Ask the Doctors October 2012 Issue

Ask The Doctors: October 2012

Knee Bracing. . . Muscle Soreness and Arthritis . . . Treating Arthritic Cysts

Q. Does a knee brace provide enough stability and comfort for an arthritic knee while the wearer is engaged in strenuous sports, like basketball or tennis?

A. While a brace might not allow you to engage in athletic activities at your previous level, medical research supports the effectiveness of bracing for managing osteoarthritis of the knee. In some patients, bracing significantly reduces pain, increases function, and reduces excessive loading to the damaged compartment.

The most common braces used for the treatment of knee arthritis are knee immobilizers, neoprene sleeves, and “unloader” braces.

An immobilizer may be useful to rest an acutely inflamed arthritic knee, but motion should be started as soon as possible to prevent muscle weakness. Although it provides little or no mechanical support, a neoprene sleeve may improve proprioception and pain. Unloader braces, which are designed to reduce the load on a particular area of the knee, have been shown to reduce pain and improve function in many patients. Neoprene sleeves are relatively inexpensive and comfortable, so you might try one of those first. The more specialized unloader braces are expensive and somewhat bulky and should be fitted by an experienced orthotist, but they have been shown to be effective in about 75 percent of patients who wear them.

Q. I’ve been diagnosed with degenerative arthritis, but my leg is painful and weak. Can arthritis cause muscle soreness and weakness? I always thought arthritis  was restricted to sore, aching bones.

A. Muscle strain can be caused by overworked muscles attempting to protect your joints from painful movements. As arthritis causes swelling and inflammation of the joints, the connecting muscles feel the stress. The swollen joints can alter the muscle attachments to the bones, setting them at odd angles that cause stress and strains. The result can be anything from mild discomfort to more severe muscle pain. 

Some studies have shown that weakness in the thigh muscles is one of the earliest symptoms reported by people who have osteoarthritis in the knee. Muscle weakness also plays a role in determining how severe and disabling osteoarthritis in the knee will be. It has generally been assumed that muscle weakness develops because pain prevents the arthritis sufferer from fully using the joint; however, a study of elderly patients suggests that, at least for women, the muscle weakness may come first—or may at least develop very early in the disease. The weakness may then contribute to progressive joint damage.

Exercising to strengthen muscles has been shown to reduce pain and improve mobility. Actually, many of the physical problems common to arthritis sufferers—loss of flexibility, muscle atrophy, muscle weakness, osteoporosis, pain, depression, and fatigue—can be alleviated through exercise.

Talk with your doctor about working with a physical therapist to design an exercise plan that targets your specific problems.

Q. My doctor tells me that I have an arthritic cyst in my shoulder joint. What is it, and how can I treat it?

A. An arthritic cyst is a benign fluid-filled sac in the bone just underlying the cartilage of a joint that has been damaged by arthritis. The cyst is an indication of the severity of the arthritis involving the shoulder.

If there are no symptoms, no specific treatment of the cyst is needed. Usually pain in the shoulder joint is caused by the arthritis and not the cyst, and treatment of the arthritis is indicated.