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Joint, tendon, and muscle pain



Related terms
Background
Treatment
Author information
Bibliography

Related Terms
  • Anti-cyclic citrullinated peptide antibody, arthritis, arthroscopy, Becker's muscular dystrophy, computed tomography, connective tissue, convulsions, crepitus, CT, depression, dermatomyositis, DEXA, dual-energy x-ray absorptiometry, Duchenne muscular dystrophy, Dupuytren's contracture, electromyography, epicondylitis, erythrocyte sedimentation rate, ESR, fibromyalgia, fibromyositis, fibrositis, gastroesophageal reflux disease, GERD, IBS, involuntary muscle, irritable bowel syndrome, joint noises, joint stiffness, magnetic resonance imaging, MD, MRI, muscle atrophy, muscular dystrophy, myalgia, myofascial pain, myofascial release, osteoarthritis, osteomyelitis, PMS, polymyositis, premenstrual syndrome, proximal myopathy, rhabdomyolysis, rheumatoid arthritis, spinal muscular atrophy, synovial fluid, temporomandibular joint disorder, tendonitis, tenosynovitis, TMJ, voluntary muscle.

Background
  • The musculoskeletal system includes bones, muscles, joints, ligaments, tendons, and bursae (fluid-filled sacs). Any of these components can be injured by trauma or affected by a number of diseases causing joint, tendon, and muscle problems.
  • Bodily movement is made possible by the interaction of the muscular and skeletal systems; for this reason, they are often grouped together as the musculoskeletal system. The skeletal system serves many important functions, including providing the structure for the body. The skeletal system comprises 206 bones that form a rigid framework. Muscles are connected to bones by tendons. Tendons are tough yet flexible bands of fibrous tissue. Bones are connected to each other by ligaments. Ligaments are fibrous bands or sheets of connective tissue linking two or more bones, cartilages, or structures together. Where bones meet one another is called a joint. Muscles that cause movement of a joint are connected to two different bones.
  • The muscles contract (get shorter) and relax (get longer) to cause movement. An example would be the contraction of the biceps (a muscle located on the front of the upper arm) and a relaxation of the triceps (a muscle located on the back of the upper arm). This produces a bend at the elbow. The contraction of the triceps and relaxation of the biceps produces the effect of straightening the arm.
  • Common symptoms of joint, tendon, and muscle problems include inflammation, pain, weakness, stiffness, joint noises, and decreased range of motion. Inflammation can result from many conditions, including musculoskeletal disorders, autoimmune disorders, obesity, and infections. When inflammation occurs in a joint, fluid may accumulate inside the joint, causing swelling and decreased range of motion.

