Pain in the joints, including the hip, knee, shoulder, elbow, and wrist can be common as we grow older. Common causes of joint pain include osteoarthritis, often due to years of overuse and wear and tear on the joints. Diffuse pain is also characteristic in patients with rheumatoid arthritis.
Diagnosis is made by your doctor after an extensive history and physical examination with special attention to the musculoskeletal system. Additional laboratory tests may be warranted as well as radiologic examinations including X-rays, arthrograms, bone scans, CT scans, and MRI imaging.
Knee Pain
Knee pain may have many different causes and there are many therapeutic options that may prevent surgical intervention. However, some injuries warrant surgical referral. Tendons (tendonitis), ligaments (ACL, PCL, Medical Collateral, Lateral Collateral), and/or the meniscus (Medial, Lateral) are common parts of the knee which are affected in work-related and sports-related injuries. Acute injury usually results in pain and swelling, as well as difficulty bending or straightening the leg. You may encounter pain along the joint line or patella with deep touch.
Degeneration of the joint structures (degenerative joint disease) is the most common cause of chronic knee pain, especially in the elderly population. As the condition becomes more severe over time, the cartilage becomes so worn down that your condition will be "bone on bone". In other words, the femur will rub directly onto the tibia resulting in severe knee pain. Another type of degeneration of the knee is known as Chondromalacia patella. In this condition, the cartilage is damaged just beneath the kneecap. It is important to identify the condition that is contributing to the patient's knee pain prior to treatment. Several conservative and interventional treatments are available including cortisone injections as well as visco-supplementation (Synvisc, Orthovisc, Euflexxa, etc.) and innovative treatment with platelet-rich plasma (PRP).
Hip Pain
Hip pain may be due to one of many causes. Acute hip pain from a fall may result in hip fractures and dislocations which may warrant acute surgical evaluation and intervention. However, there are some conditions that can be successfully treated without surgical intervention.
Osteoarthritis is the most common etiology of chronic progressive hip pain. This condition becomes more common as patients grow older, more pronounced in those over 55 years old. This may be seen more commonly in women and obese individuals. Similar to osteoarthritis of the knee, it is a degeneration of the joint cartilage or degenerative arthritis that results from wear and tear on the joint. Pain can become most significant as the joint cartilage becomes severely worn down, and the bone starts to rub against adjacent bone. Patients usually have pain that is quite significant at this point. It may wax and wane, usually becoming more intense with repetitive motions or increasing activity.
Rheumatoid arthritis is another type of arthritis of the hip that can occur, but not as commonly as osteoarthritis. It is usually seen in younger females, and it is a chronic and destructive inflammatory arthritis usually seen of smaller joints in the hands and feet.
Cartilage tears, known as labral tears, can occur as a result of injury or also normal repetitive wear and tear. These types of tears can be quite painful and patients often experience a locking or catching sensation while trying to perform certain movements of the extremity. These injuries may occur in high-impact sporting activities.
Another common cause of hip pain is due to bursitis, which is easily and effectively treated with conservative therapies. This pain is usually over the outer aspect of the hip and is worsened with lying down on the affected side at night or simple range of motion of the hip.
Nerve-related pain or neuralgia can mimic hip joint pain. In fact, there may be no abnormal structure within of the hip but rather a condition of the nerve such as in various neuralgias. Meralgia paresthetica is a nerve condition over the front of the hip and proximal thigh, and is more common in obese patients or those with tight fitting clothes at the waist.
Shoulder Pain
Shoulder pain is a very common reason for patients to visit their doctor. The shoulder is the most movable joint in the body. Causes of shoulder pain may occur from the within the joint itself, but may also be referred pain from the neck or even the abdomen. Degenerative disc disease or herniated discs in the neck often cause shoulder pain. Shoulder pain referred from the abdomen or chest include conditions involving the gallbladder, liver, or more serious, the heart.
Dislocation of the shoulder can occur after a strong force pulls the shoulder outward (abduction) or the ball of the humerus is pulled out of the joint socket by an extreme rotation of the joint. When dislocation occurs, it is known as a subluxation and this must be reduced in order to alleviate the patient's pain.
Tendinitis is inflammation or swelling of a tendon. The tendons of the shoulder that are usually involved include the biceps tendon and those tendons that make up the rotator cuff. Pain, soreness, swelling, and redness may result. If tendonitis is more moderate to severe and the rotator cuff becomes thickened and inflamed, it can get trapped by surrounding structures. This is called impingement syndrome. Repetitive use of the shoulder with overhead arm use can result in tendonitis, impingement syndrome as well as inflammation of the underlying bursa, called bursitis.
A tear of the shoulder cartilage off from the glenoid is known as a SLAP (superior labrum anterior to posterior) tear. This will result in instability of the shoulder, typically with overhead movements.
Arthritis of the shoulder can occur in the joint itself (glenohumeral joint) or where the lateral portion of the collar bone meets the acromion. This is the acromio-clavicular joint. It is usually seen in the elderly or in those with repetitive wear and tear movements of the joint, such as athletes and workers engaged in heavy duty.
