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Although there are many causes of arthritis, such as arthritis related to previous injury, age-related degeneration, inflammatory types such as gout or rheumatoid disease, or infectious, all forms involve a loss of the natural cartilage coating of the joint and a variable amount of pain, stiffness, instability, and deformity.

Each joint involved with arthritis has a unique constellation of problems and consequences for the patient. The treatment options for arthritis of the ankle may be quite different from those for the knee or shoulder.

Like my patients, I prefer to exhaust non-surgical treatment options before resorting to surgery, as surgery caries risks and even in the best of circumstances may produce a lengthy recovery.

Treatment of arthritis does depend on the type of arthritis being treated. The most common type is degenerative arthritis or osteoarthritis. All though it is a simplification to call this a “wear and tear” of the joint, this is a convenient way to think of the disease. In a sense, we are wearing out the “tread of our tires” or wearing out the “Teflon coating of our frying pans”. Although, we, as yet, do not have a way of curing the disease or of replacing worn out cartilage in all but small areas of certain joints, our goal is to relieve pain and improve function.

If non-operative treatments fail, surgery is required. For earlier forms of degenerative arthritis, minor surgery such as arthroscopy may be an option. In these procedures, tiny incisions are made, in the operating room, through which a fiberoptic camera and long thin instruments are inserted often only using local anesthesia. The recovery is often only a few weeks and requires a minimum of time off the feet.

Moderate degenerative arthritis with deformity may require soft tissue procedures to restore strength and stability, osteotomies or bone cuts to realign the joint while preserving motion, or more experimental procedures such as distraction arthroplasty, where an external frame with pins and wires is applied to the ankle for several weeks to put tension on the joint and help restore the cartilage surfaces.

For advanced arthritis, there are also experimental procedures in which bone and cartilage surfaces are transplanted from a cadaver ankle joint to maintain joint motion. However, the two most common procedures done when the joint has completely worn out are joint replacement, where the joint is resurfaced with carefully engineered metal and plastic parts and arthrodesis or fusion, where the two sides of the joint are joined together to become solid.

In most cases of advanced arthritis, arthrodesis or fusion remains the worldwide gold standard. Although these procedures need to be done by skilled and experienced surgeons, in order to insure successful fusion and proper alignment, they are predictable and durable procedures that can significantly improve the patient’s lifestyle. Many patients can carry out the majority of his or her daily activities with often little more than a supportive shoe.'


Related Resource:

Tibiotalocalcaneal Fusion Surgery for Severe Arthritis in the Ankle


The management of post operative pain from Total Joint Replacement has changed dramatically in the last few years. Gone are the days of needing strong intravenous narcotics that rob the patients of strength and their ability to progress. We have moved to multimodal pain management. We are using a nationally recognized protocol that uses smaller doses of many medications to attack postoperative discomfort along with rapid rehabilitation, and treatment to minimize the side effects of medications.

The goal is to prevent pain from becoming part of the rehab process. To start, patients are educated on what to expect from their surgical experience. The day of surgery, prior to the operation, a long acting pain medication, along with a long acting anti-nausea medication, is given in the preoperative suite. We use minimally invasive surgical techniques to minimize soft tissue trauma, and pain numbing medication is injected around the area of operation, and in some cases nerves that control pain to the area. Long acting medications, and the addition of short acting medications of low risk, create a barricade to post operative pain. Long acting nerve suppression medication is used during the hospitalization to enhance sleep and calm anxiety. 

The result is a rapid return to function, that we did not see previously. Many patients are happily going home after surgery because they are doing so well.

Through the efforts of our dedicated Physician Assistants and Orthopaedic nurses at Norwalk Hospital, the patients receive the best care possible. We also now have available at Norwalk Hospital, a dedicated surgical floor that only Total Joint patients will be admitted. This creates a special environment for patients and families to recover faster and enjoy the benefits of their joint replacement. All of these efforts are giving us tremendous results for our Total Joint Recipients. 


By Dr. Michael G. Soojian

If you are unable to fully flex and/or extend one or more of your fingers, you may be suffering from “trigger finger.” This limited finger mobility is often associated with pain as well as a locking or catching sensation. Trigger fingers occur as a result of a localized or diffuse swelling of the tendons that bend your fingers and allow you to make a fist. The swollen tendons are then unable to pass smoothly back and forth within the tendon sheaths (or tunnels) that start at the crease of your palm and extend to each fingertip. Symptoms can range from only pain and swelling to intermittent locking and catching to a locked finger that cannot even be manually unlocked. This condition can also involve the thumb in which case it is referred to as “trigger thumb.” Overall, the ring finger is most commonly affected, followed by the thumb, middle finger, index finger, and pinky finger in that order.

