Hips, Shoulders and Knees

Hip and shoulder pain become increasingly common as we age. However, it’s possible for anyone to develop them, and when that happens the ability to perform routine tasks and quality of life can be adversely affected.

Hip and Shoulder Pain Treatment: Basic Information

Your hips and shoulders are joints. This means they depend on a cushioning of slippery cartilage, lubrication by synovial fluid, and proper alignment to work as they should. When one of these elements isn’t present to the degree or in the way it should be, hip and shoulder pain can result.

Causes of Hip and Shoulder Pain

  • Osteoarthritis. This form of arthritis affects many of us from middle age onward as the cartilage in the joint deteriorates and bones grind against one another.
  • Rheumatoid arthritis. In rheumatoid arthritis, or RA, the body’s own immune system attacks healthy tissue including the synovium.
  • Sciatica. It’s possible to irritate the sciatic nerve, the largest nerve in the human body, that runs from the lower back through the hips and down the back of the leg. Lack of exercise is a frequent cause.
  • Hip fractures. As the body ages, the cells throughout the body break down and the bones can become weak and brittle. Conditions lie osteoporosis end up weakening the bones, and when they are weakened, they are more likely to break during a fall. This is especially true of the large weight-bearing bones like the leg and hip bones.
  • Bone fracture. This is a particular problem for senior citizens, whose bones can become brittle.
  • Dislocation. It usually takes a lot of force, but it’s possible to knock a bone out of the socket (like the hip joint) where it’s supposed to fit.
  • Dysplasia. A bone doesn’t fit in the socket where it belongs snugly enough because the end of it is too small. This makes it possible for it to wobble around or even become dislocated. Babies are particularly prone to dysplasia.
  • Bursitis. Bursae is the medical term used for the sacs of liquid that can occur between bone, muscles, and tendons throughout the body. They work like cushions and airbags and protect against impact damage when walking, running, or falling. But when bursae get inflamed, they can cause pain, which is usually associated with repeat injuries to that area.
  • Labral tear. This is a rip in the cartilage at the bony edge of the hip that helps hold the joint together. It’s often a sports-related injury and occurs in a twisting fall or accident, but it’s also possible for the cartilage to simply deteriorate over time.
  • Tendinitis. The stretchy bands of tissue that connect the bones and muscles together are known as tendons. They are found throughout the body and are the key to joints being able to move freely. Tendinitis is the term used for inflammation or irritation of these tendons. Stretching and tears from overuse or injury are the common causes of tendinitis.
  • Muscle or tendon strain. Recurring activities and motions can put a lot of unnatural strain on the muscles, tendons, and ligaments. This is especially true in the major joints such as the hips. When overuse or injury causes inflammation, it often leads to hip joint pain and a reduction of normal mobility.
  • Hip labral tear. This is the term used to describe a rip in the protective collar of cartilage, known as the labrum, the supports the socket joint where the bones meet in the hip. When the labrum is damaged, it is easier for the hip to slip out of place and cause pain as the bones rub together; dislocations are easier as well.
  • Cancers. Tumors caused by some cancers can start in the bone, and they can also spread to the bone through metastasis. These tumors beak down the bone and can cause pain in joints and bones that are affected. In advanced cases, the bones can become brittle and break, joints can be dislocated, and loss of mobility is commonly seen. This causes a wide range of types and severities of pain, often including hip joint pain.
  • Avascular necrosis. Commonly known as osteonecrosis, this is a condition that occurs when blood flow is reduced and the bone of the hip begins to die. Bone death can lead to breakage and collapse of the bone structure and produce hip joint pain, immobility, and increased risk of infection.
  • Strain. A strain occurs when you overstretch or tear muscles or tendons that help a joint move. (It becomes a sprain if it happens to a ligament.)

Symptoms of Hip Joint Pain

Depending on the condition that’s causing your hip joint pain, you might feel the discomfort in your:

  • Thigh area
  • Inside the joint
  • Groin area
  • Outside the joint
  • Buttocks area

Sometimes pain that begins in another area of the body can radiate to the hip, which is why any severe or persistent hip joint pain needs to be looked into: it may be a sign of another serious underlying condition. Call your health care provider if your pain doesn’t go away, or if there are any signs of infection. Get medical help right away if:

  • The pain came on suddenly without any advanced warning
  • Pain is worse when lying down or persists even with rest
  • A fall or other injury is what leads to the hip joint pain
  • Your joint is visually bruised, misshapen, or bleeding
  • There was an audible popping noise when you hurt yourself
  • You hear or feel a clicking or catching sensation when you move the hip
  • The pain is intense and is making it so you cannot sleep at night
  • You are unable to put any weight at all on the hip
  • You are unable to move your leg or hip at all

