It is widely used in physiotherapy and rehabilitation, and non-technical population is also growing interested in this technology. It is an exciting approach to improve the occurrence of acute pain in cases of joint dysfunction, musculoskeletal pain, and other conditions such as dysmenorrhea and labor.

This technique was introduced in the 1970s. It was initially thought to be a screening technique to evaluate who will benefit from implants of electrical stimulators to relieve pain. However, several patients started to experience significant pain relief after using this screening method. In the end, fewer electrical stimulators were implanted because patients using TENS no longer needed them.

But is TENS effective in reducing pain symptoms according to research? Is it safe? Are there any side effects we should know about before trying this procedure?

What is Transcutaneous Electrical Nerve Stimulation?

By definition, Transcutaneous Electrical Nerve Stimulation is a noninvasive procedure applied directly to the intact skin. Through a simple and battery-powered device, TENS delivers pulsed electrical current across the skin and stimulates peripheral nerves to inhibit pain stimuli. This is achieved by using a series of electrodes attached to the skin. It is considered to be a safe and inexpensive technique that patients can administer themselves according to easy-to-follow and simple instructions and safety guidelines.

For many years, similar forms of electricity were used for pain relief, and this numbing effect was referred to as electroanalgesia in 1965. According to electroanalgesia theories, there are excitatory and inhibitory neurons in the dorsal horn of the spinal cord. Pain stimuli travel to the brain through the dorsal horn, and other stimuli such as pressure and electrical currents use the same path and overlap with pain sensation, causing an inhibitory effect.

There are various forms of TENS, according to each patient and type of pain. We can choose a different pulse frequency, amplitude, and duration, and it is possible to try new electrode placement sites. There is also a modality named acupuncture-like TENS or AL-TENS, which uses acupuncture needles to deliver electrical currents through the skin into deeper tissues.

Using TENS for Pain Control

www.ncbi.nlm.nih.gov

Benefits of Transcutaneous Electrical Nerve Stimulation

TENS is not only an interesting theory. It also has a clinical application, and it works to improve pain symptoms in various settings. It is not likely to replace painkillers and other treatment approaches, but it is a suitable complementary treatment to enhance the quality of life of patients who need to take NSAIDs and perhaps electrical muscle stimulation to manage their symptoms.

We can count several benefits of TENS, both in the short-term and the long-term:

• It is a standard procedure in physical therapy: TENS is commonly used by physical therapists to improve pain symptoms and regain the function of the joint and the muscle in cases of rehabilitation. In these cases, TENS has an acute effect in reducing pain symptoms, but may also help patients recover faster from various causes of chronic pain through a combination of TENS, functional training and exercise.
• Reduces hospital stays: Studies show that TENS allows patients with chronic pain to increase their levels of physical activity and may be helpful to reduce hospital stay in many cases. This is particularly the case of postoperative pain after thoracic surgery, chronic low back pain, and joint pain in patients with arthritis. TENS has been found to speed up recovery and improve pulmonary function in postoperative patients.
• Improves the patient’s tolerance to physical activity: Joint pain often leads to a low tolerance to exercise, which in turn may aggravate joint pain in a vicious cycle. By reducing the perception of pain, TENS improves the joint function and allows patients to tolerate physical activity and other forms of physical therapy that will ultimately improve their quality of life in the long run.
• It works in combination with certain medications: Certain studies have shown that TENS in combination with clonidine or morphine reduces primary hyperalgesia, a condition that is difficult to manage with TENS alone. This probably results from a synergistic interaction between endogenous opioids and alpha-2-adrenergic agonist drugs. By using a combination of these drugs and TENS, patients will be able to reduce the dose of opioid medications and their side effects.
• The effect is maintained for up to 4 weeks: According to a study on the application of TENS in osteoarthritis, there was a reduction of pain in patients receiving TENS with or without physical exercise, and this decrease in the sensation of pain was maintained in the 4-week follow-up.

What you need to know before using TENS

TENS is an excellent therapy to induce analgesia in various types of pain. However, there are certain effects of this therapy you should know about before trying this pain therapy modality:

• It produces tolerance and cross-tolerance: After applying TENS daily for a long time, it is possible to develop tolerance to the treatment. On the long run, it would become ineffective in producing the same analgesic effect. TENS has a cross-tolerance impact on opioid therapy, and repeated use will render morphine ineffective to control pain symptoms. Similarly, patients who have become tolerant to morphine are not likely to find much relief after TENS.
• Pain, tingling, or burning at the electrode site: In some cases, it is possible to feel some pain, tingling or burning sensation in the skin at the site of electrode placement. This effect is often reported right after TENS session, and it is self-limited.
• Some people may not tolerate TENS: In some studies, patients were unable to tolerate TENS and reported discomfort during electrical stimulation. This is not common and was only reported in 2 out of 48 participants in one study and 1 out of 13 participants in a second study.

Transcutaneous Electrical Nerve Stimulation (TENS) remains a safe and effective way to improve the symptoms in patients with joint, chronic back pain, and even periodontal and other types of pain. It is considered by a recent Cochrane review as a potential treatment option, and it is marked as a safe alternative that’s inexpensive and readily available as an over-the-counter measure.

References:

Johnson, M. I., Paley, C. A., Howe, T. E., & Sluka, K. A. (2015). Transcutaneous electrical nerve stimulation for acute pain. Cochrane database of systematic reviews, (6).

Murina, F., & Di Francesco, S. (2015). Transcutaneous Electrical Nerve Stimulation. In Electrical Stimulation for Pelvic Floor Disorders (pp. 105-117). Springer, Cham.

Sluka, K. A., & Walsh, D. (2003). Transcutaneous electrical nerve stimulation: basic science mechanisms and clinical effectiveness. The Journal of pain, 4(3), 109-121.

The post The Positive and Negative Effects of Tens Therapy appeared first on Joint Pain Clinic.

However, their methods were not naturally not as sophisticated as our own  and involved using electrical fishes to trigger a numbing reaction in the the human body.

After the development of human-made electricity, various types of electrical stimulation were developed, and nowadays we have three main modalities:

• Transcutaneous electrical stimulation, administered on the skin surface.
• Percutaneous electrical stimulation, administered through acupuncture-like needle probes.
• Spinal cord stimulation, an invasive method.

In this article, we will cover the pros and cons of transcutaneous electrical stimulation, also known as electrical muscle stimulation or EMS. Is it useful to improve pain symptoms in your legs? Is there any side effect you should know about?

What is Electrical Muscle Stimulation?

Electrical Muscle Stimulation is a therapeutic modality for leg pain that causes muscle contractions by applying electrical currents directly to the skin. It is also known as neuromuscular electrical stimulation because it works in the neuromuscular junction by stimulating motor neurons to trigger contraction.

The neuromuscular junction is where muscle and neurons meet, and in this place, the activated neurons release neurotransmitters to the muscle receptors, triggering muscle contraction. In this regard, electrical muscle stimulation is also useful as a passive exercise modality, and apart from improving pain symptoms, it is known to stimulate blood circulation and has many health applications.

