Written and clinically reviewed by Jeremy Swisher, MD
The condition
Osteoarthritis is more than “wear and tear.”
Osteoarthritis affects the whole joint. Cartilage changes are part of it, but bone, joint lining, muscles, tendons, and the nervous system can all shape how a joint feels and functions.
Common symptoms include pain with activity, stiffness after rest, swelling, reduced motion, and difficulty with stairs, walking, exercise, or work. The amount of change on an X-ray does not always match the amount of pain a person experiences. That is why treatment should be based on the whole clinical picture rather than an image alone.
Move with more confidence
Improve strength, mobility, and tolerance for meaningful activity.
Reduce symptom burden
Choose strategies that fit your health history and daily demands.
Know the next step
Understand when to progress care or involve another specialist.
Evaluation
First, make sure the diagnosis fits.
Joint pain is not always osteoarthritis. Tendon or bursal pain, an acute injury, inflammatory arthritis, gout, infection, and pain referred from the spine can sometimes look similar. A focused evaluation helps sort out the likely pain source and what matters most to the plan.
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01
Understand the pattern
We discuss when symptoms started, stiffness and swelling, prior injury, activity limits, treatments tried, medical history, and your priorities.
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02
Examine the whole movement system
The visit may include gait or movement observation, range of motion, strength, stability, and evaluation of nearby structures.
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03
Use imaging selectively
Weight-bearing X-rays are often the most useful first study when imaging is needed. Ultrasound or MRI may answer specific questions, but neither is automatic.
More imaging is not always better care.
A test is most helpful when it is likely to clarify the diagnosis or change treatment. Prior images and reports are reviewed in the context of your symptoms and examination.
Treatment
A stepwise, non-operative plan.
The foundation is usually a combination of education, appropriate movement, and symptom-management strategies. The exact mix depends on the joint, severity, other health conditions, and what you need to do.
- Exercise and rehabilitation. Individualized land-based or aquatic exercise can build strength, mobility, balance, and capacity. Physical therapy may help translate these goals into a progressive program. Choose the beginner knee osteoarthritis program or, after building a stable base, the advanced progression.
- Activity planning. Adjusting volume, impact, or movement choices can calm symptoms while preserving meaningful activity. Complete rest is rarely a durable long-term strategy.
- Weight-management support when relevant. Even modest change may reduce joint load for some people. This should be approached neutrally and in the context of overall health.
- Braces and assistive devices. A brace, cane, footwear change, or other support may be useful for selected symptoms and activities.
- Medication options. Topical or oral medicines may help some patients, but kidney, gastrointestinal, cardiovascular, and medication risks need to be considered.
Progress is usually judged by function: how the joint tolerates daily activity, work, exercise, and the tasks that matter to you, not only by a pain score.
Shared decisions
Where injections may fit, and where they may not.
Injections can be considered as one part of a broader plan. They do not reverse osteoarthritis, regrow cartilage, or replace rehabilitation. The evidence, likely duration of benefit, risks, cost, and insurance coverage differ by option and by patient.
Corticosteroid
May provide short-term symptom relief in selected joints. Repeated exposure and individual health risks require careful discussion.
Hyaluronic acid
Evidence and professional-society recommendations vary. It is not recommended for routine use by AAOS, but may be discussed selectively.
Platelet-rich plasma
Research is evolving and preparations vary. Current guidance increasingly emphasizes total deliverable platelet dose, while uncertainty, cost, and alternatives remain important.
If an injection is considered, the visit should cover the intended goal, alternatives, procedure risks, expected aftercare, and how the response will inform next steps. An evaluation does not guarantee a same-day procedure or insurance authorization.
Coordinated care
When a surgical opinion makes sense.
Some patients benefit from speaking with an orthopedic surgeon when substantial pain or functional limitation continues despite a reasonable non-operative plan, when structural disease is advanced, or when another diagnosis may require surgery. A referral is a coordinated next step, not a failure of conservative care.
Your appointment
What to expect at the first visit.
A typical first visit includes a detailed history, focused examination, review of existing studies, and a conversation about the options that best fit your diagnosis and goals. The outcome may be a rehabilitation or testing plan rather than a procedure that day.
- Bring prior imaging and reports, including the actual image files when available.
- Bring a current medication list and details of prior injections or reactions.
- Bring therapy notes, operative reports, and a short list of treatments already tried.
- Choose two or three activities you most want to improve.
For PTs & referring clinicians
Collaborative care for persistent joint symptoms.
Dr. Swisher welcomes referrals for diagnostic clarification, imaging questions, a plateau despite appropriate rehabilitation, procedure consideration, or coordinated decisions about activity progression.
UCLA referral informationCommon questions
Osteoarthritis FAQs
Does osteoarthritis always require surgery?
No. Many people manage symptoms and remain active with education, exercise, rehabilitation, and other non-operative strategies. Surgical consultation becomes appropriate when symptoms and limitations remain substantial or the diagnosis calls for it.
Do I need an MRI?
Usually not to establish straightforward osteoarthritis. Weight-bearing X-rays often provide more useful initial information. MRI may help when another diagnosis is suspected or the result would change management.
Should I stop exercising when the joint hurts?
Not necessarily. The better question is how to adjust the type, amount, or intensity of activity so symptoms remain manageable while capacity improves. Sudden major swelling, trauma, or other warning signs need separate evaluation.
Which injection is best?
There is no single best injection for everyone. Diagnosis, evidence, medical history, prior response, goals, risks, cost, and coverage all matter. Some patients are better served without an injection.
When to seek urgent care
A new hot, rapidly swollen, very painful joint, especially with fever or feeling ill, needs prompt medical assessment to exclude infection. Call 911 or go to an emergency department for a major injury, visible deformity, severe bleeding, or a numb, cool, or pale limb.
Evidence
Sources and further reading
This page reflects major guideline themes while recognizing that recommendations and individual circumstances differ.