Understanding Arthritis Pain and Treatment Options

Understanding Arthritis Pain and Treatment Options
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Common Arthritis Myths
Only older people have arthritis. Arthritis is caused by cold, wet weather. Everyday is the same for an arthritis patient. Arthritis is a minor physical inconvenience. “Arthritis Myths: Find Out about the Misconceptions about Arthritis Treatments and the Causes of Arthritis”. DePuy Orthopaedics, Inc. 2 April, Full Text Article Arthritis Myths: Find Out about the Misconceptions about Arthritis Treatments and the Causes of Arthritis From ancient times to modern times, arthritis has been a mystery. While we know more today than ever before about the causes, complications and best treatments for this disease, there are still many myths and misconceptions floating about. The following information clears up some of the misinformation surrounding arthritis. Misconception # 1 – Every day is the same for arthritis patients. For those living and working every day with an arthritis patient, it is hard to understand why they feel better or worse on any particular day. The contradictions of arthritis can be confusing to those not familiar with the disease. Education regarding the variations of arthritis can be helpful for everyone. Misconception #2 – Only older people have arthritis. The most common misconception about arthritis is that it is a disease only of older people. In fact, arthritis can affect individuals of all ages, even children. Misconception #3 - Arthritis is caused by cold, wet weather. For years, many people thought that arthritis is caused by cold wet weather. Dry weather has been regarded as a cure, prompting some individuals to move. Unfortunately, populations in all types of climate are affected by arthritis. While warmth is soothing to everyone, it cannot prevent or reverse the effects of arthritis. Misconception #4 – Poor diet causes arthritis. Except for individuals who are found to have specific food allergies that aggravate their arthritis, there is no proven connection between a particular food source and arthritis. However, we do know that a nutritious, well-balanced diet and ideal weight can improve health and wellness for everyone, arthritis or not. Weight control is especially important for people with arthritis, because being overweight puts added stress on your arthritic joints. Misconception #5 - Arthritis is a minor physical inconvenience. It is common myth that arthritis exhibits only minor aches and pains. Television commercials, marketing simple over-the-counter remedies, do not educate the public about the more aggressive forms of arthritis that require more complex treatments. Arthritis consists of much more than just minor aches and pains. Misconception #6 – Current treatment can cure arthritis. Unfortunately, there is no scientific evidence that a cure for arthritis currently exists. Nevertheless, physicians now know more than ever before about the best treatments for arthritis and how to slow down the progression of the disease. Advances in pain management, physical therapy and preventive care address the symptoms of arthritis while a cure for this disease is sought. Misconception #7 – Joint replacements should be put off as long as possible. Total joint replacement surgery, called arthroplasty, has helped millions of Americans regain their independence and reduce pain. Unfortunately, many people endure their pain for too long before considering this successful surgery. When medicines, exercise, and physical therapy no longer provide the needed relief, it is time to talk with your doctor about the pros and cons of joint replacement. With recent advances in implant technology, no one should endure the pain and suffering of arthritis longer than necessary. V1 003

Arthritis Facts 1 of every 3 adults or 70 million people have arthritis in the U.S. #1 leading cause of disability. More women than men reported arthritic problems. “One in Three Americans Are Affected by Arthritis or Other Chronic Joint Problems”. DePuy Orthopaedics, Inc. 2 April, Mary Kay Sones. “Arthritis and Chronic Joint Symptoms More Common Than Previously Thought.” Press Release, Centers for Disease Control. Full Text Article Arthritis and other chronic joint problems are far more common than previously thought, according to data released by the Centers for Disease Control (CDC). The new data projects the number of adults in the U.S. with arthritis and chronic joint problems at 70 million (33 percent), or one of every three adults. For more information on the CDC study or to obtain a copy of the report, visit “Arthritis is the number one cause of disability, and the new data confirms that arthritis and chronic joint symptoms are one of our most common public health problems,” says CDC Director Dr. Julie L. Gerberding, in a statement released by the CDC on October 24, “The CDC is committed to continuing to support the states in finding ways to reduce the arthritis-associated pain and limitations that affect so many Americans.” The new estimate of 70 million is 60 percent higher than the 1997 estimate of 43 million. Researchers say the earlier estimate was probably too low and that the arthritis-related questions on the new survey more accurately capture undiagnosed people with chronic joint symptoms: pain, stiffness or swelling around their joints. Until now, CDC data had suggested that about one in six Americans reportedly suffered with arthritis and other rheumatic conditions. The new study was part of the CDC’s Behavioral Risk Factor Surveillance System, the first state-by-state survey of arthritis and chronic joint symptoms. More than 212,000 U.S. residents were asked whether their doctor had ever told them they had arthritis or whether they had chronic joint symptoms during the past 12 months. Those who answered yes to the second question were included in the updated arthritis count, though the CDC notes some of those people may have had joint pain unrelated to arthritis. The survey confirms previous studies indicating the incidence of arthritis rises with age and is more common in people who are overweight and physically inactive. According to the CDC survey, more women than men (37.3 percent and 28.4 percent, respectively) reported having arthritis and chronic joint symptoms, and whites (35.3 percent) and blacks (31.5 percent) were more likely to report symptoms than Hispanics (23.3 percent) and other racial or ethnic groups (27.8 percent). Of adults with arthritis and chronic joint symptoms, 10.6 percent report doctor-diagnosed arthritis, 10.0 percent report chronic joint symptoms, and 12.4 percent report both. V1 004

What is Arthritis? Osteoarthritis Rheumatoid Arthritis Fibromyalgia
Inflammation of the Joints Most common chronic condition. More than 100 types of arthritis. 3 most common forms: Osteoarthritis Rheumatoid Arthritis Fibromyalgia Dynomed, Inc. “Learning about the Most Common Types of Arthritis”. DePuy Orthopaedics, Inc. 2 April, Full Text Article Determining If Your Pain Is from Arthritis At one point or another, everyone’s body will hurt. When that pain is continuous it is time to go and see your general practitioner or primary care provider to find out what is wrong. He or she will be able to tell you if you have one of the many types of arthritis. Your doctor will probably perform an examination and/or use x-rays to see inside of your joints to determine if there has been any destruction of cartilage. The most common types of arthritis are osteoarthritis, rheumatoid arthritis and fibromyalgia. What is Osteoarthritis? Degenerative joint disease, or osteoarthritis, is the most common form of arthritis striking 121 people out of 1,000 between the ages of 18 and 79. According to the Arthritis Foundation, approximately 16 million Americans suffer from osteoarthritis. Three times as many women than men are osteoarthritis patients. When bone rubs against bone because the joint surface is gone, osteoarthritis develops. This rubbing happens when the cartilage that surrounds the ends of the bone degenerates. Cartilage provides shock absorbency and reduces friction as a joint moves. A joint consists of two or more bones and the cartilage, which helps cushion the joint. Joints can come in many sizes and shapes. Most often the weight-bearing joints, such as the hips, knees and spine, are affected with osteoarthritis. Early in the disease, your painful joints may be stiff but won’t usually be warm or swollen. Over time the pain may become constant and wake you up at night. The cartilage may continue to wear away until bone is crunching on bone and a grating sound is heard. Deformity results when one side of the joint collapses more than the other side. What is Rheumatoid Arthritis? Rheumatoid arthritis is the most common form of inflammatory arthritis, affecting about two to three million Americans. It usually first appears between the ages of 25 and 50, but it can occur in children and in senior citizens. Most commonly the joints of the fingers, wrists, arms and legs are affected and it will involve the same joints on both sides of the body. Swelling, pain, deformity and stiffness are typically present. Unlike osteoarthritis, rheumatoid arthritis may also affect the heart, lungs, and eyes of some patients. Rheumatoid arthritis can also cause an overall feeling of sickness and fatigue as well as weight loss and fever. Some patients with rheumatoid arthritis experience constant symptoms while others have courses of bad periods or flares and good periods called remissions. The cause of rheumatoid arthritis is unknown but it is thought to be an autoimmune disease meaning that the body tissue is the victim of an immune response against itself. What is Fibromyalgia? A common but misunderstood disease, fibromyalgia affects approximately five million Americans. Eighty to 90 percent of all patients are women between the ages of 35 and 60. Constant fatigue, deep muscle pain, sleeplessness and depression are widespread symptoms of fibromyalgia. Tender points under the skin have become a hallmark of this disease. For all patients, these tender points are painful when pressed. Fibromyalgia syndrome (FMS) does not involve the joints like osteoarthritis and rheumatoid arthritis. Rather it is a type of rheumatism of the muscles, ligaments, tendons or soft tissues. Rheumatism describes the stiffness and pain associated with arthritis. Although the symptoms of fibromyalgia may come and go over the years, the disease itself is chronic or long-term. Example of Rheumatoid Arthritis V1 005

Signs of Rheumatoid Arthritis
Signs include: Joint stiffness Joint swelling Symmetrical joint discomfort fever “Warning Signs of Rheumatoid Arthritis” RealAge 2 April, Full Text Article Joint stiffness that lasts more than an hour after getting out of bed Joint swelling that lasts more than six weeks Symmetrical joint discomfort (on both sides of the body) A fever in addition to joint discomfort V1 006

Signs of Osteoarthritis Arthritis
Signs include: Steady or intermittent pain Stiffness Joint swelling or tenderness National Institutes of Health, National Institute of Arthritis and Musculoskeletal and Skin Diseases. “Warning Signs of Osteoarthritis”. About, Inc. 2 April, Full Text Article The Warning Signs of Osteoarthritis Steady or intermittent pain in a joint Stiffness after getting out of bed Joint swelling or tenderness in one or more joints A crunching feeling or sound of bone rubbing on bone Hot, red, or tender? Probably not osteoarthritis. Check with your doctor about other causes, such as rheumatoid arthritis. Not always pain. Not everyone with osteoarthritis feels pain. In fact, only a third of people with osteoarthritis in their x rays report pain or other symptoms. V1 007

Signs of Fibromyalgia Signs include: Body pain Fatigue
Trouble sleeping Swollen feeling in extremities Chronic headaches “Fibromyalgia: What is it?”. Arthritis Foundation, 2 April, Full Text Article Fibromyalgia (fye-bro-my-AL-gee-ah) is an arthritis-related condition that is characterized by generalized muscular pain and fatigue. The term "fibromyalgia" means pain in the muscles, ligaments and tendons. This condition is referred to as a "syndrome" because it's a set of signs and symptoms that occur together. Fibromyalgia is especially confusing and often misunderstood condition. Because its symptoms are quite common and laboratory tests are generally normal, people with fibromyalgia were once told that their condition was "all in their head." However, medical studies have proven that fibromyalgia does indeed exist, and it is estimated to affect about 2 percent of the U.S. population today. In 1990, the American College of Rheumatology, the official body of doctors who treat arthritis and related conditions, finally legitimized fibromyalgia in the medical community by presenting its criteria for diagnosing it. It is diagnosed when the you display the following symptoms: A history of widespread pain (pain on both sides of the body and above and below the waist) that is present for at least three months Pain in at least 11 of 18 tender-point sites V1 008

