Joint Problems

Popping joints

Q . I'm 31 years old and in good health. I have noticed lately that my joints seem to pop when I move around. It is most common in my ankles, knees, and shoulders. My shoulders are also sore from time to time. I have been told that it is normal but it seems to be more common now and it is becoming a concern. What could this be?

A. A great deal depends on what you do for a living. Heavy lifting and strenuous manual labour tends to tighten rather than loosen joints while causing more wear and tear. A sedentary life loosens them all up which is why it is easier to dislocated a joint if you spend all your time sitting at a desk. It is not a sign of anything terrible about to happen but if you are very inactive you should consider a bit more exercise.

What are repercussions from fused ankle?

Q . I am 49 and have just been told that due to degenerative arthritis in my right ankle, from a fracture in 1984, that I have to have the ankle fused. Can you tell me how long I can expect to be in hospital, will I be in plaster afterwards and if so how long? What are my chances of being able to walk the golf course again on a regular basis?

A. You might not believe this but they have yet to make a working computer model of the ankle. 

The subtly of movement is so complex it is impossible to match with a machine. It has to be amazingly flexible with a wide range of movement yet withstand immense forces. Not surprisingly we suffer from ankle problems much more than four footed animals. Injury often shows up later on as osteoarthritis which is simply a wear and tear condition.

To stabilise the ankle and stop the pain is may be useful to fuse the joint so that it cannot move in one particular plane or not at all. This is not done lightly because of the obvious problems that come with it. There is no way I can say how long you will be in hospital or how soon you will be walking again except to say that it will be much sooner than you think. People don't stay in hospital as they used to and you will get extensive physio but at the end of the day it is all down to your own will power and your handicap should remain on the golf course not your body.

Pain in hip

Q . i have a constant dull pain in my lower back (right side) just above the butt cheek. sometimes the pain continues around to front and runs diagonally from my hip towards my groin. if i sit with my knees together and slowly spread my right leg to the side i get a sharp pain in the hip socket, and sometimes the joint will even pop.

I have consulted my GP and he has prescribed an anti-inflammatory, thinking that the cause of the popping may be a strained groin muscle. He also prescribed a series of exercises for the lower back.

 I have been on the medication for three weeks and the joint popping is less frequent, but has not ceased. The back exercises seemed to help and have made me realize that the pain was not really in my lower back but was actually in the upper part of my right butt cheek.

Upon my second visit to the GP he suggested continuing the routine as prescribed and has ordered a hip x-ray. I'm waiting for him to read the x-ray.

A. It is a tad tricky to give you any definitive advice with out more information, not least your age. What you describe could be caused by the joint itself, inflammatory and degenerative hip conditions will cause this kind of pain although there is generally a pattern of more pain in the morning with inflammation but more pain as the day goes on with degenerative conditions. 

A trapped nerve at the base of the spine will mimic this pain and can be caused by injury or osteoporosis (thin bones). Similarly it can result from a kidney stone. I'm afraid you will have to wait for the results of your test but don't be too disappointed if the X-ray shows nothing unusual. This is commonly the case and different examinations may be required.

Pains in joints and feet

Q . As an active man of 38 I run regularly for about 4 miles a day and play squash at a high level. But after returning from Saudi Arabia and being injury free, I find that I am developing muscular and joint problems. Whilst still being able to work I cannot perform such exercises as push ups as my left shoulder is too painful. There is no persistent pain and it is local. Also pain has developed around the right elbow similar to the shoulder. Also when I sit for a period of time and on waking up, I find it painful to stand as the soles of my feet are painful. But as I begin to move the pain subsides. Just don't tell me it's my age or to stop exercising. Thanks for any help.

A. It is unlikely that you picked something up in Saudi that has caused this problem. Without more information - your occupation, previous and family medical history along with an examination - it is impossible for me to give you definitive advice. It does sound, however, as if you have an inflammatory joint condition which may also be affecting the surrounding muscle. There is a broad range of these conditions from gout, which can affect all joints not just your big toe, through to rheumatoid arthritis. The fact that it is worse in the morning getting better with exercise as the day goes on is characteristic of a rheumatoid or inflammatory condition. There may be some family history of joint disorder. 

I recommend you attend your GP for some simple tests which will determine the cause of the problem. The good news is that the majority of these conditions can be treated very well.

Burning sensation in thigh

Q . For 3 months I have had an intermittent burning sensation in the front of my left thigh. There are no visual signs, rashes, bruises or other marks etc. It usually appears at night when in bed and this night it included a sharp pain as if stabbed by a thorn or needle just above the kneecap. Again there are no visible marks.

