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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.

Normal Joints:  
Arthroscopic view

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.

Normal knee cartilage
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.

Normal cartilage structure

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.

Arthroscopic view: Synovitis

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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