Preventing Repetitive Strain Injuries for Artists

Article featured on Practical Pain Management

Art therapy can be an effective and creative way to manage chronic pain. Just make sure you don’t add to your burden with repetitive strain injuries.

It’s no secret that art has profound benefits for mental health, including for people with a chronic pain condition, according to research such as this 2021 review published in Canadian Journal of Counselling and Psychotherapy. But if you’re not careful, your art practice can lead to repetitive strain injuries (RSIs) and actually add to—not subtract from—your chronic pain burden.

Art-related RSIs may start with tingling, numbness, aching or the unsettling realization that you’re dropping things. One day, you wake up, and the pain has gone from annoying to excruciating.

What Are Repetitive Strain Injuries?

According to Joseph Herrera, DO, a physiatrist and the Lucy G. Moses Professor and Systems Chair for the Department of Rehabilitation and Human Performance for the Mount Sinai Health System in New York, N.Y., visual artists, craftspeople, graphic designers, weavers and sculptors, as well as other types of artists, are highly vulnerable to RSIs—often known as overuse injuries—particularly of the shoulder, elbow and hand.

These result from at least two factors – sitting in one position for protracted periods and performing the same movement repeatedly without taking a break. Prolonged immobility injures postural muscles that are needed to keep the body in that position; repetitive movement injures structures responsible for that movement. Other contributing factors include poor posture, use of tools which require force or cause vibration (such as those used in sculpting) and poor and/or working environments that are too cold. “There’s a reason that athletes warm up before starting,” says Dr. Herrera.

Types of Repetitive Strain Injuries

RSI is an umbrella term for a range of musculoskeletal disorders caused by repeated micro-trauma of the structural tissues of the body – nerves, tendons, muscles and ligaments. Artists may be especially prone to these types of conditions, which can include but are not limited to:

  • Tendinitis
  • DeQuervain’s stenosing tenosynovitis
  • Bursitis
  • Dupuytren’s contracture
  • Ganglion cysts
  • Rotator cuff injury
  • Carpal tunnel syndrome
  • Epicondylitis (tennis elbow or golfer’s elbow, depending on whether the pain is on the outside or the inside of the elbow)

Other conditions that can be related to or worsened by repetitive stress include osteoarthritis, rheumatoid arthritis, and thoracic outlet syndrome.

There are a number of other injuries that can plague artists and artisans.

Graphic artists and others who spend hours hunched over a computer are very likely to develop lower back and neck pain from sitting in one position or from craning the neck forward.

“Prolonged sitting or standing puts stress on the cervical or lumbar discs that are between each vertebra of the neck or lumbar spine.” says Dr. Herrera. “Because of the line of gravity and the position of the pelvis, lying down with a small pillow under your knees is actually the healthiest position for human beings.”

Renowned Mexican artist Frida Kahlo, who had multiple catastrophic injuries and numerous surgeries due to a serious bus accident, was able to paint lying down but most painters would find that extremely difficult, if not impossible.

Preventing Art Injuries

There is a great deal of overlap between prevention and treatment for overuse injuries.

Ergonomics is the applied science that focusses on designing and arranging things that will allow people to interact with them most efficiently and safely. Ergonomic chairs with lumbar supports, specially designed mice and keyboards, sitting-standing desks and numerous other items can be irreplaceable in terms of both comfort and prevention of injuries.

A 2018 University of Pittsburgh study published in the journal Occupational and Environmental Medicine found that people with chronic low back pain reduced their pain and disability by 50% using a sit-stand desk and taking movement breaks.

“Although making art is a passion-driven activity, and it’s difficult for artists to stop when they’re absorbed in what they’re doing, intermittent periods of rest are one of the best ways to prevent repetitive stress injuries,” says Dr. Herrera, who recommends a timed break within 30-40 minutes after beginning to work and at regular intervals after.

Good posture – maintaining a straight back, keeping your neck straight and your head up to prevent “tech neck,” having both feet on the floor when sitting – and proper body mechanics when lifting or moving heavy objects such as litho stones or bags of plaster or cement are important.

There are many adaptive devices which can be helpful. Pick and choose according to the type of art you make, the positions and instruments, if any, that you frequently use. There are pencil grip tools, angled drawing boards, triangular pencils, and jigs to hold vibrating tools instead of using your hands.

Stretching, with or without the use of stretching bands can also help with constricted circulation in a body part. Yoga, tai chi, and other movement activities can be useful and relaxing. However, during the acute phase of an injury, you should seek professional advice as to what kind of exercise is appropriate.

Splinting, braces, compression gloves and whole-arm immobilizers can help with both prevention and treatment of RSIs; it is crucial that these be correctly sized and appropriate to your body, any pre-existing injury or surgery and the way you work.

Treating Repetitive Stress Injuries

Early treatment of repetitive stress injuries is important not only to relieve inflammation and pain, but also to avoid making the injury worse, avoiding the need for surgery, and to lessen the risk for deformity or severe disability.

“The most important treatment is rest of the injured part,” emphasizes Dr. Herrera. “This is not a ‘no pain, no gain’ situation, and it is not the time to power through the pain. You must listen to your body.”

Over-the-counter analgesics such as acetaminophen, non-steroidal anti-inflammatory (NSAIDs) such as ibuprofen, aspirin, and naproxen work by inhibiting the production of substances which causes pain, inflammation and fever, and are useful in relieving pain.

Applications of ice can help during the acute stages of an injury or if swelling is present.

Tricyclic antidepressants and serotonin-norepinephrine reuptake Inhibitors (SNRI’s) may be used to treat pain and any accompanying depression.

Anticonvulsants such as gabapentin and pregabalin (Lyrica) are useful in treating nerve-related pain.

Muscle relaxants and antispasmodics are typically used to ease acute pain associated with muscle tension and painful spasms, such as those often experienced with lower back pain. Steroid injections (such as cortisone) may be helpful. Opioids (used with caution) and medical marijuana are other options for pain relief.

Physical therapy, massage, trigger point massage, transcutaneous electric nerve stimulators and other pain-relieving devices can be used for either acute or chronic pain.

“Take good care of your body, be aware of potential risks, and utilize rest both prophylactically and when an injury is present. That is the best way to avoid having to come see me in my office,” says Dr. Herrera.


New Mexico Orthopaedics is a multi-disciplinary orthopedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.

New Mexico Orthopaedics offers a full spectrum of services related to orthopedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.

Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopedic condition, and offer related support services, such as physical therapy, WorkLink and much more.

If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

Common Types of Arthritis Explained

Article featured on MedicalNewsToday

Arthritis is a painful rheumatic condition that causes joint inflammation. There are many different types of arthritis that can affect the joints and other areas of the body and cause similar symptoms, such as pain, swelling, and stiffness.

There are more than 100 different types of arthritis. Some common types of arthritis include osteoarthritis (OA), rheumatoid arthritis (RA), and psoriatic arthritis (PsA).

Below, we explore these conditions, as well as other diseases that can present with arthritis. We also discuss potential treatment and when to seek medical guidance.

OA

According to the Centers for Disease Control and Prevention (CDC). OA affects over 32.5 million adults in the United States.

Symptoms

Symptoms of OA include:

  • pain and swelling in the joints
  • joint stiffness
  • limited range of motion

People often experience OA symptoms in the hips, hands, and knees.

Risk factors

The following increase the likelihood of developing OA:

  • joint overuse, which can happen due to aging
  • joint injury
  • being female
  • obesity
  • a family history of OA

RA

RA is an autoimmune condition that causes painful swelling and inflammation in the joints. It typically affects the hands, wrists, and feet.

Symptoms

RA does not only affect joints. It can also cause problems in other organs of the body, including the heart, lungs, and eyes.

While some people experience a sustained progression of the disease, the intensity of symptoms usually comes and goes. Symptoms may include:

  • pain, stiffness, and swelling in several joints at once
  • fatigue
  • unexplained weight loss
  • fever

Another characteristic of RA is symmetrical involvement. This means pain and signs of inflammation occur on both sides of the body and in the same joints.