Trigger finger is a clinical diagnosis, meaning imaging studies and other tests are not typically a necessary part of the work up. The majority of trigger fingers are “primary” trigger fingers, in that there is no underlying cause other than repetitive typical everyday activities. In some cases, trigger fingers can be associated with diabetes, rheumatoid arthritis, or other hand problems such as carpal tunnel syndrome. Symptoms are often worst early in the morning and get better as the day progresses. Patients who present to the office with long standing trigger fingers can often have stiffness of the neighboring joints.

Trigger fingers and trigger thumbs are usually treated without surgery. Conservative management is most successful when patients present with less than three months of symptoms. Non-surgical treatment options include rest, anti-inflammatory medicine, icing, splinting, and cortisone injections. Cortisone injections are the most effective means of treating a trigger finger without surgery. By injecting cortisone (an anti-inflammatory liquid medication) into the tendon sheath or tunnel, the tendon swelling can be reduced and the painful locking sensation can be alleviated. The goal of cortisone injection is to eliminate the problem as opposed to providing temporary relief. More severe trigger fingers and trigger thumbs may require a series of 2 or 3 injections.

When conservative treatment fails, surgery is recommended. This entails a small incision at the base of the finger in order to gain access to the tendon sheath. The opening of the tendon sheath is then widened by cutting through it lengthwise. Overall, trigger finger release is considered a minor surgery and is performed in an operating room often under local anesthesia with a light sedative. The majority of surgical pain is gone within 48 hours and most patients are fully recovered within 3 to 4 weeks. Post-operative hand therapy can be helpful for those patients who had significant stiffness prior to surgery or who had more than one finger operated on in one setting.


By Dr. Paul D. Protomastro

Baseball and softball season are in full swing! From the exhilaration of hitting a game winning RBI, to the satisfaction of making a double play, to the triumph of striking out the side: baseball and softball are timeless American sports that have captured the hearts of millions for over a century. Our youngsters embrace this sport with a passion and commitment like never before. Travel ball, club and elite teams and the year round nature of modern competition can stress the throwing arms of these young athletes to the point of failure!

Shoulder and elbow pain sideline throwing athletes of all ages and ability levels but child athletes are vulnerable to a unique type of injury commonly known as Little Leaguers Arm. Under age 13 in girls and 15 in boys, children’s bones are still growing. These skeletally immature bones grow in length and width at a specialized area of cartilage within the bone know as the Growth Plate. These cartilage growth centers are softer than the surrounding bone  and  are  thus  the  “weak link”.    As children grow in size, strength and ability the intensity, frequency and force of throwing can actually break their bones through these growth plates. The cumulative repetitive stress of excessive throwing can cause a stress fracture of the growth plate. The humerus (the upper arm bone), is the most commonly injured in young throwers. When the upper growth plate of the humerus becomes fractured the child will experience sharp shoulder pain when throwing. When the lower growth plate becomes fractured, the thrower will get sharp pain on the inside of the elbow. Less commonly, the growth plate on the ulna bone at the back of the elbow can fracture and give the athlete pain on the point of the elbow. Ironically, in children the soft tissue structures (tendons and ligaments) are stronger than their bones. For this reason, ligament tears and tendon ruptures are exceedingly rare in children.

Unlike rotator cuff tendon tears and ligament tears(Tommy John) in adults that do not heal without surgical repair, growth plate fractures of the shoulder and elbow in children almost always heal. The key element to healing is REST! A 3 to 4 week break from sports and gym is usually enough. Surgery is almost never required for the skeletally immature throwing athlete that spontaneously develops arm pain. Rehabilitation is occasionally necessary to return the athlete to throwing after they have healed. Developing Little Leaguers Arm is linked to three key factors: 1. the frequency and intensity of throwing, 2. improper throwing mechanics and 3. inadequate warm-up and strengthening prior to throwing. The best way to treat these arm injuries is to PREVENT them. Limiting children to a maximum number of pitches or throws per day, innings pitched and games per day or weekend is essential. Instruction in proper throwing technique is invaluable. The serious, year round throwers benefit from a home exercise program for arm flexibility and strengthening taught by a physical therapist or athletic trainer to keep their arms ready for the field.