A. It would be useful to have some more information, not least your age and whether you have any problems passing water or back pain. What you describe may be caused by compression of the femoral nerve, possibly at the place where it leaves the spine. This can result from injury to the spine, pressure from a prolapsed disc ('slipped disc'), collapse of a vertebra from osteoporosis (bone thinning), something growing inside the spine (very rare) or an infection. Common things happen commonly and it is usually something treatable and common that causes this. Obviously an awful lot depends on your age, occupation, previous medical history. You should see your GP.

Pains in joints

Q . I am a 34yr old male and suffer with severe pain in my knee and toe joints. I am overweight and also play a lot of badminton (approx 6hrs a week). My doctor can offer no more advice other than lose weight and take painkillers however I am concerned about taking pain killers every day. The knee pain is felt most in the morning or day following exercise and it is painful to touch my knee cap. I also have pain in my kunckle joints occasionally. Should I seek a second opinion or try and see a specialist??

A. Think about it this way. If you owned a Porsche and you were very concerned over the state of the brakes and the mechanic you generally use can only advise you to stick your foot out of the door to stop the car, would you want to talk to another mechanic? We doctors are just glorified mechanics and we do not mind if you want advice from someone else. I encourage my patients to do so not least so that I might learn something I didn't know about.

You may well have a form of rheumatoid arthritis. This is even more likely if there is any form of joint problem in the family. Some types are linked with bowel disorders as well. Rheumatoid arthritis is an inflammatory condition and your joints will feel hot at times. Osteoarthritis is a mechanical wear and tear problem. Both will be helped by losing weight and gentle exercise but rheumatoid arthritis needs to be treated with special drugs not just painkillers.

Ask your doctor very nicely for a second opinion, preferably from a rheumatologist. A simple blood test may be all you need to confirm or eliminate the possible diagnosis. Please let me know how you get on.

Laminectomy

This question should be directed to a Neuro Suirgeon and/or a Neurologist. I am advised that I need a surgical procedure called a laminectomy. Im diagnosed as having cervical stenosis, (narrowing of the channel between the neck and shoulder), the neurosurgeon will be removing 2 or 3 bones to allow more room, I've had this condition since January 2000. Ive tried therapy,there is some improvement in the mobility of the right arm, Im not in any pain, just lost a lot of strength in my right arm, i.e. cant lift my 20 lb gym bag to kitchen counter height. I'm in excellent health, trim, good shape, jog and work out every day, avid tennis player, of which I haven't done for a year. When tired, I get sort of a nawing or pulling on the right side of my back and a little on the neck, especially, when jogging, which I relieve by stretching my right arm overhead, and also doing neck turning exercise to right and left which I picked up from my therapy. The question is, there is no guarantee that surgery will improve my condition , depending if there is nerve damage, which they suspect there isn't or if the surgery will in fact make it worse. The dilema being, the neurologist, and the surgeon say that I am at risk of becoming paralysed if I do not have the surgery. What are your comments please?? Thanks and best regards.

Every now and then a question comes along which is so specific and depends so much on specialist advice it is impossible to give a definitive answer. Yours is one of them. I am not a neurosurgeon. In a way this might, paradoxically be useful.

If I were you I would ask the surgeon a simple question. If he or she were suffering from the same condition would they choose surgery. Perhaps it might be better to ask whether they would advise it for their wife/husband/lover/child. One of the great dilemmas of modern medicine is the need, correctly, to inform patients of the risks involved. Unfortunately, this has become protective as the medical profession is being sued on a scale which would have been inconceivable even 10 years ago. Now every surgeon will outline in graphic detail the dangers of the operation entailed to prevent their patient coming back afterwards and seeing them in court for 'lack of informed consent'. Only you can make the decision with all the facts laid at your feet.

Pain radiating out from spine

Q . I have a pain which radiates out from my spine at the top of my shoulder blades. The pain increases when I press the spine and when I lift a weight. What is the likely cause adn what can I do to cure it?

A. This pain comes from tender points or areas at the top of your spine. Some people call these tender areas "trigger points"; they are very common. They tend to occur when people are tired, sleep deprived, have a viral infection or are stressed.

Here are some simple remedies to help:

- gently massage the tender areas

- when in the shower play hot water on them

- try a hot "bean bag" which has been warmed per instructions in a microwave

Other more expensive remedies are acupuncture, use of a TENS machine and aromatherapy.

Wrist problems

Q . Both my wrists are painful. My own doctor says that it isn't arthritis or repetitive strain but gave me painkillers and told me that I am getting old!!!!! Is there anything I can do to help myself as I am not keen on taking a prolonged course of painkillers.

A. I would agree with you, painkillers, if of the ibuprofen type are better avoided if possible. Analgesics such as paracetemol should be used, one or two to be taken before commencing activities which may give you wrist pain. Keep active and try and build up the muscles in your lower arm and hands as strong muscles will help protect your joints.