Complications

RA can cause lasting tissue damage, which can lead to:

  • recurring pain
  • destruction of joints
  • deformity or incorrect alignment of joints
  • limited joint mobility

Some people who have RA may also need assistance walking.

Risk factors

Some RA risk factors include:

  • being older
  • being female
  • having specific genes
  • smoking or being exposed to cigarette smoke early in life
  • having never given birth
  • having obesity

PsA

PsA is an autoimmune condition.

Symptoms

Symptoms of PsA include:

  • swelling, pain, and stiffness in the joints
  • extreme fatigue
  • nail changes

PsA joint involvement is asymmetric, affecting different joints on either side of the body.

This type of arthritis can develop in people with a skin condition called psoriasis, which causes scaly, flushed, or silvery patches of skin. These patches can look different depending on a person’s skin color.

Risk factors

Researchers still do not fully understand what causes this form of arthritis. However, having a family history of PsA may increase a person’s risk of developing this condition.

Gout

Gout is a type of arthritis that causes painful swelling, often in a single joint at a time.

Symptoms

Symptoms of gout can flare up and go away quickly. They include:

  • pain and swelling
  • flushed skin
  • a joint that feels hot to the touch

Swelling is common in the big toe. Often, it also affects the knee or ankle joint.

Risk factors

A person may be at higher risk of developing gout if they:

  • are male
  • have overweight or obesity
  • take certain medications, such as diuretics or beta-blockers
  • drink alcohol
  • follow a diet rich in purines or fructose

Health conditions that may lead to gout include:

  • heart failure
  • high blood pressure
  • diabetes
  • kidney disease

Gout may also occur due to metabolic syndrome, which is not a condition in itself. It refers to a number of characteristics, diseases, or habits that can make a person more likely to experience other health conditions, such as heart disease, stroke, or diabetes.

Lupus

This chronic illness is an autoimmune condition that commonly affects females aged 15–44 years.

Lupus is not a type of arthritis in itself. However, arthritis is one of the most common symptoms of this condition.

Symptoms

One symptom of lupus is the characteristic butterfly rash that can develop on the face. Other rashes can also develop on the arms, hands, and face. Rashes can worsen after sun exposure.

While symptoms may differ from person to person, they generally include:

  • joint and muscle pain
  • fever during flare-ups
  • hair loss
  • chest pain
  • kidney issues
  • sores in the mouth and nose
  • chronic fatigue
  • problems with memory
  • anemia
  • eye irritation, dryness, and inflammation
  • cold sensitivity with color changes of the hands and feet

Juvenile arthritis

Juvenile arthritis, also known as childhood arthritis, affects children or even infants.

Symptoms

Symptoms of juvenile arthritis include:

  • joint pain and swelling
  • joint stiffness
  • a rash
  • fever
  • fatigue
  • eye inflammation
  • loss of appetite
  • difficulty carrying out daily activities

Cause

There is no known cause of childhood arthritis. It appears to affect children regardless of race, age, or background.

Diagnosis

Reaching a definitive diagnosis may take time, because many types of arthritis are similar or resemble other conditions.

Typically, a doctor will first check a person’s medical and family history. They will also ask about symptoms and perform a physical exam. They may run tests such as:

  • imaging tests, including X-rays, MRI scans, or ultrasound scans
  • nerve tests
  • blood tests
  • joint fluid tests
  • skin or muscle biopsies
Treatment

Arthritis management depends on the type of arthritis. There are different forms of treatment available.

Medications

Medical treatment for arthritis may involve:

  • over-the-counter nonsteroidal anti-inflammatory drugs for relief of pain and swelling caused by inflammation
  • corticosteroid injections administered by a physician
  • topical pain relief creams and gel
  • disease-modifying antirheumatic drugs
  • biologics

Surgery

Surgery may not be necessary for everyone with arthritis. However, it can benefit certain complications of arthritis that result in malalignment of joints and functional limitations due to damaged joints. It can also help with intractable pain, which is when a person experiences pain that is difficult to treat or manage.

Common surgeries for arthritis include:

  • foot, ankle, hand, or wrist surgery
  • hip or knee replacement surgery

Physical therapy

Physical therapy can be a great option for people with arthritis. It can help ease pain or increase activity.

Behavioral changes that can help with arthritis may include:

  • getting regular exercise
  • quitting smoking, if applicable
  • reaching or maintaining a moderate weight
  • eating a healthful diet

Home remedies

Some people find certain home remedies helpful in relieving pain and swelling from certain types of arthritis. These may include:

  • hot and cold therapy
  • mindfulness strategies, such as meditation
  • massage

To discover more evidence-based information and resources for arthritis, visit our dedicated hub.

When to contact a doctor

If a person has experienced joint symptoms that last more than 3 days, they should seek treatment from a healthcare professional.

Similarly, if a person has joint symptoms at different times within a month, they should also contact a doctor.

Living with arthritis

Medications and other treatments can help a person manage chronic symptoms, such as pain and swelling.

Pain will come and go with many types of arthritis. However, even if the pain resolves, a person should still seek treatment.

It is important to treat arthritis early. If left untreated, some types of arthritis may worsen over time and cause permanent disability.

Summary

Arthritis is a painful condition that causes joint inflammation.

Different types of arthritis can cause similar symptoms. It is vital to get the correct diagnosis, as it can help determine most effective treatment options.

The right treatment may also prevent future complications and help a person live a more active life.

Use Cold and Heat To Ease Arthritic Joints

Article featured on Summit Ortho

When arthritic joints become stiff or painful, we explain how and when to use the application of heat and cold for arthritis for simple, effective relief.

Arthritis is the number one cause of disability in our country. More than 50 million Americans are affected by this disease. This number represents one out of every five adults and approximately 300,000 children. People of all ages and races are vulnerable to this joint-disabling condition. It is most common among women, and our chance of developing arthritis increases as we age.

Because there is currently no cure for arthritis, many people are under the impression that there is nothing they can do to manage their symptoms. In fact, medicine offers many helpful treatments for arthritis. Some therapies help with pain, and others improve the function of affected joints. In some cases, early treatments can actually slow the progress of the disease. Below we demonstrate how best to use heat and cold for arthritis.

One simple, inexpensive, and effective way for patients to treat painful joints at home is the application of heat or cold:

The trick is to know when to reach for a heating pad and when to use a towel-wrapped bag of ice or frozen peas to ease arthritic pain. We explain how temperature works to soothe a joint, and we distinguish between the type of pain that responds to heat versus the type of pain that responds to cold therapy.

Use heat to treat chronic stiffness in arthritic joints:

Heat encourages blood vessels near the surface of the skin to expand, increasing blood flow and relaxing muscles. When you wake up with sore joints, or if you feel stiff after a period of inactivity, a heating pad or a hot shower or bath will stimulate blood flow to your joints and help to make them feel more limber. A heat treatment is also a great way to prepare arthritic joints for exercise or activity.

Use cold to treat the acute pain caused by inflammation and swelling:

Pain following activity or a period of exercise is the result of soft tissue injury; broken capillaries leak blood and serum into adjacent tissues and cause localized swelling and inflammation. When a long walk or an afternoon in the garden leaves your joints feeling thick and painful, use cold. Cold applications cause the blood vessels to constrict, preventing further leakage and additional swelling, and relieving pain by numbing the sore joint. Use a bag of ice, a bag of frozen peas, or a gel-filled cold pack wrapped in a towel to protect your skin. Apply cold for 10 to 20 minutes. Remove for at least 20 to 40 minutes, and then repeat if necessary.

Generally, heat applications work best early in the day:

Use this as a jump-start for stiff joints. Icing is used at the end of the day to minimize any inflammation sparked by your day’s activities. If you have any questions about hot and cold treatments, talk with your doctor. At Summit, our teams of physicians and healthcare professionals can manage symptoms through a variety of conservative treatments designed to restore mobility, reduce pain, and protect the lifestyle you love.