When your throwing athlete complains of shoulder or elbow pain that is sharp, intense and lasting more than a week or two at most, it is time take action. Even if the child denies pain, a reduction in throwing velocity, distance or accuracy are signs of an evolving injury. The simplest and most prudent step is to take the athlete out of all throwing activities for 2 weeks and then gradually return them to play. If this proves unsuccessful or as a parent you want assurances  the  athlete  can  “play  through”  the  pain,  evaluation  by  an  orthopaedist is recommended. If, upon evaluation, the arm has full motion and strength, no tenderness or instability, and normal x-rays: continuing to play with pain may be safe. Pitchers and catchers are most susceptible, but third basemen, short stops and outfielders are also commonly affected by Little Leaguers Arm. Moving a player with a sore arm to first, second or right field may prevent an early injury from turning into a season ending one. Enrolling child athletes in multiple sports throughout the year has merits. It not only gives their arms time to heal but also develops their balance, endurance, coordination and psychomotor skills which may ultimately make them a better baseball or softball player.


By Dr. Joshua B. Frank, OrthoConnecticut

As fall begins, we all start thinking of the busy school year and what it will bring. Many of us also start thinking of football and other fall sports. While this does cause excitement it also brings with it some trepidation.

Over the years we have learned a tremendous amount about sports, physiology, biomechanics, and technique. This advancement in knowledge has allowed athletes to become faster, stronger, quicker, and more efficient.

Another area that has advanced is that of sports medicine. In particular, the study of young athletes. Whenever we talk about sports injures, it is probably best to divide injuries into acute injuries and sub-acute or chronic injuries.

Acute injuries are often obvious and can cause immediate onset of pain. In some circumstances the initial injury is not quite as dramatic and may not cause play to stop. It is important to recognize and address these injuries in a timely manner, as they can go on to cause permanent disability. We have learned that children can sustain similar injuries as adults. The diagnosis of pediatric anterior cruciate ligament (ACL) and meniscal injuries is on the rise. This may be related to increased awareness and better diagnosis of these injuries. If left untreated, it is possible that these injuries can lead to further damage to the knee and even the onset of early arthritis. Acute knee injuries should be evaluated by a medical professional and may require x-rays or even and MRI.

Sub-acute or chronic injuries can also sideline a young athlete. Over the past years, there has been an increased focus on sports. While sports are great and teach children excellent life skills as well as improve physical condition, there is a point where it can get to be too much. That point may be different amongst athletes and may change as a child grows.

In an effort to improve athletic ability, children and adolescents are often specializing in one sport and participating in that sport year-round. Whether it be on a team, in camp, or even in the backyard, year-round sports can lead to fatigue and injury. Overuse injuries can occur all over the body. Thee are even names to associate injuries with certain sports. For example, a chronic, over-use injury to the growth plate of the proximal humerus (shoulder) is known as “Little Leaguer’s Shoulder.”

Obviously, these types of injuries are not limited to baseball. We do not yet know how much time is too much time in gymnastics practice, or ice-skating or even playing basketball outside. We do believe that performing multiple sports over the course of a year allows for different muscles to be used and rested. Also, period of rest and time without any major sports participation is also beneficial.

Another important recommendation is to prepare for the upcoming season well in advance. A period of limited activity followed by a sudden onset of intense training can easily lead to aggravation of growth plates, tendons, and apophyses. In general, a graduated schedule of increased activity with appropriate stretching may help prevent these conditions. Even though training camp begins in August, young athletes should be preparing on their own well in advance of these intense training periods.

Sports are great. With the increased prevalence of childhood obesity it has become even more evident that many children are not nearly active enough. With appropriate training, rest, and conditioning we hope to prevent many injuries and keep our young athletes safer.


By Michael M. Lynch, M.D.

Over the past ten years, it is estimated by some that the incidence of overuse sports injuries in youth has increased four or five fold. This is also reflected by a significant increase in surgeries directed at addressing these problems. The cause of this rise is primarily related to a dramatic rise in the number and duration of participants. Another major factor is a growing trend towards early commitment to single sport selection. Children that play a single sport year round, lose the necessary off season that is vital to bone, joint, muscle, and tendon recovery.