Manifestations of Hip and Shoulder Pain and Problems

  • Pain. Whatever the problem, you’re likely to feel discomfort.
  • Stiffness. This is often the case with osteoarthritis.
  • Swelling. This can result from a strain.
  • Heat
  • Reddened skin. Swelling, heat, and reddened skin can all be signs of rheumatoid arthritis.
  • Tingling
  • Numbness
  • A feeling like an electric shock. Tingling, numbness, and a feeling like an electric shock can all be signs of sciatica.
  • One leg looks shorter than the other. This is sometimes seen with hip fractures.
  • Immobility. In the case of a serious condition or injury like a bone fracture, you may not be able to move the affected limb at all.
  • A wobbly or loose feeling. If a limb’s connection to a joint feels loose, this can be a sign of dysplasia.
  • Pain that dulls and spreads over time. This can be a sign of bursitis.
  • A clicking sensation. This may indicate a labral tear.
  • Weakness. You might experience this after a strain.

Hip and Shoulder Pain, Regenerative Medicine, and Stem Cell Recruitment

Regenerative medicine is an outgrowth of translational research in tissue engineering and molecular biology. It offers the promise of restoring damaged tissue by promoting new growth.

As indicated above, hip and shoulder pain is often the result of injury, damage, or deterioration. This means the pain will stop if its cause can be identified and repaired completely.

One of the most promising avenues of regenerative medicine, and one we have extensive experience with here at the Pain Relief Institute, is stem cell recruitment. Stem cell recruitment has proved useful for addressing a variety of complaints including joint, tendon, ligament, and muscle damage, which means it can often prove therapeutic for hip and shoulder pain.

Stem cells are “undifferentiated” cells. This means they can renew themselves through cell division and have the potential to develop into many different kinds of cell that the body needs. Thus, when a therapeutic procedure called stem cell infusion applies them to a damaged area, they can promote healing through the growth of healthy new tissue and thus provide stem cell therapy for pain.

At the Pain Relief Institute, we provide stem cell recruitment therapy via stem cell amniotic fluid injection.

Hip and Shoulder Pain, Stem Cell Recruitment, and Stem Cell Amniotic Fluid Injection

Amniotic fluid is the clear yellow fluid that surrounds a fetus in the uterus. It performs many functions to protect the growing baby including cushioning from outside pressures, temperature control, and infection control, but for our purposes, what’s important about it is that it provides a source of mesenchymal (embryonic) stem cells. Embryonic stem cells are pluripotent, which means they can develop into any kind of cell. From a therapeutic perspective, that makes them more broadly useful than stem cells derived from adult tissue, which can only develop into different cell types related to the tissue of origin.

The mesenchymal cells are obtained at the time of a Caesarian birth without risk to baby or mother and with the mother’s consent. They then form the basis for therapy via stem cell amniotic fluid injection, a one-day procedure that provides an alternative to invasive surgery with its lengthy recovery time. At the Pain Relief Institute, stem cell amniotic fluid injection therapy is accomplished through the use of PalinGen® and its sister product PalinFlo®.

Knee Pain

About the Knee

Knee is the largest joint in your body. It is a complex joint made of bone, cartilage and ligaments. The cartilage in the knee acts as a cushion and gliding surface. When healthy, the cartilage keeps the bones in the joint from rubbing together. However, when the joint is affected by arthritis, the bones make contact and cause pain. Injuries, aging and degenerative conditions such as arthritis can cause the cartilage to break down.

Common Causes of Knee Pain

Osteoarthritis: Arthritis is a chronic condition that causes joint inflammation. Symptoms include redness, warmth, swelling, tenderness and pain.

Up to 40 percent of the population may have knee osteoarthritis, or “wear and tear” arthritis. This is the gradual breakdown of the cartilage in the knee. Also called degenerative joint disease, osteoarthritis usually develops over years and often is found in patients who have had a knee infection or injury and those who are overweight/

As cartilage wears away, the bones around it can grow thicker and develop bony spurs. This can lead to increased friction between the bones and disrupted movement in your knee. This also can lead to problems with the synovium, a membrane in your knee that produces a liquid to keep your cartilage slippery. This membrane can become inflamed and make too much fluid. This results in swelling, or “water on the knee.” In the most severe cases, the knee can become deformed as the continued friction wears away the bone. Common symptoms of osteoarthritis include pain, stiffness, tenderness, a limited range of motion and a grating sensation when you bend your knee. The pain is usually worse after activity.