Rheumatoid Arthritis Inflammatory disease affecting the entire body.
Women are afflicted more often than men. Onset is usually in middle age, but can occur in the 20s or 30s. Dynomed, Inc. “What is Rheumatoid Arthritis?”. DePuy Orthopaedics, Inc. 2 April, Full Text Article Rheumatoid arthritis is the most common form of inflammatory arthritis, affecting about two to three million Americans. Most often it first appears between the ages of 25 and 50 but it can occur in children and in senior citizens. Three quarters of all people with this disease are women. It is a symmetric disease, meaning that it will usually involve the same joints on both sides of the body. Most commonly, the joints of the fingers, wrists, arms and legs are affected and swelling, pain, deformity and stiffness are typically present. Unlike osteoarthritis, rheumatoid arthritis may also affect the heart, lungs and eyes of some patients and can cause an overall feeling of sickness and fatigue as well as weight loss and fever. Not only joints are affected with this disease. Muscles, tendons and tissues surrounding joints may become inflamed and reduce your mobility. You may feel a squishy sensation when you push down on a joint. This is fluid in the joint capsule and it can cause pressure on the cartilage that is surrounding and protecting the bones. Causes of Rheumatoid Arthritis The exact cause of rheumatoid arthritis is unknown. Many doctors believe that a virus or a bacterium may prompt rheumatoid arthritis to develop in those people who have a genetic predisposition to it. Seven out of ten people who have rheumatoid arthritis have an inherited chemical marker on their cells leading doctors to believe that there is a correlation. Some experts think rheumatoid arthritis is an autoimmune disease, meaning that the body tissue is the victim of an immune response against itself. The body creates antibodies that actually attack the joints causing the swelling and redness. Excess fluid will flow into the joint space making joint motion painful. Severe stress may also play a role. In some cases, rheumatoid arthritis will first appear after a person has experienced a life-changing event like a divorce, loss of a job, death of a loved one or a severe injury. Symptoms of Rheumatoid Arthritis In many cases, rheumatoid arthritis develops gradually and can come and go over the years. About half of all people with this disease will have a remission within two years. However, the symptoms can return, as there is no permanent cure for rheumatoid arthritis. If you developed rheumatoid arthritis after 60 years of age, you have a greater chance of having a milder case than someone who developed the disease when younger. The joint lining, called the synovium, becomes inflamed in cases of rheumatoid arthritis, leading to pain, stiffness, warmth, redness and swelling. These inflamed cells release an enzyme that may even digest cartilage and bone. It is important to start a course of treatment so that you can continue to live your life the way you want. Other symptoms of rheumatoid arthritis include: Fatigue and/or weakness Stiffness following periods of immobility which gradually improves with movement Rheumatoid nodules (lumps of inflamed cells) under the skin usually found on the bony part of the forearm, ankle and fingers Minor fevers, anemia, weight loss Treatment of Rheumatoid Arthritis If your doctor suspects that you have rheumatoid arthritis, he or she will order a series of diagnostic tests after performing a physical examination. One test he or she may order looks for an antibody called rheumatoid factor. Approximately 85 percent of people with rheumatoid arthritis have this antibody. Once a diagnosis is made, you can start a series of treatments designed to help you continue to live your life. Advances in treatment have been made so that few people with rheumatoid arthritis end up bed ridden. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen are used to reduce pain and swelling in the short term. Disease modifying drugs (DMARDs) may also be used if you don’t respond to NSAID treatment. These slow acting drugs are designed to help slow the progression of rheumatoid arthritis. Over the long term, biologic response modifiers may be used. These drugs are either injected or given intravenously. Corticosteroid medications, like Prednisone, may also be used to help you during flareups. Exercise is one of the best things you can do for your arthritis. It will increase your strength and give you endurance. Stretching will help your joints retain or gain flexibility. Exercise not only helps your body but also will improve your state of mind. Remember that there are many ways to exercise. Speak to your doctor before starting an exercise program. In some cases, surgery may be necessary. Surgery, such as joint replacement, is considered when you and your doctor have concluded that previous treatments for pain and mobility have been unsuccessful and your quality of life is suffering. In addition to joint replacement surgery, other types of surgery include the reconstruction or fusion of a joint and the removal of diseased tissue from the joint (synovectomy). V1 009

Symptoms of RA Inflammation of the joints, difficulty moving and pain
Loss of appetite Loss of energy Fever Anemia (decrease in hemoglobin in blood) Possible rheumatoid nodules (lumps of tissue under the skin) Dynomed, Inc. “What is Rheumatoid Arthritis?”. DePuy Orthopaedics, Inc. 2 April, Full Text Article Rheumatoid arthritis is the most common form of inflammatory arthritis, affecting about two to three million Americans. Most often it first appears between the ages of 25 and 50 but it can occur in children and in senior citizens. Three quarters of all people with this disease are women. It is a symmetric disease, meaning that it will usually involve the same joints on both sides of the body. Most commonly, the joints of the fingers, wrists, arms and legs are affected and swelling, pain, deformity and stiffness are typically present. Unlike osteoarthritis, rheumatoid arthritis may also affect the heart, lungs and eyes of some patients and can cause an overall feeling of sickness and fatigue as well as weight loss and fever. Not only joints are affected with this disease. Muscles, tendons and tissues surrounding joints may become inflamed and reduce your mobility. You may feel a squishy sensation when you push down on a joint. This is fluid in the joint capsule and it can cause pressure on the cartilage that is surrounding and protecting the bones. Causes of Rheumatoid Arthritis The exact cause of rheumatoid arthritis is unknown. Many doctors believe that a virus or a bacterium may prompt rheumatoid arthritis to develop in those people who have a genetic predisposition to it. Seven out of ten people who have rheumatoid arthritis have an inherited chemical marker on their cells leading doctors to believe that there is a correlation. Some experts think rheumatoid arthritis is an autoimmune disease, meaning that the body tissue is the victim of an immune response against itself. The body creates antibodies that actually attack the joints causing the swelling and redness. Excess fluid will flow into the joint space making joint motion painful. Severe stress may also play a role. In some cases, rheumatoid arthritis will first appear after a person has experienced a life-changing event like a divorce, loss of a job, death of a loved one or a severe injury. Symptoms of Rheumatoid Arthritis In many cases, rheumatoid arthritis develops gradually and can come and go over the years. About half of all people with this disease will have a remission within two years. However, the symptoms can return, as there is no permanent cure for rheumatoid arthritis. If you developed rheumatoid arthritis after 60 years of age, you have a greater chance of having a milder case than someone who developed the disease when younger. The joint lining, called the synovium, becomes inflamed in cases of rheumatoid arthritis, leading to pain, stiffness, warmth, redness and swelling. These inflamed cells release an enzyme that may even digest cartilage and bone. It is important to start a course of treatment so that you can continue to live your life the way you want. Other symptoms of rheumatoid arthritis include: Fatigue and/or weakness Stiffness following periods of immobility which gradually improves with movement Rheumatoid nodules (lumps of inflamed cells) under the skin usually found on the bony part of the forearm, ankle and fingers Minor fevers, anemia, weight loss Treatment of Rheumatoid Arthritis If your doctor suspects that you have rheumatoid arthritis, he or she will order a series of diagnostic tests after performing a physical examination. One test he or she may order looks for an antibody called rheumatoid factor. Approximately 85 percent of people with rheumatoid arthritis have this antibody. Once a diagnosis is made, you can start a series of treatments designed to help you continue to live your life. Advances in treatment have been made so that few people with rheumatoid arthritis end up bed ridden. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen are used to reduce pain and swelling in the short term. Disease modifying drugs (DMARDs) may also be used if you don’t respond to NSAID treatment. These slow acting drugs are designed to help slow the progression of rheumatoid arthritis. Over the long term, biologic response modifiers may be used. These drugs are either injected or given intravenously. Corticosteroid medications, like Prednisone, may also be used to help you during flareups. Exercise is one of the best things you can do for your arthritis. It will increase your strength and give you endurance. Stretching will help your joints retain or gain flexibility. Exercise not only helps your body but also will improve your state of mind. Remember that there are many ways to exercise. Speak to your doctor before starting an exercise program. In some cases, surgery may be necessary. Surgery, such as joint replacement, is considered when you and your doctor have concluded that previous treatments for pain and mobility have been unsuccessful and your quality of life is suffering. In addition to joint replacement surgery, other types of surgery include the reconstruction or fusion of a joint and the removal of diseased tissue from the joint (synovectomy). V1 010

Effects of RA General fatigue, soreness, stiffness and aching.
Pain and swelling may occur in the same joints on both sides of the body. Usually begins in the hands or feet. Dynomed, Inc. “What is Rheumatoid Arthritis?”. DePuy Orthopaedics, Inc. 2 April, Full Text Article Rheumatoid arthritis is the most common form of inflammatory arthritis, affecting about two to three million Americans. Most often it first appears between the ages of 25 and 50 but it can occur in children and in senior citizens. Three quarters of all people with this disease are women. It is a symmetric disease, meaning that it will usually involve the same joints on both sides of the body. Most commonly, the joints of the fingers, wrists, arms and legs are affected and swelling, pain, deformity and stiffness are typically present. Unlike osteoarthritis, rheumatoid arthritis may also affect the heart, lungs and eyes of some patients and can cause an overall feeling of sickness and fatigue as well as weight loss and fever. Not only joints are affected with this disease. Muscles, tendons and tissues surrounding joints may become inflamed and reduce your mobility. You may feel a squishy sensation when you push down on a joint. This is fluid in the joint capsule and it can cause pressure on the cartilage that is surrounding and protecting the bones. Causes of Rheumatoid Arthritis The exact cause of rheumatoid arthritis is unknown. Many doctors believe that a virus or a bacterium may prompt rheumatoid arthritis to develop in those people who have a genetic predisposition to it. Seven out of ten people who have rheumatoid arthritis have an inherited chemical marker on their cells leading doctors to believe that there is a correlation. Some experts think rheumatoid arthritis is an autoimmune disease, meaning that the body tissue is the victim of an immune response against itself. The body creates antibodies that actually attack the joints causing the swelling and redness. Excess fluid will flow into the joint space making joint motion painful. Severe stress may also play a role. In some cases, rheumatoid arthritis will first appear after a person has experienced a life-changing event like a divorce, loss of a job, death of a loved one or a severe injury. Symptoms of Rheumatoid Arthritis In many cases, rheumatoid arthritis develops gradually and can come and go over the years. About half of all people with this disease will have a remission within two years. However, the symptoms can return, as there is no permanent cure for rheumatoid arthritis. If you developed rheumatoid arthritis after 60 years of age, you have a greater chance of having a milder case than someone who developed the disease when younger. The joint lining, called the synovium, becomes inflamed in cases of rheumatoid arthritis, leading to pain, stiffness, warmth, redness and swelling. These inflamed cells release an enzyme that may even digest cartilage and bone. It is important to start a course of treatment so that you can continue to live your life the way you want. Other symptoms of rheumatoid arthritis include: Fatigue and/or weakness Stiffness following periods of immobility which gradually improves with movement Rheumatoid nodules (lumps of inflamed cells) under the skin usually found on the bony part of the forearm, ankle and fingers Minor fevers, anemia, weight loss Treatment of Rheumatoid Arthritis If your doctor suspects that you have rheumatoid arthritis, he or she will order a series of diagnostic tests after performing a physical examination. One test he or she may order looks for an antibody called rheumatoid factor. Approximately 85 percent of people with rheumatoid arthritis have this antibody. Once a diagnosis is made, you can start a series of treatments designed to help you continue to live your life. Advances in treatment have been made so that few people with rheumatoid arthritis end up bed ridden. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen are used to reduce pain and swelling in the short term. Disease modifying drugs (DMARDs) may also be used if you don’t respond to NSAID treatment. These slow acting drugs are designed to help slow the progression of rheumatoid arthritis. Over the long term, biologic response modifiers may be used. These drugs are either injected or given intravenously. Corticosteroid medications, like Prednisone, may also be used to help you during flareups. Exercise is one of the best things you can do for your arthritis. It will increase your strength and give you endurance. Stretching will help your joints retain or gain flexibility. Exercise not only helps your body but also will improve your state of mind. Remember that there are many ways to exercise. Speak to your doctor before starting an exercise program. In some cases, surgery may be necessary. Surgery, such as joint replacement, is considered when you and your doctor have concluded that previous treatments for pain and mobility have been unsuccessful and your quality of life is suffering. In addition to joint replacement surgery, other types of surgery include the reconstruction or fusion of a joint and the removal of diseased tissue from the joint (synovectomy). V1 011