New Mexico Orthopaedics is a multi-disciplinary orthopedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.

New Mexico Orthopaedics offers a full spectrum of services related to orthopedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.

Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopedic condition, and offer related support services, such as physical therapy, WorkLink and much more.

If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

Rheumatoid Arthritis: Can Knowing Your Risk Prompt Better Health Habits?

Article featured on Brigham Health Hub

If someone in your family has rheumatoid arthritis (RA), you may already know that you are more susceptible to developing the disease. Could understanding personal risk factors encourage you to change health habits, to possibly decrease your chances of developing RA?

Doctors at Brigham and Women’s Hospital are finding that people who learn their risks – based on genetics, blood markers, personal behaviors, and environmental exposures – are more likely to change behaviors to make them potentially less vulnerable to the disease.

“There are modifiable environmental factors that might have an impact on disease,” says Jeffrey A. Sparks, MD, MMSc a rheumatologist and assistant professor of medicine in the Division of Rheumatology, Immunology and Allergy at the Brigham. “Once you know what the risk factors are and how you can do something about it, you can act on that.”

What Causes Rheumatoid Arthritis?

Rheumatoid arthritis, the most common type of chronic arthritis, is caused by a dysregulated immune system. Symptoms include pain and stiffness in the joints (typically worse in the morning), as well as decreased energy, slight fever, appetite loss, and development of hard bumps beneath the skin near joints.

Progression varies from one person to the next. But when advanced, RA eventually can destroy both cartilage and bone, causing increased pain, swelling, deformities, and loss of mobility. Rheumatoid arthritis is more common among women and often begins between ages 40 – 60 years.

Genes probably don’t cause rheumatoid arthritis by themselves. But genetics may make a person more vulnerable to disease triggers, such as smoking and infections. In RA, the disease occurs in the “synovium” (the lining layer of the joints) when the immune system stops protecting the joints and instead damages bone and cartilage. Researchers at the Brigham and elsewhere are helping to understand the genes, health habits, and environmental factors that may increase a person’s risk of RA. They also are studying how to decrease that risk – including by changing some health behaviors such as smoking, obesity, low fish consumption, and poor dental health. These health behaviors likely affect RA risk by either increasing or decreasing the amount of inflammation in the body.

With these risk factors in mind, Brigham researchers including Dr. Sparks and Elizabeth Karlson, MD, MS are seeking ways to encourage prevention strategies for people at risk.

New Studies Suggest Knowledge Motivates Changes

Knowledge of risks is the first step to changing behavior. But what is an effective way for people to learn about their risks?

As part of the recent PRE-RA Family Study, Brigham researchers found that first-degree relatives of RA patients were familiar with the disease and symptoms. But they were relatively less aware of how their own health habits (including dental hygiene, smoking, overweight/obesity, and diet) could contribute to their risk of developing RA. In the study, those who received an interactive, web-based RA education tool that visually depicted their own personal risks showed greater increases in their knowledge of RA risk factors than those who received education that was not personalized to their own risks.

More importantly, the PRE-RA Family Study also showed that people would act on this new knowledge. Relatives who learned about their own personal risk of RA — based on genetics, autoantibody results from the blood, and their own behaviors — showed increased motivation to improve RA risk-related behaviors. The education included an interactive, visual presentation of their own risks, personalized for each participant, along with specific behavior changes (such as “eat more fish”) that might reduce those risks. Six months later, people who received personalized risk assessment and education, compared to those who received non-personalized information and education, were more likely to have increased fish intake, quit smoking, and brush and floss their teeth more frequently.

What You Can Do Right Now

For relatives of people with RA, but who themselves do not have RA symptoms, knowing and tracking your own personal health history is a good first step. The next is to be aware of how behaviors can affect your risk. Then pick actionable, attainable goals to reduce that risk, such as improved dental hygiene, quitting smoking, and maintaining a healthy weight.


New Mexico Orthopaedics is a multi-disciplinary orthopedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.

New Mexico Orthopaedics offers a full spectrum of services related to orthopedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.

Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopedic condition, and offer related support services, such as physical therapy, WorkLink and much more.

If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

Why Does RA Often Occur in the Joints of the Hands?

Article featured on MedicalNewsToday

In people with rheumatoid arthritis (RA), the immune system attacks healthy tissues in the lining of the joints. It often affects the hands, wrists, and feet. Over time, these joints can become stiff and deformed. Here’s why RA often affects these areas, along with treatments that may help prevent and treat pain.

Why does RA affect the hand joints?

RA tends to affect many joints at once. Often, symptoms first appear in the small joints of the middle fingers and in the bases of the hands and toes. It usually occurs in the same joints on both sides of the body.

RA may affect small joints in the hands first because there are many more joints in the hands than in other parts of the body.

The hands have 29 joints each. These joints are supported by a complex network of muscles, ligaments, and tendons that has evolved to perform complex tasks.

In people with RA, the immune system attacks and causes inflammation in the joint lining, or synovium. The synovium produces a fluid that lubricates the cartilage covering the ends of bones, allowing the bones to glide smoothly against each other when a person bends the joint.

A person with RA may experience symptoms such as pain, swelling, and stiffness in the joints. Over time, chronic inflammation in the joints may cause the cartilage to gradually wear away.

The condition may also progress to larger joints, such as the knees, ankles, or elbows.

In addition to affecting the joints, RA can cause inflammation that can also impact a person’s:

  • heart
  • lungs
  • eye
  • kidneys
  • skin

Common symptoms

Some research suggests that RA has a slow onset in more than 50% of cases.

Around 25% of people have abrupt RA onset. Experts believe that it is linked to gum inflammation from bacteria called Porphyromonas gingivalis. People will not experience gum inflammation or gingivitis (gum disease) from this infection unless they smoke.

RA is progressive, which means that the symptoms get worse over time. Treatments such as disease-modifying antirheumatic drugs (DMARDs) and nonsteroidal anti-inflammatory drugs can help slow the progression of RA but cannot cure the condition.

Early signs and symptoms of RA include tenderness, pain, swelling, or stiffness in joints that:

  • affect more than one joint
  • usually start in small joints, such as the hands, wrists, or feet
  • affect the same places on both sides of the body
  • last for at least 6 weeks
  • may be accompanied by stiffness in the morning for 30 minutes or longer

The fingers may appear swollen, like sausages. Inflammation can eventually cause irregularities in the joints and an inability to properly bend or straighten these joints.

Some other common symptoms of RA include:

  • weight loss
  • fever
  • weakness
  • fatigue

Over time, inflammation can affect other parts of the body, leading to symptoms such as:

  • dryness, pain, and inflammation in the eyes
  • sensitivity to light
  • small bumps in the skin over bones called rheumatoid nodules
  • shortness of breath
  • a dry mouth
  • gum inflammation or infection
  • a low red blood cell count

Home remedies

Home remedies do not replace medical treatments such as DMARDs, which can help slow the progression of RA. A person should never stop or change their prescribed treatment plan before speaking with a doctor.

Several home remedies may help alleviate pain, swelling, or stiffness in the joints due to RA. These remedies include:

  • heating pads or warm baths, to loosen up stiff joints
  • ice packs, to relieve joint pain and swelling
  • meditation and deep breathing techniques, to help a person relax and take their mind off the pain
  • acupuncture
  • massage
  • splints for the fingers or wrists
  • assistive devices, such as ergonomic keyboards or jar openers
  • lotions with capsaicin, to help relieve localized pain

The following supplements have limited scientific evidence proving their benefits but are worth bringing up with a doctor:

  • cannabidiol (CBD) products
  • fish oil
  • turmeric
  • glucosamine
  • probiotics

Making certain dietary changes can also reduce inflammation throughout the body and help a person lose weight. This may help relieve RA symptoms. Having an anti-inflammatory diet includes eating:

  • less sugar
  • fewer processed foods
  • less red meat
  • less full fat dairy
  • more fresh fruits
  • more vegetables
  • whole grains
  • lean meat
  • fish
  • legumes
  • nuts
  • seeds

Some people with RA may find that avoiding gluten or eating more fermented foods, such as yogurt and sauerkraut, helps with symptoms.