Electrical Muscle Stimulation Uses in Medical Science Research

with thanks www.ncbi.nlm.nih.gov

Benefits of Electrical Muscle Stimulation

There are many pros and health applications of electrical muscle stimulation:

• It is a non-invasive method: Compared to other techniques such as percutaneous electrical stimulation, applying a mild electrical current directly to the skin is a non-invasive method and does not require needle probes. Moreover, modern EMS devices are calibrated to deliver a type of electrical stimulation that will not give you a sudden shock or make you feel uncomfortable. Thus, it is available for a wide variety of patients, regardless of their age and previous experiences with medical procedures.
• Reduces pain symptoms in the lower extremities: Electrical Muscle Stimulation is a useful therapeutic approach to improve pain symptoms in patients with arthritis, osteoarthritis, and other causes of leg pain. There are many theories to understand why electrical stimulation works to reduce pain symptoms. One of them is because electrical stimulation activates mechanoreceptive fivers (nerves that detect movement and touch), and they reduce or inhibit pain transmission. Additionally, EMS stimulates the release of serotonin, a neurotransmitter with analgesic functions in the central nervous system.
• It is a good way to prevent muscle wasting: Since electrical muscle stimulation is known to trigger muscle contractions, it is an excellent way to prevent muscle atrophy and muscle wasting in patients who are undergoing physiotherapy. Electrical stimulation is a type of rehabilitation therapy for immobilized patients and those who suffered spinal cord damage, sarcopenia, and other health conditions associated with muscle wasting. This alternative is available for patients who need to prevent muscle atrophy but are unable to perform active exercise.

• Improves aerobic capacity: Electrical muscle stimulation improves aerobic capacity measured by peak oxygen consumption when it is used for more than 6 weeks. This effect is useful for sedentary patients and those who suffer from heart conditions that significantly reduce their activity levels, such as chronic heart failure.

• It has a positive effect on blood circulation: The effect of EMS on blood circulation adds up to the reasons why it improves pain in the lower extremities. According to studies, the transcutaneous application of electrical stimulation enhances the microcirculation in the lower extremities of diabetic patients and those with abnormal blood flow. EMS improves the endothelial function, which is fundamental to maintain our cardiovascular health. Electrical stimulation induces vasodilation through the release of calcitonin and nitric oxide. That is how both microcirculation and microcirculation are significantly improved after applying electrical stimulation.
• It is an alternative exercise for critically ill patients: Patients in hospital ICU and after ICU discharge usually have persistent muscle weakness due to an extended period of immobilization. This may also compromise their circulation, especially when there is sepsis or systemic inflammation. These patients have a catabolic state, which means their bodies are constantly breaking down muscle tissue to obtain energy.
• Improves muscle and joint function in arthritis patients: When applied in patients with osteoarthritis of the knee and other forms of arthritis, electrical muscle stimulation increases the size of muscle fibers and the resulting strength in the lower extremities. It is also known to improve microcirculation, which is the reason why it is associated with a decrease in muscular fatigue in these patients. Studies show that arthritis patients may benefit from this therapeutic modality, and it is a useful way to improve joint function and strengthen the muscles of the lower extremities in these patients.

A word of caution before using EMS

There are better techniques and devices for electrical muscle stimulation compared to the Ancient Egyptians. However, it is still important to know the downside of EMS:

• It is not the best exercise for muscle hypertrophy: EMS is a good way to prevent atrophy, and it is used in physiotherapy to recover muscle function. However, it is not the best exercise if you want to train for muscle hypertrophy. The results of EMS are not significant compared to resistance exercise to increase muscle mass.
• It is a symptomatic therapy: EMS is an effective therapeutic option to increase blood circulation and reduce pain symptoms. However, in most cases, it is only a symptomatic therapy that temporarily works to relieve pain. Thus, it should be combined with medical treatment and other approaches if you want to solve the root problem.
• Certain devices would cause superficial burns: Adverse events have been described in some studies, and one of them is superficial burns when the device is not calibrated as it should or after incorrect stimulation techniques.

In a nutshell, EMS is an effective and safe therapeutic strategy to relieve pain symptoms and improve blood circulation in the your feet, as you can see in this table:

References:

Heidland, A., Fazeli, G., Klassen, A., Sebekova, K., Hennemann, H., Bahner, U., & Di Iorio, B. (2013). Neuromuscular electrostimulation techniques: historical aspects and current possibilities in treatment of pain and muscle waisting. Clin Nephrol, 79(Suppl 1), S12-S23.

Rosemffet, M. G., Schneeberger, E. E., Citera, G., Sgobba, M. E., Laiz, C., Schmulevich, H., … & Cocco, J. A. M. (2004). Effects of functional electrostimulation on pain, muscular strength, and functional capacity in patients with osteoarthritis of the knee. JCR: Journal of Clinical Rheumatology, 10(5), 246-249.

Gerovasili, V., Tripodaki, E., Karatzanos, E., Pitsolis, T., Markaki, V., Zervakis, D., … & Nanas, S. (2009). Short-term systemic effect of electrical muscle stimulation in critically ill patients. Chest, 136(5), 1249-1256.

Banerjee, P., Caulfield, B., Crowe, L., & Clark, A. (2005). Prolonged electrical muscle stimulation exercise improves strength and aerobic capacity in healthy sedentary adults. Journal of Applied Physiology, 99(6), 2307-2311.

Parissis, J., Karavidas, A., Farmakis, D., Papoutsidakis, N., Matzaraki, V., Arapi, S., … & Pyrgakis, V. (2015). Efficacy and safety of functional electrical stimulation of lower limb muscles in elderly patients with chronic heart failure: A pilot study. European journal of preventive cardiology, 22(7), 831-836.

Parry, S. M., Berney, S., Granger, C. L., Koopman, R., El-Ansary, D., & Denehy, L. (2013). Electrical muscle stimulation in the intensive care setting: a systematic review. Critical care medicine, 41(10), 2406-2418.

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A hurting big toe might seem a small thing compared to advanced forms of rheumatoid arthritis and other causes of joint pain. However, having a swollen big toe is one of the most annoying and bothersome types of joint pain, especially for active people who are always on the go!

The big toe is clinically named the “hallux”, and it has one of the most highly flexible joint articulations in the foot.

So, if you’ve suddenly started feeling pain in your big toe and wondered if you have a broken joint, we will give you the main reasons why your hallux is hurting, including a fractured articulation and various forms of arthritis.

Why is my big toe aching?

The leading causes of hallux pain are as follows:

• Fractures and traumatic injuries: There are many types of fractures and traumatic events associated with joint pain in your big toe. Most of them are easily detected because joint pain starts after a traumatic event. However, there are also stress fractures, caused by repetitive movements for a prolonged time or an excessive load in cases of morbid obesity. Some instances might progress into a form of osteoarthritis, and in some cases, excessive healing of the bone might lead to bone spurs as a secondary cause of pain in the big toe.

• Rheumatoid arthritis: The most common type of rheumatoid arthritis is located in the hands and the knees. However, in some cases, rheumatoid arthritis can affect various articulations of the foot, especially the big toe. In these cases, rheumatoid arthritis is caused by inflammation in the toe and may or may not be associated with injuries in this area. Symptoms include pain, stiffness, and swelling, but in advanced cases of rheumatoid arthritis the disease progresses to cause deformation in the articulation.

