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Acupuncture for Knee Pain

This following information is from College of Integrated Chinese Medicine conditions notes and is being used as placeholder text as this page is being developed October - November 2021

The main pathological processes to affect the internal structure of the joints are inflammation and degeneration. The term arthritis, literally meaning inflammation of the joints, is confusingly often used to describe both of these processes.
Arthritis can be caused by a wide range of different factors. It may affect a single joint, or may occur as part of a generalised or systemic disease in which a number of joints are affected. In systemic arthritis the joints are often affected in a symmetrical fashion.
In inflammatory arthritis the affected joints tend to be hot and painful. In synovial joints the inflammation affects the synovial membrane lining the interior of the joint. The inflammation can then lead to excessive fluid production from the membrane, and if prolonged, damage to the cartilage of the joint. The inflamed joint is therefore swollen and may become deformed as the internal structure becomes destroyed.
Inflammatory arthritis of a single joint can result from infection within the joint, a condition known as septic arthritis. This infection can originate from another site in the body, or can arise as a result of a penetrating injury into the joint. Joint infection is very serious, because, like osteomyelitis, the infectious agents are relatively protected from the immune system, so that the infection can progress rapidly. The production of pus can result in permanent inflammatory damage to the interior of a joint.
In septic arthritis the patient is very unwell with a red, tense and very painful joint and a high fever. However these symptoms may be less marked in people with chronic illness such as diabetes or rheumatoid arthritis, or in the elderly.
The treatment is hospitalisation and urgent administration of antibiotics, ideally by intravenous injection for the first week. Up to 12 weeks of antibiotic treatment may be given to ensure eradication of the bacterium.
Some infectious diseases can lead to a generalised form of arthritis. These will be discussed in the next lesson.
Crystal arthritis is a form of non-infectious inflammatory arthritis which can appear very like septic arthritis. This is caused by the formation of small crystals within the joint fluid which are highly irritating and thus cause inflammation. Gout is the most common form of crystal arthritis. This will be discussed in more detail in the next lesson.
Bleeding is another cause of inflammation in a joint. This usually occurs as a result of an injury, but may occur spontaneously in a person who suffers from a clotting disorder such as haemophilia. The technical term for blood in a joint space is haemarthrosis. The blood cells within the joint break down and are very irritating to the synovial membrane. They then induce severe inflammation. Like infection, a haemarthrosis can also result in permanent damage to the structure of the joint. This is one mechanism for the severe disability which can occur in people with haemophilia.
Other non-infectious systemic conditions can affect the joints, leading to a generalised inflammatory arthritis. The underlying cause of inflammation may be due to deposition of auto-antibodies within the joint (such as occurs in rheumatoid arthritis and systemic lupus erythematosus or SLE) or may be unclear (such as in ankylosing spondylitis and inflammatory bowel disease). If the inflammation occurring in these conditions isprolonged, then the joints may become permanently deformed. These generalised causes of arthritis will be discussed in the next lesson.
The joints can also become damaged as a result of a process which is largely degenerative, and which leads to thinning or destruction of the protective cartilage which covers the ends of the bones within the joint. This process, known as osteoarthritis, is loosely described as "wear and tear" by many doctors to their patients. Osteoarthritis is more likely to occur in joints which have become damaged through injury or overuse, or in those which are held slightly out of alignment due to chronic muscular tension. Conversely "wear and tear" may occur because of excessive laxity of the ligaments (hypermobility), so that the joint repetitively is taken through a much wider range of movements than those for which it was designed. A rather confusing lay-person's term for hypermobility is "double-jointedness".
Generalised osteoarthritis usually occurs as a part of the ageing process and tends to affect the joints in a symmetrical fashion. This will be described in the next lesson.
Damage to the internal structures of the joints
As you learned in Lesson 4.2a, some of the synovial joints contain additional structures. The joint between the femur and the tibia at the knee is the most important example of such a joint. Firstly, it contains two C-shaped pads of cartilage which act as cushions for the condyles of the femur upon the table of the tibia. Secondly, two thick ligaments (cruciate ligaments) cross within the joint to prevent the joint from dislocating in an anterior or posterior direction. An injury to the knee, particularly if the joint is twisted, can cause a tear to occur in the cartilage or a rupture of one of the two ligaments.
Torn cartilage may prevent full mobility of the joint. A sign of this is that the joint may lock in a flexed position. Particles of broken cartilage can also impair the mobility of the joint and be a cause of pain and inflammation. A torn ligament will reduce the support to the knee joint and cause it to be prone to further injury. In both, if not well healed, the risk of future osteoarthritis of the knee is increased. Both injuries usually require surgical repair if severe. This may be performed by means of the arthroscope.
In Chinese medicine the pain of arthritis is a form of Painful Obstruction Syndrome, involving Blood and Qi Stagnation. In most cases there is also evidence of a Pathogenic Factor (Bi Syndrome). Inflammatory arthritis always involves Heat, but Wind and Damp may also be present. Degenerative arthritis may simply reflect underlying deficiency, particularly of the Kidneys, but very often Damp or Cold has also lodged in the affected joints to give symptoms of stiffness and deep pain.
The pain from an injury to the internal structures of the joint reflects Blood and Qi Stagnation. If adequate healing fails to take place, chronic Qi and Blood deficiency of the joint can develop, and Pathogenic Factors such as Damp and Cold may invade.

Joint cysts and ganglions
These are fluid filled cysts which appear close to the margin of a synovial joint. The cyst is an out-pouching of the synovial membrane, and is filled with synovial fluid. Cysts generally appear as part of a degenerative process. The most common site for a joint cyst to form is at the edge of the wrist joint, where it appears as a smooth, firm, slightly compressible lump (ganglion). Joint cysts at the back of the knee ("Baker's cysts") may also be degenerative, but also can develop as part of a generalised inflammatory disorder such as rheumatoid arthritis.
Joint cysts are usually painless, but may ache or lead to restriction of movement of the affected joint.
Occasionally the cyst can burst and release fluid into the surrounding tissues. This may lead to resolution of the problem, although commonly the cyst will reform. Rupture of a large cyst such as a Baker's cyst can cause marked inflammation. In the case of a Baker's cyst the inflammation can mimic that of a deep vein thrombosis because the released fluid tracks down the muscles of the calf to cause a tender and swollen calf muscle.
The most effective form of treatment for these cysts is surgical removal. Fluid can be drawn out of the cysts by syringe for relief of discomfort, but this tends to re-accumulate in a short space of time.
In Chinese medicine the development of a joint cyst probably reflects Phlegm caused by Stagnation of Body Fluids.

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