A person should always talk with a doctor before trying any new supplements or making any major dietary changes.

Exercises

For people with RA hand pain, exercise may improve the symptoms and maintain joint mobility and function.

Some research suggests that performing therapist-recommended hand exercises may improve grip and hand function while also relieving RA symptoms.

A 2018 study in 841 people with RA suggests that hand exercises may improve mobility and function. The study also concludes that performing a hand exercise routine likely does not relieve pain or improve a person’s grip and strength in the short or long term.

  • Here are three simple hand exercises that a person can try:
  • Gently squeeze a small, squishy ball or a stress ball.
  • Place the hand out flat with the palm up. Bend each finger, one by one, into the palm. Hold, release, and repeat.
  • Place the hand flat on a table. Lift one finger off of the surface and release it back down. Repeat with each finger, one by one.
  • Getting regular, gentle, full body exercise helps increase strength and range of motion in the joints, which can improve daily functioning. It also helps a person maintain a moderate weight, which can improve RA symptoms.

A person should aim to incorporate the following into their routine:

  • cardiovascular exercises, such as walking or swimming
  • full body strengthening exercises
  • light stretching

Some exercise is always better than none. Although feeling some discomfort is OK, a person should stop exercising if they feel significant pain.

When to talk with a doctor

A person should talk with a doctor if they experience any early symptoms of RA, including:

  • persistent pain or stiffness in the joints
  • joints that are warm to the touch
  • difficulty moving or engaging in daily activities

For people who already have a diagnosis of and treatment plan for RA, a doctor visit is warranted if they:

  • experience any new symptoms
  • feel that their treatments are no longer managing their symptoms
  • develop any side effects from their medications

A person should also talk with a doctor before starting new supplements or a new diet. Also, they should always talk with a doctor before changing or discontinuing their medications.

  • A person should ask questions of their care team as needed. The team will often consist of the following healthcare professionals:
  • a primary care physician
  • a rheumatologist, who will specialize in treating musculoskeletal conditions such as RA
  • a rheumatology nurse, who can help educate the person about RA
  • a physical therapist, to help with mobility issues and teach hand exercises
  • an occupational therapist, to share devices and techniques that help a person live with their symptoms and go about their daily tasks
  • a mental health professional, to help with stress and anxiety, which are more common in people with RA
  • an orthopedic surgeon, to correct joint damage with surgery as necessary

The takeaway

RA is an autoimmune condition that affects many joints in the body. The condition causes the immune system to attack the lining in the joints, causing pain and swelling. Because there are many joints in the hands, people usually experience the first symptoms of RA in their hands.

Medications such as DMARDs help slow the progression of the condition. Several home remedies can also help manage the symptoms. Hand exercises may improve hand mobility, while full body exercise may relieve the symptoms and improve overall well-being.

A person’s healthcare team can help determine the best treatment plan to manage pain and improve functioning.


New Mexico Orthopaedics is a multi-disciplinary orthopedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.

New Mexico Orthopaedics offers a full spectrum of services related to orthopedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.

Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopedic condition, and offer related support services, such as physical therapy, WorkLink and much more.

If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

9 Best Exercises for Rheumatoid Arthritis Pain

Article featured on MedicalNewsToday

For people with rheumatoid arthritis (RA), exercise can be hugely beneficial for relieving pain and joint stiffness.

People with RA who exercise may find that they have less pain than those who do not. Exercise can reduce painful symptoms, improve joint function and flexibility, increase range of motion, and boost mood.

It is best to seek medical advice before starting any exercise program and work with a doctor and a physical therapist to develop a tailored exercise plan.

Treatment for Rheumatoid Arthritis

Explore our comprehensive information on FDA-approved medications for rheumatoid arthritis. Learn about side effects, dosage, interactions, and more.

Best exercises for RA pain

The following types of exercise may help relieve the pain, joint stiffness, and other symptoms that RA can cause:

  1. Stretching

Stretching can help improve flexibility, reduce stiffness, and increase range of motion. Stretching daily is important for relieving RA symptoms.

The ideal stretching routine will be different for each person and depend on which joints are affected and what symptoms occur. However, stretches often involve slowly and gently moving the joints of the knees, hands, and elbows.

A typical stretching routine may consist of:

  • warming up by walking in place or pumping the arms while sitting or standing for 3–5 minutes.
  • holding each stretch for 20–30 seconds before releasing it.
  • repeating each stretch 2–3 times. Using a yoga strap may help people maintain proper form while stretching. If someone does not have a yoga strap, they could use an alternative such as a dog leash.

Some people may find it beneficial to work with a physical therapist who understands RA to learn the correct way to perform the stretches that meet their personal needs.

  1. Walking

Walking is a low-impact form of exercise that can help with aerobic conditioning, heart and joint health, and mood.

It is essential to wear proper shoes and stay hydrated, even if the walking is not strenuous. It is often sensible to walk slowly initially and then increase the pace when possible.

A person may want to start a walking routine on flat, even surfaces before progressing to uphill, downhill, or uneven surfaces.

  1. Flowing movements, such as tai chi and yoga

Both tai chi and yoga combine deep breathing, flowing movements, gentle poses, and meditation. They increase flexibility, balance, and range of motion while also reducing stress.

A 2013 study of participants with RA who had done group tai chi suggested that tai chi could reduce anxiety and depression while increasing self-motivation and self-esteem.

The participants did tai chi twice a week for 12 weeks.

A 2013 study of women with RA who did Iyengar yoga suggests that this exercise had mood, fatigue, and pain disability benefits. The participants did yoga twice a week for six weeks.

It is possible to find free online videos or apps like Gaia for tai chi or yoga workouts, including some yoga workouts specifically for people with RA. A person should always talk to their doctor before starting a yoga or tai chi practice.

  1. Pilates

Pilates is a low-impact activity that can increase flexibility for enhanced joint health.

It can be helpful to do Pilates poses that activate the core muscles and emphasize movements that help with stability. Pilates can be good for overall movement patterns, similar to tai chi and yoga.

People new to Pilates should begin slowly and seek guidance from a certified trainer if possible.

  1. Water exercises

Water helps support body weight by minimizing gravity, which means that water exercises do not impact heavily on the joints.

Swimming, water aerobics, and other gentle water exercises can increase flexibility, range of motion, strength, and aerobic conditioning. They can also reduce joint stress and stiffness.

More studies on the benefits of water exercises on RA are needed.

  1. Cycling

As RA increases the risk of cardiovascular disease, it is vital to keep the heart as healthy as possible. Cycling can help improve cardiovascular function.

Riding a stationary bike can be a safe way to get the joints moving and improve cardiovascular fitness. A benefit of a stationary bike is that a person can be supervised while riding. A person can also ride their bike outdoors to get fresh air.

In addition to improving aerobic conditioning, cycling can reduce stiffness, increase range of motion and leg strength, and build endurance.

  1. Strength training

Strengthening the muscles around the affected joints can help increase strength while reducing pain and other RA symptoms.

Using a resistance band is a way to challenge the body and build muscle over time. A physical therapist who works with people with RA should be able to offer guidance on suitable exercises.

  1. Hand exercises

RA can sometimes lead to limited use of the hands. A person with RA may lose their grip strength or find that they are dropping things.

Bending the wrists up and down, slowly curling the fingers, spreading the fingers wide on a table, and squeezing a stress ball can all help increase strength and flexibility in the hands.

  1. Gardening

Light gardening can be a beneficial exercise for a person with RA.

People should be gentle with their body, work slowly, and avoid overstraining the muscles and joints.