Many are familiar with the woes of the weekend warrior, often referred to as “Baby Boomeritis”. Children and teens are also very susceptible to overuse injuries, but for different reasons. Their immature bones are partly made of cartilage and that growing cartilage is very prone to repetitive stress. The growth factor alone is also a contributing element. As children hit growth spurts, their bones outpace the muscle and ligament units surrounding them rendering them relatively “tight” and inflexible. Inadequate conditioning, prior injury, and anatomic alignment are other intrinsic factors that lead to overuse injury.

Extrinsic influences on this phenomenon are equally important. These include training error (too rapid or too intense training progression, and inadequate rest), inappropriate equipment/footwear, athletic surfaces, and poor technique. Most of these factors can be influenced by appropriate intervention. It is most useful to intervene in a proactive and preventive manner.

Overuse injuries occur when structural breakdown follows repetitive loading of a bone or tendon. Macro trauma refers to demonstrable failure such as tendon rupture, or bone fracture. Micro trauma occurs at sub-clinical levels and is a cumulative phenomenon. A familiar demonstration would be the paper clip example. If you bend it back and forth one hundred times it breaks. At fifty times there is no visible breakage, but microscopically structural damage can be seen. When this occurs in a tendon for example, it stimulates a healing response involving the generation of enzymes and inflammatory cells. Without adequate rest, there is over stimulation of the healing process and it runs awry, inciting pain and dysfunction. Left unchecked this can turn into a degenerative process.

The vast majority of these conditions can be treated successfully with a regimen of rest, ice, and rehabilitation. The rest is vital, and with children often the most difficult to impart. Once the acute pain is controlled, rehabilitation through stretching and strengthening exercises can help to further resolve these issues, and more importantly, prevent their return. Only in certain cases is surgery necessary to bring about relief.

As with most medical conditions, when there is opportunity for prevention, this becomes the most effective strategy by far. Sensible participation levels, multi-sport involvement (NOT all in one season!), adequate rest, proper equipment all can be instituted prior to injury appearance. Peer pressure, coaching pressure and, most influentially, parental pressure should be minimized to allow healthy, unencumbered sports play. “No pain, no gain” is not an appropriate tenet for youth sports. Should an injury arise, prompt attention will make recovery more feasible.


By Paul A. Markey, MD

One of the most common causes of knee pain is a torn cartilage, and it usually occurs without any warning or traumatic event.  Each knee joint contains two cartilage pads; the medial meniscus and the lateral meniscus, which help to carry our weight.  Their job is to   distribute weight evenly in the knee and to help stabilize the knee.  These two menisci withstand very large forces when we walk, run, jump, squat, pivot and change direction quickly.  Most menisci make it through life without a problem, but it is not at all unusual   for a meniscus to develop a split or tear.

A tear can happen in a normal meniscus with an unusually stressful activity of the knee, such as a combination of bending and twisting, as may occur in sports, gardening or high-spirited dancing at a wedding.  More often it happens in a meniscus which has already been   weakened by mild osteoarthritis, which most people get sooner or later to some degree and may or may not know they have.  A meniscus weakened by osteoarthritis can tear under the ordinary forces of daily activities which do not bother a normal meniscus. No matter   how a meniscus tears, the result is usually unpleasant.  The knee often becomes painful and unable to move normally.  The pain can be felt in the right or left, back or front of the knee, is often sharp and caused by a specific motion of the knee and sometimes wakes one   from sleep when the sore knee rests against the other knee.   Interestingly, the meniscus itself cannot feel any pain; the pain is   felt by the synovium, which is the sensitive membrane which lines the knee joint and to which the meniscus is attached. The torn part of   the meniscus tugs painfully on the synovium like a torn fingernail tugs on its nail bed.  There may be popping, clunking, catching, locking or buckling of the knee, or a feeling of something shifting in and out of place in the joint.  There is often swelling, which is fluid  accumulation in the knee joint which forms in reaction to the tear. 