RA Treatment Options Early treatment is critical. Medications
Exercise, rest, and physical therapy Surgery for damaged and painful joints Dynomed, Inc. “What is Rheumatoid Arthritis?”. DePuy Orthopaedics, Inc. 2 April, Full Text Article Rheumatoid arthritis is the most common form of inflammatory arthritis, affecting about two to three million Americans. Most often it first appears between the ages of 25 and 50 but it can occur in children and in senior citizens. Three quarters of all people with this disease are women. It is a symmetric disease, meaning that it will usually involve the same joints on both sides of the body. Most commonly, the joints of the fingers, wrists, arms and legs are affected and swelling, pain, deformity and stiffness are typically present. Unlike osteoarthritis, rheumatoid arthritis may also affect the heart, lungs and eyes of some patients and can cause an overall feeling of sickness and fatigue as well as weight loss and fever. Not only joints are affected with this disease. Muscles, tendons and tissues surrounding joints may become inflamed and reduce your mobility. You may feel a squishy sensation when you push down on a joint. This is fluid in the joint capsule and it can cause pressure on the cartilage that is surrounding and protecting the bones. Causes of Rheumatoid Arthritis The exact cause of rheumatoid arthritis is unknown. Many doctors believe that a virus or a bacterium may prompt rheumatoid arthritis to develop in those people who have a genetic predisposition to it. Seven out of ten people who have rheumatoid arthritis have an inherited chemical marker on their cells leading doctors to believe that there is a correlation. Some experts think rheumatoid arthritis is an autoimmune disease, meaning that the body tissue is the victim of an immune response against itself. The body creates antibodies that actually attack the joints causing the swelling and redness. Excess fluid will flow into the joint space making joint motion painful. Severe stress may also play a role. In some cases, rheumatoid arthritis will first appear after a person has experienced a life-changing event like a divorce, loss of a job, death of a loved one or a severe injury. Symptoms of Rheumatoid Arthritis In many cases, rheumatoid arthritis develops gradually and can come and go over the years. About half of all people with this disease will have a remission within two years. However, the symptoms can return, as there is no permanent cure for rheumatoid arthritis. If you developed rheumatoid arthritis after 60 years of age, you have a greater chance of having a milder case than someone who developed the disease when younger. The joint lining, called the synovium, becomes inflamed in cases of rheumatoid arthritis, leading to pain, stiffness, warmth, redness and swelling. These inflamed cells release an enzyme that may even digest cartilage and bone. It is important to start a course of treatment so that you can continue to live your life the way you want. Other symptoms of rheumatoid arthritis include: Fatigue and/or weakness Stiffness following periods of immobility which gradually improves with movement Rheumatoid nodules (lumps of inflamed cells) under the skin usually found on the bony part of the forearm, ankle and fingers Minor fevers, anemia, weight loss Treatment of Rheumatoid Arthritis If your doctor suspects that you have rheumatoid arthritis, he or she will order a series of diagnostic tests after performing a physical examination. One test he or she may order looks for an antibody called rheumatoid factor. Approximately 85 percent of people with rheumatoid arthritis have this antibody. Once a diagnosis is made, you can start a series of treatments designed to help you continue to live your life. Advances in treatment have been made so that few people with rheumatoid arthritis end up bed ridden. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen are used to reduce pain and swelling in the short term. Disease modifying drugs (DMARDs) may also be used if you don’t respond to NSAID treatment. These slow acting drugs are designed to help slow the progression of rheumatoid arthritis. Over the long term, biologic response modifiers may be used. These drugs are either injected or given intravenously. Corticosteroid medications, like Prednisone, may also be used to help you during flareups. Exercise is one of the best things you can do for your arthritis. It will increase your strength and give you endurance. Stretching will help your joints retain or gain flexibility. Exercise not only helps your body but also will improve your state of mind. Remember that there are many ways to exercise. Speak to your doctor before starting an exercise program. In some cases, surgery may be necessary. Surgery, such as joint replacement, is considered when you and your doctor have concluded that previous treatments for pain and mobility have been unsuccessful and your quality of life is suffering. In addition to joint replacement surgery, other types of surgery include the reconstruction or fusion of a joint and the removal of diseased tissue from the joint (synovectomy). V1 012

Osteoarthritis Most common type of arthritis Wear and tear Disease
Characterized by the breakdown of the joint’s cartilage. Affects middle aged and older people. Targets hands and weight-bearing joints, such as knees, hips, feet and back. Dynomed, Inc. “Osteoarthritis: Know the Risk Factors, Symptoms, Medications and Other Available Treatments”. DePuy Orthopaedics, Inc. 2 April, Full Text Article Osteoarthritis is the most common form of arthritis affecting one out of eight people between the ages of 18 and 79. According to the Arthritis Foundation, approximately 16 million Americans suffer from osteoarthritis, three times as many women than men. As we grow older, parts of our body wear out. This is true of cartilage, the shock absorber and sliding surface that covers the ends of bones. By the time you are 50 years old, there is a 90 percent chance that you will have some visible change in your cartilage. Osteoarthritis develops when cartilage wears out and bone rubs against bone. Cartilage contains fluid and elastic tissue, and reduces friction as the joint moves. Most often the weight-bearing joints, such as the hips, knees and spine, are affected by osteoarthritis. Causes of Osteoarthritis Osteoarthritis used to be seen only as an older person’s disease. Now, because of the modern stresses in our lives, people of all ages suffer from the aches and pains associated with osteoarthritis. General wear and tear on the joints can cause osteoarthritis. However, playing sports such as jogging, tennis and skiing are also potential instigators of the disease. If your occupation entails heavy lifting or excessive use of your hands, you may be at a greater risk of developing osteoarthritis. There is no known cause of osteoarthritis. A specific joint injury or other joint disease like rheumatoid arthritis may cause osteoarthritis. Gout and congenital defects to the joint are secondary causes of osteoarthritis. Hypermobiles, or people that are extremely flexible, are also more prone to the disease. Some recent studies have pointed to genetics as a possible cause. It could be possible that some cartilage is more likely to degenerate than others. Chemical reactions in your body could also lead to the breakdown of cartilage, various experts believe (The Arthritis Bible, Healing Arts Press, 1999). At this time researchers are trying to develop a test that will detect the breakdown of cartilage. As with most types of arthritis, being overweight also plays a role because of the added pressure on the body. Symptoms of Osteoarthritis The most common symptoms are pain and stiffness in the joint. Early on in the disease, pain may only be felt after exercise, but will go away after you rest. Over time, the occasional pain may become constant and wake you up at night. The cartilage may continue to wear away until bone is crunching on bone and a grating sound is heard. In the long term, loss of mobility may occur. The joint may feel warm to the touch and may be swollen. This is called erosive inflammatory osteoarthritis. Deformity may result when one side of the joint collapses more than the other side. However, most people do not become crippled as a result of osteoarthritis. If you suspect you have osteoarthritis, visit your doctor. He or she will perform a series of tests to determine if you have arthritis and what type. X-rays may be ordered to see if the bone and cartilage have been damaged. Blood tests may be ordered to rule out other types of disease. The outlook for the disease depends mainly on which joints are affected and how serious it is. There are many forms of treatment and, by starting early, you can start to live your life more fully. Treatment of Osteoarthritis The good news is that osteoarthritis does not need to get worse over time. At this time, there is no known cure for osteoarthritis. However, there are treatments that help decrease the arthritis pain you are feeling and help you regain mobility. Exercise, weight loss, rest and proper nutrition are very helpful in treating this disease. Through exercise, you can regain strength and manage your body weight. Proper nutrition and rest will make sure you feel your best. It is important to discuss any exercise program with your doctor or physical therapist before starting one. You should also talk with your doctor before taking alternative medicines, food supplements, and herbal medicines to treat your arthritis. There are many assistive devices designed to make your life easier. Opening car doors and cans and bottles is made easier through new inventions. The old-fashioned cane can help you continue to walk and to get your exercise. Some people find that using heat or cold applications or paraffin baths help relieve pain and regain joint mobility. Arthritis pain relief may be found in taking aspirin or acetaminophen. These drugs are called nonsteroidal anti-inflammatory drugs (NSAIDs). By discussing your pain with your doctor, he or she will be able to tell you which type of drugs will work best for you. There are several types of surgical treatments available. Surgery may be an option if you are suffering from osteoarthritis of the hip, knee, back, shoulder, hand or foot. Joint replacement techniques have advanced in the last 25 years making this surgery more common. Your doctor will help you make this serious decision based on the level of your pain, job and age. Learning that you have osteoarthritis, does not have to mean an end to your active lifestyle. Your physician can help you find the most effective treatment for managing your osteoarthritis and controlling your arthritis pain. V1 013

Risk Factors and Diagnosis of OA
Age Obesity Joint injuries due to sports, work-related activity or accidents Diagnosis based on a physical exam, x-rays and history of symptoms. Dynomed, Inc. “Osteoarthritis: Know the Risk Factors, Symptoms, Medications and Other Available Treatments”. DePuy Orthopaedics, Inc. 2 April, Full Text Article Osteoarthritis is the most common form of arthritis affecting one out of eight people between the ages of 18 and 79. According to the Arthritis Foundation, approximately 16 million Americans suffer from osteoarthritis, three times as many women than men. As we grow older, parts of our body wear out. This is true of cartilage, the shock absorber and sliding surface that covers the ends of bones. By the time you are 50 years old, there is a 90 percent chance that you will have some visible change in your cartilage. Osteoarthritis develops when cartilage wears out and bone rubs against bone. Cartilage contains fluid and elastic tissue, and reduces friction as the joint moves. Most often the weight-bearing joints, such as the hips, knees and spine, are affected by osteoarthritis. Causes of Osteoarthritis Osteoarthritis used to be seen only as an older person’s disease. Now, because of the modern stresses in our lives, people of all ages suffer from the aches and pains associated with osteoarthritis. General wear and tear on the joints can cause osteoarthritis. However, playing sports such as jogging, tennis and skiing are also potential instigators of the disease. If your occupation entails heavy lifting or excessive use of your hands, you may be at a greater risk of developing osteoarthritis. There is no known cause of osteoarthritis. A specific joint injury or other joint disease like rheumatoid arthritis may cause osteoarthritis. Gout and congenital defects to the joint are secondary causes of osteoarthritis. Hypermobiles, or people that are extremely flexible, are also more prone to the disease. Some recent studies have pointed to genetics as a possible cause. It could be possible that some cartilage is more likely to degenerate than others. Chemical reactions in your body could also lead to the breakdown of cartilage, various experts believe (The Arthritis Bible, Healing Arts Press, 1999). At this time researchers are trying to develop a test that will detect the breakdown of cartilage. As with most types of arthritis, being overweight also plays a role because of the added pressure on the body. Symptoms of Osteoarthritis The most common symptoms are pain and stiffness in the joint. Early on in the disease, pain may only be felt after exercise, but will go away after you rest. Over time, the occasional pain may become constant and wake you up at night. The cartilage may continue to wear away until bone is crunching on bone and a grating sound is heard. In the long term, loss of mobility may occur. The joint may feel warm to the touch and may be swollen. This is called erosive inflammatory osteoarthritis. Deformity may result when one side of the joint collapses more than the other side. However, most people do not become crippled as a result of osteoarthritis. If you suspect you have osteoarthritis, visit your doctor. He or she will perform a series of tests to determine if you have arthritis and what type. X-rays may be ordered to see if the bone and cartilage have been damaged. Blood tests may be ordered to rule out other types of disease. The outlook for the disease depends mainly on which joints are affected and how serious it is. There are many forms of treatment and, by starting early, you can start to live your life more fully. Treatment of Osteoarthritis The good news is that osteoarthritis does not need to get worse over time. At this time, there is no known cure for osteoarthritis. However, there are treatments that help decrease the arthritis pain you are feeling and help you regain mobility. Exercise, weight loss, rest and proper nutrition are very helpful in treating this disease. Through exercise, you can regain strength and manage your body weight. Proper nutrition and rest will make sure you feel your best. It is important to discuss any exercise program with your doctor or physical therapist before starting one. You should also talk with your doctor before taking alternative medicines, food supplements, and herbal medicines to treat your arthritis. There are many assistive devices designed to make your life easier. Opening car doors and cans and bottles is made easier through new inventions. The old-fashioned cane can help you continue to walk and to get your exercise. Some people find that using heat or cold applications or paraffin baths help relieve pain and regain joint mobility. Arthritis pain relief may be found in taking aspirin or acetaminophen. These drugs are called nonsteroidal anti-inflammatory drugs (NSAIDs). By discussing your pain with your doctor, he or she will be able to tell you which type of drugs will work best for you. There are several types of surgical treatments available. Surgery may be an option if you are suffering from osteoarthritis of the hip, knee, back, shoulder, hand or foot. Joint replacement techniques have advanced in the last 25 years making this surgery more common. Your doctor will help you make this serious decision based on the level of your pain, job and age. Learning that you have osteoarthritis, does not have to mean an end to your active lifestyle. Your physician can help you find the most effective treatment for managing your osteoarthritis and controlling your arthritis pain. V1 014

