Joint Pain (Knee, Shoulder, and Hips)

Condition

Definition: Joint pain is discomfort that arises from any joint — the point where two or more bones meet. Joint pain is sometimes called arthritis or arthralgia. Joint pain can be mild, causing some soreness each time you move your joint. Or joint pain can be severe, making it impossible to use your joint. Joint pain is rarely an emergency. Most cases of mild joint pain can be successfully managed at home.

Causes:

  • Adult Still’s disease
  • Muscle strains
  • Avascular necrosis
  • Bone cancer
  • Broken bone
  • Bursitis
  • Complex regional pain syndrome
  • Dislocation
  • Fibromyalgia
  • Gout
  • Hemochromatosis
  • Hypothyroidism (underactive thyroid)
  • Juvenile rheumatoid arthritis
  • Leukemia
  • Lupus
  • Lyme disease
  • Osteoarthritis
  • Osteomalacia
  • Osteomyelitis
  • Paget’s disease of bone
  • Pseudogout
  • Psoriatic arthritis
  • Reactive arthritis
  • Rheumatoid arthritis
  • Rickets
  • Sarcoidosis
  • Septic arthritis
  • Sprains and strains
  • Tendinitis

From: Mayo Clinic Staff

Treatments

Steroid Injections in the Knee

  • Hyaluronic acid supplements: Although not technically medications, these substances are injected into knee joints to supplement naturally occurring hyaluronic acid. In healthy joints hyaluronic acid acts as a shock absorber and lubricant, allowing joints to move smoothly over each other. However, the acid appears to break down in people with osteoarthritis. Injecting it into a joint may lessen pain and inflammation. The injections are given weekly for three or five weeks, depending on the product (examples are Synvisc and Hyalgan). A small amount of joint fluid is removed first to make room for the hyaluronic acid.
  • Corticosteroid Injections: Doctors sometimes inject corticosteroids directly into the knee joint for quick relief of pain and inflammation. Their benefits may last anywhere from a few days to more than six months. While the injections bring targeted relief to the joint and lack many of the side effects of oral corticosteroid medications, they are not without risks. Repeated knee injections may actually contribute to cartilage breakdown. For that reason your doctor will likely put a limit on the number of injections you can receive.
  • Arthrocentesis: Also called joint fluid aspiration, arthrocentesis is removal of joint fluid through a hollow needle inserted into the joint space of the knee. Although the purpose of removing joint fluid from the knee is usually so that it can be tested in the lab, removing excess fluid can also quickly ease pain and swelling. Often after withdrawing fluid, doctors use the same puncture site where the fluid was removed to inject a corticosteroid preparation and/or anesthetic into the knee joint to further relieve pain and inflammation.

From: Arthritis Foundation

Genicular Nerve Block and Radiofrequency Ablation

  • For Radiofrequency Ablation: Radiofrequency ablation uses a special type of needle to apply radio waves to a painful nerve, in turn “stunning” it and relieving the pain. The procedure is referred to by many names: RF, RFA, rhizotomy, and neurotomy. There are several different types of Radiofrequency Ablation:
    • Thermal or Conventional RFA: A radiofrequency current is created which causes energy to pool in the tissue. This energy converts into heat which creates a small lesion on the nerve rendering it unable to transmit painful signals.
    • Pulsed RFA: Similar to thermal, however, a higher voltage is used in a pulsing fashion, allowing the energy to dissipate more easily and less heat to generate. This particular type of RFA leaves the nerve intact, while selectively “shocking” the A-delta and C fiber (pain conductors).
    • Water-Cooled or Cooled RFA: Using a multi-channel electrode that is actively cooled by a continuous flow of water, the radiofrequency current is prevented from reaching temperatures as high as thermal/conventional. This effectively creates a larger and more complete lesion.
  • Genicular Nerve Block: is a brand new, innovative treatment option for treating knee pain without surgery. This highly advanced procedure is on the absolute cutting edge of medicine. By selectively applying a sophisticated type of radio wave to the nerves surrounding the knee (the genicular nerves), one can effectively relieve pain in the knee from any number of causes.From: Ainsworth Institute of Pain Management
  • ViscosupplementationThe most recent research, however, has not found viscosupplementation to be effective at significantly reducing pain or improving function. Although some patients report pain relief with the procedure, some people are not helped by the injections.Viscosupplementation was first used in Europe and Asia, and was approved by the U.S. Food and Drug Administration in 1997. Several preparations of hyaluronic acid are now commercially available.

From: OrthoInfo

Staff

Jonathann Kuo, MD
Pain Medicine / Executive Director
Alexander Rances, DO
Pain Medicine / Medical Director
Robert Zhang, MD
Pain Medicine / Anesthesiology
Patrick Jean-Pierre, MD
Internal Medicine, Anti-Aging Medicine

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