occurs when the surfaces in the joint begin to wear down.

What Is Osteoarthritis?

The joints of the body are normally surrounded by a fluid that acts as a lubricant and shock absorber. This fluid is lacking in patients with osteoarthritis, and leads to pain and inflammation in the joints.

Osteoarthritis, also known as degenerative joint disease, occurs when the cartilage that covers the tops of bones, known as articular cartilage, degenerates or wears down. The roughened and jagged bone surfaces become inflamed causing swelling, pain, and sometimes the development of osteophytes (or bone spurs) when the ends of the two bones rub together.

Who Gets Osteoarthritis?

Osteoarthritis most often occurs in people who are over the age of 50. In younger people, osteoarthritis can result from an injury or trauma, such as a fractured or dislocated shoulder. Osteoarthritis may also be hereditary.

What Are the Symptoms of Osteoarthritis?

As with most osteoarthritis, pain is a primary symptom. A person is likely to have pain with activity, certain ranges of motion and at rest due to inflammation-causing difficulty sleeping. Range of motion generally decreases over time.

While osteoarthritis can affect any joint in your body, the disorder most commonly affects joints in your:

  • Hands
  • Hips
  • Knees
  • Neck
  • Lower back
  • Ankle and foot

Osteoarthritis gradually worsens with time, and no cure exists, but osteoarthritis treatments can relieve pain and help you remain active. Taking steps to actively manage your osteoarthritis may help you gain control over your symptoms.

Osteoarthritis symptoms often develop slowly and worsen over time. Signs and symptoms of osteoarthritis include:

  • Pain: Your joint may hurt during or after movement
  • Tenderness: Your joint may feel tender when you apply light pressure to it
  • Stiffness: Joint stiffness may be most noticeable when you wake up in the morning or after a period of inactivity
  • Loss of flexibility: You may not be able to move your joint through its full range of motion
  • Grating sensation: You may hear or feel a grating sensation when you use the joint
  • Bone spurs: These extra bits of bone feel like hard lumpsand may form around the affected joint

How Is Osteoarthritis Diagnosed?

History and Examination: A history of your complaints including duration, what makes it better and worse is very important. Previous treatments and outcomes, as well as orthopedic examination of the muscles, joint, movement and strength are also used for diagnosis.

X-rays: Plain X-rays can reveal narrowing of the space in the joints revealing wear and tear on the cartilage and bone spurs that can interfere with movement. X-ray can also show changes in the shape of the bones.

MRI: Magnetic Resonance Imagingis a noninvasive procedure that can revealthe detail of structures surroundingan arthritic joint such as cartilage, tendons and ligaments. These structures can become damaged due to rubbing and friction from a roughened arthritic joint and hold importantclues as to what is causing the pain. Tendonitis and bursitis is more common in a joint that is arthritic.

Myelography/CT scanning: Sometimes used as an alternative to MRI.

Diagnostic ultrasound Imaging: Unlike an x-ray, which shows only the bone, diagnostic ultrasound has a huge advantage by showing the causes of your  joint pain in real time with great accuracy. Ultrasound imaging offers the unique advantage of viewing the joint while it is in motion. This provides important information about conditions such as impingement,whereinflamed tendons or joint capsules get pinched while the patient is moving, thereby restricting the range of motion and causing pain.

With musculoskeletal ultrasound imaging (MSUS), the muscles, tendons, ligaments, cartilage, nerves and joints can be accurately examined at the time of your visit. This provides immediate information about the health of your joint and what factors are contributing to your pain. With this information at hand, specific treatment options can be established immediately!


When joints are painful or damaged there are successful treatment options.

Why are ultrasound-guided injections better and more accurate?

When using an injection to deliver treatment into painful joints, it is necessary to be exact and precise. Dr. Isidro and his team are highly trained in ultrasound-guided injections. These procedures are performed in the office, at the time of your visit. Some of the common structures involved in joint pain may be as little as 2-3mm wide and therefore require a high level of precision to be accurate. In addition, when performing an injection, there are also structures that you want to avoid so you don’t knick or damage them on your way into the joint. The ultrasound machine provides live imaging in real time, to safely place injectable medications or treatments into or around the joint with laser-like precision.

Consider trying to hit a target blindfolded¾you may know the general direction but would not be certain if you have actually hit your target. With live ultrasound imaging, the targeted areas of pain are viewed in real time while the injection is taking place, guiding the needle with pin-point accuracy!

Cortisone Injection:

Painful arthritic joints, chronic tendinitis, bursitis and inflammation respond quickly to cortisone. In many cases this is the head start patients need to allow for gains with more conservative care and no further treatment is required. Many patients think that cortisone is bad for you. Too much of anything is not good. Using cortisone infrequently, as much as several times per year will not do any harm. If the pain continues to return, other treatment options should be considered.

Cortisone is injected using continuous live ultrasound guidance exactly where it is needed to quickly reduce inflammation and pain.

Lubrication for Arthritis:

Why Hyalgan?

A squeaky gear needs the most oil!

