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Osteoarthritis

Osteoarthritis – Causes, Symptoms & Treatment

Osteoarthritis, one of the most common conditions we see and treat at Integrative Sports Medicine, affects millions of people in the U.S.  Osteoarthritis can be, however, surprisingly treatable. Many of our patients are surprised at how much function they are able to get back and how rapidly their function and pain improved.  We often hear “You are the fourth doctor I have seen and the first to give me any hope.”

Osteoarthritis arises when enzymes actively eat away at cartilage. Most people think of it as “wear and tear”, but this isn’t necessarily accurate. The good news is, that these enzymes can be stopped with treatment and should be stopped with treatment, otherwise the osteoarthritis will continue to progress. As osteoarthritis progresses, cartilage breaks down cell by cell, day by day.  Knee arthritis and hip arthritis often times progress the fastest once the arthritis sets in.

Osteoarthritis mainly affects the weight-bearing joints: the knee, the hip, the ankle and the foot joints.  It can, however, appear in the rest of the joints of the body, most particularly the shoulder, the hands and the elbows. At times, it appears in the spine.  Osteoarthritis causes stiffness, most often in the morning, and pain during activity. A loss of range of motion can also signal that you need to seek out a Sports Medicine physician.

Treating osteoarthritis early is key.  The earlier we can identify and treat it, the better the chances we have of maintaining normal joint function. We want to avoid invasive treatments like surgery as long as possible as the spectrum of success with surgery ranges from “100% better all the way to “much worse than before the surgery.”  

Non-operative treatments generally do not have as much medical risk. At Integrative Sports Medicine, we have a special interest in cartilage. When you schedule an appointment, your joint will be diagnosed with x-ray generally, and if appropriate, treated at our office.  If the situation is not appropriate for non-operative treatment, we will offer you additional options including giving you a referral to see a surgeon. 

How to Diagnose and Treat a Rotator Cuff Tear without Surgery

To first, diagnose whether or not your rotator cuff has been torn, a targeted examination takes place. This exam works to determine what part of the shoulder is hurt.  Often when a diagnosis becomes clear the exam will be stopped in order not to aggravate the shoulder, and typically proceed with diagnostic ultrasound.

In some cases, one or more of the following imaging tests may be recommended:

Ultrasound

Diagnostic ultrasound uses sound waves to produce images.  It is particularly good at seeing details within soft tissues such as the rotator cuff.  Often, this is the only study necessary in order to get an informed diagnosis. During an exam, the joint can be moved to see how the structures within the joint moves.  This is an advantage over MRI.

X-rays

This is usually only needed in the setting of trauma or suspected arthritis.

Magnetic Resonance Imaging (MRI)

An expensive test but sometimes required during certain diagnoses such as a labral tear.

 

Rotator Cuff Treatment Options without Surgery

 

Injections

We may recommend a steroid injection into your shoulder joint.  These can temporarily reduce pain. However, at the same time, they may shut down all healing and make the tendons weaker.  We reserve these treatments for true rescues – such as times when the person cannot sleep for multiple days in a row or is elderly and has little chance of healing a shoulder problem.  We consider steroid injections generally harmful and to be used only in desperation to relieve pain.

Growing evidence shows that regenerative medicine can help tendons heal and improve their connection to the bone.  A powerful article in the Feb. 2019 issue in Medicine Science Sports & Exercise shows that PRP therapy heals certain partial rotator cuff tears that ordinarily never heal.

Therapy

We recommend physical therapy. A mainstay of rotator cuff treatment in any scenario, physical therapy restores natural movements and encourages healing through movement. This type of intentional activation of muscle-tendon groups works well to move the healing process along.