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Where does it hurt?

Where does it hurt?

Pain is the single most devastating symptom for individuals suffering from bone and joint disease. At Orthopaedic Research UK we highly value our patients and therefore by collaborating with the MSK laboratory at Imperial College London, we have put together some useful information regarding some key painful bone and joint conditions thought to reduce the quality of life for many. Our readers can navigate the website and find some background information about each condition and hopefully have a better understanding of their conditions.

Important notice: Please note that Orthopaedic Research UK does not provide any medical advice and all information provided is for educational purposes only. 

Hip: Joint

The hip is a synovial ball and socket joint which joins the pelvis to the lower limbs. Because it is a weight-bearing joint with a generally reliable surgical procedure, hip replacement is one of the most common operations done, usually for arthritis. In the year 2015-16, nearly 84,000 hip replacement procedures were performed in the UK according to the 13th annual report of the National Joint Registry (NJR) [1].

The pathology causing the pain means that movement becomes painful and depending on the cause, is usually progressive.

Because the hips are major weight bearing joints, even simple activities such as walking can eventually become difficult and painful. Sufferers may lose the ability to participate in hobbies, particularly where they are ‘high demand’ (such as skiing or running) and in time even ‘low demand’ activities (gardening or walking) can be compromised.

In cases where the cause is tightness or impingement, physiotherapy can help and in problems such as arthritis weight loss is certainly a factor. When the symptoms and imaging (x-rays done by a doctor) demand it, hip surgery may be required and there is evidence that hip resurfacing may enable a more normal gait than hip replacement [2].

Hip: Joint
Spine: “Slipped disc” & “Sciatica”

Around 70-80% of people will experience an episode of lower back pain in their lives [1][2], although the vast majority are self-limiting and resolve without any intervention [2] (and indeed many cases go unreported [3]). It is one of the top 10 health burdens worldwide according to the World Health Organisation [4]. In some cases, the inter-vertebral disc (which act like cushions between the spinal bones) can herniate and bulge out (a ‘slipped disc’), and they make contact with the spinal nerves – when this occurs in the nerves to the legs, this is known as ‘sciatica’.

The bulge of the disc on the nerve root can make it very sensitive and can cause pain in the lower back (lumbago) and/or going down the buttock and back of the leg (sciatica).

Bending and lifting activities can become difficult and painful so that for a time, even getting in/out of a bed/chair or walking around can become very challenging. In a small proportion of cases, a complication can occur when control of bladder and bowel can be affected – this becomes an emergency.

The majority of slipped discs will only touch one side of the nerve (as the middle section is stronger and doesn’t tend to ‘slip’). This means that in the majority of cases, a single buttock and leg are affected, and 80-90% will settle spontaneously within six weeks [2] during which time treatment is with painkillers and sometimes muscle relaxants. In cases where the bladder or bowel are affected, emergency surgery may be required – seek immediate medical attention.

Spine: “Slipped disc” & “Sciatica”
Elbows: “Tennis elbow” and “Golfer’s elbow”

These terms refer to overuse injuries (strain/sprain) with swelling and irritation at the lateral and medial epicondyle (outside and inside of the elbow) respectively. They are named after the sports with which they are commonly associated but both can be seen outside of sports injuries as they are also seen in other situations of overuse (such as mechanics, cooks and butchers).

The pain at the origin of the muscles means that all movements can become painful, particularly when they are repetitive.

Movements of the elbow and possibly the wrist become painful and difficult and can take several months to improve. With the avoidance of use on one side, it is not unusual for the other side to be affected by the additional demands placed upon it.

Gentle exercises with physiotherapy (and possibly kinetic tape), painkillers and anti-inflammatory medication can help with symptoms. Some patients may benefit from a steroid injection to help with this process. Surgery is seldom required, but may be required for recalcitrant cases.

Elbows: “Tennis elbow” and “Golfer’s elbow”
Shoulder: “Frozen shoulder” (adhesive capsulitis)

Occurring in about three percent of the population, this is a painful and disabling condition which is not fully understood but is usually self-limiting. The tissues of the shoulder joint become inflamed, stiff and painful and several possible causes have been implicated.

Abnormal attachment/scar tissue (adhesions) with an inflamed joint capsule in the shoulder can lead
to pain and stiffness which can last many months.

This causes difficulties with movement and even everyday activities can become challenging for a time.

For most people, gentle exercise guided by physiotherapy and symptomatic relief with
painkillers and anti-inflammatories will help to alleviate the worst of their problem but it can take 12-
18 months to settle down. Occasionally, a more radical approach is required such as keyhole surgery to cut
away some of the inflamed abnormal attachments in the shoulder (arthroscopy) or using high pressure
water in the joint to achieve a similar effect (hydrodistension).

Shoulder: “Frozen shoulder” (adhesive capsulitis)
Neck: Whiplash

Soft tissues in the beck can become stretched or sprained, leading to pain and stiffness. Onset can be minutes or even hours as the muscles go into spasm and it can be associated with difficulties moving the head or even headaches, irritability, poor concentration, memory loss, or pins and needles in the arms/hands.

Common causes are road traffic collisions or sudden jerking movements such as a fall or during contact sports.

Movement can cause pain in areas which are sprained or stiff and becomes difficult.

The normal movements may become difficult or painful and people often struggle to move normally for a few days, struggling when wanting to turn to look over a shoulder – this can make driving very challenging.

Symptoms can be alleviated by progressive return to normal activities with gentle exercises,
painkillers, anti-inflammatory medication and sometimes muscle relaxants to help with stiffness. For most
people the symptoms will subside over days or weeks.

Neck: Whiplash
Arthritis: Joints

Arthritis is a very common condition, with osteoarthritis affecting around 8 million people in the UK and rheumatoid arthritis nearly half a million [1]. Osteoarthritis is usually as a result of wear and tear but can be brought about by injuries to joints.

Bone ends are normally lined by cartilage – this provides smooth, low friction surfaces which allow the bearing surfaces to smoothly glide over one each other to allow normal everyday movements.

As these surfaces wear, they are less smooth and generate more friction, causing pain, particularly where there is bone on bone contact and eburnation.

The surface has very little (if any) ability to heal but painkillers, anti-inflammatories and weight loss may help to alleviate symptoms. A well planned exercise regimen can help both with weight loss and with stiffness. Surgery may be required as the condition progresses and daily activities are affected.

Arthritis: Joints

References

1 – NHS Choices. Arthritis