William W. Forgey, MD
Orthopedics part 2 - Joint Pain
Updated: Nov 13, 2020
Joint Pain (part 2 of a weekly series of posts focusing on Orthopedics) Excerpt from The Prepper's Medical Handbook. Page reference numbers point to more in-depth treatment and self-reliant care available within the book. Joint Pain-No Acute Injury Pain in the joint without history of injury is generally due to arthritis, bursitis, or tendinitis. Without a history of previous arthritis, the latter two are the more likely diagnosis, but the treatment is the same for all three. The most common reason for tendon or joint inflammation is overuse. French trappers frequently complained of Achilles tendinitis while snowshoeing, which they appropriately termed mal de raquette. Persons hammering, chopping wood, or playing tennis are familiar with “tennis elbow” (epicondylitis of the elbow). Tendinitis can occur in the thumb and wrist-in fact, any tendon in the body can become inflamed with overuse. Joints similarly become inflamed with repetitious activity or even unusual compression. Bricklayers and others who must work kneeling will, on occasion, encounter a patellar bursitis of the knee (called commonly housemaid's knee). Many people form bursitis flare-ups in a shoulder after repetitive arm actions or in the forearm due to the overuse of flexor tendons of the wrist. Treatment of these conditions must include adjusting the technique for the activity that seems to have caused it. By changing a grip on an axe or hoe, using the tool with a different pitch to the blades, or altering a movement in any fashion to avoid generating additional pain, the victim can try to alleviate the discomfort and avoid inflaming it more. Prior to an activity, the application of heat to the sore area helps with prevention. Immediately after aggravating the condition, applying cold is of benefit. Within an hour, return to a local heat application and continue this during the evenings. Applying a cream such as Aspercreme (other brand names are Myoflex and Mobisyl) with a dry heat might help a tendinitis, as the active ingredient (trolamine salicylate 10% concentration) penetrates the skin and provides local anti-inflammatory action. Sports creams that feel warm, such as Icy Hot, simply irritate the skin surface to cause an increased blood flow and thus provide warmth to the area. They do not have an anti-inflammatory effect, nor do they provide any benefit over the application of heat. This does not mean that these creams do not have a potentially valuable role here. It is very difficult to apply hot soaks sometimes, and these creams can serve the purpose. Topical products containing diclofenac are now widely available by prescription (brand names Voltaren 1% gel, Pennsaid, or Flector 1.3% patches). These are the most effective topical treatment possible, but the onset of relief takes a few days of application. If hot compresses seem to aggravate the pain, switch to a cold compress. Avoid making any movements that seem to cause the most pain for 5 to 7 days. Splinting may help during this period. Avoid nonuse of the shoulder for longer than 2 weeks, as it is prone to adhe sion formation, and loss of function can result. The best medication for chronic joint pain is ibuprofen from the Non-Rx Oral Medication Module due to its anti-inflammatory action; 4 tablets every 6 hours will help with joint and tendon pain. From the Rx Oral/Topical Medication Module, one could use Decadron, 4 mg, given once daily for 7 days for joint inflammation. Note: See the warning in the discussion of the use of the antibiotic Levaquin with regard to tendonitis and tendon rupture (page 286). Joint Pain-Acute Injury Immediately after a joint injury, we all want to evaluate the injury, determine how serious it is, and figure out how or if the injury may affect our whole group's survival situation. Frankly, making a precise diagnosis usually isn't possible initially, so our approach to the acute joint injury must be to look at methods of treatment and potential long-term care. The discussion on orthopedic injuries in this book considers the body by region, not by precise diagnosis of injury. Nevertheless, we must try to have some understanding of what might have happened, make an accurate prognosis early in the event, and minimize the damage while keeping the victim as functional as possible. Unusual stress across a joint can result in damage to supporting ligaments. Ordinarily this is a temporary stretching damage, but in severe cases rupture of ligaments or even fracture of bones or tears of cartilage can result. These injuries are serious problems and may require surgical repair. This is best done immediately but can be safely delayed 3 weeks. Fractures entering the joint space may result in long-term joint pain and subsequent arthritis. Cartilage tears do not heal themselves, unlike ligament, tendon, and bone damage. These frequently cause so much future pain and instability that surgical correction is required. Proper care of joint injuries must be started immediately. RICE (Rest, Ice, Compress, Elevate) forms the basis of good first aid management. Cold should be applied for the first 2 days as continuously as possible. Then apply heat for 20 minutes or longer, 4 times daily. Cold decreases the circulation, which lessens bleeding and swelling. Heat increases the circulation, which then aids the healing process. This technique applies to all injuries, including muscle contusions and bruises. Elevate the involved joint, if possible. Wrap with elastic bandage or cloth tape to immobilize the joint and provide moderate support once ambulation or use of the joint begins. Take care that the wrap pings are not so tightly applied that they cut off the circulation. Use crutches or other supports to take enough weight off an injured ankle or knee so that increased pain is not experienced. The patient should not use an injured joint if it causes pain, as this indicates further strain on the already stressed ligaments or fracture. Conversely, if use of the injured part does not cause pain, additional damage is not being done even if there is considerable swelling. If the victim must walk on an injured ankle or knee, and doing so causes considerable pain, then support it the best way possible (wrapping, crutches, decreased carrying load, tight boot for ankle injury) and realize that further damage is being done, but that, in your opinion, the situation warrants such a sacrifice. While compression is good for an acute injury, too much could cut off circulation and must be avoided. If an ankle is injured, the boot can provide needed compression, but remove it if the pain becomes intolerable. A boot can always be put back on a swollen ankle by undoing the laces and just wrapping them around the boot circumference rather than using the eyelets. Pain medications may be given as needed, but elevation and decreased use will provide considerable pain relief.
Be sure to check out part 3 of our Orthopedic series next week on the subject of fractures.