OA Treatment Options Exercise Heat/cold therapy for temporary relief
Joint protection to prevent strain or stress Weight control Medications Surgery to relieve chronic pain Dynomed, Inc. “Osteoarthritis: Know the Risk Factors, Symptoms, Medications and Other Available Treatments”. DePuy Orthopaedics, Inc. 2 April, Full Text Article Osteoarthritis is the most common form of arthritis affecting one out of eight people between the ages of 18 and 79. According to the Arthritis Foundation, approximately 16 million Americans suffer from osteoarthritis, three times as many women than men. As we grow older, parts of our body wear out. This is true of cartilage, the shock absorber and sliding surface that covers the ends of bones. By the time you are 50 years old, there is a 90 percent chance that you will have some visible change in your cartilage. Osteoarthritis develops when cartilage wears out and bone rubs against bone. Cartilage contains fluid and elastic tissue, and reduces friction as the joint moves. Most often the weight-bearing joints, such as the hips, knees and spine, are affected by osteoarthritis. Causes of Osteoarthritis Osteoarthritis used to be seen only as an older person’s disease. Now, because of the modern stresses in our lives, people of all ages suffer from the aches and pains associated with osteoarthritis. General wear and tear on the joints can cause osteoarthritis. However, playing sports such as jogging, tennis and skiing are also potential instigators of the disease. If your occupation entails heavy lifting or excessive use of your hands, you may be at a greater risk of developing osteoarthritis. There is no known cause of osteoarthritis. A specific joint injury or other joint disease like rheumatoid arthritis may cause osteoarthritis. Gout and congenital defects to the joint are secondary causes of osteoarthritis. Hypermobiles, or people that are extremely flexible, are also more prone to the disease. Some recent studies have pointed to genetics as a possible cause. It could be possible that some cartilage is more likely to degenerate than others. Chemical reactions in your body could also lead to the breakdown of cartilage, various experts believe (The Arthritis Bible, Healing Arts Press, 1999). At this time researchers are trying to develop a test that will detect the breakdown of cartilage. As with most types of arthritis, being overweight also plays a role because of the added pressure on the body. Symptoms of Osteoarthritis The most common symptoms are pain and stiffness in the joint. Early on in the disease, pain may only be felt after exercise, but will go away after you rest. Over time, the occasional pain may become constant and wake you up at night. The cartilage may continue to wear away until bone is crunching on bone and a grating sound is heard. In the long term, loss of mobility may occur. The joint may feel warm to the touch and may be swollen. This is called erosive inflammatory osteoarthritis. Deformity may result when one side of the joint collapses more than the other side. However, most people do not become crippled as a result of osteoarthritis. If you suspect you have osteoarthritis, visit your doctor. He or she will perform a series of tests to determine if you have arthritis and what type. X-rays may be ordered to see if the bone and cartilage have been damaged. Blood tests may be ordered to rule out other types of disease. The outlook for the disease depends mainly on which joints are affected and how serious it is. There are many forms of treatment and, by starting early, you can start to live your life more fully. Treatment of Osteoarthritis The good news is that osteoarthritis does not need to get worse over time. At this time, there is no known cure for osteoarthritis. However, there are treatments that help decrease the arthritis pain you are feeling and help you regain mobility. Exercise, weight loss, rest and proper nutrition are very helpful in treating this disease. Through exercise, you can regain strength and manage your body weight. Proper nutrition and rest will make sure you feel your best. It is important to discuss any exercise program with your doctor or physical therapist before starting one. You should also talk with your doctor before taking alternative medicines, food supplements, and herbal medicines to treat your arthritis. There are many assistive devices designed to make your life easier. Opening car doors and cans and bottles is made easier through new inventions. The old-fashioned cane can help you continue to walk and to get your exercise. Some people find that using heat or cold applications or paraffin baths help relieve pain and regain joint mobility. Arthritis pain relief may be found in taking aspirin or acetaminophen. These drugs are called nonsteroidal anti-inflammatory drugs (NSAIDs). By discussing your pain with your doctor, he or she will be able to tell you which type of drugs will work best for you. There are several types of surgical treatments available. Surgery may be an option if you are suffering from osteoarthritis of the hip, knee, back, shoulder, hand or foot. Joint replacement techniques have advanced in the last 25 years making this surgery more common. Your doctor will help you make this serious decision based on the level of your pain, job and age. Learning that you have osteoarthritis, does not have to mean an end to your active lifestyle. Your physician can help you find the most effective treatment for managing your osteoarthritis and controlling your arthritis pain. V1 015

Diet and Exercise Extra weight can put more pressure on your weight-bearing joints, making arthritis worse. Arthritis causes fatigue and stiffness, limiting valuable physical activity. Weight loss and exercise can reduce arthritis symptoms. “Exercise and Weight Loss: A Simple Regimen that Could Change Your Life ”. DePuy Orthopaedics, Inc. 2 April, Full Text Article Many Americans, who suffer from arthritis, battle to maintain a healthy weight. In fact, about one in 10 of all U.S. adults suffer from knee osteoarthritis, a condition in which the tissue between the joints in the knee gets worn down according to the University of Florida, Division of Rheumatology. Many people struggle with weight gain. However, people with arthritis may have an even tougher time shedding extra pounds. Their arthritis pain causes fatigue and stiffness, which can discourage physical activity. This creates a harmful cycle. The extra weight makes arthritis worse by putting extra pressure on the weight-bearing joints of the body, especially in the knees, hips and ankles. Study Highlights a Straightforward Regimen of Diet and Exercise There are many ways arthritis sufferers can cope with their pain, ranging from prescription medications to joint replacement surgery. While there is no cure for arthritis, one recent study shows how a simple regimen of diet and exercise can significantly reduce the symptoms associated with knee osteoarthritis. This pilot study took place at the Department of Health and Exercise Science at Wake Forest University in Winston-Salem, North Carolina. According to the National Library of Medicine’s Website at the study set out to explore the relationship between diet, exercise and weight loss in overweight older adults who suffered from knee osteoarthritis. Several factors were measured, including gait, strength, knee pain, cartilage degradation, and physical function. Over a period of six months, two groups of participants began therapy regimens. The first group had both exercise programs and dietary restrictions; the second only exercise. At the end of the study, the exercise and diet group lost four times more weight than the exercise-only group. However, according to the study, significant physical improvements were reported in both groups. Key benefits of these programs include less pain and disability and greater ease of walking. Weight Management is a Key in Avoiding or Delaying the Onset of Osteoarthritis The Arthritis Foundation agrees that weight management is a key factor for not only coping with osteoarthritis, but in helping to avoid it altogether. In their brochure about osteoarthritis, the Foundation states that being overweight increases the odds that a person will suffer from knee osteoarthritis later in life. As the Wake Forest study and the Arthritis Foundation literature report, when diet and exercise are incorporated into the lives of those who suffer from knee osteoarthritis, their quality of life is greatly improved. In particular, a diet with adequate protein and calcium is especially important. The Arthritis Foundation explains that when arthritis flares up, most sufferers lose their appetites and don’t take in adequate nutrients. In addition, the Foundation recommends no more than modest alcohol consumption and not smoking for most sufferers. Exercises that Work for People with Arthritis Most people who suffer from knee osteoarthritis find activity of any kind painful, which can lead to a sedentary lifestyle and gradual weight gain. Thankfully, there are many exercises arthritis sufferers can do to strengthen their painful joints and reduce excess body weight. Swimming, for example, is a popular form of exercise because the water’s buoyancy provides a no-impact work out. Riding a bike and walking are two of the most beneficial exercises for arthritis sufferers that cause the least amount of damage to arthritis joints. By working closely with their physicians, sufferers can begin an exercise regimen that fits well with their individual needs and lifestyles. V1 016

Weight Management A healthy diet and exercise are key factors in improving quality of life. Some recommendations Diet with adequate protein, calcium and low in saturated fats Modest alcohol consumption and sugar intake Exercise regularly Examples: biking, walking, swimming “Exercise and Weight Loss: A Simple Regimen that Could Change Your Life ”. DePuy Orthopaedics, Inc. 2 April, Full Text Article Many Americans, who suffer from arthritis, battle to maintain a healthy weight. In fact, about one in 10 of all U.S. adults suffer from knee osteoarthritis, a condition in which the tissue between the joints in the knee gets worn down according to the University of Florida, Division of Rheumatology. Many people struggle with weight gain. However, people with arthritis may have an even tougher time shedding extra pounds. Their arthritis pain causes fatigue and stiffness, which can discourage physical activity. This creates a harmful cycle. The extra weight makes arthritis worse by putting extra pressure on the weight-bearing joints of the body, especially in the knees, hips and ankles. Study Highlights a Straightforward Regimen of Diet and Exercise There are many ways arthritis sufferers can cope with their pain, ranging from prescription medications to joint replacement surgery. While there is no cure for arthritis, one recent study shows how a simple regimen of diet and exercise can significantly reduce the symptoms associated with knee osteoarthritis. This pilot study took place at the Department of Health and Exercise Science at Wake Forest University in Winston-Salem, North Carolina. According to the National Library of Medicine’s Website at the study set out to explore the relationship between diet, exercise and weight loss in overweight older adults who suffered from knee osteoarthritis. Several factors were measured, including gait, strength, knee pain, cartilage degradation, and physical function. Over a period of six months, two groups of participants began therapy regimens. The first group had both exercise programs and dietary restrictions; the second only exercise. At the end of the study, the exercise and diet group lost four times more weight than the exercise-only group. However, according to the study, significant physical improvements were reported in both groups. Key benefits of these programs include less pain and disability and greater ease of walking. Weight Management is a Key in Avoiding or Delaying the Onset of Osteoarthritis The Arthritis Foundation agrees that weight management is a key factor for not only coping with osteoarthritis, but in helping to avoid it altogether. In their brochure about osteoarthritis, the Foundation states that being overweight increases the odds that a person will suffer from knee osteoarthritis later in life. As the Wake Forest study and the Arthritis Foundation literature report, when diet and exercise are incorporated into the lives of those who suffer from knee osteoarthritis, their quality of life is greatly improved. In particular, a diet with adequate protein and calcium is especially important. The Arthritis Foundation explains that when arthritis flares up, most sufferers lose their appetites and don’t take in adequate nutrients. In addition, the Foundation recommends no more than modest alcohol consumption and not smoking for most sufferers. Exercises that Work for People with Arthritis Most people who suffer from knee osteoarthritis find activity of any kind painful, which can lead to a sedentary lifestyle and gradual weight gain. Thankfully, there are many exercises arthritis sufferers can do to strengthen their painful joints and reduce excess body weight. Swimming, for example, is a popular form of exercise because the water’s buoyancy provides a no-impact work out. Riding a bike and walking are two of the most beneficial exercises for arthritis sufferers that cause the least amount of damage to arthritis joints. By working closely with their physicians, sufferers can begin an exercise regimen that fits well with their individual needs and lifestyles. V1 017

