Does a bone-on-bone X-ray mean nothing can be done for the pain?

X-rays and symptoms disagree. People with severe joint-space narrowing walk comfortably. People with mild films cannot climb stairs. A knee film taken in Godfrey says how much cartilage is left. It does not say why this knee hurts today, or that nothing can be done until someone replaces it.

Three things decide how much an arthritic joint hurts. The first is mechanics: load through thinned cartilage irritates the bone underneath and the joint lining. The second is biology. That lining is part of the immune system. In a body running high insulin and high leptin, it makes inflammatory signals of its own. That is why hand joints that carry no weight also break down in metabolic disease. The third is money: a joint waiting its turn for an operation tends to get nothing in the meantime except a prescription. The Metro East patient we see most often is living inside that gap.

Can bone-on-bone knee pain be treated without surgery?

The knee capsule gets its feeling from a small set of sensory nerves, the genicular nerves. They run over the bone on the inside and outside of the joint. Numbing them under imaging is a test. If the pain drops for the life of the anesthetic (as long as the numbing lasts), those nerves are carrying it. Then radiofrequency ablation of the same nerves can quiet the signal for months while the joint is unchanged. A 2011 double-blind trial of 38 patients with severe knee osteoarthritis found the treated group substantially better than sham at twelve weeks. It was small and short, and later trials disagree on how long relief lasts. You will hear both before you agree to it.

The hip: a joint you cannot reach by feel

The hip sits deep behind a thick cuff of muscle. A needle placed by feel lands in the joint far less reliably than one placed under ultrasound or fluoroscopy (live X-ray). A 2016 systematic review of hip injection studies found image guidance far more accurate. A diagnostic anesthetic that missed the joint reads as a negative test. It sends you down the wrong path. Groin pain that gets worse putting on socks points at the hip. Buttock pain running down the leg points at the spine.

Does insulin resistance make arthritis pain worse?

Osteoarthritis has a metabolic type now described as its own condition. Joints break down in people with insulin resistance, high blood pressure and abdominal fat. The cause is low-grade inflammation, not weight alone. That is why the first visit draws blood. Cortisone into a joint being inflamed from the inside holds for weeks. Lowering the insulin signal changes the terrain the joint lives in.

Dr. Gurpreet Singh Padda, MD, MBA, MHP has drawn his own blood and worn an EKG through a sauna experiment rather than ask a patient to test an idea first. The same rule runs here: a nerve is tested before it is treated.

What happens at the first pain management visit?

What else helps arthritis pain besides injections?

Forty to fifty percent of the plan is behavior, and each piece has a reason. Quadriceps strength unloads the knee with every step. A weak quadriceps hands that load to the joint surface. Cutting acellular carbohydrate lowers insulin. The inflammatory output of the joint lining drops with it. Acceptance and Commitment Therapy is done in-house by a licensed pain-trained clinician, because a knee protected for two years has to be taught to be trusted again. And isolation turns pain up. So a walking route around Godfrey with a neighbor is part of the prescription.

From Godfrey and the towns around it

Free-flow times with no traffic. From Godfrey the route is US-67 south through Alton and over the Clark Bridge, where US-67 becomes Lindbergh Boulevard and meets I-70 one exit from Woodson Rd.

Frequently asked questions

Is a genicular nerve block the same as a cortisone shot?

Cortisone goes into the joint. A genicular nerve block numbs the nerves outside it. Its value is diagnostic first: it tells us whether ablating those nerves would help.

My X-ray says bone-on-bone. Is there any point in anything except a replacement?

The X-ray describes cartilage, not pain, and the knee pain page walks through what treats the signal while the joint is what it is.

How do I know whether it is my hip or my back?

Groin pain brought on by putting on socks points at the hip. Buttock pain running down the leg points at the spine. The hip pain page explains the anesthetic test that settles it when the exam cannot.

Can a hip injection be done without imaging?

It can, and it misses the joint often enough that we do not do it that way. Our page on image-guided joint injections explains why the picture is the difference between a test and a guess.

Can you live with bone-on-bone knees without surgery?

Many people do. An X-ray shows how much cartilage is left, not how much the knee hurts, and people with severe joint-space narrowing often walk comfortably. The pain travels on small genicular nerves. If numbing them drops the pain, radiofrequency ablation of those same nerves can quiet the signal for months while the joint stays as it is. Stronger quadriceps also take load off the joint with every step.

Can you walk with knee arthritis?

Yes, and walking is part of the plan. Films and symptoms disagree: some people with severe narrowing walk comfortably, while others with mild films cannot climb stairs. Strong quadriceps unload the knee with every step; a weak quadriceps hands that load to the joint surface. Isolation turns pain up, so a walking route around Godfrey with a neighbor is written into the prescription.

What are the treatment options for knee pain caused by osteoarthritis?

That depends on what the diagnostic block shows. First comes an exam, a read of your imaging with you, and bloodwork. Then a numbing block under ultrasound or fluoroscopy tests the nerves. The options that follow are radiofrequency ablation, an image-guided joint injection, an orthobiologic where it fits, or a surgical opinion. Forty to fifty percent of the plan is behavior: quadriceps strength, less acellular carbohydrate and Acceptance and Commitment Therapy.

Related reading

• Knee pain
• Hip pain
• Genicular nerve block
• Image-guided joint injections
• Metabolic health and pain
• PRP injections and orthobiologics, explained for Illinois patients