In most cases,tendonitis occurs because of overuse or overload. Although tendonitis may affect tendons anywhere in the body,the most common sites are the shoulder,elbow,knee,wrist.and hand. In general, tendonitis produces pain in the tissues-surrounding a joint,especially after excissive use of the joint during play or work In some cases,there may be weakness at the involved joint,and the affected area may be red,swollen,and warm to the touch.

 

Your doctor may also ask you to perform specific limb maneuveres, such  as raising your arm above your head or bending your wrist. These maneuveres may be may be painful,but important and necessary as part of the diagnostic process because they tell the doctor which tendons are affected. In selected patients,blood tests may be necessary to rule out other causes of inflammation around the joints,such as gout or RA.

 

Bursitis: The bursa is a sac-like membrane near the joint space that acts as a cushion between the fibrous muscle,and bony prominences. Without the bursa,friction caused by movement would impede flexibility in the joints. bursitis,the inflammation of the bursa,is a common condition that occurs often when a specific joint is overused,in rarer cases include gout and infection. One form of bursitis called "housemaid's knee" occurs when the bursa in the front of the kee swells,because to much weight has been put on the joint,over a long time-period.

 

Bursitis is more common in overweight,older,and diabetic persons, although it commonly develops in healthy people,without a clear reason. Pain may occur around such joints as the elbows, hip, shoulder, big-toe.and knee,especially if pressure is applied. to the area or with use. Redness,warmth,and swelling are less common,and may indicate infection.

 

If the doctor suspects that gout or infection is the cause of bursitis,he or she may recommend that you undergo a minor procedure in which a sample of the fluid is removed from the bursa for analysis.

 

Carpel Tunnel Syndrome---Patient's wake up in the middle of the night with burning pain in the fingers. They feel numb,especially the thumb and the next three fingers. When patients hang their arm over the side of the bed,or shake the hand vigoursly,the numbness improves. It comes on during the day too,

especially if they're holding up a newspaper or gripping something for a extended period.

 

The most common cause is compression of nerves. This occurs most frequently in the hands, The carpel tunnel is a narrow shallow tunnel in the wrist through which all of the important nerves,tendons,and blood supply to the hand pass. Inflammation within this tunnel,caused by arthritis or other conditions, creates pressure on one of the nerves passing through it,which leads to irritation.

 

 Pressure on the nerve results in numbness in the palm of the hand and the second,thrird,and fourth fingers Pressure can be due to many things, including some that have nothing to do with arthritis ( pregnancy and low thyroid function are just two ). It is common in RA.

 

Median nerve pressure is caused by inflammatory swelling of the tissues at the wrist that lie just beneath the nerve. The nerve gets trapped between this swollen tissue and the tough ligament that crosses above it(passing through the narrow tunnel ).

 

An occupational therapist can provide the patient with a carpel tunnel splint to wear at night, This keeps the wrist from bending and putting even more pressure on the nerve.

 

If symptoms are really severe and medical management do not help,surgery is done. If symptoms persist for too long,the nerve can be permanently be damaged. Pressure can be relieved permanently by a simple surgical procedure,"carpel tunnel release ",which involves cutting the restraining ligament. It can be done in an out-patient basis,with the patient going home the same day.

 

It is commonly said,that CTS occurs in people who do repitive work,with their finger,but the condition is found in patients,who do not,do repetitive work,with their fingers.

 

Fingers that lock : Rheumatologists call this a "trigger finger". It's fairly common, and it's due to inflammatory thickening on one of the tendons that bend the fingers. This thickening,like a knot in a rope,blocks the smooth flow of the tendon as the finger muscles contract. The knot gets stuck,or catches on corners. An injection of a corticosteriod in the thickened area usually frees things up.

 

The suddenly droopy finger : The extensor tendons of the fingers ( those on the back of the hand,which allow us to point fingers ) pass through some tissue at the back of the wrist called "tenosynovial sheath". This tissue is often inflamed, swollen and painful in RA,and the inflammation can thin and weaken the tendons.

