Obtaining a Quality Diagnosis
The medical management of arthritis and joint degeneration may be handled by a family doctor, an internist, or a rheumatologist. However, when medical management is not effective, an orthopedic surgeon should be consulted to determine if surgery is an option. In some cases, the orthopedic surgeon may be the first physician to see a patient and make the diagnosis of arthritis.
The Orthopedic Evaluation
While every orthopedic evaluation is different, there are many commonly used tests that an orthopedic surgeon may consider in evaluating a patient's condition.
In general, the orthopedic evaluation usually consists of:
- A thorough medical history
- A physical examination
- Additional tests, as needed
A medical history is taken to assist the orthopedic surgeon in evaluating your overall health and the possible causes of your joint pain. In addition, it will help him or her determine to what degree your joint pain is interfering with your ability to perform everyday activities.
What the physician sees during the physical examination, which includes standing posture, gait analysis (watching how you walk), sitting down, and lying down, helps confirm (or rule out) the possible diagnosis. The physical exam will also enable the orthopedic surgeon to evaluate other important aspects of your hip and legs, including:
If you are experiencing pain in your hip joint, your back may be examined because hip pain may actually be the result of problems in the lower spine.
After the physical examination, x-ray evaluation is usually the next step in making the diagnosis. The x-rays help show how much joint damage or deformity exists. An abnormal x-ray may reveal:
- Narrowing of the joint space
- Cysts in the bone
- Spurs on the edge of the bone
- Areas of bony thickening called sclerosis
- Deformity or incorrect alignment
Occasionally, additional tests may be needed to confirm the diagnosis. Laboratory testing of your blood, urine, or joint fluid can be helpful in identifying specific types of arthritis and in ruling out certain diseases. Specialized x-rays of the back can help confirm that hip pain isn't being caused by a back problem. Magnetic Resonance Imaging (MRI) or a bone scan may be needed to determine the condition of the bone and soft tissues of the affected joint.
In order to assist the orthopedic surgeon in making a diagnosis, it may be helpful to write down your answers to the following questions before the appointment:
- Where and when do I have pain?
- How long have I had this pain?
- Do I have any redness or swelling around my joints?
- What daily tasks are hard to do now?
- Did I ever the hurt the joint or overuse it?
- Does anyone in my family have similar problems?
Following the orthopedic evaluation, the orthopedic surgeon will review and discuss the results with you. Based on his or her diagnosis, your treatment options may include:
Many different medications are used to treat the pain and stiffness of arthritis. One of the most commonly prescribed types of drugs are the non-steroidal anti-inflammatory agents, or NSAIDs, which can be taken long-term to reduce both the pain and swelling caused by arthritis.
Another type of medication prescribed to reduce severe pain and swelling are corticosteroids. Corticosteroid injections offer quick, effective pain relief. However, they can be used only a few times a year because they weaken bone and cartilage. Also, corticosteroids can cause other potentially serious side effects; their use must be monitored by a physician.
Physical Therapy can be helpful in the management of OA and RA. For example, a physical therapist may recommend:
- Isometric ("pushing") exercises to help build muscle strength without subjecting inflamed joints to excessive wear
- Isotonic ("pulling") exercises to further increase muscle strength and help preserve function
- Daily walking, using a cane or other assistive device as needed
Joint Fluid Supplements
For patients whose knee joint pain does not improve with medication or physical therapy, "joint grease" injections may provide temporary relief. The knee is injected with a joint fluid supplement that acts as a lubricant for the damaged joint. Joint injection schedules and duration of relief vary according to the treatment chosen and the individual patient. However, these injections do not cure the diseased knee, and joint replacement may be needed as the joint worsens with time.
Total Joint Replacement