• Osteoarthritis: It is a type of arthritis that is mainly triggered by wear and tear of the articulation. It is commonly associated with past trauma in the articulation of the big toe (a broken joint or a ligament sprain), but it is also prevalent in older and overweight people. When the cartilage wears down in osteoarthritis, it often causes popping sounds when moving the big toe.

• Gout: It is an important cause of toe pain, especially in males. Gout is caused by an accumulation of uric acid crystals in the articulations of the foot. These crystals grow bigger and impair the normal function of the articulation, causing severe and sudden bursts of joint pain. These symptoms may be easily mistaken with traumatic pain as in a broken joint.

• Hallux rigidus: It is also known as a stiff big toe. It is a medical condition that develops in adults aged 30 to 60 years old. Similar to arthritis, hallux rigidus is associated with swelling, an inability to bend the hallux, and severe pain that becomes worse after walking or moving the articulation.

Injuries to the Hallux (Big Toe)

with thanks www.ncbi.nlm.nih.gov

As you can see, each one of these causes should be properly evaluated before reaching a final diagnosis. Thus, if you’re in doubt, it is essential to ask your doctor about your symptoms in order to be properly guided according to your individual condition.

If the Toe bone re-heals, Can it become stronger?

You may have heard the old wives tale that when a bone re-heals it will make a stronger bond. This is simply not the case…..

If you have a broken articulation and give it enough time to recover, a healthy body will be able to recover the normal function of the articulation. However, in most cases there are consequences after having a broken bone. After re-healing, the affected bone turns out to be exactly the same as before or might also become more fragile, especially in older adults. This is why it is essential to pay attention and avoid any future traumatic event after you’ve had a fracture.

In some cases, the process of healing in your bones becomes excessive, but this is not good news and does not mean your bone becomes stronger after enduring a fracture. For example, another cause of prolonged joint pain in your big toe is a bone spur.

It is an overgrowth of bone tissue in the articulation of the big toe that results from traumatic injuries and osteoarthritis. In an attempt to repair the damage, the body adds excessive layers of bone, and instead of making the articulation stronger, it leads to chronic pain when bone spurs stick out and rub against the adjacent bone.

What can you do about it?

When hallux pain is associated with a traumatic event, and it becomes swollen and tender, a broken articulation in your big toe is a possibility we should evaluate with a health professional. However, some minor injuries might respond to home treatments and remedies. In any case, it is advisable to check and treat your Big Toe with appropriate resting, applying ice, and elevating the articulation.

Resting includes not walking and using crutches or special shoes to walk. When applying ice, we should be careful not to do it directly over the skin. Instead, you can place a piece of cloth or towel, or buy special ice packs meant to be used for this purpose. Elevating your toe reduces swelling by favoring circulation of blood back to the heart, and in most cases, it helps to reduce pain symptoms as well.

Another important measure you can use if you suspect a broken articulation in your big toe is buddy taping the affected toe. You can do this as a first-aid measure until medical help arrives. Materials for buddy taping include adhesive tape and a piece of gauze or cotton. The objective is to attach the affected articulation to the adjacent toe by taping them together, and it is the easiest way to splint a broken articulation in your big toe. The piece of gauze or cotton should be placed between the toes to prevent sores, and you should be careful not to tape your toes too tightly that your circulation might become compromised.

References:

Logterman, S. L., & Hunt, K. J. (2019). Hallux Rigidus. In Sports Injuries of the Foot and Ankle (pp. 259-264). Springer, Berlin, Heidelberg.

Qaseem, A., McLean, R. M., Starkey, M., & Forciea, M. A. (2017). Diagnosis of acute gout: a clinical practice guideline from the American College of Physicians. Annals of internal medicine, 166(1), 52-57.

Makhni, M. C., Makhni, E. C., Swart, E. F., & Day, C. S. (2017). Phalanx Fractures of the Foot. In Orthopedic Emergencies (pp. 379-381). Springer, Cham.

Welck, M. J., Hayes, T., Pastides, P., Khan, W., & Rudge, B. (2017). Stress fractures of the foot and ankle. Injury, 48(8), 1722-1726.

Stolt, M., Suhonen, R., & Leino-Kilpi, H. (2017). Foot health in patients with rheumatoid arthritis—a scoping review. Rheumatology international, 37(9), 1413-1422.

The post Do I have a Broken Joint in my Big Toe? appeared first on Joint Pain Clinic.

Articulations such as the hips, shoulders, and knees are often subject to incapacitating symptoms because these highly mobile articulations are needed for almost every major movement.

Thus, in these cases when pain is not controlled by anything else, doctors recommend corticosteroid injections to reduce the symptoms and improve the function of the articulation.

However, some patients have reported more pain instead of major improvement for a few hours or a few days after receiving a corticosteroid shot.

Other patients may also experience a progressive worsening of their symptoms and the disease, and wonder why this happens and whether or not it is something they should worry about.

Cortisone flares and other causes of pain after a cortisone shot

Feeling more articular pain shortly after a cortisone shot is not the most common outcome, but it is still possible and has various explanations. Find out more about Hip pain in Adults. So, according to studies, the prevalence is varied according to the site of injection, and the individual characteristics of the patient and 3-81% of cortisone shots may result in acute bouts of pain. But where does pain come from?

There are at least 3 causes of acute pain after a cortisone shot:

• Cortisone flares: These reactions to cortisone injections usually last for one or two days, but in some cases, it may be limited to a few hours. After that, the pain recedes, and the articular symptoms start to show significant improvements. Cortisone flares are caused by the crystallization of cortisone around the synovial capsule and other soft tissues of the joint. This leads to inflammation of the articulation that is self-limited after steroids become fluid once again.
• Inflammation of the injection site: An intraarticular injection of cortisone in the hip is not like a regular intramuscular injection. It goes through deeper layers of skin and muscle to reach the articulation of the hip. Depending on each individual, this may lead to injury to the soft tissue and inflammation, which is another possible cause of a cortisone flare.
• Incorrect technique: When the procedure is not applied correctly, or with sufficient guidance, an intraarticular injection in the area of the hip may cause major injuries to the soft tissues, release cortisone where it shouldn’t, or hurt nerve terminals and directly trigger pain sensation.

Severe side effects to consider

In patients with severe pain after intraarticular steroid shots, it is essential to consider other severe causes of pain, including septic arthritis and severe side effects of cortisone in the articulation.

• Septic arthritis: Arthritis is typically caused by an immune reaction in the articulation. This immune reaction results from an autoimmune disorder in rheumatic arthritis or degeneration and inflammation of the tissues in case of osteoarthritis. In septic arthritis, inflammation is caused by a bacterial or viral infection, and a simple steroid shot may result in this severe condition in some instances of improper technique or incomplete cleaning of the punctured area.
• Side effects of steroid shots: Corticosterone steroids are known to improve pain symptoms and the articular function in patients with arthritis, but it also has severe side effects to consider. In the long term, and after repeated applications of intraarticular steroids, they lead to degeneration of the cartilage of the articulation, which may progressively aggravate joint pain after many years. Note that this side effect is not acute but chronic, which means that it develops slowly and gradually.

Should I worry about hip pain after a cortisone shot?

