What to do for knee, hip, shoulder, or elbow soreness

What to try for each sore joint

Knee soreness often shows on stairs or after sitting. Hip soreness may sit in the groin or along the outer hip.

Extra walking can stir either joint. Arthritis, old harm, or an overworked tendon, the tissue linking muscle to bone, may be involved.

That tissue works much like a rope pulling the joint. Repeated use can make it sore where it meets bone.

Try short rounds of easy movement first. A cane or brace may steady your steps.

Shoulder soreness can make reaching and sleeping difficult. Elbow soreness often worsens when you grip or lift.

The rotator cuff means the muscles and tendons holding your shoulder steady. A tear there can cause weakness as well as soreness.

Ease off the sharp movement, but keep safe motion. Physical therapy may rebuild strength without forcing the sore area.

Knee osteoarthritis means wear and swelling inside the knee joint. It can cause stiffness after rest and soreness during walking.

An exam can tell whether the joint or nearby tissue hurts. It also helps match each choice to the cause.

Get checked when soreness lasts or changes how you walk. New weakness that makes you drop things also needs attention.

Seek prompt care after a pop causes sudden weakness. Fever with a hot joint also needs urgent care.

Tell the clinician which movement brings the soreness. You'll get more useful advice than one label can provide.

Sources

1. A clinical-recommendations review graded PRP indication by indication: good evidence for leukocyte-poor PRP in knee osteoarthritis; moderate-to-high-quality evidence for leukocyte-rich PRP in patellar tendinopathy and for PRP in plantar fasciitis; INSUFFICIENT evidence to routinely recommend PRP for rotator cuff tendinopathy, hip osteoarthritis or high ankle sprains; and demonstrated LACK of efficacy for Achilles tendinopathy, muscle injuries, acute fracture or non-union, and as a surgical augment in rotator cuff repair, Achilles repair and ACL reconstruction.

   Le ADK, Enweze L, DeBaun MR, et al. — Current Clinical Recommendations for Use of Platelet-Rich Plasma. Current Reviews in Musculoskeletal Medicine, 2018. DOI: 10.1007/s12178-018-9527-7.

2. A 12-centre randomized controlled trial of 230 patients with chronic lateral epicondylar tendinopathy compared tendon needling with leukocyte-enriched PRP against tendon needling alone. At 12 weeks there was no significant difference (55.1% versus 47.4% pain improvement; P=.163). At 24 weeks the PRP group reported 71.5% versus 56.1% pain improvement (P=.019), a 83.9% versus 68.3% success rate (P=.037), and significantly less residual elbow tenderness (29.1% versus 54.0%; P=.009). No significant complications occurred in either group.

   Mishra AK, Skrepnik NV, Edwards SG, et al. — Efficacy of platelet-rich plasma for chronic tennis elbow: a double-blind, prospective, multicenter, randomized controlled trial of 230 patients. American Journal of Sports Medicine, 2014. DOI: 10.1177/0363546513494359.

3. Two-year follow-up of the same 80-patient gluteal tendinopathy trial found the single leukocyte-RICH PRP injection produced improvement that was sustained at 104 weeks (mHHS 53.77 at baseline to 82.59 at two years; P<.0001), whereas the corticosteroid improvement peaked at six weeks and was not maintained beyond 24 weeks. This is one of the clearest demonstrations that leukocyte-rich PRP is the formulation with evidence in TENDON, not in cartilage.

   Fitzpatrick J, Bulsara MK, O'Donnell J, et al. — Leucocyte-Rich Platelet-Rich Plasma Treatment of Gluteus Medius and Minimus Tendinopathy: A Double-Blind Randomized Controlled Trial With 2-Year Follow-up. American Journal of Sports Medicine, 2019. DOI: 10.1177/0363546519826969.

4. A placebo-controlled, double-blind randomized trial of 40 patients with chronic rotator cuff tendinopathy compared a single ultrasound-guided subacromial injection of 5 mL PRP with 5 mL saline, with both groups completing a 6-week standard exercise programme and follow-up to one year. PRP did not produce better outcomes than saline on any measure - a reminder that the exercise programme, not the injectate, carried the improvement.

   Kesikburun S, Tan AK, Yilmaz B, et al. — Platelet-rich plasma injections in the treatment of chronic rotator cuff tendinopathy: a randomized controlled trial with 1-year follow-up. American Journal of Sports Medicine, 2013. DOI: 10.1177/0363546513496542.

5. A meta-analysis of six randomized trials (211 PRP patients, 197 hyaluronic acid patients, mean follow-up about 12 months) in hip osteoarthritis found NO significant difference between PRP and hyaluronic acid in weighted improvement on WOMAC, VAS or Harris Hip Score - including in a subanalysis isolating leukocyte-poor PRP.

   Belk JW, Houck DA, Littlefield CP, et al. — Platelet-Rich Plasma Versus Hyaluronic Acid for Hip Osteoarthritis Yields Similarly Beneficial Short-Term Clinical Outcomes: A Systematic Review and Meta-analysis of Level I and II Randomized Controlled Trials. Arthroscopy, 2022. DOI: 10.1016/j.arthro.2021.11.005.

6. A systematic review and meta-analysis of PRP for hip osteoarthritis found intra-articular PRP more effective at time points earlier than three months, with diverse results between 4 and 12 months and only one included study reporting significantly better outcomes for PRP than the comparator. The authors judged PRP possibly beneficial and safe at mid-term follow-up but said its superiority over alternatives such as hyaluronic acid remains unclear.

   Medina-Porqueres I, Ortega-Castillo M, Muriel-Garcia A — Effectiveness of platelet-rich plasma in the management of hip osteoarthritis: a systematic review and meta-analysis. Clinical Rheumatology, 2021. DOI: 10.1007/s10067-020-05241-x.

7. In the RESTORE trial - the largest placebo-controlled PRP trial in knee osteoarthritis - 288 adults aged 50+ with symptomatic Kellgren-Lawrence grade 2-3 medial knee OA received three weekly intra-articular injections of leukocyte-poor PRP from a commercial system or saline placebo. At 12 months the mean change in knee pain was -2.1 points with PRP versus -1.8 with saline (difference -0.4; 95% CI -0.9 to 0.2; P=.17) against a minimum clinically important difference of 1.8, and the change in medial tibial cartilage volume was -1.4% versus -1.2% (difference -0.2%; 95% CI -1.9% to 1.5%; P=.81). Twenty-nine of 31 prespecified secondary outcomes showed no significant between-group difference. The authors concluded the findings do not support use of PRP for knee OA.

   Bennell KL, Paterson KL, Metcalf BR, et al. — Effect of Intra-articular Platelet-Rich Plasma vs Placebo Injection on Pain and Medial Tibial Cartilage Volume in Patients With Knee Osteoarthritis: The RESTORE Randomized Clinical Trial. JAMA, 2021. DOI: 10.1001/jama.2021.19415.