Joint Pain: Causes, Symptoms, Treatment, Pathophysiology, Types
What is Joint Pain?
Joint pain is a symptom of an underlying condition or disease. Any individual may suffer from joint pain be it men, women, or children. Joint pain also called as arthralgia is caused due to injury to the ligaments, bursa, or tendons that surround the joint or any injury to the ligaments, cartilage, or bones within the joint and in case of inflammation of the joint such as arthritis. Presence of a tumor in a joint also causes joint pain or arthralgia. Joint pain may affect the performance of day-to-day activities and also affects the quality of life and should be treated as soon as possible or rather immediately. Pain may be present in a single joint or may be present in multiple joints. Pain may also affect range of motion of a joint. This pain can be sharp, dull, stabbing, burning or throbbing in nature and ranges in intensity from mild to severe. As mentioned above, there are many causes for joint pain or arthralgia like injury, infection, arthritis, and other ailments. The most common cause of joint pain or arthralgia is inflammation of the joints that is arthritis. Treatment for joint pain or arthralgia usually depends on the affected joint, the intensity and chronicity of the pain, and the underlying cause. If the underlying cause is treated, then the individual experiences relief of symptoms. Minor joint pains can be treated with over-the-counter pain medicines that reduce pain and swelling. Joint pain or arthralgia can also be treated by icing, taking warm baths, or stretching. For more severe pains, procedures such as steroid injections, joint aspiration, or physical therapy is done.
Earlier and accurate diagnosis of the underlying cause of joint pain helps in preventing irreversible damage and disability. Although complications from joint pain are rarely life-threatening, however, patient should seek immediate medical attention if they have joint pain or arthralgia due to injuries that involve profuse bleeding or tissue damage, severe joint pain, or high fever (higher than 101 degrees Fahrenheit). Medical attention is also required if symptoms recur or are persistent even after treatment.
Types of Joint Pain
Joint Pain can be local or referred pain.
- Local Joint Pain: This type of pain is localized to the joint and its surrounding area. The affected joint may be painful to touch, inflamed, and swollen. The surrounding structures of a joint where the pain may occur are the overlying muscle, tendon or tendon sheath, associated joint bursa, external & internal joint ligaments, outer and inner joint capsule, joint synovium and the periosteum. The causes for the localized joint pain include: Sprain, myofascial pain, bursitis, tendonitis, partial or full thickness tear, capsulitis, and frozen shoulder.
- Referred Joint Pain: This type of pain is present in locations which are distant to the affected joint. This type of pain is referred to other structures which are away from the affected joint. The structures where the joint pain may be felt are: Proximal muscles and joints, nerves and spinal structure. The causes for referred pain include: All the above mentioned local causes also lead to referred joint pain, neuralgia, sciatica, lower back pain and neck pain.
Other than this, the other types of Joint Pain or Arthralgia are:
- Trauma-Induced Joint Pain: This is a common type of joint pain and often occurs during sports activity or following motor vehicle accidents. Trauma based joint pain involves damage and injury to ligaments, tendons, muscles or tissues, including the bursa. Bursa is the fluid-filled sac that helps decrease friction between tendons and bones surrounding the joint. Tear in the ligament, tendon or muscle around a joint also causes pain and swelling and limits the joint movement. Traumatic injuries like fractures or broken bones also cause joint swelling and joint pain. The severity of trauma-induced joint pain depends on the type and location of the injury. Joint injury causes dislocation or subluxation of joint resulting in joint pain. Injuries of the soft tissues supporting joint also induces severe pain. Soft tissue injury like tendon tear or sprain, ligamental tear or laceration and muscle tear may need surgical treatment.