A person can avoid overstraining by avoiding bending and twisting in ways that can aggravate the lower back. A gardener should make sure to properly hinge at the hips when working in the garden.

Tips for exercising with RA

The tips below may improve safety and comfort when exercising with RA:

Be consistent

People need to exercise consistently to achieve meaningful results. It is important to keep at it and practice regularly. A person with RA will benefit from consistent and lifelong aerobic and muscle strengthening exercises. Some days may be less comfortable than others, but it is possible to adjust the intensity accordingly.

Accessorize for comfort and protection

The following methods can help people exercise more comfortably with less risk of injury and falls:

  • choosing proper shoes that provide the right protection and balance
  • using a slip-resistant yoga mat
  • wearing comfortable clothes that wick sweat away quickly

Seek variety

RA symptoms can vary daily, and they tend to come in waves. People often experience flares and periods of remission.

Doing a variety of exercises and mixing up the daily routine can help people avoid overworking one set of muscles or particular joints.

For example, a person doing morning stretches each day may choose to add strength training twice a week, a water workout once a week, and yoga or tai chi twice a week, symptoms permitting.

This variety should prevent any overuse injuries, which can aggravate symptoms and counter the benefits of the exercise.

Adjust exercises according to symptoms

People can reduce the intensity of an exercise on days when symptoms are more severe. For example, they could place a resistance band around the forearms instead of holding it in the hands.

Alternatively, they can try a different type of exercise or exercise for a shorter time.

On days when cycling or swimming seems too much, switching this type of activity to a leisurely stroll or some stretching will still be beneficial.

Listen to the body

It is important for people with RA to remain as physically active as possible. However, it is equally crucial to avoid discomfort or injuries.

It is vital to choose the right pace and listen to the body. If exercise causes discomfort or a flare, it is best to reduce the session. For example, do 10 minutes instead of 30. People should also take time off when necessary.

Pay attention to small things

Most exercises focus on large muscle groups. It is essential to make time for smaller parts of the body, such as the hands and fingers. It is also important to do small exercises with the toes and feet. Exercises that help with balance, such as yoga, are important also.

Creating a daily routine for these exercises can help.

Work with a physical therapist

Working with a physical therapist who specializes in RA can be helpful in developing a safe and appropriate exercise routine. This collaboration can be particularly beneficial for people with a new RA diagnosis or those who are experiencing a severe flare.

Exercises to avoid

People with RA should avoid strenuous exercise or any exercises that cause pain. These may include high-impact exercises that put excessive strain on the joints.

However, there are no specific exercises that everyone with RA should avoid. Each person is different, and an activity that causes pain for one person may not have the same effect on another person.

What is suitable for someone will depend on their situation and health condition. However, everyone is likely to benefit from paying close attention to their body and working with a doctor or physical therapist for guidance, if possible.

Summary

Exercise is usually helpful for people with RA. It offers a range of benefits, which include relieving symptoms, improving joint function, building strength, increasing flexibility, helping daily functioning, improving aerobic fitness, and boosting mood. It can reduce RA flares and make the symptoms of this condition easier to manage.

A person should work with a doctor and physical therapist, if possible, to develop a personalized exercise program for the best possible results.


New Mexico Orthopaedics is a multi-disciplinary orthopedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.

New Mexico Orthopaedics offers a full spectrum of services related to orthopedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.

Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopedic condition, and offer related support services, such as physical therapy, WorkLink and much more.

If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

What is Degenerative Arthritis?

Article featured on MedicalNewsToday

Arthritis is an umbrella term for diseases that affect a person’s joints. Degenerative arthritis, also known as osteoarthritis, is a form of arthritis that develops due to aging or overuse.

Degenerative arthritis is the most common form of arthritis in the United States, where more than 32.5 million adults are living with the condition.

It is sometimes known as the “wear and tear” form of arthritis, as it often occurs due to the natural aging process. It can also develop as a result of an injury or the overuse of a particular joint.

In this article, we look at the causes, risk factors, symptoms, diagnosis, and treatment of degenerative arthritis.

Symptoms of degenerative arthritis

The symptoms of degenerative arthritis vary depending on where in the body a person develops the disease. They usually get worse over time rather than occurring suddenly, except in the case of injuries.

Regardless of which parts of the body the condition affects, common symptoms may include:

  • pain, often throbbing
  • dull aching
  • swelling
  • reduced flexibility
  • clicking or popping noises when a joint bends
  • stiffness
  • decreased range of motion

Typically, joint stiffness will present early in the morning or after periods of rest, and it will last for up to 30 minutes before loosening up again. The joint pain can either be predictable and low level, lasting for long periods, or take the form of intense unpredictable bursts of pain.

According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases, the parts of the body that OA most often affects include the:

  • fingers and thumbs
  • knees
  • hips
  • neck
  • lower back

As the condition progresses, people may find themselves unable to complete activities such as holding a coffee pot, going up steps, or walking long distances.

Causes of degenerative arthritis

People develop degenerative arthritis when the joint cartilage between bones becomes damaged or breaks down.

Often, the body activates a repair mechanism to attempt to remedy this damage. As part of this, bone spurs, or osteophytes, may grow within the joint at the end of the bone. These can then cause friction within the joint and lead to pain when the person uses it.

Risk factors

Certain factors may increase a person’s chance of developing degenerative arthritis. These include:

  • Age: Symptoms generally appear in adults over the age of 50 years, although they can occur earlier.
  • Sex: Females are more likely than males to develop OA.
  • Genetics: OA tends to run in families.
  • Weight: Having obesity can increase a person’s likelihood of developing OA, as the additional weight can place extra stress on the joints.
  • Overuse: Repetitively using the same joints, such as in sports or at work, can sometimes lead people to develop OA.

Some of these risk factors, such as weight, are modifiable, whereas a person cannot change others, such as age and genetics.

Diagnosis of degenerative arthritis

There is no single test to confirm the diagnosis of degenerative arthritis.

Instead, doctors will ask a series of questions about the person’s medical history, such as when the pain began and whether they have sustained any injuries to the affected joint or joints. They may also want to know when the pain occurs and what, if anything, makes it worse.

In addition, the doctor can use X-rays to check for bone spurs or other types of bone damage. They may also take samples of fluid from the joints to rule out infection or gout and run blood tests to exclude other possible causes.

Treatment for degenerative arthritis

Healthcare professionals may treat degenerative arthritis in various ways. Some people with the condition may receive a combination of treatments.

The main aims of treatment include:

  • reducing symptoms
  • improving joint function
  • preventing the condition from progressing further
  • maintaining or improving the person’s quality of life

Medications

Doctors prescribe medications to help reduce the pain and inflammation associated with degenerative arthritis.

Medications may include:

  • oral pain relievers, such as acetaminophen, or nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen
  • oral anti-inflammatory medications
  • corticosteroid injections to relieve inflammation and pain
  • topical products, such as creams, sprays, or rubs, to soothe sore joints

Physical therapy

Combining physical therapy with increased activity levels can help a person manage degenerative arthritis symptoms. People should ensure that they only participate in low impact activities to prevent further damage to the joints.

Maintaining an active lifestyle may help by:

  • reducing pain
  • improving function
  • increasing muscle and bone strength
  • improving mood
  • increasing quality of life
  • preventing falls by improving balance

It can also help a person maintain a moderate weight, which experts advise people with OA to try to do.

Surgery

Some people may need surgery if other treatments prove ineffective or the damage to the joint is extensive.

This surgery could be in the form of an osteotomy, during which a surgeon removes or reshapes part of the damaged bone.

Alternatively, a person may have a partial or total joint replacement, which involves a surgeon partially or entirely removing the joint and replacing it with a synthetic one.

Nonmedical options

Maintaining a moderate weight can help remove the added stress that excess body weight can put on the joints. People can do this by following a nutritious, well-balanced diet and engaging in regular, low impact physical activity.

Hot and cold therapies may also help relieve pain and stiffness in the joints. People should alternate the application of hot and cold compresses to the areas over the affected joints.