If you’re experiencing a flare-up of pain after a cortisone shot, keep in mind this is not an unexpected outcome, and it is described in the literature. There are many causes, but the most common are not severe or life-threatening.

Septic arthritis is very unlikely to happen after a cortisone shot, and it is often accompanied by high fever and severe swelling of the articulation that slowly aggravates after the procedure.

On the other hand, doctors understand the risks associated with intraarticular injections of cortisone, and only recommend this measure in certain cases and if the patient fulfills a series of conditions in order to make sure they will not experience this side effect. Similarly, an incorrect technique with a severe injury to deep tissues in the hip is unlikely if you’re being treated by a specialist. Thus, the majority of concerning causes of pain after corticosterone shots are less likely in the hands of skilled professionals.

Increased risk for multiple Hip Cortisone injections Research 

That leaves us with inflammation of the area of injection and corticosterone flare-ups as the most common causes, and they are both transient and self-limited. In the majority of cases, the symptoms associated with flare-ups and inflammation can be controlled by taking over-the-counter medications. However, it is essential to ask your doctor before taking these and other medicines, especially if you have more than one chronic medical condition.

Another recommendation is applying ice on the affected area, but not to your naked skin. You can use a towel an ice pack, and it is an effective and easy measure to improve inflammation associated with cortisone flares. Finally, be sure to rest the articulation properly, and remember your hips are one of the most mobile joints in your body. Find out how to improve your Hip Pain when sleeping on your side.

Do not engage in physical activity unless absolutely necessary or recommended by your doctor as a part of your rehabilitation program.

If your pain continues for more than 2 days or further aggravates despite following the recommendations, ask your doctor about your symptoms.

Keep in mind that arthritis is an inflammatory condition, and flare-ups may be associated with mild fever, but if you’re concerned with the severity of your symptoms do not delay and talk to your doctor to be guided according to your individual condition.

References:

Brinks, A., Koes, B. W., Volkers, A. C., Verhaar, J. A., & Bierma-Zeinstra, S. M. (2010). Adverse effects of extra-articular corticosteroid injections: a systematic review. BMC musculoskeletal disorders, 11(1), 206.

Fawi, H. M., Hossain, M., & Matthews, T. J. (2017). The incidence of flare reaction and short-term outcome following steroid injection in the shoulder. Shoulder & elbow, 9(3), 188-194.

McCabe, P. S., Maricar, N., Parkes, M. J., Felson, D. T., & O’Neill, T. W. (2016). The efficacy of intra-articular steroids in hip osteoarthritis: a systematic review. Osteoarthritis and cartilage, 24(9), 1509-1517.

McAlindon, T. E., LaValley, M. P., & Harvey, W. F. (2017). Intra-Articular Steroids May Hasten Cartilage Loss in Knee Osteoarthritis. Journal of Clinical Outcomes Management, 24(7).

The post Why is my Hip pain WORSE after a cortisone injection? appeared first on Joint Pain Clinic.

There are many causes of hip pain, especially joint conditions that might be temporary, as in bursitis, or chronic and degenerative, as in the case of osteoarthritis.

In pregnant women, hip pain might also be a concern in their late pregnancy, and it is usually accompanied by lower back pain. In each and every case, there’s a solution that will help you regain your sleeping habits and enjoy a full night’s rest.

What you can do if you suffer from acute hip pain at night

If you woke up with a sharp surge of hip pain, it would be complicated to go back to sleep. Simple measures such as changing your position might help, but in the majority of cases, you will require over-the-counter medications such as naproxen or ibuprofen to relieve your pain and go back to sleep.

How we as Doctors conduct evaluation of Hip Pain

with thanks www.ncbi.nlm.nih.gov

An emergency measure would be placing one pillow under your knees and another between your knees. The pillow under your knees will relieve pressure on your sciatic nerve in case your piriformis muscle is creating tension. The pillow between your knees keeps your legs a bit separated from each other and reduces the stress that is placed on the articulation of the hip.

What your doctor might recommend

Depending on your joint problems, your doctor might recommend certain measures to relieve or prevent hip pain. For instance, we can list the following medical recommendations:

• Physical therapy: It is useful to lubricate your joints, reduce muscle tension that might be pressing upon nerves, help you relax through massaging and aromatherapy, among others.
• Anti-rheumatic medications: They are fundamental to treating rheumatoid arthritis and, in some cases, you might need an adjustment in doses or a change in drugs to improve your condition.
• Steroid injections: In inflammatory conditions, your doctor might recommend steroid injections to reduce inflammation and improve pain symptoms. A single injection might improve your symptoms for a prolonged time.
• Draining fluid from the articulation: In some cases, the hip articulation becomes filled with articular fluid, and the extra pressure causes pain in the affected joint.
• Surgery: In some cases, you might also need an arthroscopic intervention or hip replacement surgery. Not every situation requires this measure, and not every patient is fitting to endure surgery.

Easy lifestyle modifications to improve hip pain while sleeping

There is a medical treatment for each of the conditions that may trigger recurrent hip pain, but there is also a series of lifestyle modification known to improve this symptom and reduce the incidence of hip pain at night.

One crucial lifestyle modification is starting stretching exercises and low-impact exercises. Yoga is an excellent way to start physical activity with stretching exercises and proper postures that strengthen your muscles and lubricate your joints. You can also try water activities such as swimming, jogging, and walking. It all depends on your levels of physical activity and your mobility issues.

Another thing you can try is changing your mattress and your pillows. For instance, you can replace your current mattress with a memory foam mattress to make sleeping more comfortable. There are special pillows you can try, and they are designed to achieve a correct sleeping posture and prevent hip pain in cases of joint problems.

There are three main types of pillows to relieve hip pain:

• Full-body pillows: These are very large pillows you can adapt to your body, and they are further divided into various types according to their shape. For example, you have the most traditional U-shaped pillows which provide a sort of nest you can rest in. J-shaped pillows are curved at one end and made to provide more space on the free side. You can hug them, place your knees on top, rest one knee on top and the other on the bottom, and straighten your back at the same time. Thus, it is an excellent option for pregnant women.
• Knee pillows: If you’re a side sleeper, a knee pillow is fundamental to align your spine and separate your legs a bit to reduce the stress placed upon the articulation of the hip. These special pillows are different from regular pillows you can put between your legs because they are shaped to match your legs, and they are made of memory foam. They are excellent for pregnant women, people who suffer from hip pain, and might even improve sciatica pain. Some of them might be a bit heavier than others, and one thing you might want to look for is a breathable and removable cover.
• Bolster pillows: These pillows typically adopt a cylinder shape, but there’s also a half-moon version that looks like a cylinder cut in half. These half-moon pillows are excellent to support your articulations, and they are typically filled with memory foam, which makes it an excellent aid for pregnant women, people with hip pain, lower back pain, sciatica, and much more. These pillows improve blood circulation and provide comfortable support to your joints and muscles to prevent nerve entrapment and reduce the symptoms in various types of joint disease.

CHECK BEST PRICE FOR HIP CUSHION ON AMAZON NOW

Using these pillows and maintaining good sleeping hygiene will help you enjoy a good night’s sleep and prevent hip pain episodes.