An orthopaedic surgeon can diagnose the cause of knee pain, of which there are many.  A history and physical examination and often X- rays and an MRI are done.  If a torn meniscus is the problem, there are treatment options.  A torn meniscus is not dangerous.  It is all   right to keep walking on the knee as tolerated.  The only harm it causes is pain and aggravation.  Sometimes the pain will subside by itself after a while, but the tear in the meniscus will never heal, and therefore the pain can return.  Simple treatments can be tried, such as ice and an Ace bandage and over -the-counter pain relievers.   A knee brace and an occasional cortisone shot may help.   If the pain persists despite such measures, arthroscopy, which a small ambulatory operation, is done under local anesthesia with sedation, with two one-quarter-inch incisions.  Usually the surgeon removes the small torn piece of meniscus.  The patient goes home within a couple of hours, and may resume walking immediately without crutches.  Other activities, including sports, may be resumed gradually as tolerated.  In most cases, this operation gets rid of the pain. Occasionally the meniscus can be repaired instead of a piece being removed.  In this case, the recovery is much   longer, and crutches are usually needed for about six weeks. 
  Although no operation can guarantee success, and all operations have some risk, arthroscopic meniscectomy, which is the arthroscopic removal of a torn piece of meniscus, is one of the smallest, quickest, safest, most common and most successful operations in  orthopaedic surgery.


By Jeffrey V. DeLuca, M.D.

The anterior cruciate ligament (ACL) is the major stabilizing ligament of the knee.  It is located in the center of the knee and runs from the femur (thigh bone) to the tibia (shin bone). The ACL can be injured by trauma or sporting events. Usually it is torn by a sudden direction change, twisting or hyperextending your knee. Sports associated with ACL tears are basketball, soccer, skiing and gymnastics. Female athletes are more susceptible to ACL injuries because of imbalanced thigh muscles, with stronger muscles at the front of the thigh (quadriceps), compared with those of the back of the thigh (hamstrings). Also limb alignment, joint laxity and a narrow notch (the tunnel at the end of the femur bone where the ACL runs through) may lead to an increased risk of ACL rupture for women.

Symptoms of an acute ACL injury include; a feeling of having a pop in the knee at the time of injury, significant swelling of the knee within hours of the injury and limited knee movement because of pain or swelling. Later, the feeling of instability or the knee giving out when walking can occur. If you experience any of these symptoms you should see an orthopedist right away.

The diagnosis of an ACL injury can be made by a physical exam, aspiration of blood from the knee and an MRI. Approximately 50 percent of all ACL injuries occur in combination with damage to the articular cartilage (the smooth white tissue that covers the ends of the bones), the meniscus (soft cartilage pads inside the knee) and other knee ligaments.  These injuries can also be seen on an MRI.

The initial treatment of an acute ACL injury often includes ice, anti-inflammatory medication and physical therapy which help restore the movement and strength back to the knee. Non-operative treatment may be considered in older or sedentary patients, patients involved in non-pivoting sports such as biking, running and rowing, or in patients not able to participate in 6 months of a complete rehabilitation program.  Surgical reconstruction should be considered if your knee is very unstable, you’re very active or want to resume heavy work, you want to return to pivoting type sports or if you have damage to other parts of your knee.

ACL reconstruction is outpatient surgery using arthroscopic techniques. The ACL tear cannot be sewn together, therefore a substitute graft needs to replace it. Graft options include your own patellar tendon or hamstring tendons which are used in younger patients or an allograft (cadaver) for patients over 40 years old. Post-operatively patients are started in physical therapy right away and use a leg brace and crutches until they gain adequate muscle strength and control so they can walk without them. Significant time and effort is required during the post-op rehabilitation to ensure an excellent result.

With an estimated 200,000 ACL related injuries occurring annually in the US and 100,000 ACL reconstructions performed year, ACL reconstruction is a very successful operation. 90% of patients have a favorable result with reduced pain, good knee function and stability and a return to normal levels of activity and sports.


By Michael G. Soojian, M.D.

Carpal tunnel syndrome (CTS) is a nerve compression syndrome that occurs as a result of pressure on the median nerve in the wrist. As the median nerve enters the hand, it passes through an enclosed space known as the carpal tunnel, along with the tendons that bend the fingers and thumb. If pressure builds up within the carpal tunnel, the median nerve gets irritated

and inflamed causing feelings of tingling, burning, and numbness in the finger tips, specifically in the thumb, index finger, middle finger, and part of the ring finger. If CTS goes untreated long enough, it can irreversibly damage the median nerve, resulting in permanent numbness and weakness in the hand.CTS is commonly associated with repetitive use of the hands, and may be associated with either leisure or work-related activities. CTS may also be related to an underlying medical condition such as diabetes, hypothyroidism, pregnancy, or an inflammatory condition like rheumatoid arthritis. It also can develop as a result of a wrist fracture or other types of trauma.