Knee problems

Q . I have a recurring pain in my knees, greater in my left than right. I think it might be related to my weight but not totally because the pain in my left seems to be centered under the knee cap. I can actually touch the pain at the bottom of the knee cap. I feel the pain most when kneeing down, running (i.e the impact upon landing), and at times when sitting I can feel a strain across the front of my left knee. I am 25 15.5 stones and 6'1"

A. This knee pain is not related to your weight. It is much more likely to be related to your activities which are causing the ANTERIOR KNEE PAIN. This is why you feel it at the front of your knee - behind the knee cap (the patella).

The best treatment is to wear better quality trainers or change the inner soles in your trainers to ones made of SORBITHANE. Sorbithane is a quality, shock absorbing material which should allow your anterior knee pain to settle. It would also be worth putting a thin sorbithane insole in your everyday shoes. The inner soles can be obtained from a good sports shop and will cost approximately £15.

Aching hands and wrists

Q . Just recently, over the last 2 weeks, both my hands and wrists have started to ache. Not much, but just a slight throbbing feeling. I just wondered if you knew what it was?

A. I would love to know if you have just changed jobs, started work on those DIY tasks you promised to do last year or have lost the immediate attention of your girlfriend. What you describe fits very well with unaccustomed activity involving your hands. Typing is the classic culprit but many other forms of repetitive exercise will do the trick just as well. For most men the problem comes on either very early after starting some new form of exercise or after prolonged exposure to the sort of work which can enforce stylised movements without the training to avoid repetitive strain injury (RSI). 

Simply avoiding the repetitive movement which brings on the discomfort will help, otherwise try wrist and hands exercises such as clenching a soft foam ball while rotating the wrists. If things get very bad a course of anti-inflammatory drugs such as ibuprofen can help. As a last resort you can ask your doctor for steroid injections or find a new girlfriend. Preferably the latter unless you fancy your GP and can kill two birds with one stone.

Broken thumb?

Q . I slipped recently and an now experiencing mild pain at the base of my thumb. It is worse when I attempt to put weight on it or carry things. I appreciate you cannot see it but might it be broken?

A. This can be a real problem, especially if it is affecting your dominant hand. The thumb is the most important digit of the hand as it opposes every other finger so it is worth taking this seriously. Falling on the hand can cause a whole scale of injuries but a common trauma involves the thumb. Hyper extension - severe bending back - of the thumb may not always fracture the bones but it may damage the tendons and ligaments which stabilise and move the thumb. This is usually felt as a dull ache made much worse by flexing or extending the thumb. It can be treated by strapping it for a few weeks but generally it is better to rest it for a few weeks followed by gentle exercises such as gripping a foam ball. Very rarely it will require injections of steroid. 

A fracture can occur in the small bones at the base of the thumb which needs an X ray to confirm. Fractures of the bones inside the thumb itself are usually fairly obvious and need only strapping. A potentially serious fracture involves the tiny base bone of the thumb called the scaphoid. Unless this fracture is diagnosed by X ray and treated by a plaster cast there is the danger of permanent problems with thumb function. Check with your doctor.

Pain in knee

Q . Recently I have started running on a treadmil approximately 2.25 miles a day for about 6 weeks. Now I get a pain at the top of my knee cap when I get out of the car or a chair. This pain will occur when pressure is applied on the muscles under my leg just above the knee, not on the calf. Help!!

A. This pain is similar to pain produced by physiotherapy in muscles not accustomed to being used or exercised. It is unlikely to denote damage; nor is it a warning to stop exercising. Usually, continuing to exercise at a less strenuous level will resolve the "problem" over a few days. Using massage oils before and after exercising will help, as will the use of good quality shock absorbing running shoes. Always remember to "warm down" - don't just stop the treadmill.

Pains in knees

Q . I have pains in my knees when cycling/hillwalking have been told it's tendonitis. What's the best treatment bearing in mind I can't take brufen or any simillar drug. Please advise, cheers.

A. There are two simple measures which may help considerably:

1. use Sorbithane innersoles in your boots

2. try a Neaprene knee support which will alter the tracking of your kneecap and probably limit the pain.

Pain in knee and joint

Q . I often experience severe pain in both the left knee joint or the top of the left shoulder although not at the same time. This tends to happen particularly at night or when sitting watching television. The knee joint when aching can be quite tender to the touch.Am I right in assuming it is something to do with rheumatics. I used to do a lot of heavy weight training until a couple of years ago.

A. Severe pains like this from joints, when resting or sleeping, seem to be a type of relaxation cramp. These pains appear to be worse in people who have exercised excessively in the past or even taken body building substances.

Simple advice is to do some "warming down" stretching exercises in the evening, preferably an hour or so before going to bed and then again a few minutes before going to bed.