 Stretch a bit before going to sleep, ease up the tension with a massage or a foam roller, use a special support with one of the pillows we just described, and only take over-the-counter medications if you wake up with an acute episode of hip pain.

Finally, remember how important it is to be guided by a professional, and do not neglect your condition if you suffer from any degenerative problem in your articulations and symptoms are starting to get out of control.

References:

Dieppe, P. A., & Lohmander, L. S. (2005). Pathogenesis and management of pain in osteoarthritis. The Lancet, 365(9463), 965-973.

Woolhead, G., Gooberman‐Hill, R., Dieppe, P., & Hawker, G. (2010). Night pain in hip and knee osteoarthritis: a focus group study. Arthritis care & research, 62(7), 944-949.

Joelsson, M., Olsson, L. E., & Jakobsson, E. (2010). Patients’ experience of pain and pain relief following hip replacement surgery. Journal of clinical nursing, 19(19‐20), 2832-2838.

Bursa, G. T. (2003). Diagnostic and therapeutic injection of the hip and knee. Am Fam Physician, 67(10), 2147-2152.

Plante, M., Wallace, R., & Busconi, B. D. (2011). Clinical diagnosis of hip pain. Clinics in sports medicine, 30(2), 225-238.

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We are dog lovers here so we want the best for our pets as we do for ourselves……

Among dogs, there are three main types of arthritis, and they have an increased incidence compared to other animals because they are more active in exercising and running, may develop a genetic predisposition in some cases, and commonly suffer injuries and wounds that may become infected and trigger a type of bacterial arthritis we will cover in this article. Amazon can offer your dog Arthritis relief click here.

According to statistics, one in four dogs may suffer from a type of arthritis throughout their lifetime, and even though there is variation in type and progression, the main symptoms when dogs have Arthritis is pain, lameness, and changes in behavior you will be able to notice if you pay close attention to your dog.

UK Dog Arthritis Research and Data

with thanks www.ncbi.nlm.nih.gov

Types of arthritis you should know about

There are three main types of arthritis in dogs, each one with a prognosis that depends on the course of the disease and how soon your dog is diagnosed and treated. They are as follows:

• Osteoarthritis: It is the most common type of arthritis in dogs, and results from wear and tear of the articulations. Osteoarthritis is associated with a significant loss of cartilage and bone, especially in articulations with a wide range of movements. In dogs, osteoarthritis has 4 stages that will be described in the following table:

• Immune-mediated polyarthritis: This problem is more common in medium to large breeds after their middle age, as in German Shepherds, spaniels, and retrievers. As the name implies, it is a polyarthritis, which means it affects various articulations at the same time, and it can be either erosive with deformation of the articulation or nonerosive without significant changes in the structure of the joint. This disease is triggered by an abnormal immune reaction against healthy tissue of the joint, and one of the subtypes is rheumatoid arthritis, as seen in the table below:

• Septic arthritis: It is one of the rarest forms of arthritis and results from bacterial infection. It has a sudden onset of pain and lameness with inflammation, heat, and tenderness in the joints. It may be caused by a hematogenous spread of bacteria in chronically debilitated animals, but the majority of reported cases are infected surgical wounds, bite wounds, and other penetrating injuries. It is a monoarticular disease (it affects only one joint) and pain is commonly associated with changes in leukocyte count and other signs.

Is my dog going to live a long and happy life?

As you can see in the chart and bullet points above, there’s no way to answer that question without analyzing each case separately. There are many types and subtypes of arthritis in dogs, but the majority of them have a very good prognosis when the diagnosis is made in an early phase.

Your dog can live his entire lifespan with an improved quality of life in some cases, but in others, there is a high chance of severe and life-threatening complications with a guarded prognosis.

Erosive forms of arthritis are associated with a poor prognosis with a significant reduction in quality of life. Conversely, non-erosive types of arthritis are entirely benign.

What Can I do to help the best?

The majority of cases of idiopathic polyarthritis (the most common form of arthritis in dogs) improve significantly with early treatment and relapse is unlikely.

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When there is a relapse, dogs may require life-long therapy to improve their symptoms, but most of them respond to treatment, improve their symptoms, and will be able to live a happy life for many years to come!

References:

Abercromby, R., Innes, J., & Clements, D. (2018). Arthritis. In BSAVA Manual of canine and feline musculoskeletal disorders (pp. 65-86). BSAVA Library.

Soontornvipart, K., Kohout, P., & Proks, P. (2003). Septic arthritis in dogs: a retrospective study of 20 cases (2000-2002). Acta Veterinaria Brno, 72(3), 405-413.

Johnson, K. C., & Mackin, A. (2012). Canine immune-mediated polyarthritis: part 1: pathophysiology. Journal of the American Animal Hospital Association, 48(1), 12-17.

Johnson, K. C., & Mackin, A. (2012). Canine immune-mediated polyarthritis: part 2: diagnosis and treatment. Journal of the American Animal Hospital Association, 48(2), 71-82.

Bland, S. D. (2015). Canine osteoarthritis and treatments: a review. Veterinary Science Development.

The post How long can a dog live with Arthritis? appeared first on Joint Pain Clinic.

As you will see in this article, there are many types of kneecap fractures, and even though it’s not a good idea to walk around after an injury that results in deformation of your knee, there ARE ways to get back on track and recover your mobility and ability to walk after enduring a fractured kneecap.

Kneecap fractures and twisting injuries

Knee pain is increasingly common after we age, and may result from trauma and aggressive twisting movements when playing sports. The most common causes are inflammation or a partial tear of ligaments, but sometimes a very aggressive trauma might also result in injuries to your kneecap or patella. This structure is very solid and mobile. It is also covered by other anatomical structures, so it is not common to endure a fracture or dislocation unless a great deal of force strikes the knee as in a car accident, a very bad fall of an overweight individual, a gunshot, and others.

Kneecap or patellar injuries are divided into two main types: a dislocation, when the kneecap is forced out of place, and patellar fractures when it’s broken. Moreover, a patellar fracture can be comminuted when it’s broken in several pieces, transverse or vertical when it’s broken in two parts, and osteochondral when it involves the cartilage that is found at the bottom of the kneecap.

Can you walk right after a kneecap fracture?

The knee is one of the areas with a broader range of movement in the body, and it is heavily used throughout the day. It is essential to maintain balance in the body, as it carries a considerable hefty weight every step you take, and aids in the movement, which is why people with a kneecap fracture have severe mobility issues after enduring knee trauma.

Thus, it is not a good idea to keep on walking and moving around right after enduring a kneecap fracture. They make your knee look different and deformed, and trigger significant swelling and pain that limits your movement and may lead to losing your balance. You may also note a visible gap in the central area of your knee if there is no blood blocking your view.

If you have experienced and note any of the signs and symptoms we mentioned above, do not try to move or walk with a broken kneecap! You should go to the emergency room as soon as possible. There are many different treatment modalities available to recover from a fractured patella, and in some cases, more than one surgery will be required to regain full mobility of the affected limb.

