Your joints
A joint in our body consists of two or more articulating bones, which usually situated at both ends of a bone. The part of the bone which articulates which each other is covered with a layer called cartilage.
Dr Ahmad Riaz Fami Bin Razali
MBCHB (Otago, NZ) MS Ortho (UKM)
Consultant Orthopaedic Surgeon
Pantai Hospital Ayer Keroh
I would normally describe the cartilage to be similar to the white-flesh structure inside a coconut. The joint is lubricated with an oily substance called Synovial fluid. Synovial fluid is produced from the inner part of the capsule called synovium. All these structure inside a joint is contained within a capsule.
The range of motions that a joint can perform, depends on the shape of the articulating bones, surrounding soft tissues such as the tendons, ligament and the muscles surrounding it and soft tissues within I the joint such as the meniscus and labrum.
Damage to joints
Damage to any of the structures above may cause joint pain, stiffness and instability. Sport injuries cause a variety of damage to the joint. Most commonly, sport injuries causes tears to the ligaments, tendons and capsule of the joint. Injuries such as Torn Anterior or Posterior Cruciate Ligaments of the knee, Torn Collateral ligaments of the knee, Meniscal Tear or the knee and Rotator Cuff tear of the shoulder are some examples of joint injuries that one can sustain in sports. Interestingly, women in sports are four to six times likely to sustain a torn anterior cruciate ligament (ACL) compared to men. This is attributed to multifactorial causes such as anatomy, joint laxity, ACL diameter and hormonal differences. These injuries cause joint instability, pain and swelling. Contusions on the articular cartilage may weaken it and causes it erodes. This causes joint pain during movements.
Previous trauma to the joint following a fall, motor-vehicle accident or repetitive work-related trauma that damages any structure of the joint, may be further deteriorated by time, if it was not properly attended too earlier. Partial tears of tendons and ligaments may be torn completely after a simple trauma. Incongruency of the articulating bones or a damaged cartilage surface due to a fracture, may shave of further cartilage off the articulating bone surfaces.
Osteoarthritis causes damage to the articulating cartilage. It produces erosions of varying degree on the articulating bone. Pain is more pronounce once the cartilage has totally eroded and bare bones are forced to articulate with one another. Just like holes on a tooth, nerve ending will be exposed and this elicits pain when friction between bare cartilage-less articulating bones are applied. This results in bone deformity, pain and swelling.
Rheumatoid Arthritis causes damage to the synovium and capsule initially. Subsequently, surrounding structures such as the cartilage, ligaments and tendons may be involved. This results in joint deformity, swelling, pain and instability.
What to do when you have a joint injury
The most important thing to do following a joint injury is the true and tested pneumonic P.R.I.C.E. The first letter P stands for ‘Protection’ which refers to protection of yourself and the affected joint followed by the letter R for ‘Rest’. Immediately when you feel a sharp pain on your joint, you should stop whatever you are doing. Drop on the ground if you have to. Either slowly move yourself to a safer area (i.e. Out of the playing field or court) or ask someone to assist you (i.e. A stretcher or someone to carry you out). Apply a simple splint or an arm sling to stabilise the joint and rest on the sidelines. Next, application of ‘Ice’ or something cold, will reduce the pain, joint swelling and inflammation. Apply it over a piece of cloth as continuous direct contact to skin may be unbearable. Followed by ‘Compression’ with a crepe bandage to provide protection as well as swelling reduction. Make sure not to wrap the joint too tightly as it may impede the blood supply. Finally, ‘Elevate’ the affected joint, if possible above the level of the heart, which also helps in reducing the swelling.
Medication of joint injuries
It is important to manage the pain that is associated with a joint injury. Analgesia such as Non-steroidal Inflammatory drugs (NSAIDs), Cox-2 inhibitors, mild opioids and even paracetamol is often used to treat such pain.