Treatment
  • General: Joint, tendon, and muscle problems are often managed with medications that reduce pain and inflammation. Treatment depends on the cause of the problem. In severe cases, surgery may be necessary to repair damage.
  • In order to properly manage pain and prevent joint damage, individuals should take their medications as prescribed by their healthcare providers. Individuals with joint, tendon, and muscle problems should also tell their healthcare providers if they are taking any other drugs (prescription, over-the-counter, or dietary supplements) because they may interfere with treatment.
  • Corticosteroids: Corticosteroids, such as prednisone (Deltasone®) and methylprednisolone (Medrol®), are occasionally used to reduce inflammation and pain and slow joint damage. These drugs are generally very effective when used short-term. However, if used for many months to years, these drugs may become less effective and serious side effects may develop. Side effects may include easy bruising, thinning of bones, cataracts, weight gain, a "moon" face (swelling of the face), and type 2 diabetes.
  • Corticosteroids are usually prescribed for a certain amount of time and then the individual is gradually tapered off the medication. Individuals should not stop taking corticosteroids suddenly or change their dosages without first consulting their healthcare providers.
  • Nonsteroidal anti-inflammatory drugs (NSAIDs): Nonsteroidal anti-inflammatory drugs (NSAIDs) have been used to relieve pain and inflammation caused by joint, tendon, and muscle problems. Some commonly used over-the-counter NSAIDs include ibuprofen (Advil® or Motrin®) and naproxen sodium (Aleve®). Higher doses of these drugs are also available by prescription. Commonly prescribed NSAIDs include diclofenac (Cataflam® or Voltaren®), nabumetone (Relafen®), and ketoprofen (Orudis®). NSAIDs may be taken by mouth, injected into a vein, or applied to the skin. These medications are generally taken long term to manage symptoms.
  • The frequency and severity of side effects vary between NSAIDs. The most common side effects include nausea, vomiting, diarrhea, constipation, decreased appetite, rash, dizziness, headache, and drowsiness. The most serious side effects include kidney failure, liver failure, ulcers, heart-related problems, and prolonged bleeding after an injury or surgery. About 15% of patients who receive long-term NSAID treatment develop ulcers in the stomach or duodenum.
  • Pain relievers: Over-the-counter (OTC) pain relievers used in the treatment of joint, tendon, and muscle pain include acetaminophen (Tylenol®). It is important to monitor the amount of acetaminophen taken, as greater than 4 grams daily may cause liver damage. Prescription pain relievers, including tramadol (Ultram®), have been used to reduce pain caused by joint, tendon, and muscle problems. Although this drug, which is available by prescription, does not reduce swelling, it has fewer side effects than NSAIDs. Tramadol is generally taken as a short-term treatment to reduce symptoms of flare-ups.
  • Narcotic pain relievers, such as acetaminophen/codeine (Tylenol with Codeine®), hydrocodone/acetaminophen (Lorcet®, Lortab®, or Vicodin®), or oxycodone (OxyContin® or Roxicodone®), may be prescribed to treat severe joint, tendon, and muscle pain. However, they do not reduce swelling. These medications are only used short-term to treat flare-ups. Common side effects include constipation, drowsiness, dry mouth, and difficulty urinating. Narcotic pain relievers should be used cautiously because individuals may become dependent upon them.
  • Selective COX-2 inhibitors: Celecoxib (Celebrex®) has been taken by mouth to reduce pain and inflammation caused by joint, tendon, and muscle problems such as osteoarthritis. Celecoxib is currently the only COX-2 inhibitor that is approved by the U.S. Food and Drug Administration (FDA). Celecoxib is generally taken long term to manage symptoms.
  • COX-2 inhibitors have been linked to an increased risk of serious heart-related side effects, including heart attack and stroke. Selective COX-2 inhibitors have also been shown to increase the risk of stomach bleeding, fluid retention, kidney problems, and liver damage. Less serious side effects may include headache, indigestion, upper respiratory tract infection, diarrhea, sinus inflammation, stomach pain, and nausea.
  • Topical pain relievers: Topical pain relievers are creams, ointments, gels, and sprays that are applied to the skin to alleviate pain. Many over-the-counter (OTC) pain relievers may temporarily help reduce the pain caused by joint, tendon, or muscle problems. Products such as Aspercreme®, Sportscreme®, Icy Hot®, and Ben-Gay® may help reduce arthritis pain. Capsaicin cream, which is made from the seeds of hot peppers, may reduce pain in joints that are close to the skin surface, such as the fingers, knees, and elbows. However, pain may worsen for a few weeks when beginning to use capsaicin cream. Lidocaine patches (Lidoderm®) may also be used. Lidocaine is an anesthetic and when applied topically may decrease pain associated with joint, tendon, and muscle problems.
  • Antidepressants: Some individuals with joint, tendon, and muscle problems may also suffer from depression. Commonly prescribed anti-depressants for arthritis patients include amitriptyline, nortriptyline (Aventyl®, Pamelor®), and trazodone (Desyrel®). These drugs may also help with nerve pain associated with joint, tendon, and muscle disorders. Side effects of antidepressant medications include drowsiness, fatigue (excessive tiredness), constipation, dry mouth, and blurred vision.