Shoulder V1 018

Shoulder Joint Healthy shoulder joint Arthritic shoulder joint V1 019

Shoulder Anatomy Made up of 3 bones: the scapula (shoulder blade), the humerus (upper arm bone) and the clavicle (collarbone). “Arthritis of the Shoulder ”. DePuy Orthopaedics, Inc. 2 April, Full Text Article The shoulder is made up of three bones: the scapula (shoulder blade), the humerus (upper arm bone) and the clavicle (collarbone). The tendons of four muscles form the rotator cuff. The muscles are called the supraspinatus, infraspinatus, teres minor, and subscapularis. The rotator cuff connects the humerus with the scapula (shoulder blade) and helps raise and rotate the arm. As the arm is raised, the rotator cuff also keeps the humerus tightly in the socket (glenoid) of the scapula. The part of the scapula that makes up the roof of the shoulder is called the acromion. Between the acromion and the rotator cuff tendons there is a bursa. There are many bursae all over the body where tissues must move against one another. The bursa is a lubricated sac of tissue that protects the muscles and tendons as they move against one another. The bursa simply allows the moving parts to slide against one another without too much friction. The humeral head of the shoulder (the ball portion) has several blood vessels that enter around the base of the articular cartilage (the smooth surface that covers the bone surface). Certain types of fractures of the shoulder can injure these blood vessels, leading to a condition where the ball no longer has any blood supply. This can lead to a collapse of the joint surface even if the fracture heals. Over time, this can result in arthritis of the joint. This condition is called aseptic necrosis of the humeral head. In some cases, when such fractures occur, your doctor may recommend a shoulder replacement rather than try to fix the broken bones. The risk of developing avascular necrosis is so high that it makes more sense to go ahead and replace the humeral head immediately. Otherwise, if the fracture was fixed and aseptic necrosis resulted, you would need a second operation to replace the shoulder. V1 020

How Does the Shoulder Works?
Ball is 2 times larger than the socket. Very mobile joint Extensive array of ligaments and muscles. “Arthritis of the Shoulder ”. DePuy Orthopaedics, Inc. 2 April, Full Text Article The shoulder is made up of three bones: the scapula (shoulder blade), the humerus (upper arm bone) and the clavicle (collarbone). The tendons of four muscles form the rotator cuff. The muscles are called the supraspinatus, infraspinatus, teres minor, and subscapularis. The rotator cuff connects the humerus with the scapula (shoulder blade) and helps raise and rotate the arm. As the arm is raised, the rotator cuff also keeps the humerus tightly in the socket (glenoid) of the scapula. The part of the scapula that makes up the roof of the shoulder is called the acromion. Between the acromion and the rotator cuff tendons there is a bursa. There are many bursae all over the body where tissues must move against one another. The bursa is a lubricated sac of tissue that protects the muscles and tendons as they move against one another. The bursa simply allows the moving parts to slide against one another without too much friction. The humeral head of the shoulder (the ball portion) has several blood vessels that enter around the base of the articular cartilage (the smooth surface that covers the bone surface). Certain types of fractures of the shoulder can injure these blood vessels, leading to a condition where the ball no longer has any blood supply. This can lead to a collapse of the joint surface even if the fracture heals. Over time, this can result in arthritis of the joint. This condition is called aseptic necrosis of the humeral head. In some cases, when such fractures occur, your doctor may recommend a shoulder replacement rather than try to fix the broken bones. The risk of developing avascular necrosis is so high that it makes more sense to go ahead and replace the humeral head immediately. Otherwise, if the fracture was fixed and aseptic necrosis resulted, you would need a second operation to replace the shoulder. V1 021

Causes of Shoulder Arthritis
Osteoarthritis or wear and tear Repeated dislocations or fractures Rheumatoid arthritis “Causes of Shoulder Arthritis ”. DePuy Orthopaedics, Inc. 2 April, Full Text Article The most common cause leading to a shoulder replacement is osteoarthritis, or wear and tear arthritis. Osteoarthritis can occur without any injury to the shoulder, but it is uncommon. This is in large part because the shoulder is not a weight-bearing joint. Wear and tear arthritis is more common in the hip and knee. More commonly, osteoarthritis occurs many years after an injury to the shoulder. A shoulder dislocation can result in instability of the shoulder that leads to chronic instability. Repeated dislocations over many years damage the joint leading to arthritis. Some fractures of the shoulder can also lead to arthritis. The problem with aseptic necrosis described above can also lead to osteoarthritis. Other types of arthritis affect the shoulder joint as well. Systemic diseases, such as rheumatoid arthritis, affect all the joints of the body. The result is much the same as osteoarthritis, making the shoulder painful and difficult to use due to the pain. V1 022

Diagnosing Shoulder Arthritis
Physical examination Medical history review X-Rays Arthrogram MRI Blood tests “Diagnosing Arthritis of the Shoulder ”. DePuy Orthopaedics, Inc. 2 April, Full Text Article The diagnosis of osteoarthritis of the shoulder begins with a complete history of the problem, followed by a physical examination of the shoulder. Your doctor will ask you about old injuries of the shoulder. He will ask about any other medical conditions and surgical conditions. A physical examination will be performed to try and determine how much strength and motion you have in the shoulder. Your doctor may look at other joints for other signs of systemic arthritis. X-rays of the shoulder will be necessary to make the diagnosis of osteoarthritis. X-rays will show the degree of changes in the bones of the shoulder and give some idea as to how much wear and tear is present. If your doctor is concerned that you also have a rotator cuff tendon tear, he may also suggest either an arthrogram or a MRI scan of the shoulder. An arthrogram is a test where a special dye is injected into the shoulder joint. X-rays are taken to see if the dye leaks out of the shoulder joint. If it does, then a tear of the rotator cuff tendon is present. The MRI scan can also be used to actually look at the rotator cuff tendons and determine whether or not they are torn. An MRI scan is a special radiological test where magnetic waves are used to create pictures that look like slices of the shoulder. The MRI scan shows more than the bones of the shoulder. It can show the tendons as well, and whether there has been a tear in those tendons. The MRI scan is painless, and requires no needles or dye to be injected. V1 023

Shoulder Arthritis Treatment: Non-Surgical
Anti-inflammatory medicine Analgesics Injections Rest Activity Modification Light exercise and stretching “Treating Arthritis of the Shoulder”. DePuy Orthopaedics, Inc. 2 April, Full Text Article An artificial shoulder replacement is not the only treatment available for osteoarthritis of the shoulder. Once the diagnosis is made, your doctor may suggest several treatments to ease your pain and delay the artificial shoulder replacement. Like any arthritic condition, osteoarthritis of the shoulder may respond to anti-inflammatory medications such as aspirin or ibuprofen. The pain may also respond to acetaminophen (Tylenol® Arthritis Extended Relief). Orthopaedic surgeons are using some of the newer medications such as glucosamine and chondroitin sulfate more commonly today. These medications seem to be effective in helping reduce the pain in osteoarthritis of all joints. There are also new injectable medications that lubricate the arthritic joint. These medications have been studied mainly in the knee. It is unclear if they will help the arthritic shoulder. Physical therapy may be suggested to regain as much of the motion in the joint and strength in the shoulder muscles as possible before undergoing a shoulder replacement. An injection of cortisone into the shoulder joint may give temporary relief. Cortisone is a powerful anti-inflammatory medication that can ease the inflammation and reduce the pain, possibly for several months. Most surgeons will limit the number of cortisone shots in any joint to two or three. If the shots fail to provide any lasting relief for several weeks to several months, your doctor may suggest considering something more permanent, like surgery to replace the shoulder. V1 024

Shoulder Arthritis Treatment: Surgical
Synovectomy Arthroscopy Shoulder replacement surgery Soft Tissue Repair “Arthritis and Yours Joints: Shoulder ”. DePuy Orthopaedics, Inc. 2 April, V1 025

Elbow V1 026

Elbow Anatomy Elbow is a hinged joint.
Composed of the humeral bone of the upper arm and the radial and ulnar bones of the forearm. “Anatomy of the Elbow ”. DePuy Orthopaedics, Inc. 2 April, Full Text Article The elbow joint is a hinge. The joint surface is covered by articular cartilage that protects and cushions the joints. The large muscle in the back of the arm, the triceps, attaches to the point of the ulna (called the olecranon). When this muscle contracts, it straightens out the elbow. The biceps muscle in the front of the arm, when contracted, bends the elbow. The elbow joint is made up of the humerus (the upper arm bone) and the ulna and radius bones of the forearm. The ulna forms the part of the joint that allows the hinge motion of the elbow. Part of the radius bone of the forearm (the head of the radius) sits against the humerus and turns to allow the forearm to turn. This motion is called pronation and supination. Pronation is the motion where you turn your palm down and supination is when you turn your palm up. V1 027

Causes of Elbow Arthritis
Injury to the elbow (bad sprain or fracture). Excessive pressure on cartilage surface. “Causes of Arthritis of the Elbow ”. DePuy Orthopaedics, Inc. 2 April, Full Text Article The term degenerative joint disease describes a wearing out of the joint over a period of many years. Injury to a joint, such as a bad sprain or fracture, can damage the articular cartilage. Excessive pressure on the cartilage surface of a joint can also damage the cartilage. If you look at the surface it may not appear to be any different since injury to the cartilage doesn't appear until months later. Sometimes the cartilage surface is severely damaged, ripping cartilage pieces from the bone that must be removed from the joint surgically so they don’t cause the joint to catch and cause additional cartilage damage. Torn or fractured pieces of cartilage do not normally grow back. The defects are filled with scar tissue that is not nearly as good a material for covering joint surfaces as the cartilage it replaces. An elbow joint injury can alter how the joint works even if it does not injure the articular cartilage directly. When an injury changes the way the elbow joint moves, forces on the articular cartilage surfaces may be increased. Like any mechanical device, if the mechanism is out of balance it wears out faster. Over many years an imbalance in the joint mechanics can lead to damage. When the joint becomes unable to compensate for the increasing damage, it begins to hurt. V1 028

Diagnosing Elbow Arthritis
Physical examination Medical history review X-Rays Appropriate blood tests “Diagnosis of Arthritis of the Elbow ”. DePuy Orthopaedics, Inc. 2 April, Full Text Article Diagnosing degenerative elbow arthritis begins by telling your doctor details about injuries to your elbow joint, especially any previous dislocation. "Throwing athletes", especially baseball pitchers, may be at higher risk of developing osteoarthritis of the elbow in later years. Following the history, a physical examination of the elbow joint (and possibly other joints in the body) will be done to see how the motion of the elbow joint has been affected. Catching sensations could suggest loose fragments of cartilage and bone. X-rays will show how much the joint is damaged and how much articular cartilage is left in the elbow joint. V1 029

Elbow Arthritis Treatment: Non-Surgical
Anti-inflammatory medications Cortisone Injections “Treating Arthritis of the Elbow ”. DePuy Orthopaedics, Inc. 2 April, Full Text Article Degenerative elbow arthritis treatment can be divided into the non-surgical means to control the symptoms and the surgical procedures available to treat the condition. Surgery is usually not considered until it has become impossible to control the symptoms with non-surgical treatments. Treatment usually begins when the elbow first becomes painful. Often pain only occurs with heavy use and may simply require mild anti-inflammatory medications such as aspirin, Tylenol® or Motrin®. Reducing activity or discontinuing heavy repetitive use of the arm may be necessary to help control the symptoms. An injection of cortisone into the joint may give temporary relief. Cortisone is a powerful anti-inflammatory medication. Pain relief is temporary and usually lasts several weeks to months. There is a small risk of infection with cortisone injections. V1 030