 

 A sudden "ping".a sharp pain,and a finger droops. Sometimes it rupture,not as common as one would normally expect as it's common occurance. Sometimes a surgeon removes the inflamed tissue if wrist pain on finger movement suggests that tendon rupture is likely. Usually,however,surgery occurs after the event. The tendon is reattached or replaced and the inflammatory tissue removed.

 

Raynaud's phenomenon  occurs when the fingers are exposed to cold,it turns white and feeling in the fingers is lost. When the fingers are exposed to heat they go purple,then fiery red,and patients complain,"they burn for a few moments".This can be a part of SLE or scleroderma. Most of the time they don't signify an underlining problem.

 

Arthritis of the knee--- A person who has arthritis of the knee may experience pain,swelling,and a decrease in knee motion. A common symptom is morning stiffness that lessens after moving around. Sometimes the knee joints locks or clicks when the knee is bent or straightened,but these signs may also occur in other knee disorders.

 

Most of OA of the knee is treated with NSAIDs and exercise to restore joint movement and restore joint movement,and strengthen the knee itself. RA of the knee may include a treatment plan that includes physical therapy,and use of more powerful medication.In people with arthritis of the knee,a seriously damaged joint,may need to be surgically  replaced with a artificial one.

 

Arhtritis of the shoulder---Most OA patients are treated with NSAIDs. RA patients also may encounter this problem.. The usual signs of arthritis of the shoulder are pain,particularily over the AC joint and a decrease in shoulder motion. A corticosteriod injection can be very helpful.

 

With a frozen shoulder,the joint becomes so tight and stiff that it is nearly impossible to carry out simple movements,such as raising the arm. Patients complain that the discomfort worsens at night. An arthrogram may confirm the diagnosis.

 

Back pain--Stiffness and pain in the neck or in the lower back can result from OA of the spine (lumbar spinal stenosis ). Weakness or numbness of the arms or legs can also result Also OA of the hip can cause pain,stiffness,and severe disability. Patients may feel the pain in their hips,or in their groin,inner thigh,or knees.

 

Chronic low back pain,long-term and persiting despite all interventions, represent only a small fraction of back pain,but constitue the central problem of back pain. Doctors have very little into the cause of this problem.

 

X-rays are often a waste of money,even such special ones as MRI and CT scanning can't distinguish these patients from those with episodic back pain or even from many who have any trouble with their backs. NSAIDs aren't helpful,and surgery invariably either does nothing or makes things worse.

 

There are many different types and cause of lower-back pains. Many people with spinal stenosis put up with the limitations imposed by the pain and weakness,and some show definite improvement with time.

 

Headaches associated with arthritis---Headaches associated with arthritis (also called cervical headaches) are caused by arthritis in the neck and spine (usually). Pain is usually located in the back of the head. In the case of a pinched nerve from arthritic bone or disk degeneration,pain may be accompanied by weakness in the arms/or tingling or numbness in the neck,scalp or arms. The pain of arthritis results from inflammation and subsequent damage of the joints and connective tissue (RA)

 

There are many different forms of arthritis,but the connection to headache is related more to the location of the arthritis then type.If the cervical vertebrae are involved,headache is likely to occur. RA and degenerative joint disease are the most common causes of cervical headache.

 

Treatment is usually NSAIDs (Acetaminophen,among others). Sometimes additional pain relievers are helpful Heat,massage,and exercise--under a doctor's supervision,are also helpful. A neck collar worn only intermittenly,may reduce symptoms. If there has been damage  to the neck so that nerves or  the spinal cord is compressed, surgery may be necessary.

 

Many older RA patients will have OA and RA but OA is often a "by-product" of the continued destructive process,encountered in RA. However,the condition is not limited to a certain age group or sex.

 

Cartilage is a tough,spongy,whitish layer that covers bone ends where they meet in a joint. It's a living tissue that grows,breaks down,and repairs itself. The first step in the development of osteoarthris occurs when the repair process no longer matches the rate of breakdown. Sometimes this happens because the cartilage itself is abnormal,such as in chondrocalcinous (arthritis-crystal ). In most cases,though,cartilage breakdown occurs because abnormal stresses,either mechanical or chemicals,are brought to bear on normal cartilage.