If patients are seen within a few months or less of initial symptoms, CTS can usually be treated without surgery. An important aspect of non-surgical treatment is figuring out the cause and then modifying activities appropriately. Ergonomic changes to computer workstations and wearing a brace to hold the wrist in a straight position can reduce pressure on the median nerve. Cortisone (a liquid anti-inflammatory) can be injected into the carpal tunnel as a means of decreasing nerve inflammation.

When non-operative treatment fails, or when patients have severe symptoms, surgery can be considered. A nerve test known as an EMG (or electromyography) with NCV (nerve conduction velocity) may be ordered. This test can serve to confirm the diagnosis of CTS and rule out other potential causes of nerve inflammation. Surgery is performed on an outpatient basis, usually with a combination of local anesthesia and a sedative injected through an IV. The goal of surgery is to cut through a ligament known as the transverse carpal ligament to convert the carpal tunnel from an enclosed space into an open space. This in turn releases pressure on the median nerve and allows it to recover and heal. Cutting through this ligament does not compromise wrist function and in some cases, patients experience an immediate dramatic relief in their numbness and tingling. In other cases, it can take weeks or months for the nerve to fully recover. Patients who are initially seen with constant numbness and weakness (signs of permanent nerve damage) usually do not regain normal nerve function, but often experience an improvement in symptoms.

In regards to both operative and non-operative treatment of CTS, the most important prognostic factors are the severity of the symptoms (numbness/ tingling) and the duration of time they have been present.


Many patients with arthritis in their hips, knees, ankles ask whether they can continue with sports and with running. The traditional understanding of osteoarthritis, the most common form of degenerative joint disease, is that it involves simply wear and tear of the joints, much like breaking down the pads on your car’s brakes. If osteoarthritis were this simple, it would make sense that with more mileage, especially with high impact activities, the joints would break down more quickly, and, therefore, less activity should preserve them longer. As we learn more about the causes of osteoarthritis, we learn that this is not necessarily the case. Sedentary activity may have the exact opposite effect on our joints leading to more rapid deterioration.

We do know that osteoarthritis is progressive and, at this point, irreversible. Destruction of the joint involves not only a wearing of the slippery cartilage surface but a change in the underlying bone, with areas of bone irregularity, hardening of the bone near the surfaces, bone spurs, misalignment, and some degree of stiffness or instability. Though we may be getting closer to medications that can help to grow new cartilage, if we cannot reverse the changes to the bony architecture, then we are left with a surface that is inhospitable to the regeneration of a new cartilage surface. A medication, by mouth or by injection, that will change this joint architecture, is hard to imagine. We are likely closer to finding genetic markers, in our youth, which may predict the onset of arthritis, so that we may develop strategies to slow or prevent the development of osteoarthritis, in the first place.

As we have yet to find a cure for osteoarthritis, our goal with treatment, whether it is non-surgical or surgical, is to relieve symptoms, thereby decreasing pain and improving function. Currently we use medications, vitamin supplements, injections, physical therapy, and often, ultimately, joint replacement surgery. Although hip, knee, and ankle replacement have been shown to be some of the most life changing advances in modern medicine, they are big operations with significant recovery and are not without risk.

Although exercise is not a cure for osteoarthritis, the benefits of exercise far outweigh any risk. I tell patients that our muscles are more than just movers of our joints; they are shock absorbers and stabilizers. A joint free of pressure and motion has been shown to deteriorate faster than one that is used. Although high impact activities that involve jumping and cutting may become impossible for many patients with advancing osteoarthritis, I allow my patients to continue with any activities that they enjoy, based solely on their level of comfort. As we cannot blame moderate exercise for the development of osteoarthritis, then I have no reason, other than pain, to make my patients stop.

An added benefit of exercise is to curb obesity. We are learning more about the effect of fat on our entire bodies. Fat was once thought of as simply our bodies’ storage place for excess calorie intake. Obesity has been linked to the earlier development of osteoarthritis, especially in the knees. However, we are starting to find that the fat adversely affects our joints through more than just an increase in stress. Our fat stores act like an endocrine organ, adversely affecting our joints through inflammatory pathways and through interaction with our other organ systems. This theory is supported by data that shows a slowing of arthritis progression through weight loss, in the non-weight bearing upper limbs, not just in the legs.

At this time, there are no magic pills that will cure your osteoarthritis. We need to approach this huge worldwide problem from many directions. But, immobilization, inactivity, and deconditioning are certainly not the answers. Get out there and enjoy the activities that you have always loved, as long as you can do them safely and your body will allow you to do them without excessive discomfort.