Elbow Arthritis Treatment: Surgical
Arthroscopic debridement Elbow fusion surgery Fascial reconstruction Synovectomy Elbow replacement surgery “Arthritis and Your Joints: Elbow ”. DePuy Orthopaedics, Inc. 2 April, V1 031

Wrist V1 032

Wrist Anatomy Complicated collection of many joints and bones.
Extremely mobile “Anatomy of the Wrist ”. DePuy Orthopaedics, Inc. 2 April, Full Text Article The wrist is a collection of many joints and bones with one main purpose; to allow you to use your hands. The wrist has to be extremely mobile. At the same time, it has to provide the strength for gripping. The wrist comprises eight separate small bones called the carpal bones. These bones connect the two bones of the forearm, called the radius and the ulna, to the bones of the hand and fingers. The metacarpal bones are the long bones that lie mostly underneath the palm, and they are in turn attached to the phalanges; the bones in the fingers and thumb. The wrist is complicated because every small bone forms a joint with its neighbor. Ligaments connect all the small bones to each other, and to the radius, ulna and metacarpal bones. A wrist injury, such as falling on the outstretched hand, can damage these ligaments and change the way the bones of the wrist work together. Hand surgeons are just beginning to realize how many ways the wrist can be injured. Some injuries seem to be no more that a simple sprain of the wrist when the injury occurs, but problems can develop years later. The joints are covered with articular cartilage that cushions the joints. A more serious injury, such as a fracture of one or several bones of the wrist, can injure the articular cartilage surfaces of the joints and lead to “degenerative” arthritis. V1 033

Causes of Wrist Arthritis
Wear and tear Injury (sprain or fracture) Too much pressure on articular cartilage “Causes of Arthritis of the Wrist ”. DePuy Orthopaedics, Inc. 2 April, Full Text Article The term arthritis means inflammation of a joint. Degenerative arthritis refers to inflammation of a joint due to wear and tear. Injury to the wrist, such as a bad sprain or fracture, can cause damage to the articular cartilage. The cartilage can also be damaged when too much pressure is exerted on the cartilage surface of a joint causing “bruising”. Initially the surface may not appear to be any different since injury to the tissue doesn't show up until months later. Sometimes the cartilage surface is damaged even more severely, and pieces of the cartilage are ripped from the bone. These pieces do not heal and usually must be removed surgically. If not, they may float around in the joint, causing the joint to “catch” and be painful. These fragments of cartilage may also do more damage to the joint surface. When cartilage is torn or fractured, the damaged areas do not normally grow back. Instead, the defects fill with scar tissue that is not nearly as good a material for covering joint surfaces as the cartilage it replaces. Even if it does not injure the cartilage directly, a wrist injury can alter how the joint works. This is true for a wrist fracture where the bone fragments heal slightly different from the way they were before the break occurred. It is also true when ligaments of the wrist are damaged and cause instability in the joint. When an injury results in a change in the way the joint moves, forces on the cartilage may increase. This is very similar to any mechanical device. If a mechanism is out of balance, it wears out faster. Over many years, imbalance in the joint mechanics can lead to damaged cartilage. Since cartilage cannot heal itself, the joint is no longer able to compensate for the increasing damage and it begins to hurt. V1 034

Diagnosing Wrist Arthritis
Physical examination Medical history review X-Rays Blood tests “Diagnosis of Arthritis of the Wrist ”. DePuy Orthopaedics, Inc. 2 April, Full Text Article Diagnosing degenerative arthritis of the wrist begins with a patient history. Details about any previous injuries to the wrist joint are important to understanding why the condition exists. In addition, a physical examination of the wrist joint, and possibly other joints in the body, will be done. It will be important for your doctor to see how the motion of the wrist joint has been affected. The alignment of the wrist joint will also be assessed. X-rays will be taken to assess the damaged joint. This test to determine how bad the degenerative arthritis has become is usually the most important. The amount of cartilage remaining in the wrist joint can be estimated with the x-rays. If there is any question whether the arthritis may by caused by something other than degenerative arthritis, blood tests may be ordered to look for systemic diseases, such as rheumatoid arthritis. A needle may be inserted into the joint to remove some of the joint fluid to check for crystals from gouty arthritis or for signs of infection. Gout is a disease that leads to a chemical imbalance causing crystals to form in the joint fluid. The crystals cause an inflammation of the joint, a true arthritis. V1 035

Wrist Arthritis Treatment: Non-Surgical
Anti-inflammatory medicine Injections Reducing activity or avoiding heavy repetitive use of the hand and wrist. Braces may give extra support and reduce pain “Treating Arthritis of the Wrist ”. DePuy Orthopaedics, Inc. 2 April, Full Text Article The treatment of degenerative arthritis of the wrist can be divided into the non-surgical means to control the symptoms and the surgical procedures to treat the condition. Surgery is usually not considered until it has become impossible to control the symptoms with non-surgical treatment methods. Treatment usually begins when the wrist first becomes painful. This may only occur with heavy use and may simply require mild anti-inflammatory medications such as aspirin, Tylenol® or Motrin®. Reducing the activity, or avoiding heavy repetitive use of the hand and wrist, may be necessary to help control the symptoms. Braces that support the wrist joint may reduce the pain. Cortisone is a very powerful anti-inflammatory medication. When injected into the joint, cortisone can help relieve the pain. Pain relief is temporary and usually only lasts several weeks to months. There is a small risk of infection with cortisone injections. V1 036

Wrist Arthritis Treatment: Surgical
Wrist joint fusion Synovectomy Wrist replacement “Arthritis and Your Joints: Wrist ”. DePuy Orthopaedics, Inc. 2 April, V1 037

Finger V1 038

Finger Joint Healthy finger joint Arthritic finger joint V1 039

Anatomy of Finger Joint
Each finger has 3 bones and 3 joints “Anatomy of the Finger ”. DePuy Orthopaedics, Inc. 2 April, Full Text Article There are three bones in each finger called the proximal phalanx, the middle phalanx and the distal phalanx. Each finger has three joints. The first joint is where the finger joins the hand. This joint is where the bones that form the palm of the hand, the metacarpals, join with the first bone of the finger, called the proximal phalanx. The second joint is the proximal interphalangeal joint, sometimes called the PIP joint for short. The last joint of the finger is called the distal interphalangeal joint, or DIP. Each of these joints is covered with articular cartilage. Articular cartilage is the smooth spongy material that covers the end of bones that make up a joint. The cartilage allows the bones to slide easily against one another as the joint moves through its range of motion. V1 040

Causes of Finger Arthritis
Wear and tear Rheumatoid arthritis “Causes of Arthritis of the Finger ”. DePuy Orthopaedics, Inc. 2 April, Full Text Article When you stop to think about how much you use your hands, it’s easy to see why the joints of the fingers are so important. Arthritic finger joints can lead to difficulty in daily activities due to pain and deformity, which may require surgical treatment as the arthritis progresses. The term degenerative arthritis describes a condition where a joint wears out, usually over a period of many years. Degenerative arthritis means deterioration of a joint due to wear and tear. You may also hear the term degenerative arthrosis used. Some doctors believe that degenerative arthritis isn't a true arthritis, and the term can cause confusion. These doctors use the term arthrosis to describe the condition of a worn-out joint; they use the term arthritis to describe the true inflammatory conditions such as gout, infection and rheumatoid arthritis. Joints are protected by special material called “articular cartilage.” Injury to a joint, such as a bad sprain or fracture, can damage the cartilage. An injury to any of the joints of the fingers -- even if it does not injure the cartilage directly -- can alter how the joint works. This is true for a fracture that involves the joint where the bone fragments don't quite "line up" correctly and heal slightly different from the way they were before the break occurred. This is very similar to machinery. If a mechanism is out of balance, it wears out faster. Over the years this imbalance in the joint mechanics can lead to damage of the cartilage. Since articular cartilage cannot heal itself very well, the damage adds up. Finally, the joint is no longer able to compensate for the increasing damage, and it begins to hurt. The damage occurs well before the pain begins. V1 041

Diagnosing Finger Arthritis
Physical examination Medical history review X-Rays “Diagnosis of Arthritis of the Finger ”. DePuy Orthopaedics, Inc. 2 April, Full Text Article The diagnosis of arthritis of the finger joints begins with a history of the problem. Details about any injuries that may have occurred to the hand are important and may suggest other reasons why the condition exists. Following the history, a physical examination of the hand, and possibly other joints in the body, will be done. It will be important for your doctor to see how the motion of each joint has been affected. X-rays will be taken to see how much of the joint is damaged. This is usually the most important test to determine the severity of the degenerative arthritis. The amount of articular cartilage left in the joint can be estimated using x-rays. V1 042

Finger Arthritis Treatment: Non-Surgical
Anti-inflammatory medicine Reducing activity or avoiding heavy repetitive use of the hand and wrist. “Treating Arthritis of the Finger ”. DePuy Orthopaedics, Inc. 2 April, Full Text Article The treatment of degenerative arthritis of the finger joints can be divided into the non-surgical means to control the symptoms, and surgical procedures to treat the condition. Surgery is usually not considered until it has become impossible to control the symptoms with non-surgical treatments. Treatment usually begins when the joint first becomes painful. This may only occur with heavy use and may simply require mild anti-inflammatory medications such as aspirin, Tylenol® or Motrin®. Reducing activity, or choosing occupations that don't require repetitive gripping with the hand, may be necessary to help control the symptoms. V1 043

Finger Arthritis Treatment: Surgical
Finger joint fusion Excisional arthroplasty Finger joint replacement “Arthritis and Your Joints: Finger ”. DePuy Orthopaedics, Inc. 2 April, V1 044

Hip V1 045

Hip Joint Healthy hip joint Arthritic hip joint V1 046

Anatomy of the Hip Ball and socket joint
“Anatomy of the Hip ”. DePuy Orthopaedics, Inc. 2 April, Full Text Article A painful hip can severely affect your ability to lead a full and active life. Over the last twenty five years, major advancements in hip replacement have improved the outcome of this very common surgery greatly. The hip joint is one of the true ball and socket joints of the body. The hip socket is called the acetabulum and actually forms a deep cup that surrounds the ball of the upper thigh bone or femoral head. The hip is surrounded by the thick muscles of the buttock at the back and the thick muscles of the thigh in the front. The surface of the femoral head and the inside of the acetabulum are covered with articular cartilage. This material is about 1/4 of an inch thick in most large joints. The articular cartilage surface is a tough, very slick material that allows the surfaces to slide against one another without damage to either surface. V1 047

Causes of Hip Arthritis
Wear and tear Avascular necrosis Abnormalities in the joint from fractures and congenital abnormalities “Causes of Arthritis of the Hip ”. DePuy Orthopaedics, Inc. 2 April, Full Text Article There are many conditions that can result in degeneration of the hip joint. Osteoarthritis is perhaps the most common reason that patients need to undergo hip replacement surgery. This condition is commonly referred to as "wear and tear arthritis." Osteoarthritis can occur with no previous history of injury to the hip joint. The hip simply "wears out." There may be a genetic tendency in some people that increases their chances of developing osteoarthritis. Avascular necrosis is another cause of hip joint degeneration. In this condition, the femoral head (the ball portion) loses a portion of its blood supply and actually dies. This leads to collapse of the femoral head and degeneration of the joint. Avascular necrosis (AVN) has been linked to alcoholism, fractures and dislocations of the hip, and long-term cortisone treatment for other diseases. Abnormalities of hip joint function resulting from fractures of the hip and some types of hip conditions that appear in childhood can lead to degeneration many years after the injury. The mechanical abnormality leads to excessive wear and tear, much like the out-of-balance tire that wears out too soon on your car. V1 048

