Joints Stiffness

What joint stiffness is

A joint moves freely when several things are in order: the cartilage surfaces are smooth, the capsule and ligaments are long enough to allow the arc, the muscles crossing it can lengthen, and nothing is caught between the surfaces. Stiffness means one of those conditions has failed, and it can feel much the same regardless of which. That is why a description of stiffness on its own rarely points to a treatment.

The causes fall into a few groups. Some are inside the joint: cartilage loss and bone spurs block motion, a loose fragment can jam the surfaces, and an old fracture that healed out of shape restricts the arc. Some are in the capsule, which can thicken and contract after injury or surgery, or sometimes without an identifiable cause. Some lie outside the joint entirely, in muscles shortened during immobility, in scar tissue, or in bone that has formed in soft tissue after trauma. Inflammatory disease produces a swollen joint lining and characteristically causes prolonged morning stiffness in more than one joint. Finally, a joint can be held stiff simply because moving it hurts, and guarding can itself lead to a contracture.

Symptoms and patterns that often bring people in

• Difficulty straightening or bending a knee, elbow, hip or shoulder that used to move freely.
• Stiffness on waking, or after sitting still, that loosens once you get going.
• A joint that locks or catches.
• Stiffness in several joints at once, sometimes with swelling, warmth or general fatigue.
• Progressive loss of motion after an injury, a fracture or an operation on the same limb.

How it is evaluated

The central manoeuvre is comparing active and passive motion. If you cannot lift a limb but the examiner can move it freely for you, the problem is more likely weakness, tendon rupture or pain. If the limit is the same either way, the restriction is mechanical and lies in the joint, capsule or surrounding tissue. The examiner also notes how the movement stops, since a springy resistance feels different from a firm block, and a hard stop suggests bone or a fragment. The history covers prior injury, surgery, immobilization and whether other joints are involved. X-rays show joint space, spurs and bone formed in soft tissue; CT defines bony blocks, and MRI shows capsule and cartilage. When several joints are involved, blood tests and evaluation by a rheumatologist may be recommended.

Treatment options in general terms

Treatment follows the cause, and non-surgical measures are the starting point for most stiff joints.

• Physical therapy. A supervised program to restore length in shortened tissue and strength in the muscles that control the joint.
• Splinting and bracing. Devices that apply gentle, sustained position to help hold gained range.
• Pain control. Medication categories that make movement possible, since a joint that cannot be moved comfortably is hard to rehabilitate.
• Injections and disease management. Corticosteroid injection is one option; when inflammatory arthritis is the driver, medical management is coordinated with a rheumatologist.

When a mechanical block persists and function is limited, surgical options may be raised.

• Arthroscopic release and debridement. Removing scar tissue, inflamed lining, loose fragments and impinging spurs through small incisions.
• Capsular release. Dividing the contracted portions of the capsule, sometimes with moving the joint under anesthesia.
• Excision of abnormal bone. Removing bone formed in the soft tissues after injury that is blocking motion.
• Reconstruction or arthroplasty. Correcting a joint surface that healed out of position, or replacing damaged surfaces.

What to expect when you consult Dr. Wolfson

Dr. Wolfson has particular experience with stiffness that follows trauma, fractures and previous surgery, where several causes can be present in the same limb. At a consultation he will measure motion, distinguish what you can do from what the joint allows, and explain which structure appears responsible. Second opinions are welcome.

This page provides general information about joint stiffness and is not medical advice. It is not a substitute for examination, imaging and diagnosis by a qualified physician. Every case is different and requires individual evaluation. If you have severe pain, an obvious deformity, loss of function, fever, or an injury from a significant accident, seek medical care promptly.

Contact Dr. Wolfson if you would like to setup an appointment. If you are a new patient, please book all in-person appointments with Dr. Wolfson via telephone.

If you live outside of the San Francisco Bay Area, you can request a complimentary phone consultation with Dr. Wolfson to assess your case. Please call or e-mail us to set up your complimentary consultation.

Call: (415) 221-4400

E-mail: [email protected]