Rheumatoid arthritis: Rheumatoid arthritis can affect joints on both sides of the body (both knees, both hands and/or both wrists). In rheumatoid arthritis, your body’s cells attack your own tissues. Rheumatoid arthritis affects three to five times more women than men and often presents between the ages of 20 and 50.

Over time, rheumatoid arthritis can cause cartilage to wear away, swelling in the synovium, and excess fluid in the knee. In later stages, bones can rub against each other.

Bursitis: Bursitis is the inflammation of any of the fluid-filled sacs (bursae) protecting the body’s joints. This is usually caused by repetitive motions or by a stress such as kneeling. Sometimes, a sudden injury can cause bursitis.

Tendonitis: The tendons – rope-like tissues connecting muscles to bone at the knee and other joints – can become painfully inflamed by repetitive and strenuous movement. Tendonitis is a common sports injury, caused by overuse of the same parts of the body. Patellar tendinitis, or “jumper’s knee,” is an inflammation or irritation of the tendon between the knee cap and the shin bone.

Patellofemoral pain syndrome (PFPS): Knee pain or discomfort while walking up and down stairs, jumping or squatting may be symptoms of patellofemoral pain syndrome. This common knee problem is felt toward the front of the knee. It can cause a grinding sensation when bending or straightening your leg, and can cause the knee to occasionally buckle. Sometimes called “runner’s knee,” patellofemoral pain syndrome may be caused by a kneecap that is not aligned properly, overuse, injury, excess weight or when the cartilage in the knee cap is worn significantly.

Injuries: Knee injuries can be the result of sports, falls or trauma. They typically involve the ligaments that hold two of the bones of the knee – the femur and tibia – together eg-ACL,MCL,& Meniscal injuries

How is Knee Pain detected?

A careful medical history which includes
  • A description of knee pain (aching, tenderness, burning or swelling)
  • Where the pain is located and when it occurs?
  • When did the pain start(and if it is the result of an injury or accident )?
  • Anything that makes the pain worse or better

Investigations Conducted for Knee Pain

X-rays, MRI, CT Scan

Knee Pain Treatment

Conservative care: Many types of knee pain can be relieved and/ or resolved with conservative treatments such as:

Rest: When the knee is injured or is inflamed, as in bursitis, tendonitis or arthritis, it’s important to rest the joint and avoid overuse. That may mean keeping the knee straight (extended) or in positions that limit bending.

Ice/heat: Applying ice or cold packs to the knee can reduce inflammation and swelling, especially after an injury. Once swelling is gone, heat may be used to help relax and loosen tissues – although ice is the primary treatment.

Pain relievers: Over-the-counter anti-inflammatory medicines can help relieve knee pain, including ibuprofen and naproxen

Weight loss: Lose weight to reduce pressure on the knees.

Braces: In general, knee braces wrap around the knee and leg and help limit unwanted movement while supporting the knee. They are commonly used when knee ligaments are weak, and help to keep the knee from “buckling.”

Injections in the Knee Joint: Potent anti-inflammatory agents can be injected inside the knee to reduce pain and inflammation. Ozone Gas can also be injected into the knee to reduce pain and inflammation. Another nonsurgical injection technique that can provide relief from knee pain is viscosupplementation. This treatment involves injecting a lubricant into the knee. The filler lubricates and adds cushioning to the joint, allowing bones to move more easily and reducing friction. It is a viable solution for mild to moderate OA.

Stem Cell/Platelet Rich Plasma (PRP) therapy: PRP therapy involves injecting platelets from the patient’s own blood to rebuild a damaged tendon or cartilage. It has been successful in not only relieving the pain, but also in jumpstarting the healing process. The patient’s blood is drawn and placed in a centrifuge for 15 minutes to separate out the platelets. The platelet-rich plasma is then injected into the damaged portion of the tendon or cartilage.

Physical therapy: Physical therapies can help you recover from the injury and decrease the pain you are experiencing. They may also include low-impact stretches and exercises that can strengthen muscles in your knee, improve stability and flexibility, and reduce pressure on the joint.

Surgical options: These includes partial and total knee replacements in case of OA or RA knee . In cases of injuries, we can go for arthroscopic or open repair.

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Pain Physicians of Wisconsin, the goal of our pain treatment is to help our patients live their healthiest lives possible by easing pain symptoms and restoring function and movement.

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