  • Lifestyle modifications: Many lifestyle changes, including regular exercise, weight management, and consumption of a healthy diet may help reduce symptoms of joint, tendon, and muscle problems. A healthcare provider may recommend a physical therapist, nutritionist, or registered dietician to help determine the best treatment plan for the individual.
  • Individuals with joint, tendon, and muscle problems, such as osteoarthritis or rheumatoid arthritis, should wear comfortable footwear that properly supports their weight. This may reduce the amount of strain put on the joints during walking.
  • Individuals with joint, tendon, and muscle problems may require canes, walkers, or other devices to help them get around. If the hands are severely affected, braces may be beneficial. Individuals should talk to their healthcare providers about assistive devices that are available.
  • Individuals with joint, tendon, and muscle problems should maintain good posture. This allows the body's weight to be evenly distributed among joints.
  • Cool compress or ice pack: Applying a cool compress or ice pack to the affected joint during a flare-up may help reduce swelling and pain.
  • Heat application: Applying a hot pack to affected joints may help reduce pain, relax muscles, and increase blood flow to the joint. It may also be an effective treatment before exercise. Alternatively, individuals may take a hot shower or bath before or after exercise to help reduce pain.
  • Joint replacement surgery: In some cases, individuals with joint disorders suffer from permanent joint damage. In such instances, joint replacement surgery may be necessary. During the procedure, the damaged joint is surgically removed and replaced with a plastic or metal device, called prosthesis. The most commonly replaced joints are the hip and knee, but other joints, including the elbow, shoulder, finger, or ankle joints, can be replaced.
  • Joint replacement surgeries are generally most successful for large joints, such as the hip or knee. Researchers estimate that hip or knee replacements last at least 20 years in 80% of patients. After a successful surgery and several months of rehabilitation, individuals are able to use their new joints without pain.
  • As with any major surgery, there are risks associated with joint replacements. Patients should discuss the potential health risks and benefits of surgery with their healthcare providers.
  • Viscosupplementation: Viscosupplementation is a type of therapy in which the hyaluronic acid in the affected joints can be changed through a series of injections. Hyaluronic acid (HA) is a substance found in the connective tissue of the body that cushions and lubricates the joints. Sometimes, either through the effects of aging, accident, or a disease, such as arthritis, components of the synovial fluid, including HA, may begin to break down. In patients with osteoarthritis, the concentration of HA in the synovial fluid is reduced, resulting in smaller and less effective molecules. The HA loses some of the lubricating and shock absorbing properties that protect the joint. Researchers believe that this can result in joint pain, stiffness, and perhaps an onset or worsening of osteoarthritis.
  • Viscosupplementation injections are administered in a clinician's office. Treatment consists of a series of three to five injections, one given each week, directly into the affected joint. Relief is often felt during the injection series but full effect should not be expected until the injection series is complete. Patients report reduced pain and increased joint mobility lasting from a few months to over a year.
  • Individuals should not receive HA viscosupplementation if they ever had an allergic reaction to any other hyaluronate preparations or are allergic to poultry products. Individuals should not receive the injections if infection or skin disease is present around the injection area. As with any injection, mild pain may occur at the injection site. Swelling, heat, and/or redness, rash, itching, or bruising around the joint may also be present. These reactions are generally mild and usually do not last long.

Author information
  • This information has been edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).

Bibliography
  1. Centers for Disease Control and Prevention. .
  2. Barr KP. Review of upper and lower extremity musculoskeletal pain problems. Phys Med Rehabil Clin N Am. 2007;18(4):747-60.
  3. Chakrabarty S, Zoorob R. Fibromyalgia. Am Fam Physician. 2007;76(2):247-54.
  4. Clark KL. Nutritional considerations in joint health. Clin Sports Med. 2007;26(1):101-18.
  5. Littlejohn G. Regional pain syndrome: clinical characteristics, mechanisms and management. Nat Clin Pract Rheumatol. 2007;3(9):504-11.
  6. National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS). .
  7. Natural Standard: The Authority on Integrative Medicine. .
  8. Paulson MR, Dekker AH, Aguilar-Gaxiola S. Eliminating disparities in pain management. J Am Osteopath Assoc. 2007;107(9 Suppl 5):ES17-20.

Copyright © 2011 Natural Standard (www.naturalstandard.com)


The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.



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