Immobilization and rehabilitation of a kneecap fracture

Either or not you need surgery to bring together the pieces of your kneecap, in most cases, it will be necessary to immobilize the affected leg with a cylinder cast. This is because your kneecap receives a significant portion of the tension in your quads and will be completely torn and unlikely to heal if you keep moving your leg muscles. When your articulation is immobilized, it will be possible to walk around with your kneecap fracture. This type of immobilization usually lasts for a couple of weeks, and it is followed by a splint or a hinged knee brace, or even crutches especially in cases of surgery because your doctor will need to take care of the surgical wound after a few days.

After this immobilization time, which may typically last for 4-6 weeks, you will be able to walk once again without an immobilizer, but it will be a good idea to use a cast because your quadriceps will become weak after such a long period without any type of physical activity. Thus, rehabilitation will be the next step to recover your mobility after a kneecap fracture.

Fractures of the Knee Cap (Patella)

Rehabilitation or physiotherapy is the last stage in the recovery of a patella fracture, and it should be performed under the guidance of your doctor and always supervised by a physiotherapist. If you want to regain your mobility and walk again normally as you did before, don’t miss an appointment and complete the exercises recommended by your physiotherapist at all times.

What you can do

Any step you want to take in this recovery period should be supervised by either your doctor or your physiotherapist before you try anything new. Besides your physio appointments, there are many things you can do at home at various stages of your recovery, and one thing that may be helpful when you have regained some strength in your quadriceps will be exercising in a static bicycle or pedal exerciser. This works fantastically to increase your range of motion while most physio exercises are meant to strengthen your quadriceps.

So, if you asked a doctor whether or not it is possible to walk after a kneecap fracture, the recommendation will be trying to immobilize the affected limb until it is examined by a doctor.

After your articulation has been treated and properly immobilized to bring together the pieces of your kneecap, it will be possible to walk once again, and the limitation will depend on your own capacity.

If your patellar fracture is not severe, you may not need a full immobilization with a cast but will be recommended to use a hinged knee brace. In this case, limit your walking to the essentials to perform your daily activities and do not engage in physical exercise involving your lower extremities unless recommended by a doctor.

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In the following table, we will show you what you can do to regain your mobility in each step of the rehabilitation process.

References:

Schenck Jr, R. C., McGanity, P. L., & Heckman, J. D. (1997). Femoral-sided fracture-dislocation of the knee. Journal of orthopaedic trauma, 11(6), 416-421.

Anand, S., Hahnel, J. C. R., & Giannoudis, P. V. (2008). Open patellar fractures: high energy injuries with a poor outcome?. Injury, 39(4), 480-484.

Catalano, J. B., Iannacone, W. M., Marczyk, S., Dalsey, R. M., Deutsch, L. S., Born, C. T., & Delong, W. G. (1995). Open fractures of the patella: long-term functional outcome. Journal of Trauma and Acute Care Surgery, 39(3), 439-444.

Luo, T. D., & Pilson, H. (2018). Fracture, Patella. In StatPearls [Internet]. StatPearls Publishing.

The post Can you walk with a fractured Kneecap? appeared first on Joint Pain Clinic.

Coming across alarming signs and symptoms is a common problem if we’re reading online information, and in most cases, we will never have these severe complications.

We will cover all of the 10 most Unusual Symptoms of Rheumatoid Arthritis below in detail:

1. High Fever
2. Numbness
3. Skin Rash
4. Dry Eyes
5. Visual problems
6. Chest Pains
7. Short Breath
8. Anemia
9. Easily Bruised
10. Chronic Neck Pain

Since there are so many signs and symptoms associated with rheumatoid arthritis, it is essential to know which ones are more common. Conversely, there are unusual symptoms that will not appear in most patients, and when they do, they are either alarming signs or symptoms associated with particular types of rheumatoid arthritis. We are advancing our knowledge with research funding in the UK. Donations are welcome.

In this article, we will cover 10 unusual symptoms of rheumatoid arthritis and discuss life-threatening complications and rare forms of rheumatoid arthritis associated with each one of them.

High fever

A mild fever might be a common symptom of rheumatoid arthritis because it is an inflammatory disease. In some cases, inflammation is severe enough to cause a subtle rise in temperature, especially during flare-ups. But high fever is not common in rheumatoid arthritis, and when it appears, it is usually caused by overlapped infections and not rheumatoid arthritis itself.

An infection could lead to a rheumatoid arthritis flare-up, and cases of high fever should be looked after, especially when accompanied by altered consciousness and other concerning symptoms.

Numbness or tingling sensation

In some cases, the inflammation in the articulations becomes quite severe and starts irritating the nerves that run along the joint. That’s why some cases of rheumatoid arthritis trigger a carpal tunnel syndrome or ulnar nerve entrapment.

Skin rash

Most people with rheumatoid arthritis develop a butterfly-like rash, but there are other types of uncommon skin rashes. For instance, palmar erythema doesn’t itch and affects the palms of both hands. In some cases, skin rash is associated with inflammation of the blood vessels, which is a medical problem called vasculitis, and it can be quite severe.

Visual disturbances

The inflammatory condition in rheumatoid arthritis can also affect various linings of the eyeball, especially the sclera (the white portion of the eye) and the uvea (which is the vascular layer of the eye). In rare cases, even small blood vessels in the retinal will be affected, leading to gradual vision loss.

Dry eyes

It is known as keratitis sicca or dry eye syndrome, and it happens in patients with rheumatoid arthritis when there are not enough tears to lubricate and protect the eyes from foreign particles.

In cases of dry eyes, patients usually have a sensation of foreign material in their eyes, a blurred vision, and a higher susceptibility to scarring and infections.

This eye condition can be a clue for your G.P to diagnose Rheumatoid Arthritis.

Chest pain

Chest pain in rheumatoid arthritis should be carefully examined because these patients have a higher risk of suffering from myocardial infarction and other cardiovascular problems. It may also be caused by an inflammation of the tissue that surrounds the heart, called pericardium, and it is also important to rule out any respiratory infection that may be causing chest pain, usually associated with cough.

Shortness of breath

A persistent cough and shortness of breath in rheumatoid arthritis is not a common symptom and should be evaluated by a professional. One of the consequences of a widespread inflammation is that the lungs undergo a severe thickening ultimately affecting the normal function of exchanging gasses. This is called pulmonary fibrosis, and it is a severe complication of rheumatoid arthritis that is not common but should be carefully assessed.

Anemia

It refers to low hemoglobin levels, and it is quite common in patients with or without rheumatoid arthritis. So, it is not necessarily triggered by the inflammatory condition. When anemia is caused by rheumatoid arthritis, it is very similar to iron-deficiency anemia, and often difficult to differentiate. This is because inflammatory conditions may start affecting the way iron is stored and used in the body, making it unavailable for hemoglobin production.

Easy bruising

In some cases, rheumatoid arthritis will also lower your platelet count, and these small cells are essential to promote faster healing and trigger blood clotting when it’s necessary.

In flare-ups and special conditions during rheumatoid arthritis, your body starts using platelets too much or destroying them faster than the rate of platelet production. In these cases, patients experience easy bruising and continuous bleeding.

