Thursday, 22 November 2012

Joint Problems (Osteoarthritis, Osteoarthrosis, Tendinitis & Tendinosis)

Joint Problems (Osteoarthritis, Osteoarthrosis, Tendinitis & Tendinosis)

The common joint problem seen in our hospital is painful/tender, swollen and/or stiff joint usually following an episode of trauma or injury to any component tissue, of that joint. This is a form of  secondary osteoarthritis (having a causative factor for the ongoing inflammation). Primary osteoarthritis is related to the process of aging without any causative factor. This is also known as osteoarthrosis:
 '-osis' means degeneration relating to aging without inflammation and '-itis' means inflammation with a causative factor, without any relation to the process of aging.

In people who are active in sports, tendon injuries are common (tendons link muscles to bones, while ligaments link bones to bones). With damage to the tendon, there will be painful joint movements in the short term, arising from the process of inflammation. Tendinosis is ongoing, continuous weakening or disruption of the tendon relating to aging and/or ongoing injuries/trauma. Thus, weakening the tendon and increasing the chances of tendon rupture. 

The principles of treatment for joint problems in our setting are:

  • 1. RICE (Rest, Ice, Compression & Elevation) treatment in the first few seconds to minutes of injury
  • 2. Rest & Minimal Use of joint for the first 2-3 weeks
  • 3. Early treatment with oral Diclofenac or Ibuprofen  
  • 4. Warm baths & application of topical Diclofenac or Salicylic acid 1-2 days following the injury for up to 2-3 weeks (while on oral Diclofenac or Ibuprofen)
  • 5. For patients who present to us more than 1 week after the injury, Ibuprofen may be more effective than Diclofenac
  • 6. Paracetamol (Panadol) is reserved for patients with fever and headaches 
  • 7. Oral Predisolone is not given to patients with OsteoarthritisOsteoarthrosisTendinitis & Tendinosis
  • 8. Oral Prednisolone is reserved for patients with multiple joint inflammation, as a result of autoimmune disorder (Rheumatic Arthritis)
  • 9. Intralesional/Intraarticular Methylprednisolone is given to patients with persistent, significant joint inflammation and/or, stiffness for more than 1 month after the injury
  • 10. Indometacin is not as effective as Ibuprofen & and is often associated with gastritis
  • 11. Oral Aspirin (Salicylic acid) is not given to patients with OsteoarthritisOsteoarthrosisTendinitis & Tendinosis
  • 12. Early, gradual mobilization with load increment is advised, once the signs/symptoms of inflammation subsides, while on the medications described above
  • 13. Surgery is not usually indicated for OsteoarthritisOsteoarthrosisTendinitis & Tendinosis, accept in severe joint stiffness (those presenting late and not following the above principles) and complete tearing of tendon and/or tethering of tendon and those with associated fractures
  • 14. Surgery is advised,  after the signs/symptoms of inflammation subsides
  • 15. Paracetamol is given, instead of Diclofenac and Ibuprofen, for patients with associated fractures as they may cause delayed or non union of fractured ends

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