications and non-drug therapies. Exercise is particularly important in many types of joint problems, especially in arthritis, and in rehabilitation after surgery. 

Medications

The following types of medication are used to treat joint problems: 

• Pain medications such as non-prescription acetaminophen (Tylenol) or prescription drugs including tramadol, narcotics containing oxycodone or hydrocodone.
• Nonsteroidal anti-inflammatory drugs (NSAIDs) which are used both for pain and to reduce swelling. Non-prescription and prescription NSAIDs include aspirin, ibuprofen, and naproxen.
• Topical medications, including creams, gels, or ointments that may contain an NSAID, or substances such as menthol or capsaicin (an extract of hot peppers).
• Anti-immune system medications such as DMARDs and genetically engineered “biologics” for autoimmune diseases such as rheumatoid arthritis (e.g., methotrexate, etanercept, infliximab). You will need to be carefully monitored when taking these medicines, since they may increase your risk of infections or cancer.
• Corticosteroids, for example prednisone and cortisone, reduce swelling and suppress the immune system. They may be taken orally or injected into the affected area. Side effects of long-term use include infections and bone loss.
• Antidepressants are sometimes helpful for conditions such as fibromyalgia.
• Muscle relaxants may be useful in some cases.

Non-drug Treatments

ExerciseExercise to strengthen weakened muscles and move the joints will improve function and reduce your pain. The earlier you get started, the better. Depending on your diagnosis, therapy may have to be done for a few weeks, or for many months. Exercise programs, which should be individually designed for you at the correct intensity by a physical therapist, include:

• Walking
• Swimming (especially good for arthritis of the hip)
• Individualized exercises including stretching and resistance training that you do at home
• Yoga and tai chi (exercise programs that employ stretching, slow movements, and balance).   

The following are some other ways you can reduce symptoms and improve function:

• Lose weight
• Apply heating pads or ice packs a couple of times a day (maximum of 20 minutes at each application)
• Wear splints or braces if recommended by your healthcare professional
• Use aids or devices (cane, modified shoes) to help you keep your weight off an affected hip, knee, or other weight-bearing joint
• Rest: stop or modify any repeated movements that may cause or worsen your condition. 

Your healthcare professional or physical therapist may suggest treatments with:

• Ultrasound (gentle sound-wave vibrations) to soothe tissues and improve blood flow
• Transcutaneous electrical nerve stimulation (TENS) to soothe muscles and nerves and block pain sensations
• Hyaluronic acid injections for knee arthritis
• Massage. 

Many people use alternative or complementary approaches. Although most of these techniques have no proven benefits (such as, copper bracelets), they may help occasionally. The most promising are:

• Acupuncture – in which fine needles are inserted into the skin to reduce pain
• Dietary supplements containing glucosamine and chondroitin, available over-the-counter and taken orally
• Chiropractic treatments by a licensed practitioner.

Surgery

For some people, physiotherapy and pain medicines are not enough. Depending on your general health and your specific disability, your doctor may suggest surgery and referral to an orthopedic surgeon after carefully weighing risks and benefits. Five common types of surgery are: 

Joint Fusion
If your joint problems are located in small bones such as those in your fingers, wrist, ankles, or spine, your surgeon may recommend joint fusion. In this operation, the ends of the bones in the affected joint are removed and the two bones are fused together. The joint can no longer be bent after fusion surgery, since the connection will be rigid, but the pain and deformity will be gone. 

Joint Replacement
Larger joints can often be partially or completely replaced. The most common joint replacement surgeries are for the knee and hip. Joint replacement relieves pain and can let you move easily again. If your pain is keeping you up at night or preventing you from taking even a short stroll, surgery may be what you need. 

Having a joint replaced is major surgery. You must be in good enough health to withstand the operation and undergo a few weeks or months of physiotherapy afterwards, usually – at least partly – in a rehabilitation facility. Exercising as well as you can before the surgery will strengthen your muscles and help ensure a speedier rehabilitation and recovery. 

Arthroscopic Knee Surgery
In some cases, knee disabilities like locking, swelling, weakness, and pain are the result of damaged cartilage in the joint. A relatively simple day procedure with minimal anesthesia and home rehabilitation may be all that you need. In an arthroscopic procedure, only a couple of tiny incisions are necessary and the surgical instruments, with a camera, are threaded into the knee with virtually no damage to adjacent tissues. 

Rotator Cuff or Frozen Shoulder Repair
If you have a major tear in some component of the rotator cuff or if your shoulder is frozen and you have tried rest and physiotherapy without improvement for at least 6-12 months, your doctor may decide to refer you to a surgeon for surgical repair of the damaged tissue. 

Carpal Tunnel Syndrome Surgery
When rest and appropriate conservative treatments have not helped your carpal tunnel disability, surgery is often beneficial. In this outpatient day surgery – known as “open release surgery” – the ligament that has been putting pressure on the median nerve is cut, allowing more room for the nerve. A newer endoscopic procedure minimizes tissue damage and may allow a faster and less painful recovery. Most symptoms are relieved immediately, but full functional recovery may take a few months and physiotherapy is needed. 

Rehabilitation 

The role of rehabilitation is:

• to get you back to your prior level of physical function
• to allow you to return home or to your previous residence as soon as possible. 

If you have had surgery, you may need to recuperate afterwards in a rehabilitation facility of some kind, depending on the surgery you have undergone, your health, and the availability of caregivers and a supportive environment at home. People who have had hip or knee replacements almost always spend at least some time in a rehabilitation center before returning home. 

Different types of rehab facilities include:

• acute (hospital) or subacute rehabilitation centers
• nursing homes
• skilled nursing facilities
• home care. 

In acute and sub-acute care rehab centers, you will receive at least 3 hours of rehabilitation per day, 5 days per week, from a team of healthcare professionals including physical therapists, occupational therapists, rehab nurses, social workers, physiatrists, and others if needed. Nursing homes and skilled nursing facilities provide therapy as well, but the intensity and number of hours of rehabilitation are usually lower. Home care may be used after some time in a rehabilitation residence or if your doctor feels that a rehab facility is not needed in your case. The home care nurse will schedule visits from a physical therapist, occupational therapist, social worker, and any other healthcare professional considered necessary. 

Monitoring

If you have osteoarthritis in your knees or hips, you should be checked at least once a year by your healthcare provider to assess your ability to carry out daily functions and to make sure your pain is well controlled. 

Other joint problems need to be evaluated periodically as well, especially since ignoring pain or other symptoms may cause irreparable damage that could have been avoided.

Updated: March 2012
Posted:  March 2012