Joint, ligament & bone disorders


Updated April 2008 Arthritis
The term arthritis covers a group of inflammatory and degenerative conditions that cause stiffness, swelling and pain in the joints. There are several different types of arthritis, each having different characteristics. The most common form is osteoarthritis which most often involves the knees, hips and hands and usually affects middle-aged and older people. Rheumatoid arthritis is a damaging condition that causes inflammation in the joints and in other body tissues, such as the membranous heart covering, lungs, and eyes.

Osteoarthritis
Gradual degeneration of the cartilage covering the bone ends within joints.

In a joint affected by osteoarthritis, the protective cartilage found at the ends of bones is worn away. As the condition develops, the bone around the affected joint thickens, and bony growths called osteophytes form. If the synovial tissue that lines the joint capsule becomes inflamed, fluid may accumulate within the joint. These changes cause pain, swelling, and stiffness of the joints reducing their mobility.

Osteoarthritis is most common in weight-bearing joints, such as knees and hips but it may also affect hands, feet, neck and shoulders. Nearly everyone has developed a degree of osteoarthritis by the age of 70, but only some people have symptoms. Osteoarthritis is rare under the age of 45, and increasingly common over the age of 60. Women are twice as likely to be affected as men and their symptoms are more severe.

There is often no obvious cause for the onset of osteoarthritis, but there are known factors that may increase the risk of developing the disorder. Wear occurs most often in joints that have been damaged by repeated strenuous activity or by repeated minor injuries. Excessive weight can also increase a person’s risk of developing the condition because of the extra stress it places on the joints. Osteoarthritis can sometimes run in families.

The symptoms of osteoarthritis may include:
  • pain and tenderness that worsen with activity and are relieved by rest
  • swelling around the joint
  • stiffness lasting a short time after a period of inactivity
  • restricted joint movement
  • enlarged, distorted finger joints if the hands are affected
  • crackling noise on moving the affected joint.
Osteoarthritis cannot be cured, but with treatment most symptoms can be relieved. This will include gentle exercise to help to lose weight (if needed), maintain muscle tone, and delay the progression of the disease. Supportive shoes with rubber soles will absorb shock and reduce further wear on joints. A walking stick can be used for support. Massage, warm baths or a heat pad may also ease joint pain and increase mobility.

Use of analgesic or anti-inflammatory drugs in older people should be with caution given the increased risk of side effects.

Rheumatoid Arthritis
A persistent disorder that can cause the joints to become painful, swollen, stiff, and deformed.

In rheumatoid arthritis, the affected joints become stiff and swollen as a result of inflammation of the synovial membrane, which encloses each joint. If the inflammation persists, it may damage both the ends of the bones and the cartilage that covers them. Tendons and ligaments, which support the joints, may also become worn and slack, and deformity of the joints can occur. In most cases, rheumatoid arthritis affects several joints. The disorder usually appears first in the small joints of the hands and feet but may develop in any joint. Rheumatoid arthritis is a long-term disease and usually recurs in episodes lasting for several weeks or months. The disorder is most common over the age of 40. It affects about one in 100 people and is three times more common in women than in men.

Rheumatoid arthritis usually develops slowly, although sometimes the onset of the inflammation can be abrupt.

General symptoms associated with the condition may include loss of weight, tiredness, and poor appetite, with specific symptoms including:
  • painful, swollen joints that are stiff on waking in the morning
  • painless, small bumps (nodules) on areas of pressure, such as the elbows.
Over time, thinning of the bones and a greater susceptibility to fractures may develop, partly as a result of the disease itself and partly due to reduced mobility. There is no cure for rheumatoid arthritis and, since the condition can be both painful and debilitating, it may lead to depression. The aim of treatment is to control symptoms and reduce further joint damage by slowing the progression of the disease. Many people with rheumatoid arthritis are able to lead a normal life, but lifelong drug treatment may be needed to control the symptoms. The particular drug treatment used will depend on the severity and progression of the disease, age, and general health.

Further information: Lower Back Pain
Pain in the back, below the waist, that may be sudden and sharp or persistent and dull.

Lower back pain affects about six in 10 adults during the course of a year. In most cases, the pain lasts for only a week or so, but many people find that their problem recurs. In a minority of people, persistent lower back pain causes long-term disability. Lower back pain is usually caused by minor damage to the ligaments and muscles in the back. The lower back is vulnerable to these problems because it supports most of the body’s weight and is under continual stress from movements such as bending and twisting. Less commonly, lower back pain may be the result of an underlying disorder such as a prolapsed or herniated disc in the spine. Persistent lower back pain may be caused by joint disorders, such as osteoarthritis in people over the age of 45.