Chronic neck pain

In cases of long-standing rheumatoid arthritis, a condition doctors should consider in cases of chronic neck pain is cervical myelopathy. When being referred to a consultant your G.P should give you the option of a Chiropractor or Osteopath for neck pain. In these cases, rheumatoid arthritis leads to degenerative problems in the cervical spine, which in turn affects the spinal cord. There’s excessive pressure to this part of the nervous system, leading to chronic neck pain and mobility problems in your upper extremities. This condition should be examined promptly to prevent any permanent damage to the spinal cord.

Watch Jeans story about how odd symptoms can be a wake-up call to potentially have Rheumatoid Arthritis…

with thanks www.nras.org.uk

As you can see in the following table, the symptoms described above are not common in rheumatoid arthritis unless they are associated with comorbidities or related health conditions.

References:

Collins, C. E., La, D. T., Yang, H. T., Massin, F., Gibot, S., Faure, G., & Stohl, W. (2009). Elevated synovial expression of triggering receptor expressed on myeloid cells 1 in patients with septic arthritis or rheumatoid arthritis. Annals of the rheumatic diseases, 68(11), 1768-1774.

Lee, K. H., Lee, C. H., Lee, B. G., Park, J. S., & Choi, W. S. (2015). The incidence of carpal tunnel syndrome in patients with rheumatoid arthritis. International journal of rheumatic diseases, 18(1), 52-57.

Makol, A., Matteson, E. L., & Warrington, K. J. (2015). Rheumatoid vasculitis: an update. Current opinion in rheumatology, 27(1), 63-70.

Chua-Aguilera, C. J., Möller, B., & Yawalkar, N. (2017). Skin manifestations of rheumatoid arthritis, juvenile idiopathic arthritis, and spondyloarthritides. Clinical reviews in allergy & immunology, 53(3), 371-393.

Vignesh, A. P. P., & Srinivasan, R. (2015). Ocular manifestations of rheumatoid arthritis and their correlation with anti-cyclic citrullinated peptide antibodies. Clinical ophthalmology (Auckland, NZ), 9, 393.

Lamba, N., Lee, S., Chaudhry, H., & Foster, C. S. (2016). A review of the ocular manifestations of rheumatoid arthritis. Cogent Medicine, 3(1), 1243771.

Meissner, Y., Zink, A., Kekow, J., Rockwitz, K., Liebhaber, A., Zinke, S., … & Strangfeld, A. (2016). Impact of disease activity and treatment of comorbidities on the risk of myocardial infarction in rheumatoid arthritis. Arthritis research & therapy, 18(1), 183.

Paulin, F., Doyle, T. J., Fletcher, E. A., Ascherman, D. P., & Rosas, I. O. (2015). Rheumatoid arthritis-associated interstitial lung disease and idiopathic pulmonary fibrosis: shared mechanistic and phenotypic traits suggest overlapping disease mechanisms. Revista de Investigación Clínica, 67(5), 280-286.

Fraenkel, P. G. (2017). Anemia of inflammation: a review. Medical Clinics, 101(2), 285-296.

Zhang, T., & Pope, J. (2015). Cervical spine involvement in rheumatoid arthritis over time: results from a meta-analysis. Arthritis research & therapy, 17(1), 148.

The post 10 Unusual symptoms of Rheumatoid Arthritis appeared first on Joint Pain Clinic.

Let us save you the journey and making the effort an appointment with your G.P even if you could get through and make one. The NHS isn’t what it used to be. So we are here to help you and give you FAST acting remedies here at the Joint Pain Clinic.

Here are some things to consider when you have this kind of pain.

The most common cause of wrist pain is trauma in active people and athletes and when making repetitive movements when you are struggling in the office working at a job or in more sedentary individuals. However, many long-term conditions may also cause wrist pain. However, if we want to determine the origin of this type of pain, it is essential to locate the source and examine the structures in the affected region.

Another important aspect is whether the pain is acute or chronic. Acute pain has a sudden and unexpected onset and usually results from injuries and trauma, while chronic pain points out at inflammatory or degenerative conditions that develop in the long term.

In this article, we will examine the causes of wrist pain located on the ulnar side of the wrist, also known as the pinky side.

Structures in the ulnar side of the wrist

The ulnar aspect of the wrist joins the distal part of the ulna with a shock-absorbing structure called “triangular fibrocartilage complex”. This structure is fundamental in stabilising the wrist; it looks like a triangle with no bone in the radiographs because it is formed by a series of ligaments, tendons, and a fibrocartilaginous structure called ulnomeniscal homologue. All of them join together to form a complex that works similar to the meniscus in the knee.

The triangular fibrocartilage complex is attached to a depression in the bone that is next to the styloid process. This area has one ligament that runs along the carpal rows of bones (lunotriquetral ligament) and the tendon of the extensor carpi ulnaris, the muscle that extends the pinky finger.

What causes ulnar wrist pain when twisting?

Pain located in the ulnar side of the wrist usually has an associated trauma in the area. In most cases, the pain symptom gets worst when performing twisting movements and may even start with an exaggerated twisting motion during contact sports or overuse injuries over the course of weeks or months.

There’s a broad range of possible causes, depending on the structure affected on the ulnar side of the wrist. The main symptom is pain on the pinky side of the wrist and may or may not have an associated boney prominence. Tenderness in the area may indicate stress injury or bone fracture. In some cases, patients may also report that the bones move out of place or make a popping sound that is often associated with pain symptoms.

We can differentiate at least three medical conditions, one of them related primarily to the ulna and the remaining two directly involving the triangular fibrocartilage complex.

Ulnar Impaction syndrome

It is also known as ulnar abutment syndrome and causes long-standing pain in the outer region of the wrist that worsens and makes it difficult to perform natural twisting movements such as opening a doorknob.

The origin of ulnar impaction syndrome is a difference of length between the radius and the ulna. The ulna is usually more elongated and creates an anatomic defect that results in an uneven surface in the wrist joint.

This is a congenital abnormality and does not mean that every patient with this anatomic variation will have chronic ulnar wrist pain. Instead, they are more susceptible to injuries in the wrist articulation and would develop the pain symptoms after a fall or trauma to the hand or wrist.

It is essential to diagnose and treat this condition as soon as possible because having an uneven surface in the articulation of the wrist involves excess stress on the joint. The resulting alteration to the triangular fibrocartilage complex becomes worse when the problem is not properly treated. Thus, do not neglect your symptoms and talk to your doctor to get a series of diagnostic tests and trace the origin of your wrist pain.

Traumatic injuries to the triangular fibrocartilage complex

There are various types of traumatic injuries to the triangular fibrocartilage complex, depending on the severity. They range from a simple tear or perforation to a combination of ligament tear with a fracture in the ulnar styloid process and more severe tears that make the wrist articulation loose and unstable.

These traumatic injuries are more common in athletic patients and those undergoing certain types of trauma.

Degenerative injuries to the triangular fibrocartilage complex

Contrary to traumatic injuries, degenerative lesions to the triangular fibrocartilage complex develop over the course of weeks, months or years. All of them consist of tears further classified in various stages depending on whether or not there’s a perforation in the triangular fibrocartilage complex, an alteration to the ulnar head, degenerative arthritis, and other mounting joint problems.

The ulnar impaction syndrome is usually behind this subtype of injuries but may be caused by inflammatory conditions as well, such as rheumatoid arthritis and other degenerative process such as osteoarthritis.