The joints of the body are normally surrounded by a lubricant and shock absorber called Synovial fluid. Patients with osteoarthritis experience pain and inflammation because arthritic damage in thejoint causes the Synovial fluid to break down over time.

This process causes increased friction and excess wear and tear on the cartilage cushioning movement that becomes rough and jagged causing the joint further deteriorate. Range of motion, walking, getting up from a seated position, climbing and descending steps and weight bearing is often painful. Pain is often increased during or after activity.

What is Hyalgan?

Hyalgan is a naturally derived lubricant that instantly cushions and lubricates painful arthritic joints. By restoring lubrication and cushion, your joints move more freely again with less friction and most importantly, less pain. Hyalgan is injected using continuous live ultrasound guidance ensuring pin-point accuracy exactly where it is needed.

Platelet Rich Plasma Therapy (PRP): Jump starting the healing signals:

Why use PRP?

When there is damage, tissue tears or arthritis, this exciting new procedure (made popular by professional athletes) that heals damaged structures in a joint such as the labrum, tendons, muscle, ligament or cartilage is showing exciting results!

How does PRP work?

When you cut your skin and it bleeds, platelets collect and gather at the wound site. Once there, platelets act like a conductor in an orchestra. They release growth factors that signal the healing activities to begin, resulting in a cascade of events that restore the damaged tissue.

Joints, however, do not have a direct blood supply. Therefore, when a joint structure is damaged or torn, platelets do not gather and orchestrate the necessary events for that damage to be restored. Joint damage either heals slowly or not at all. That is where Platelet Rich Plasma Therapy (PRP) proves valuable!

AmnioFix: Healing Damage – Tears and Chronic Tendinitis:

Why use AmnioFix?

When there is damage, tissue tears or arthritis this exciting new treatment can be used to heal the structures in a joint such as the labrum, tendons, muscle, ligament or cartilage.

What is AmnioFix?

AmnioFix is a new treatment that harnesses the power of 13 growth factors in a pre-packaged application. AmnioFix is hydrolyzed micronized amniotic membrane allograft containing 13 powerful growth factors. That’s a mouth full! Amniotic Membrane has been used in wound healing for many years. By placing the allograft over wounds that aren’t healing, as with burn victims, new tissue grows. Just recently, the allograft has been processed into a form that is dehydrated and micronized.

As with the explanation above regarding platelets, damage in the body is healed by an orchestrated cascade of events guided by the release of specific growth factors in the areas where damage occurs. Because joints and surrounding tendons lack a direct blood supply, damage heals slowly or often not at all.

Have you tried Physical Therapy in the past and it hasn’t worked for you?

A Different Approach Other Than Routine Painful Exercises:

We see many patients who come to us in chronic pain. Many have also had experience with physical therapy where they spent much of their sessions doing exercises and it hasn’t helped. Think of being in pain, having joint stiffness, loss of range of motion or chronic inflammation and then doing exercises to get rid of it. In most cases, you’ll feel worse not better.

Exercise is critical to maintain proper joint strength, but done at the wrong time and your pain often becomes worse. That is why we take an entirely different approach with treatment plans using three phases:

  • Therapeutic Modalities:

Our physical therapy team specializes in using certain modalities like electrical stimulation or ultrasound to reduce swelling and inflammation and increase local circulation to help the healing process. Different modalities can be applied to successfully address spasm, trigger points, inflammation, edema, swelling and damage from tendonitis and tears.

  • Joint Release Techniques:

Techniques are done by hand to gently stretch, massage and release the pressure in each of the muscles, tendons and ligaments surrounding the joint. The result is a soothing improvement in joint pain.

  • The Selective Functional Movement Assessment:

Our physical therapy team is certified in the Selective Functional Movement Assessment (SFMA), which is a series of 7 full body movement tests designed to assess fundamental patterns of movement such as bending and squatting in those with known joint pain. When the clinical assessment is initiated from the perspective of the movement pattern, our therapy team has the opportunity to identify meaningful impairments that may be seemingly unrelated to the main joint pain complaint, but contribute to the pain.

Think of having a painful right knee and favoring that side for an extended period of time. Following a period of uneven gait you may develop pain on the opposite unrelated side. This concept, known as Regional Interdependence, is the hallmark of the SFMA.

The assessment guides our clinical physical therapist to the most dysfunctional non-painful movement pattern, which is then assessed in detail. By addressing the most dysfunctional non-painful pattern, the application of targeted interventions (manual therapy and therapeutic exercise) is not adversely affected by pain.

When to see a doctor

If you have swelling or stiffness in your joints that lasts for more than two weeks, make an appointment with your doctor.

  • Pain lasting more than two weeks
  • Chronic pain that is getting worse
  • Movement and weight bearing is limited
  • You have pain getting up from sitting
  • Going up stairs is painful
  • You have swelling of the joints



Can an OptimumJoint traditional or regenerative medical procedure help me? To find out if you might be a candidate for an OptimumJoint medical treatment procedure, complete our Optimum Joint Procedure Candidate Form online.