- Inflammation Induced Joint Pain: Inflammation in the joints also causes pain or discomfort of the joint. Arthritis and osteoarthritis are the two most common inflammatory disorders causing joint pain. Rheumatoid arthritis usually affects joints on both sides of the body and is more often seen in women than men. It may occur at any age and often affects the wrists, fingers, knees, feet and ankles. The course and severity of rheumatoid arthritis varies between different individuals. Osteoarthritis is also known as degenerative joint disease or osteoarthrosis. This is the most common type of arthritis and occurs when joint cartilage wears down over a period of time. Osteoarthritis symptoms are joint pain, tenderness, stiffness and lack of flexibility. Joints most commonly affected by osteoarthritis are hands, hips, knees, neck and lower back. Osteoarthritis worsens over time and there is no definite cure for it. Osteoarthritis medications help in relieving joint pain and allows the patient to remain active. Joint inflammation is also observed in rheumatoid arthritis, psoriatic arthritis and septic arthritis. Inflammatory joint pain is often caused by soft tissue inflammation as observed in bursitis, tendinitis and myofascitis.
- Internal Derangement Induced Joint Pain: This type of pain occurs when fluid accumulates within the joint following injury, ligament and cartilage tears and when there are loose bodies such as bone or cartilage floating in the joint space and also in meniscoid entrapment. Excessive fluid accumulation within a joint causes pain and swelling around joint. Ligament and cartilage tears are quite common, especially within the knee joint, and usually involving one or both of the cruciate ligaments and menisci. Sometimes, a piece of bone or cartilage will break away from the joint structures and float in the joint space causing pain and locked joint. Meniscoid entrapment may also cause joint pain and inflammation and restrict joint range of motion.
Causes of Joint Pain
There are many causes for joint pain. Some of which are the following:
Arthritic Causes of Joint Pain
- Gout causes joint pain, especially around the foot joint.
- Osteoarthritis causes pain in the joints
- Reiter's Syndrome
- Rheumatoid Arthritis
- Septic Arthritis (infectious arthritis)
- Rheumatic Fever
Traumatic Causes of Joint Pain:
- Physical Trauma to any of the joints can cause severe joint pain
- Broken Bones or a fractured bone can cause excruciating joint pain
- Dislocation of Bones
- Sprains and Strains
- Stress Fractures
- Tendon Rupture
- Herniated Disc (Ruptured or Slipped Disc)
- Joint Overuse Injury
- Nerve Entrapment or Compression (Pinched Nerve)
- Repetitive Motion Disorders
Infectious Causes of Joint Pain:
Joint Pain can be caused by any of the following infectious disease:
- Mononucleosis (viral infection)
- Influenza (flu)
- Mumps (viral infection of the salivary glands in the neck)
- Lyme Disease
- Gonococcal Arthritis
Other Causes of Joint Pain
- Osteomyelitis (Bone Infection).
- Side Effects or Allergic Reaction to Medications.
- Systemic Lupus Erythematosus.
- Tumor of bone, Joint, and/or Soft Tissue.
Risk Factors for Joint Pain
- Advanced age is one of the leading causes of joint pain.
- Obesity. Excess body weight increases the chances of joint pain in knee and ankles.
- Indulging in repetitive activities that puts pressure on the joints puts you at a higher risk for joint pain.
- Old joint injury.
Pathophysiology of Joint Pain
Joint pain occurs on activation of nociceptors or free nerve endings. Complex neuronal activation occurs when the nociceptive signals release a large number of neuro-mediators that involve local sensitization of joint nociceptors and also modifications in central pain pathways. Pain from the affected joint is mediated through afferent fibers. Afferent fibers are capable of enhancing and diminishing their capacity to detect and respond to various stimuli. The first group of afferent fibers is low threshold afferents activated by innocuous stimuli. The second group is afferents activated mainly by noxious stimuli. Some afferent fibers do not react to any stimulus. These are called silent nociceptors. Pain and mechanical hypersensitivity can not only develop as a result of sensitization of primary afferents which are directly involved in the inflammatory process but also after sensitization of neuronal processing in the spinal cord. Inflammatory pain is associated with sensitization of sensory proteins at the nociceptive endings whereas pain that results from damage to the nerve or neuropathic pain has been linked to changes in axonal ion channels giving out ectopic discharge in nociceptors as a source of pain. New goals for analgesic therapy include sensory proteins at the nociceptive nerve endings such as the activating TRPV and ASIC channels as well as inhibitory opioid and cannabinoid receptors. Joint pain can be caused due to cartilage destruction and the deposition of crystals in the joints from osteoarthritis.