Diagnosing Hip Arthritis
Physical examination and history MRI X-Rays Blood tests “Diagnosis of Arthritis of the Hip ”. DePuy Orthopaedics, Inc. 2 April, Full Text Article The diagnosis of a degenerative hip starts with a complete history and physical examination by your doctor. X-rays will be required to determine the extent of the degenerative process and suggest a cause for the degeneration. Other tests may be required if there is reason to believe that other conditions are contributing to the degenerative process. MRI scanning may be necessary to determine whether avascular necrosis is causing your hip condition. Blood tests may be required to rule out systemic arthritis or infection in the hip. V1 049

Hip Arthritis Treatment: Non-Surgical
Anti-inflammatory medications Weight control Rest and activity modification “Treating Arthritis of the Hip ”. DePuy Orthopaedics, Inc. 2 April, Full Text Article Not all hip conditions require a hip replacement as the initial treatment. Your doctor may suggest several alternative treatments to put off the decision for replacing the hip as long as possible. Using a cane may help alleviate some of your pain and allow you to walk more comfortably. Anti-inflammatory medications may reduce the inflammation from the arthritis and reduce your pain. The pain may also respond to acetaminophen (Tylenol® Arthritis Extended Relief). V1 050

Hip Arthritis Treatment: Surgical
Osteotomy Hip replacement surgery “Arthritis and Your Joints: Hip ”. DePuy Orthopaedics, Inc. 2 April, V1 051

Knee V1 052

Knee Joint Healthy knee joint Arthritic knee joint V1 053

Anatomy of the Knee The knee is made up of three bones: the femur (thigh bone), the tibia (lower leg bone) and the patella (kneecap). “Anatomy of the Knee ”. DePuy Orthopaedics, Inc. 2 April, Full Text Article A painful knee can severely affect your ability to lead a full active life. Over the last twenty five years, major advancements in artificial knee replacement have improved the outcome of the surgery greatly. Artificial knee replacement surgery is becoming more and more common. The knee is made up of three bones: the femur (thigh bone), the tibia (lower leg bone) and the patella (kneecap). V1 054

Causes of Knee Arthritis
Wear and tear Fractures, torn cartilage and torn ligaments “Causes of Arthritis of the Knee ”. DePuy Orthopaedics, Inc. 2 April, Full Text Article There are many conditions that can result in degeneration of the knee joint. Osteoarthritis is the most common reason that patients need to undergo knee replacement surgery. This condition is commonly referred to as "wear and tear arthritis." Osteoarthritis can occur with no previous history of injury to the knee joint - the knee simply "wears out." There may be a genetic tendency in some people that increases their chances of developing osteoarthritis. The major problem in osteoarthritis is that the cartilage (the articular cartilage) on the surface of the bone inside the joint wears away. This results in bone rubbing against bone since the slick protective surface of the articular cartilage is absent. This causes pain. Abnormalities of knee joint function resulting from fractures of the knee, torn cartilage and torn ligaments can lead to degeneration many years after the injury. The mechanical abnormality leads to excessive wear and tear - just like the out-of-balance tire that wears out too soon on your car. V1 055

Diagnosing Knee Arthritis
Physical examination Medical history review X-Rays Blood tests Aspiration “Diagnosis of Arthritis of the Knee ”. DePuy Orthopaedics, Inc. 2 April, Full Text Article The diagnosis of a degenerative knee starts with a complete history and physical examination by your doctor. He will ask about any other medical conditions and surgical conditions. X-rays will be required to determine the extent of the degenerative process and may suggest a cause for the degeneration. Other tests may be required if there is reason to believe that other conditions are contributing to the degenerative process. Blood tests may be required to rule out systemic arthritis (such as rheumatoid arthritis) or infection in the knee. V1 056

Knee Arthritis Treatment: Non-Surgical
Anti-inflammatory medications Injections Weight control Orthotics Assistive devices (Cane, etc) “Arthritis and your Joints: Knee”. DePuy Orthopaedics, Inc. 2 April, Full Text Article V1 057

Knee Arthritis Treatment: Surgical
Synovectomy Tibial osteotomy Knee replacement “Arthritis and Your Joints: Knee ”. DePuy Orthopaedics, Inc. 2 April, V1 058

Ankle V1 059

Anatomy of the Ankle Hinge Joint
Made up of 3 bones: the lower end of the tibia (shinbone), the fibula (the small bone of the lower leg) and the talus, the bone that fits into the socket formed by the tibia and the fibula. “Anatomy of the Ankle ”. DePuy Orthopaedics, Inc. 2 April, Full Text Article The ankle joint is made up of three bones: the lower end of the tibia (shinbone), the fibula (the small bone of the lower leg) and the talus, the bone that fits into the socket formed by the tibia and the fibula. The talus sits on top of the calcaneus (the heel bone). The talus moves mainly in one direction. It works like a hinge to allow your foot to move up (dorsiflexion) and down (plantarflexion). There are ligaments on both sides of the ankle joint that hold the bones together. There are many tendons that cross the ankle to move the ankle and move the toes. Ligaments connect bones to bones while tendons connect muscles to bones. The large Achilles tendon in the back of the ankle is the most powerful tendon in the foot. It connects the calf muscles to the heel bone and gives the foot the power to walk, run and jump. Inside the joint, the bones are covered with a slick, smooth material that is called articular cartilage. Articular cartilage is the material that allows the bones to move against one another in the joints of the body. The cartilage lining is about 1/4 inch thick in most weight-bearing joints such as the ankle, hip or knee. It is soft enough to allow for shock absorption but tough enough to last a lifetime--as long as it is not injured. Osteoarthritis, sometimes called degenerative arthritis, is a disease that involves the breakdown of the tissue (cartilage) that normally allows the joint to move smoothly. When the gliding surface of the cartilage is gone, the bones grind against each other, creating popping sounds, pain and loss of normal ankle movement. This condition occurs primarily in people over 50. Rheumatoid arthritis is considered a systemic disease because it can attack any or all joints of the body. It affects women more often than men and can strike both young and old. Rheumatoid arthritis causes the body's immune system to produce a chemical that attacks and destroys the protective cartilage that covers the joint surface, causing deterioration. Trauma-related arthritis results when the joint is injured either by fracture, dislocation or damage to the ligaments surrounding the joint. This resulting damage predisposes the joint to traumatic arthritis. V1 060

Causes of Ankle Arthritis
Wear and tear Injury “Osteoarthritis of the Ankle ”. DePuy Orthopaedics, Inc. 2 April, Full Text Article The ankle joint is a commonly injured joint in the body. While ankle fractures and ankle sprains heal pretty well, they can lead to problems much later in life. This is due to the wear and tear that occurs for years after the injury. This condition is called osteoarthritis, or post-traumatic arthritis. The term "trauma" means injury, and the term post-traumatic arthritis is used to describe the condition of the arthritis after injury. Degeneration is a term that describes a condition where something wears out over time. Osteoarthritis is usually considered a type of degenerative arthritis, or wear and tear arthritis. Doctors usually consider osteoarthritis pretty much the same whether it appears years after an injury to the joint or whether it simply appears without any history of injury. Over the past several years, there has been increasing evidence that osteoarthritis is genetic, meaning that it runs in families. Research suggests that osteoarthritis that occurs without any injury may be related to differences in the chemical makeup of the articular cartilage with which people are born. Injury to a joint, such as a bad sprain or fracture, can cause actual damage to the articular cartilage. The cartilage can be damaged by "bruising" when too much pressure is exerted on the cartilage surface of a joint. This damages the cartilage, although if you look at the surface it may not appear to be any different. The injury to the material doesn't show up until months later. Sometimes the cartilage surface is damaged even more severely and pieces of the cartilage are ripped from the bone. These pieces do not heal back and usually must be removed from the joint surgically. If not, they may float around in the joint causing the joint to catch and be painful. These fragments of cartilage may also do more damage to the joint surface. The areas where these pieces of cartilage are ripped from do not normally grow back. Unlike bone, the holes in the surface are not simply replaced by the cartilage tissue around the hole. Instead the defects are filled with scar tissue. The scar tissue that forms is not nearly as good a material for covering joint surfaces as the cartilage it replaces. It just can't support weight bearing like true articular cartilage. An injury to a joint, even if it does not injure the articular cartilage directly, can alter how the joint works. This is true for a fracture where the bone fragments heal slightly different from the way they were before the break occurred. It is also true that when ligaments are damaged it leads to instability in the joint. When an injury results in a change in the way the joint moves, the injury may increase the forces on the articular cartilage. This is very similar to any mechanical device or machinery. If the mechanism is out of balance, it wears out faster. Over many years this imbalance in the joint mechanics can lead to damage to the articular surface. Since articular cartilage cannot heal itself very well, the damage adds up. Finally, the joint is no longer able to compensate for the increasing damage and it begins to hurt. The damage is occurring well before the pain begins. Degenerative arthritis may come from differences in how each of us is put together based on our genes; a condition best described as osteoarthritis. Or degenerative arthritis may come years after an injury has occurred that leads to slow damage to the joint surfaces; a condition probably best described as post- traumatic arthritis. Either way the joint is worn out - and it hurts. V1 061

Diagnosing Ankle Arthritis
Physical examination Medical history review X-Rays “Diagnosis of Osteoarthritis of the Ankle ”. DePuy Orthopaedics, Inc. 2 April, Full Text Article When conservative measures of treatment fail to provide adequate relief, either an ankle fusion or ankle arthroplasty may be considered. Ankle fusion has been the traditional method of treating arthritis of the ankle. However, due to the detrimental long-term effects ankle fusion has on the other joints in the foot, ankle replacement surgery may be a better alternative. Your orthopaedic surgeon will evaluate your ankle, determining the type of arthritis you have and other factors important in deciding whether or not an ankle arthroplasty can be expected to be successful. In the process of the examination, not only will the motion of your ankle be measured, but also fluid may be taken from the joint to determine if infection is present. X-rays will also be taken to assess the size and condition of your ankle. The ankle joint, in the process of wearing out, can either settle with the foot turned in or turned out. Most deformities can be corrected at the time of surgery, but the primary purpose of ankle replacement surgery is to relieve pain. Motion can be gained following replacement surgery, but this is somewhat dependent on the amount of stiffness before surgery and the length of time the joint was stiff. Postoperatively, therapy is important and may be started soon after surgery, based on the advice of your surgeon. V1 062