How you can Treat Ulnar-sided wrist pain!

There are certain home measures to manage the symptoms of ulnar-sided wrist pain, including resting the articulation and applying ice. However, this type of pain should be assessed by a doctor because it is likely to become worse.

The first stage of the treatment is usually conservative management lasting around 3 months. It consists of resting the articulation, applying ice and immobilising the articulation for a few weeks followed by physical therapy.

When conservative treatment does not successfully improve the symptoms, surgery is the next option. However, it is contraindicated in unhealthy patients not likely to endure complex surgery or patients with minimal symptoms, even if they do have radiographical findings.

Summary table

References:

Vezeridis, P. S., Yoshioka, H., Han, R., & Blazar, P. (2010). Ulnar-sided wrist pain. Part I: anatomy and physical examination. Skeletal radiology, 39(8), 733-745.

Watanabe, A., Souza, F., Vezeridis, P. S., Blazar, P., & Yoshioka, H. (2010). Ulnar-sided wrist pain. II. Clinical imaging and treatment. Skeletal radiology, 39(9), 837-857.

Yamabe, E., Nakamura, T., Pham, P., & Yoshioka, H. (2012, September). The athlete’s wrist: ulnar-sided pain. In Seminars in musculoskeletal radiology (Vol. 16, No. 04, pp. 331-337). Thieme Medical Publishers.

Sachar, K. (2012). Ulnar-sided wrist pain: evaluation and treatment of triangular fibrocartilage complex tears, ulnocarpal impaction syndrome, and lunotriquetral ligament tears. The Journal of hand surgery, 37(7), 1489-1500.

The post How can I prevent Ulnar wrist pain when twisting? appeared first on Joint Pain Clinic.

However, typically in many cases, they shouldn’t because your ankle consisted of tough bones carefully formed to balance thestresses and burden and should usually prevent excess pressure. Your ankles are a combination of hard bones and flexible articulations that work together simultaneously every time you take a step forward. However, sometimes, this flexibility makes it a soft spot for joint pain.

Ankle pain is often dull and poorly located, and there are various causes such as arthritis, gout, and ankle sprain. However, what if you can identify your ankle pain precisely in front of the articulation? What is located there, and what could it possibly be?

What is located in the front of your ankle?

The front of your ankle contains bony structures, tendons, nerves, and blood vessels. All of them can be affected or injured in various ways. Find out more about Ankle Pain from BMI Healthcare UK

The bony structures in this region are the lower portion of the tibia and the fibula.

Right in front of these bony structures run down a series of tendons extending to the toes. They are called tibialis anterior, extensor hallucis longus, and extensor digitorum. These tendons attach to the toe bones and move them according to the commands of the muscles above.

Between the tibialis anterior tendon and the extensor hallucis longus tendon runs down a blood vessel (anterior tibial artery) and a nerve (deep peroneal nerve).

If your pain is not dull and dispersed in a large area but located in the front of your ankle, your doctor will probably try to rule out a traumatic event or an injury to one of the structures we mentioned above. But what is happening and what can you do about it?

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Causes of pain in front of the ankle

There are various causes of pain in the anterior aspect of the ankle. In order of importance and frequency, they are as follows:

• Anterolateral Ankle impingement: This apparently complicated wording simply means that an excess of either bony tissue or soft tissue is causing interference to the regular movements of the ankle joint. Every time you flex your ankle, the joint meets this excess tissue, and your range of motion feels limited and painful. This may appear in patients who underwent an ankle sprain and neglected their condition. The tissue does not heal properly and instead grows an excess tissue that limits ankle flexion.

• Degenerative joint disease: Either arthritis or osteochondritis causes swelling and pain in the front of the ankle. The articulation is stiff, and it may have either a mechanical or inflammatory cause. Osteochondritis is also common in patients with a previous ankle sprain who were not correctly treated and developed microscopic fractures in severe cases.

• Tendonitis: Out of the three tendons we mentioned early, the most commonly affected is the tibialis anterior. This one runs down to reach the toes and passes straight in front of the ankle. In runners and people who use this articulation excessively or heavily (as in morbid obesity), this tendon becomes inflamed, the whole area goes through swelling, and nerve terminals are stimulated to deliver continuous pain that exacerbates by flexing the articulation. In tibialis anterior tendonitis, pain and tenderness are felt especially when touching the area of the tendon while at the same time flexing your ankle.

• Fractures or subluxation: It is also possible to experience a subluxation, fractures, or stress fractures in the area of the ankle with subsequent pain sensation upon moving the articulation. Similar to the ailments we have mentioned above, these cases are commonly associated with heavy use of the articulation. However, this time, there is usually an acute episode of trauma, ankle twisting, or fall related to the start of the symptoms.

Improving ankle pain and what you should avoid

As you have probably noticed, ankle impingement, tendonitis, and fractures are associated with heavy use of the articulation, and some cases of degenerative joint disease in the ankle have a similar origin.  It is a similar condition to Peroneal Tendonitis. Thus, if you’re having pain in front of your ankle, it is highly likely your putting much load in the articulation of your ankles.

If you’re a runner or have the daily habit of jogging, this might be due to overuse of the articulation. Similarly, other activities like aerobic dancing and leg exercises might be triggering this condition. Even if you don’t have much physical activity, overweight and obesity might be increasing the loads in the articulation, and seemingly small strains contribute a big deal to the problem at the end of the day.

All of the causes we have described above have something in common: they need appropriate rest to improve the pain symptom. Thus, stop dancing, running, and doing any activity that contributes to flexion and extension of the ankle. Resting your articulation for 4 weeks should be enough in severe cases, but in milder pain, you might start feeling better before that time.

You can apply ice and only resume physical activity when there is no pain at all. Over-the-counter medications help a big deal in reducing inflammation, and in some severe cases, your doctor might consider appropriate to schedule a rehab program or even apply a plaster cast. Thus, do not neglect your condition and talk to your doctor about your symptoms to know specific recommendations according to your case.

It should also be a good idea to identify altered foot biomechanics by visiting an orthopedist, especially if you’re overweight or obese. The whole flexing pain might be triggered or worsened by an altered use of muscles or pressure points in your feet. Thus, you might start feeling better by using special padding in your shoes.

How can I stop and prevent the Pain at the Front of my Ankle?

Thus, if you have experienced this bothering symptom, chances are you will be back on track very soon. The most common conditions are called ankle impingement, degenerative joint disease, tibialis anterior tendonitis, and fractures or subluxation. All of them are associated with heavy use of the articulation, as in running, dancing, doing aerobics or certain leg exercises, especially if you’re overweight or obese. Thus, according to your case, follow the advice of your doctor and only resume physical activity once your symptoms are fully resolved.

References:

Liu, S. H., & Nguyen, T. M. (1999). Ankle sprains and other soft tissue injuries. Current opinion in rheumatology, 11(2), 132-137.

Robinson, P., & White, L. M. (2002). Soft-tissue and osseous impingement syndromes of the ankle: role of imaging in diagnosis and management. Radiographics, 22(6), 1457-1469.

Robinson, P. (2007). Impingement syndromes of the ankle. European radiology, 17(12), 3056-3065.

Medicine Journal UK

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