Rendering of Joint Pain in the Knee

Written by Robert Dean, M.D.

Joint pain is one of the most common health-related issues affecting people today, and it often prevents them from enjoying their lives to the fullest. In order to effectively treat joint pain, we must first understand the root cause of it. The causes can vary widely, from something as simple as overuse to inflammation to gout, or even to an infection inside of the joint. In this blog post, we will talk about some of the more common causes of joint pain that bring patients to our offices for our minimally-invasive procedure.

At AROmotion, our patients present with knee, hip, or shoulder “joint” pain. However, often these pain symptoms are not truly inside of the joint, but rather outside and around the joint. They may involve the overlying tendons, ligaments, or bursa that live next to and around the actual joint. So, the most important first step in evaluating a person’s pain is to determine whether it is truly the joint that is source of the pain!

A “true joint” is composed of the two bones and lubricating fluid inside of a joint capsule. It is important to know that the bones are covered with a hard ceramic/Teflon-like coating called Hyaline Cartilage (click the link here to dive deeper into the topic with Science Direct). Hyaline Cartilage is critical since bone is alive with sensory nerve endings and blood vessels. So, for any condition to cause joint pain, it must agitate or stimulate those pain-sensing nerves that are inside of the bone underneath of the hard Hyaline Cartilage. (By the way, this Hyaline cartilage that I’m describing, this hard Teflon like coating, is the same type of cartilage you will see on the end of a chicken bone! That hard rubbery cartilage on the tip of the bone is in fact the Hyaline cartilage.)

Joint pain typically involves inflammation or swelling inside of this joint capsule, which puts pressure on the Hyaline Cartilage coating the bone. When the pressure is severe enough, the pain-sensing nerves inside of the bone will be agitated and transmit pain signals to your brain. So, for example, if you do a lot of yard work like raking and digging, you overuse the hip and shoulder joints. This overuse will cause inflammation and swelling inside the joint capsule. This puts pressure on the Hyaline Cartilage and the nerve endings underneath. Pain signals will transmit to your brain stiffness and soreness and if severe enough actually pain.

Hyaline Cartilage
Image of Hyaline Cartilage

There are many conditions that lead to symptoms of joint pain. So, in the end, it is the pressure and agitation to these sensory nerves that tell you that the joint hurts!

Simple injuries, like accidentally dropping something on your hand or twisting/spraining your knee or ankle can also cause joint pain. This is because there’s a direct force to Hyaline Cartilage and to the bone underneath, agitating those pain-sensing nerve endings. The painful nerves trigger inflammatory cytokines that will cause the joint to swell. Cytokines in an acute setting or one-time setting, like a knee sprain, are actually a useful part of the healing process. In chronic arthritic syndromes, however, it is this pain that perpetuates the cycle of inflammatory cytokines via a neuropeptide called Substance P which is secreted by the agitated sensory nerve endings. Nerve pain – Substance P - Inflammatory Cytokines  swelling that leads to more nerve pain. The cycle of pain and inflammation smolders as a feedback loop in chronic joint pain conditions!

Summary:

From garden variety Osteoarthritis to more complex diseases like Rheumatoid Arthritis, infection, or even cancer, joint pain is always the end result of the agitated sensory nerve endings inside of the bone.

The most important point is that most joint pain is our body’s response to something irritating the sensory nerves inside of the bone. There’s always a cause and an effect. The only way you’re going to have true joint pain is by irritating and stimulating the pain-sensing nerves in the bone underneath of the protective Hyaline Cartilage. 

Any other pain that you may be experiencing from a “joint” is most likely outside of the joint and not truly joint pain. Rather, it is a result of painful tendons, ligaments, or bursa near or around the area. So first the diagnosis of joint pain needs to be correctly made and then the workup and diagnosis of the underlying cause of the pain will direct proper medical treatment.

This is where AROmotion comes in. If you are experiencing joint pain and have been told to either treat the pain with over-the-counter medications or that you may need joint replacement surgery, contact us today for a free consultation. One of our board-certified physicians will talk with you and determine if you are a candidate for our minimally-invasive procedure that stops joint pain and gets you in and out of our office the same day, with minimal recovery time. Simply fill out the form below to request your free consultation with us today.

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Robert Dean, M.D., is board-certified in internal medicine and leads the practice at AROmotion. Since 1997, Dr. Dean has helped patients in clinical practice and has given numerous talks at various medical conferences. He has traveled around the world with the Starkey Hearing Foundation helping to give the gift of hearing. He. was voted one of the Top Doctors in Florida by his peers and is known for his ability to simplify conditions and treatments from confusing medical jargon for his patients.

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