Visco-supplementation tablets such as Glucosamine sulphate and chondroitin sulphate claim to provide added lubrication to joints, hence reducing friction that causes cartilage degradation. However, these medication need to be taken for at least one to two months for it to take effect because of its distribution to all of the joints in the body as well as the affected joint. An injection of Hyaluronic Acid into the affected joint may be a more direct approach of lubricating an affected joint. These injections even claim to be able to repair and grow new cartilage. Nevertheless, these vicso-supplement therapies are only beneficial among mild to moderate cartilage damages.
Mild steroidal injections are used to provide fast relief on inflammations of tendons and ligaments. They are often used in the treatment of Tennis Elbow, Golfer Elbow, DeQuervains Tenosynovitis and shoulder impingement syndrome. However, there are not to be used often in view of their side effects. Surgery is indicated if pain is intolerable and affects activity of daily living, constant instability and severe deformity.
Generally, supplements are not indicated for healthy adults. However, postmenopausal women are at risk of developing osteoporosis. Hence, supplements of Calcium, Phosphate and Vitamin D are useful in strengthening bones and preventing low-impact fractures.
Supports or Orthosis for injured joints
There are many products available to protect an injured joint. These supports provide stability and pain relief to those joints, while allowing certain safe functional motion. They cater for various joints of the body and the protection they offer depends on the rigidity of the product. There are products with adjustable dials that allows the doctors to set a prescribed degree of motion such as a knee brace, while others restricts a motion of a joint altogether. Doctors will choose the best suited support which caters for the specific injury of a patient. Therefore it is best to get a doctors or a physiotherapist consult before buying one, which may be quite expensive and unsuited for the injury.
Mobilisation supports such as walking sticks, axillary crutches, elbow crutches, walking frames and wheelchairs are sometimes required to alleviate any type of load and pressure on an injured joint. They may look simple to use, but they needed to be personalised according to a patients’ injury, height, weight and level of fitness.
Care of injured joints
Car of an injured joint depends on the structure that is injured. For cartilage injuries, it is advisable to refrain from high impact activities to the joints such as running and jumping. Keep the joint moving with low impact exercises like stationary cycling or swimming. For Ligament and tendon injuries, we need to maintain full range of motion of the joint to prevent stiffness. Protect the ligaments with braces or guards that limit the straining and stretching of the affected ligament or tendons.
Joint injuries may lead to stiffness and muscle wasting. It is important to maintain normal full range of motion of the affected joint for normal activities of daily living such as sitting, standing from a sitting position, getting in and out if a vehicle and climbing staircases. Furthermore, most Asians are very particular in wanting to be able to be in a kneeling and squatting position.
Prevention of joint injuries/care of joints
Regular exercise which subjects the joints to its full range of motion should prevent joint stiffness. Stretching exercises elongates the muscle-tendon complex which allows for full range of motion and prevents stiffness. Muscle strengthening exercises protects the joints from excessive loads that may force the joint to move beyond its intended range of motion.
Avoid running on uneven surfaces as the risk of injuring joints is higher. Contact sports have higher risk of joint injury as we are unable to control collisions with opponents such as football and rugby. Sports that require twisting and cutting of knees such as football has higher risk of non-contact ligamentous knee injuries. External protection such as knee, elbow and wrist guards are helpful in preventing injuries.
I personally advocate muscle strengthening exercise with moderate to heavy weights. This type of exercise works your joints through its full range of motion and strengthens muscles in a controlled and tolerable manner. Bones are also strengthened as essential minerals in the body will deposit itself on weak areas, which the body will identify as we lift those weights.
Generally, bone mass of a healthy person steadily increases until it reaches its ‘peak bone mass’ at approximately 30 years of age. Subsequently, bone mass decreases slowly as we age. Hence, optimising bone mass before the age of 30 is important in minimising the risk of bone fractures in old age. This is achieved by maintaining a balanced diet with the required dietary requirement of calcium, phosphate and Vitamin D.
