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| Understanding Joint Pain |
| Introduction:
Your joints are involved in almost every activity you do. Simple
movements such as walking, bending, and turning require the use
of your hip and knee joints. Normally, these joints work together
to provide smooth, painless movement. When the joints become diseased
of injured, the resulting pain can limit your ability to move and
work.
If you suffer from joint pain, this section will help you understand
the causes of joint pain and treatment options. Most importantly,
it will give you hope that you will be able to do more of the things
you enjoy – with less pain.
Gaining as much knowledge as possible will help you make better
choices regarding joint health. Be sure to make notes so you can
ask your doctor any questions you may have.
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| Normal Joints: |
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| Arthroscopic view |
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A basic understanding of normal joints
will help you make sense of what goes wrong with joints, and helps
your doctor select the best treatment options.
In normal joints, bone, cartilage, ligaments and muscle must work
together to provide both the mobility and stability required to
perform normal activity. Damage to any of these joint tissues can
result in pain and loss of function. |
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| Normal knee cartilage |
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Cartilage: Normal joints are roughly
10-100X more “slippery” than the best bearing man has ever made. Cartilage
is a smooth, white rubbery tissue that covers the ends of bone in
joints. In finger joints, cartilage tissue is about 1.0- 2mm thick.
Under the kneecap (patella) cartilage can be more than 8 mm thick.
The inset image shows normal, smooth white cartilage in a knee viewed
with an arthroscope. |
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| Normal cartilage structure |
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Microscopically, cartilage consists of a fibrous net or sponge where
the holes are filled with large molecules that include chondroitin
sulfate and glucosamine. The large molecules repel each other on the
submicroscopic level, and attract water. They will expand as far as
the fibrous net allows, like water in a balloon. When joints are loaded,
a little bit of the water may seep out of the net on to the surface
of the cartilage. This makes the joint surface more slippery, similar
to water on wet black ice. When the load is released, the water is
instantly resorbed, restoring normal springiness of the cartilage.
Disease or trauma can disrupt this elegant lubricating system.
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| Arthroscopic view: Synovitis |
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Synovium / Capsule: Healthy joints are surrounded by a tough
balloon like structure, the joint capsule. The joint capsule is lined
with a thin layer of special cells that nourish and protect the joint,
called synovium. (si-no-vee-um). Synovium cells secrete a scant amount
of lubricating fluid that nourishes the joint, and allows free movement
of the soft tissue and muscle about the bone. In joint injury or disease,
the joint may fill with a large amount of fluid, and the synovium
can become thickened and enlarged. |
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