Ankle Arthritis Treatment: Non-Surgical
Anti-inflammatory medications Physical therapy, including heat, ultrasound, phoresis, massage, and electrical stimulation Joint protection Topical agents Exercise Weight control “Treating Arthritis of the Ankle ”. DePuy Orthopaedics, Inc. 2 April, Full Text Article Your First Visit to Physical Therapy On your first visit, your physical therapist will want to gather some more information about the history of your ankle problem. You may be given a questionnaire that helps you tell about the day-to-day problems you are having with your ankle. The information you give will help measure the success of your treatment. You may also be asked to rate your pain on a scale of one to ten. This will help your physical therapist gauge how much pain you have now and how your pain changes once you've had treatment. Your physical therapist will probably ask some more questions about your ankle problem to begin zeroing in on the source and location of your pain and to know what will be needed to help relieve it. Here are some questions your physical therapist may ask you: How long have you had ankle pain? Where do you feel the pain? What makes the pain better or worse? How do your symptoms affect your daily activities? Do you have pain in your lower leg, knee, or hip? Does your ankle swell? Does your ankle ever feel like it's going to give out? Do you have any numbness or tingling? Physical Therapy Evaluation Once all this information has been gathered, your condition will be evaluated. Posture: Your physical therapist will begin by checking your overall posture, including your foot and leg alignment. Imbalances in the position of your foot and leg can put extra pressure on your ankle. If alignment is a problem, your therapist may take some measurements to see if a special shoe insert, or orthotic, will be needed to take away the pressure and pain. Observation: Your therapist will note if there is any swelling in or around the ankle joint. If so, measurements will be taken to get an idea of how much swelling is present. Volumetric testing is done by placing your foot and lower leg in a container of water and measuring how much water is displaced. The results of each ankle and leg are compared. Another way to measure swelling is to use a tape measure and compare several measurements around one ankle and then the other. These measurements can be rechecked later on to get an idea if the swelling is going away. Gait analysis: By watching you walk back and forth, your therapist can see if how you walk may be linked with your condition. Even subtle changes in your stride, foot and knee position, or hip movement can create problems like ITB syndrome. Range of motion (ROM): Next, your physical therapist will check the ROM in your ankle. This is a measurement of how far you can move your ankle in different directions. Ankle movements include bending the ankle up and down (dorsiflexion/plantarflexion) as well as in and out (inversion/eversion). Your therapist may also want to get an idea of how other joints around the ankle are moving, including the lower leg, knee, and possibly even your hip. Your ROM is written down to compare how much improvement you are making with the treatments. Strength: Your therapist will then test the strength of your muscles. You'll be asked to hold against resistance as your therapist tests the muscles around the ankle. Other areas that may be checked include the muscles of the knee and hip. These measurements are compared to your other leg. Weakness in key muscles of the leg or ankle will be addressed with a strengthening program. Trained muscles can help control your sore ankle, which eases pain and keeps the joint healthy for as long as possible. Manual Examination: You may be given a manual examination of the muscles and joints of the ankle. Your physical therapist will carefully move your ankle in different positions to make sure that the joints are moving smoothly. This will help guide treatment to the areas that are tight (called a hypomobility) or where the joint may have been injured and is moving too much (called a hypermobility). Your physical therapist will also look at the flexibility of the muscles and tendons around your ankle. This type of exam can help guide your therapist to know where your soreness is coming from and which type of treatment will help you the most. Palpation: The evaluation usually ends with palpation. Palpation is when your physical therapist feels the soft tissues around the joint. This is done to check the skin for changes in temperature, areas of soreness, and whether you have swelling. Palpation is also done to find whether there are tender points or spasm in the muscles around the ankle. This can help your therapist get a good idea about which treatments will help you the most. Treatment Plan: Once the examination is done, your therapist will put together a treatment plan. The treatment plan lists the types of treatments that will be used for your condition. It gives an indication of how many visits you will need and how long you may need therapy. The plan also lists the goals that you and your therapist think will be the most helpful for getting your activities done safely and with the least amount of soreness. Finally, it will include a prognosis, which is how your therapist feels the treatment will help you improve. Physical Therapy Treatment Your therapist may choose from one or more of the following tools, or modalities, to help control the symptoms caused by ankle osteoarthritis: Heat: Heat makes blood vessels get larger, called vasodilation. This action helps to flush away chemicals that are making your ankle hurt. It also helps to bring in nutrients and oxygen which help the area heal. True heat in the form of a moist hot pack, a heating pad, or warm water whirlpool or bath is more beneficial than creams that merely give the feeling of heat. Hot packs are usually placed on the sore area for 15 to 20 minutes. Special care must be taken to make sure your skin doesn't overheat and burn. It's also not a good idea to sleep with an electric hot pad at night. Ultrasound: An ultrasound machine produces high frequency sound waves that are directed toward the sore area. Passing through the body's tissues, these waves vibrate molecules. This causes friction and warmth as the sound passes through the tissue. The rest of the sound changes to heat in the deeper tissues of the body. This heating effect helps flush the sore area and brings in a new supply of nutrient and oxygen-rich blood. Ultrasound treatments are a way for your therapist to reach tissues that are over two inches below the surface of your skin. Phoresis: This means to "carry or transmit." There are two methods that therapists can use to transmit substances across the skin. Phonophoresis uses the high frequency sound waves of ultrasound to "push" a steroid medication (cortisone) through the skin. Iontophoresis uses a small machine that produces a mild electrical charge, which is used to carry medicine, usually a steroid, through the skin. The steroid is a very strong anti-inflammatory medication that actually stops the pain-causing chemical reaction within the cells of the sore tissue in your body. Either type of phoresis may be used in place of a cortisone injection. Electrical Stimulation: This treatment stimulates nerves by sending an electrical current gently through your skin. Some people say it feels like a massage on their skin. Electrical stimulation can ease pain by sending impulses that are felt instead of pain. This procedure is based on the Gate Theory which says that when you feel a sensation other than pain, like rubbing, massage, or even a mild electrical impulse, your spinal column will actually "close the gate" and not let pain impulses pass to the brain. In the case of electrical stimulation, the electrical impulses speed their way across the skin and on to the central nervous system much faster than pain. By getting there first, the electrical information "closes the gate" to pain, blocking its passage to the brain. Once the pain eases, muscles that are in spasm begin to relax, letting you move and exercise with less discomfort. Other settings on the machine can be used to help your body release endorphins. These are natural chemicals formed within your body that behave like a strong drug in reducing the perception of pain for up to eight hours at a time. Soft Tissue Mobilization/Massage: Physical therapists are trained in many different forms of massage and mobilization when treating the neck. Massage has been shown to calm pain and spasm by helping muscles relax, by bringing in a fresh supply of oxygen and nutrient-rich blood, and by flushing the area of chemical irritants that come from inflammation. Soft tissue treatments can help tight muscles relax, getting them back to a normal length. This will help you begin to move with less pain and greater ease. Joint Mobilization: These are graded pressures and movements that are done by skilled physical therapists. Gentle graded pressures help lubricate joint surfaces, easing stiffness and helping you begin moving with less pain. Pain that is left unchecked can quickly escalate to an uncomfortable "cycle of pain and muscle guarding." In other words, the pain can make your muscles go into spasm, in which your muscles try to guard the sore joints, keeping you from wanting to move your ankle at all. When movement stops, your brain gets an uninterupted flow of pain sensation. Ouch! This leads to a cycle of even more muscle spasm and pain because your muscles try to "protect" you from painful movement. By applying gentle pressures, or mobilizations, your therapist will begin to halt the flow of pain information, which helps muscles relax. Once your muscles begin to relax, you will begin to feel other sensations than pain. As your pain eases, more vigorous grades of mobilization may be used to lengthen tissues around the joint helping restore better movement in your ankle. Topical Agents: Certain topical ointments (such as Capsaicin®) have been shown to ease pain by blocking chemicals that cause pain. Improving Range of Motion: When movement of a joint is limited, pain and other problems may worsen. Improving ankle movement can help keep the joint surfaces healthy, while helping to control soreness. Getting more motion can give you the relief you need to do your day-to-day activities. If you don't have full range of motion, your therapist has several ways to get more movement in the ankle. Your therapist can use graded joint mobilization, manual stretching, and select exercises. Active movement and stretching either as part of a home or pool therapy program can also be helpful. Strengthening: In the early stages, strengthening may be done by using isometric exercise. These are exercises where the muscles around the joint are worked, but the joint stays in one position. Isometrics help restore strength while protecting you from further pain and irritation. As your muscles gain strength, you may notice less pain while experiencing a sense of ease with walking and other activities. Joint Protection: These are ways to give your joint the edge it needs to stay healthy for as long as possible: Muscular Control: Sometimes the ankle gets an extra jolt when you suddenly miss a stair or stub your toe. Untrained leg muscles are slow to respond in protecting the ankle joint, and these jolting forces can do more damage to the softer bone under the cartilage. A trained muscle will generate force quickly. Conditioning exercises help ankle and leg muscles generate forces more quickly, preparing them to act as shock absorbers to protect your ankle joint. Shock Absorption: A good pair of shoes will also help reduce shock. If walking is one of your primary exercises, choose a soft walking surface like cinder or grass. Avoid cemented or other hard surfaces. Limit your walking speed, especially if you find that increasing your walking speed irritates your ankle pain. Other types of exercise that prevent high impact on your joints include stationary biking and swimming. Walking Aids: In cases of severe pain or joint wear and tear, you may need to use a cane or walker until your condition is stabilized. Using a walking aid can take some of the pressure off the ankle joint, protecting it from undue stress and strain. Alignment: When the leg and ankle are not properly aligned, you may be getting extra pressure around the foot and ankle. In these cases, a special shoe insert, or orthotic, can help relieve pressure and pain. Sometimes a small heel lift or cushion can be placed in your shoe to limit pressure on a stiff ankle joint, helping you to enjoy walking longer distances without a limp. Daily activities: Here are some helpful hints to use during the day to limit strain on your ankle. Avoid standing for greater than 10 minutes; instead take frequent rests. Use a heel or shoe cushion when standing or walking on hard surfaces. Limit stair climbing; take the elevator, escalator, or ramp. Avoid bending and squatting by storing items at waist level. Or use a reacher. Park close to your destination. Exercise Progression: Your exercise program will be advanced cautiously to include strengthening, balance, endurance, and other exercises that mimic your daily activities. Your program will address key muscle groups of the hips, thighs, calves, and foot. You will be trained in exercises that help stabilize and control the ankle. Other exercises can be used to simulate day-to-day activities like raising up on your toes, stepping off a curb, or descending a ramp. Specific exercises may also be used to simulate your work or hobby demands. Daily Exercise: Your joint surfaces can remain healthier by consistently working your ankle through a full range of motion and using safe, load-bearing exercises. Do exercises as prescribed to keep the hip, knee, and ankle muscles strong. Avoid pain by exercising with pain-free movements, by limiting walking speeds, and by not overdoing it. If you feel pain, you may need to back off and do gentle range of motion and isometric exercises. General Fitness: The Surgeon General recommends that everyone get at least 30 minutes of moderate activity a day for as many as seven days a week. Along with reducing the risk of heart disease, lowering stress, managing body weight, and prolonging life, a general fitness program can also assist you in managing ankle osteoarthritis. Moderate activity can include walking, swimming, stationary biking, or low impact aerobics. Before undertaking such a program, consult your physician. Long-term management: Here are some long-term solutions to help manage your ankle condition: Control pain and inflammation with heat, cold, and medication (as prescribed by your doctor). Reduce shock by using a walking aid, wearing good shoes, choosing soft surfaces, and keeping the leg muscles conditioned for unexpected stresses. Exercise often to maintain range of motion, strength, and cardiovascular fitness. Use a shoe orthotic in cases where leg and foot alignment is a problem. Take precautions with daily activities to avoid stressing the ankle. Home Program: Once your pain is controlled, your range of motion is improved, and your strength is returning, you will be progressed to a final home program. Your therapist will give you some ideas to help take care of any more soreness at home. You'll be given some ways to keep working on the range of motion and strength too. Before you are done with physical therapy, more measurements will be taken to see how well you're doing now compared to when you first started in therapy. V1 063

Ankle Arthritis Treatment: Surgical
Ankle fusion Ankle replacement “Arthritis and Your Joints: Ankle ”. DePuy Orthopaedics, Inc. 2 April, V1 064

Treatment Choices Patients play a role in their treatment; they are part of the team. V1 065

Result of Treatment The result of regaining the ability to move without pain? Independence V1 066

Expectations We’re all individuals so recovery is different for each person. Most people who work at their rehabilitation regain strength and mobility. V1 067

End Result Returning to an independent healthy lifestyle is the best outcome. V1 068

THANK YOU V1 069

Understanding Arthritis Pain and Treatment Options

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Understanding Arthritis Pain and Treatment Options

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Presentation on theme: "Understanding Arthritis Pain and Treatment Options"— Presentation transcript:

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About project

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