Joint pain

Abstract

Joint pathologies often involve multiple structures within one joint or body region. Pain may arise from the muscles, ligaments, tendons, bones, cartilage, and nerves. Pain can be acute (having a recent onset) or chronic (long-lasting), localized in one area, or widespread. Often, problems in one joint will result in abnormalities in adjacent joints by alterations in mechanics, kinematics, and muscular firing patterns. Patients with a propensity for injury or systemic arthropathies may present with involvement in multiple joints or other connective tissues. In this chapter we focus on pain of the joints of the extremities and its many causes. Common symptoms, diagnoses, and treatment modalities are discussed, but the reader should keep in mind basic principles that apply to most joints: if there is swelling within the joint (effusion), the problem usually involves inflammation of intra-articular structures (cartilage, synovium, and ligaments) as opposed to periarticular structures such as muscles or adjacent tendons. If swelling is severe, then autoimmune, crystalline, or infectious etiologies should be considered. If the joint appears normal on examination, other pain sources (nerve, vascular, referred pain, etc.) should be investigated. Corticosteroid injections discussed here are often very helpful at reducing acute pain and inflammation but are usually reserved as second-line treatments after physical modalities, bracing, and oral analgesics. Treatment regimens should include not only analgesia, but also activity modifications, physical modalities, orthotic devices, and functional exercises.