However, a person should always wrap an ice pack in a cloth first so that they are not applying it directly to their skin.


New Mexico Orthopaedics is a multi-disciplinary orthopedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.
New Mexico Orthopaedics offers a full spectrum of services related to orthopedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.
Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopedic condition, and offer related support services, such as physical therapy, WorkLink and much more.
If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

Rheumatoid Arthritis within Foot and Ankle

Article featured on OrthoInfo

Rheumatoid arthritis is a chronic disease that attacks multiple joints throughout the body. It most often starts in the small joints of the hands and feet, and usually affects the same joints on both sides of the body. More than 90% of people with rheumatoid arthritis (RA) develop symptoms in the foot and ankle over the course of the disease.

Description

Rheumatoid arthritis is an autoimmune disease. This means that the immune system attacks its own tissues. In RA, the defenses that protect the body from infection instead damage normal tissue (such as cartilage and ligaments) and soften bone.

How It Happens

The joints of your body are covered with a lining — called synovium — that lubricates the joint and makes it easier to move. Rheumatoid arthritis causes an overactivity of this lining. It swells and becomes inflamed, destroying the joint, as well as the ligaments and other tissues that support it. Weakened ligaments can cause joint deformities — such as claw toe or hammer toe. Softening of the bone (osteopenia) can result in stress fractures and collapse of bone.

In RA, the lining of the joint swells and becomes inflamed. This slowly destroys the joint.

Rheumatoid arthritis is not an isolated disease of the bones and joints. It affects tissues throughout the body, causing damage to the blood vessels, nerves, and tendons. Deformities of the hands and feet are the more obvious signs of RA. In about 20% of patients, foot and ankle symptoms are the first signs of the disease.

Statistics

Rheumatoid arthritis affects approximately 1% of the population. Women are affected more often than men, with a ratio of up to 3 to 1. Symptoms most commonly develop between the ages of 40 and 60.

Cause

The exact cause of RA is not known. There may be a genetic reason — some people may be more likely to develop the disease because of family heredity. However, doctors suspect that it takes a chemical or environmental “trigger” to activate the disease in people who inherit RA.

Symptoms

The most common symptoms are pain, swelling, and stiffness. Unlike osteoarthritis, which typically affects one specific joint, symptoms of RA usually appear in both feet, affecting the same joints on each foot.

Anatomy of the foot and ankle

Anatomy of the foot and ankle.

Ankle

Difficulty with inclines (ramps) and stairs are the early signs of ankle involvement. As the disease progresses, simple walking and standing can become painful.

Hindfoot (Heel Region of the Foot)

The main function of the hindfoot is to perform the side-to-side motion of the foot. Difficulty walking on uneven ground, grass, or gravel are the initial signs. Pain is common just beneath the fibula (the smaller lower leg bone) on the outside of the foot.
As the disease progresses, the alignment of the foot may shift as the bones move out of their normal positions. This can result in a flatfoot deformity. Pain and discomfort may be felt along the posterior tibial tendon (main tendon that supports the arch) on the inside of the ankle, or on the outside of the ankle beneath the fibula.

Midfoot (Top of the Foot)

With RA, the ligaments that support the midfoot become weakened and the arch collapses. With loss of the arch, the foot commonly collapses and the front of the foot points outward. RA also damages the cartilage, causing arthritic pain that is present with or without shoes. Over time, the shape of the foot can change because the structures that support it degenerate. This can create a large bony prominence (bump) on the arch. All of these changes in the shape of the foot can make it very difficult to wear shoes.

Rheumatoid arthritis of the midfoot

This x-ray shows signs of RA of the midfoot. Note that the front of the foot points outward and there is a large bump on the inside and bottom of the foot.

Forefoot (Toes and Ball of the Foot)

The changes that occur to the front of the foot are unique to patients with RA. These problems include bunions, claw toes, and pain under the ball of the foot (metatarsalgia). Although, each individual deformity is common, it is the combination of deformities that compounds the problem.
The bunion is typically severe and the big toe commonly crosses over the second toe.

Illustration of bunion and claw toe

People with RA can experience a combination of common foot problems, such as bunions and clawtoe.

There can also be very painful bumps on the ball of the foot, creating calluses. The bumps develop when bones in the middle of the foot (midfoot) are pushed down from joint dislocations in the toes. The dislocations of the lesser toes (toes two through five) cause them to become very prominent on the top of the foot. This creates clawtoes and makes it very difficult to wear shoes. In severe situations, ulcers can form from the abnormal pressure.

Severe claw toes can become fixed and rigid. They do not move when in a shoe. The extra pressure from the top of the shoe can cause severe pain and can damage the skin.

Doctor Examination

Medical History and Physical Examination

After listening to your symptoms and discussing your general health and medical history, your doctor will examine your foot and ankle.
Skin. The location of callouses indicate areas of abnormal pressure on the foot. The most common location is on the ball of the foot (the underside of the forefoot). If the middle of the foot is involved, there may be a large prominence on the inside and bottom of the foot. This can cause callouses.
Foot shape. Your doctor will look for specific deformities, such as bunions, claw toes, and flat feet.
Flexibility. In the early stages of RA, the joints will typically still have movement. As arthritis progresses and there is a total loss of cartilage, the joints become very stiff. Whether there is motion within the joints will influence treatment options.
Tenderness to pressure. Although applying pressure to an already sensitive foot can be very uncomfortable, it is critical that your doctor identify the areas of the foot and ankle that are causing the pain. By applying gentle pressure at specific joints your doctor can determine which joints have symptoms and need treatment. The areas on the x-ray that look abnormal are not always the same ones that are causing the pain.

Imaging Tests

Other tests that your doctor may order to help confirm your diagnosis include:
X-rays. This test creates images of dense structures, like bone. It will show your doctor the position of the bones. The x-rays can be used by your doctor to make measurements of the alignment of the bones and joint spaces, which will help your doctor determine what surgery would best.
Computerized tomography (CT) scan. When the deformity is severe, the shape of the foot can be abnormal enough to make it difficult to determine which joints have been affected and the extent of the disease. CT scans allow your doctor to more closely examine each joint for the presence of arthritis.
Magnetic resonance imaging (MRI) scan. An MRI scan will show the soft tissues, including the ligaments and tendons. Your doctor can assess whether the tendon is inflamed (tendonitis) or torn (ruptured).

Rheumatology Referral

Your doctor may refer you to a rheumatologist if he or she suspects RA. Although your symptoms and the results from a physical examination and tests may be consistent with RA, a rheumatologist will be able to determine the specific diagnosis. There are other less common types of inflammatory arthritis that will be considered.

Nonsurgical Treatment

Although there is no cure for RA, there are many treatment options available to help people manage pain, stay active, and live fulfilling lives.
Rheumatoid arthritis is often treated by a team of healthcare professionals. These professionals may include rheumatologists, physical and occupational therapists, social workers, rehabilitation specialists, and orthopaedic surgeons.
Although orthopaedic treatment may relieve symptoms, it will not stop the progression of the disease. Specific medicines called disease-modifying anti-rheumatic drugs are designed to stop the immune system from destroying the joints. The appropriate use of these medications is directed by a rheumatologist.
Orthopaedic treatment of RA depends on the location of the pain and the extent of cartilage damage. Many patients will have some symptom relief with appropriate nonsurgical treatment.

Rest

Limiting or stopping activities that make the pain worse is the first step in minimizing the pain. Biking, elliptical training machines, or swimming are exercise activities that allow patients to maintain their health without placing a large impact load on the foot.

Ice

Placing ice on the most painful area of the foot for 20 minutes is effective. This can be done 3 or 4 times a day. Ice application is best done right after you are done with a physical activity. Do not apply ice directly to your skin.

Nonsteroidal Anti-inflammatory Medication

Drugs, such as ibuprofen or naproxen, reduce pain and inflammation. In patients with RA, the use of these types of medications should be reviewed with your rheumatologist or medical doctor.