Many older people consider that back pain is an inevitable consequence of ageing and may not consult their doctor about it. Pain in the lower back can take various forms:
  • sharp pain localised to a small area of the back
  • more general, aching pain in the back and buttocks, which is made worse by sitting and relieved by standing
  • back stiffness and pain on bending
  • pain in the back that radiates to the buttock and leg, sometimes accompanied by numbness or tingling.
In most cases lower back pain can be treated by taking an over-the-counter painkiller, with relief coming in the form of a heat pad or wrapped hot-water bottle, and sometimes by ice, placed against the back. If the pain is severe, bed rest may be more comfortable, but should not last for more than two days. It is important to start moving around as soon as possible and gradually return to normal activities. A doctor should be consulted if the pain worsens or is still too severe after a few days. To help prevent recurrence of the pain it is important to adopt a good posture, lift correctly, and do regular exercises to strengthen the back muscles and make the spine more flexible.

It should be noted that the older the patient is, the more likely it becomes that persistent, and particularly worsening, back pain will be due to a serious underlying cause (primary or secondary cancers or osteoporotic vertebral collapse). Those with persisting pain or additional symptoms (general ill health, weight loss, back pain producing loss of sleep) should therefore consult their doctor.

Further information: Hip Replacement
Replacement of a damaged hip joint with an artificial joint.

Hip replacement is performed when, as a result of arthritis, the smooth lining of the hip joint (cartilage) wears away and the roughened bony surfaces of the thigh bone and pelvis rub together. This causes pain, usually felt as groin pain, stiffness, and sometimes deformity. Other conditions such as rheumatoid arthritis or hip fractures may also lead to cartilage damage. By replacing the damaged surfaces, the joint is made smooth again, allowing return of movement, correction of deformity and, in almost all patients, complete pain relief.

The hip is the most commonly replaced joint in the body. During the operation, both the pelvic socket and the head of the femur (thighbone), which fits into the socket, are replaced. The operation is often carried out under spinal anaesthesia with the pain being controlled effectively.

Initially, a physiotherapist will help with walking using a frame or crutches, but after several weeks the patient will be able to walk with one or two sticks.

Further information: Knee Replacement
Replacement of a damaged knee joint with an artificial joint.

The joints in the body that are most commonly replaced are the hips, shoulders, and knee. Joints that have been severely damaged by a disorder such as arthritis or by an injury may be surgically replaced with artificial joints made of metal, ceramic, or plastic. During the operation, performed under general anaesthesia, the ends of damaged bones are removed and the artificial components are fixed in place. The operation usually relieves pain and increases the range of movement in the affected joint. Moderate pain is often experienced after the operation, but may be alleviated with patient-controlled analgesia, or epidural analgesics (spinal) to control the pain for the first few days after surgery. Pain should gradually decrease, and by the third day oral analgesic medications may be sufficient to control it.

Further information: Sciatica
Pain in the buttock and down the back of the leg, occurring when the sciatic nerve or its roots are compressed or damaged.

Sciatica is a form of nerve pain that may be felt anywhere along the course of one of the sciatic nerves – the two largest nerves in the body and the main nerve in each leg. They run from the base of the spine down the backs of the thighs to above the knees, where they divide into branches that supply the front and back of the leg and foot. The pain of sciatica is caused by compression of, or damage to, the sciatic nerve, usually where it leaves the spinal cord. Often, only one leg is affected and in most cases, the pain disappears gradually over one to three weeks, but it may recur.

Sometimes the cause of sciatica is unknown. In older people, sciatica may be caused by changes in the spine as a result of various conditions, such as osteoarthritis. The symptoms can be mild or severe, with spasmodic or persistent pain in the affected leg.

Symptoms may include:
  • pain that is made worse by movement or by coughing
  • tingling or numbness
  • muscle weakness.
If sciatica is severe, it may be difficult to lift the foot on the affected side because of muscle weakness. Medical attention should be sought. Advice may include bed rest on a firm mattress for a couple of days and painkillers to relieve discomfort. Occasionally, the condition can be helped by regular physiotherapy, exercise or chiropractic treatments.

Further information:

© British Medical Association 2008

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