Signs and Symptoms of Joint Pain
Joint pain itself is a symptom of an underlying condition like injury, infection etc and can be described as stabbing, throbbing, burning, dull or sharp, and its intensity could vary from being mild to severe. The most common cause for joint pain is arthritis. Some of the other common symptoms along with joint pain are:
- Pain or tenderness
- Redness, warmth or swelling
- Reduced mobility (range of motion of the joints)
- Tingling or other unusual sensations
Symptoms of Joint Pain Indicating Serious Condition:
- Bone protruding from the skin
- Profuse bleeding
- High fever
- Severe joint pain
- Sudden development of joint deformity
Treatment for Joint Pain
- Treatment depends on the underlying cause of joint pain and varies depending on the joint that is affected and the severity of the pain. When the underlying cause is treated, it alleviates the symptoms.
- Minor joint pain can be managed through home remedies like icing the joint, taking warm baths, limiting physical activity or performing stretching exercises.
- Over the counter medicines can also be given to reduce pain and swelling around joint.
- Those medications should be discontinued that are causing an allergic reaction or side effects in the form of joint pain.
- In quite a few cases, physical therapy may also be beneficial for joint pains.
- For joint inflammation, steroid injections are the common choice of treatment.
- Joint aspiration (arthrocentesis) can also be done to remove fluid from the affected joint.
- Joint pain due to a broken bone/fracture may require surgery or casting.
- Joint pain due to an infection in the joint may require surgery to clean out the infection and antibiotics are given post surgery.
- Joint replacement surgery is undertaken for severely damaged joints.
- Immunosuppressants are given for joint pain caused by immune system dysfunction.
- Apart from this, other complementary treatments like chiropractic treatment, acupuncture, massage therapy and yoga can also provide relief.
What Can Cause Joint Pain and How is It Treated?
Tests to Diagnose Joint Pain
- Performing physical exam will reveal inflammation and deformity of the joints.
- Blood Tests to Identify the Cause of Joint Pain: Anemia may be present due to chronic disease or blood loss from gastric irritation secondary to NSAIDs. Neutrophilia is present in septic arthritis, eosinophilia is present in polyarteritis nodosa, neutropenia is present in Felty's syndrome and leukopenia is present in SLE. Platelets may be decreased in SLE and increased in rheumatoid arthritis.
- Acute Phase Proteins: Estimated sedimentation rate and C-reactive protein are nonspecific indicators of an inflammatory activity causing joint pain.
- Uric acid may be raised in gout which is known to cause severe joint pain.
- Renal Function: Renal dysfunction may be present in chronic disease such as gout or connective tissue disorders.
- Autoantibodies: RA factor may support the diagnosis of rheumatoid arthritis causing joint pain.
- Antinuclear antibodies may indicate Systemic Lupus Erythematosus or other connective tissue disorders.
- Serology can be done for detection of HIV.
- Urine Tests: Proteinuria may be present in nephrotic syndrome associated with connective tissue disease causing joint pain.
- Synovial Fluid Tests: White cell count is raised in infection.
- Gram Stain and C & S (Culture & Sensitivity) for tuberculosis detection.
- Crystal Identification: Urate, calcium pyrophosphate.
- X-Rays may show distinctive changes in RA (Rheumatoid Arthritis) or OA (Osteoarthritis). Chest x-ray is indicated for lung involvement in RA, SLE, vasculitis, and tuberculosis.
- Ultrasound delineates soft tissue abnormalities like synovial cysts causing joint pain.
- CT Scan and MRI give more information regarding bone, joint and soft tissue.
- Gives a direct view of joint and synovial fluid. It is also helpful for biopsy and other therapeutic procedures.