Orthotics

An orthotic (shoe insert) is a very effective tool to minimize the pressure from prominent bones in the foot. The orthotic will not be able to correct the shape of your foot. The primary goal is to minimize the pressure and decrease the pain and callous formation. This is more effective for deformity in the front and middle of the foot/
For people with RA, hard or rigid orthotics generally cause too much pressure on the bone prominences, creating more pain. A custom orthotic is generally made of softer material and relieves pressure on the foot.

Braces

A lace-up ankle brace can be an effective treatment for mild to moderate pain in the back of the foot and the ankle. The brace supports the joints of the back of the foot and ankle. In patients with a severe flatfoot or a very stiff arthritic ankle, a custom-molded plastic or leather brace is needed. The brace can be a very effective device for some patients, allowing them to avoid surgery.

Ankle brace

A custom-molded leather brace can be effective in minimizing the pain and discomfort from ankle and hindfoot arthritis.

Steroid Injection

An injection of cortisone into the affected joint can help in the early stages of the disease. In many cases, a rheumatologist or medical doctor may also perform these injections. The steroid helps to reduce inflammation within the joint. The steroid injection is normally a temporary measure and will not stop the progression of the disease.

Surgical Treatment

Your doctor may recommend surgery depending upon the extent of cartilage damage and your response to nonsurgical options.
Fusion. Fusion of the affected joints is the most common type of surgery performed for RA. Fusion takes the two bones that form a joint and fuses them together to make one bone.
During the surgery, the joints are exposed and the remaining cartilage is removed. The two bones are then held together with screws or a combination of screws and plates. This prevents the bones from moving.
Because the joint is no longer intact, this surgery does limit joint motion. Limited joint motion may not be felt by the patient, depending on the joints fused. The midfoot joints often do not have much motion to begin with, and fusing them does not create increased stiffness. The ankle joint normally does have a lot of motion, and fusing it will be noticeable to the patient. By limiting motion, fusion reduces the pain.
Fusion can be a successful technique. However, because patients with RA also show damaged cartilage and loose ligaments, the success rate of this type of surgery is lower in patients with RA than in patients without RA. The use of newer generation medication can slow the progression of the disease and impact the type of surgeries that can be performed successfully.
Other surgeries. The front of the foot is where there are more surgical options for some patients. Surgeons can now perform joint sparing operations to correct the bunion and hammertoes in some patients. Your surgeon will review the most appropriate options for your case.

Ankle

Ankle fusion and total ankle replacement are the two primary surgical options for treating RA of the ankle. Both treatment options can be successful in minimizing the pain and discomfort in the ankle. The appropriate surgery is based upon multiple factors and is individualized for every patient.

Ankle fusion and ankle replacement

This patient had arthritis of the hindfoot. It was treated by fusing all three joints of the hindfoot (triple fusion). An ankle replacement was also done in order to improve mobility and avoid the severe stiffness that would result from another ankle fusion. The ankle replacement implants can be seen here from the front and the side.

Patients with severe involvement of other joints around the heel or patients who have previously undergone a fusion on the other leg, may be more suited for ankle replacement. In addition, patients who have fusions within the same foot may be more suited for an ankle replacement.
Newer generation ankle replacement implants have shown promising early results. Ankle replacement implants have not yet been shown to be as long-lasting as those for the hip or knee, due to the fact that the newer generation of implants have not been available long enough to determine how long they will last.

Ankle fusion

These x-rays show an ankle fusion from the front and the side. The number and placement of screws and the use of a plate are dependent upon the surgeon’s technique.

Following ankle fusion, there is a loss of the up and down motion of the ankle. The up and down motion is transferred to the joints near the ankle. This creates a potential for pain in those joints, and possibly arthritis.
Patients are able to walk in shoes on flat, level ground without much difficulty after an ankle fusion, despite the loss of ankle motion. The joints in the foot next to the ankle joint allow for motion similar to the ankle joint, and help patients with fused ankle joints walk more normally.

Arthritis in subtalar joint

Over time, the increased stress that is placed on the rest of the foot after an ankle fusion can lead to arthritis of the joints surrounding the ankle. This patient had pain in the subtalar joint (arrow) and required an additional fusion of that joint to minimize the pain. Increased stress on other joints is the most concerning problem following ankle fusion.

Hindfoot (Heel Region of the Foot)

A fusion of the affected joints of the hindfoot is the most common surgery used to treat patients with flatfoot or arthritis of the hindfoot. A triple arthrodesis is a fusion that involves all three joints in the back of the foot. Occasionally, the joint on the outside of the foot is not fused if there is minimal to no involvement of that joint (this is at the surgeon’s discretion). This type of fusion eliminates the side-to-side motion of the foot, while preserving most of the up and down movement.
If RA is only in one joint, then a fusion of just that affected joint may be all that is needed.

Ankle fusion

(Left) In this x-ray, two of the three joints in the hindfoot have been fused. (Right) Just the subtalar joint is fused in this x-ray.

Any fusion of the hindfoot will limit side-to-side motion of the foot. This will affect walking on uneven ground, grass, or gravel. There is no method to replace the joints of the hindfoot.

Midfoot (Middle of the Foot)

Fusion is the most reliable surgical method to treat RA of the midfoot joints. If the shape of the foot is not normal, surgery is designed to help restore the arch and minimize the prominences on the foot.
There are joint replacement implants available for joints on the outside of the midfoot. This may preserve some midfoot motion. However, the use of these implants is at the surgeon’s discretion. These implants are not available for the joints on the inside of the midfoot.
Although the foot cannot be returned to a normal shape, the goals are to reduce pain in the foot and improve the potential for the patient to wear more normal shoes.

Reconstruction of collapsed arch

(Top) This x-ray shows RA of the midfoot that has collapsed the arch. (Bottom) The surgical reconstruction involved a fusion of the middle of the foot with plates and screws.

Forefoot (Toes and Ball of the Foot)

The choice of treatment for patients with a bunion or lesser toe deformities (hammer or claw toes) depends on a number of factors.
If the disease is very mild, joint-sparing procedures that preserve motion can be considered. The decision is dependent on the medication that the patient is taking and the amount of damaged cartilage that is present. A fusion of the great toe may be recommended despite that fact the bunion is very mild. If there is damage to the cartilage of the great toe joint, correcting the bunion will not minimize the arthritic pain.
If the RA has progressed and the lesser toes (two through five) have dislocated, a complex operation to minimize the pain and restore the shape of the foot may be recommended. The operation involves fusion of the big toe and removing a portion of bone of each of the metatarsals. This surgery removes the prominent bone on the bottom of the foot that is a source of the pain and allows the toes to re-align into a better position.
Occasionally, the lesser toe metatarsals can be preserved by shortening them to allow the toes to resume their position within the joints. This is not always possible, however, and the joint may have to be removed.

RA of the forefoot before and after fusion

(Left) RA of the forefoot. The big toe is deviated and crosses over the second toe, a typical appearance of a bunion. The lesser toes (two through five) are dislocated, resulting in painful and severe claw toes. (Right) This x-ray taken immediately after fusion of the big toe shows that the prominent bones on the ball of the foot were removed and the claw toes were corrected. The pins hold the toes in place while the soft tissues heal. The pins are removed in the office after 4 to 6 weeks with minimal discomfort.

To fix the bend in the toes themselves, the surgeon may suggest cutting a tendon or removing a small portion of bone of the toes to allow them to straighten. Pins that stick out of the foot are temporarily required and will be removed in the office after healing takes place.
There are some newer implants available that can be buried within the toes, which avoid the need for pins sticking out of the foot. These implants may not work if the bone is soft, or if significant destruction of the joints has occurred.
This operation puts a lot of stress on the blood vessels and skin of the foot. In severe cases, the toes may not survive the operation and may require amputation of a portion or the entire toe. This operation can provide the patient with a high level of function and the ability to enjoy a wider variety of shoewear.

Footwear

Reconstruction of the foot does not mean that a patient will be required to wear bulky and unappealing shoes every day. The patient shown here had both feet reconstructed. She is able to wear sandals and mild heels without difficulty. Although these types of shoes are not recommended all the time, they can be worn from time to time. Not all patients will achieve such an excellent result.

Preparing for Surgery

Many of the medications that help with RA also affect the ability of the body to heal wounds and fight infection. Your surgeon will work with your rheumatologist or medical doctor to review which of your medications will need to be stopped prior to surgery. Once the wounds are healed, the medication is typically resumed.
This period of time can be very difficult for patients with other areas of the body that are affected by RA. Many fusions require at least 6 weeks of time where no pressure can be placed on the foot. Making appropriate preparations to ensure you have help at home is crucial for success after surgery.


New Mexico Orthopaedics is a multi-disciplinary orthopedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.
New Mexico Orthopaedics offers a full spectrum of services related to orthopedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.
Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopedic condition, and offer related support services, such as physical therapy, WorkLink and much more.
If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

Options for Treating Arthritis in the Knee

Article featured on The Noyes Knee Institute
Knee osteoarthritis can occur when the cartilage around the knee wears down. Without the protection of cartilage, bones in the joint grind together, causing inflammation and pain. In severe cases, a knee surgeon might recommend knee replacement or arthroscopic surgery. Fortunately, many non-invasive options help relieve the pain of arthritis in the knee.

Osteoarthritis and Rheumatoid Arthritis: What’s the Difference?

Knee osteoarthritis is a progressive condition in which the subchondral bone suffers damage as the cartilage slowly wears away. This type of arthritis is common in middle-aged and elderly patients and happens more frequently in females than males.
Rheumatoid arthritis (RA) is a disorder of the autoimmune system which leads to chronic inflammation. RA usually presents in both knees at the same time. Other joints, including fingers, toes, ankles, and wrists may also be affected.
Both types of arthritis respond to the conservative treatments listed below. However, as an auto-immune disorder, RA also requires specific medical care.

Treatments for Arthritis in the Knees

Weight Loss

For every pound of weight lost, you relieve four to six pounds of pressure from the knee. Carrying a significant amount of extra weight puts extra strain on knee joints which aggravates arthritis symptoms. However, even if you are not obese, losing just five to ten pounds could significantly relieve arthritis pain.

Avoid Aggravating Activities

While it’s important to continue exercising and moving your knees, overdoing it can make problems worse. Avoid the following activities if you notice pain or swelling up to 24 hours after participation:

  • High-impact exercise/sports
  • Kneeling/squatting
  • Walking for periods longer than 60-90 minutes without a rest break
  • Using stairs (inclining or declining)
  • Sitting in one position for more than 30 minutes without a break (such as during a long drive)
  • Standing for periods longer than 30-60 minutes

It may not be practical to avoid all of these activities every day, but reducing them as much as possible should help alleviate arthritis knee pain.

Anti-Inflammatory Medications

NSAIDs can be extremely helpful in easing arthritis pain. However, it’s important to use prescription or over-the-counter anti-inflammatory medications only as recommended by your physician. Overuse can cause serious side effects.

Knee Injections

Steroid or synthetic lubricant injections such as Synvisc may be recommended when diet and other lifestyle changes are ineffective.

Physical Therapy

Physical therapy and “knee-friendly” exercises are often recommended to help regain strength and flexibility in the knee joint.

Knee Surgery

When conservative methods fail, it may be time to consider knee surgery. Many people automatically think of total knee replacement when they think of surgery for treating knee arthritis, but there are several other surgical options to consider:

  • Arthroscopic debridement, abrasion arthroplasty
  • Autologous chondrocyte implantation
  • Femoral osteotomy
  • High tibial osteotomy
  • Meniscus transplantation
  • Osteochondral autograft transfer
  • Partial knee replacement

You and your knee surgeon will determine the surgical option that’s best for your situation. If you have sustained additional knee injuries, other procedures may be performed simultaneously as surgery to correct arthritis.

Should I see a Knee Surgeon?

If you have tried conservative therapies, but your arthritis pain continues to get worse, it may be time to consider surgery.


New Mexico Orthopaedics is a multi-disciplinary orthopaedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.
New Mexico Orthopaedics offers a full spectrum of services related to orthopaedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.
Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopaedic condition, and offer related support services, such as physical therapy, WorkLink and much more.
If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

Jog on: Exercise Won’t Raise Your Odds for Arthritic Knees

Article featured on MedicineNet
Dr. Kim Huffman, an avid runner, gets a fair amount of guff from friends about the impact that her favorite exercise has on her body.
“People all the time tell me, ‘Oh, you wait until you’re 60. Your knees are going to hate you for it’,” Huffman said. “And I’m like, ‘That’s ridiculous’.”
Next time the topic comes up, Huffman is well-armed: An extensive British analysis of prior study data has found no link between a person’s amount of exercise and their risk for knee arthritis.
The research team combined the results of six clinical trials conducted at different places around the globe, creating a pool of more than 5,000 people who were followed for 5 to 12 years for signs of knee arthritis.
In each clinical trial, researchers tracked participants’ daily activities and estimated the amount of energy they expended in physical exertion.
Neither the amount of energy burned during exercise nor the amount of time spent in physical activity had anything to do with knee pain or arthritis symptoms, the researchers concluded.
“This helps dispel a myth that I’ve been trying to dispel for quite a while,” said Huffman, an associate professor at the Duke University Medical Center’s division of rheumatology.
“If you add up the amounts of activity that people do and also the duration of activity, neither of those is associated with knee arthritis,” added Huffman, who wasn’t involved in the analysis.
Dr. Bert Mandelbaum is chief medical officer of the Los Angeles Galaxy soccer club and team physician for the U.S. Soccer Men’s National Team.
He agreed the study “further corroborates the fact that levels of exercise in one’s personal life do not increase the risk, the onset or progression of osteoarthritis.”

So where did this misconception come from?

Huffman thinks it’s because people mistake exercise-related injuries for the effect that exercise itself has on your joints.
“Right now, the clear risks for knee arthritis are genetics, injuries and female sex,” Huffman said. “People who exercise more may be more likely to injure their knee. That’s where I think the myth comes from.”
In fact, exercise can help ward off knee arthritis in several ways, Huffman said:

  • Flexing and extending the knee during exercise promotes the diffusion of fluid into the joint, promoting better nutrition.
  • An elevated metabolism created by exercise helps control inflammation in the knee joint.
  • Weight loss reduces the amount of load placed on the knee.
  • Exercise strengthens the muscles surrounding the knee, stabilizing it and reducing the risk of injury.

“I don’t think we’re finding that simple overuse or using your joint is a problem. It’s more an association with injuries and perhaps in the setting of obesity or high genetic risk,” Huffman said.
Your best bet is to choose an exercise that poses the least risk of a knee injury, Huffman said.
“If you want to go snow skiing, I don’t think that’s a huge problem but you’re probably going to be more likely to injure yourself downhill skiing than, say, walking in your neighborhood or training for a marathon,” Huffman said. “It’s not soccer or football or skiing itself. It’s just the risk for injury during those activities.”
On the other hand, exercise provides benefits that go far beyond healthy joints, said Mandelbaum, co-chair of medical affairs at Cedars-Sinai Kerlan-Jobe Institute at Santa Monica, Calif. He played no role in the research review.
“Physical activity is essential to optimize both physical and mental health and plays a central role in facilitating life’s quality and quantity,” Mandelbaum said. “The list of benefits includes decreased anxiety, better mood, decreased levels of coronary disease, hypertension, diabetes and obesity, and therefore a longer life.”


New Mexico Orthopaedics is a multi-disciplinary orthopaedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.
New Mexico Orthopaedics offers a full spectrum of services related to orthopaedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.
Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopaedic condition, and offer related support services, such as physical therapy, WorkLink and much more.
If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.