September is Pain Awareness Month, a national effort focused on helping people with pain feel heard, understood, and connected to useful care. In 2026, the U.S. Pain Foundation is highlighting that pain affects people of all ages and can come from many different diagnoses.[1]
For orthopedic patients, one of the most important messages is simple: pain is a symptom, not a diagnosis.
A painful knee may be osteoarthritis, a meniscus injury, tendon irritation, a stress injury, inflammation, or something else entirely. Hip pain may come from the hip joint, the tendons around the hip, the spine, or referred pain. Shoulder pain can come from the rotator cuff, the biceps tendon, arthritis, frozen shoulder, or instability.
That is why the best next step is not always to “push through it,” order an MRI immediately, or assume surgery is inevitable. The right plan starts with understanding what structure is painful, why it hurts, how much function has changed, and whether there are warning signs that need faster evaluation.
This guide explains how orthopedic clinicians approach joint pain and when an evaluation can help.
When is joint pain worth getting checked?
Some aches improve after a few days of rest, activity modification, or gradual return to normal movement. Others keep coming back, worsen with time, or begin to interfere with sleep, work, walking, exercise, or basic daily activities.
An orthopedic evaluation becomes more useful when pain is:
- Persistent despite reasonable self-care
- Recurrent every time you return to activity
- Associated with swelling, catching, locking, instability, or giving way
- Limiting walking, stairs, lifting, work, sport, or sleep
- Following a significant injury
- Progressively worsening without a clear reason
- Accompanied by stiffness or loss of motion that is not improving
- Severe enough that you are changing your life around it
The goal of evaluation is not to “find a surgery.” The goal is to identify the diagnosis and match treatment to the problem.
When is joint pain urgent?
Some symptoms deserve prompt or same-day assessment rather than a routine appointment.
Seek urgent medical care for joint pain associated with:
- A visibly deformed joint after injury
- Inability to bear weight or use the limb after significant trauma
- A hot, markedly swollen joint with fever or systemic illness
- New numbness, weakness, or loss of function after an injury
- A pale, blue, unusually cold, or poorly perfused hand or foot
- An open wound over a suspected fracture or dislocation
- Rapidly increasing swelling or severe pain that seems out of proportion to the injury
If you have chest pain, difficulty breathing, signs of stroke, or another life-threatening emergency, call 911.
Why does the location of pain matter?
Patients understandably describe pain by body region: “my knee hurts,” “my hip hurts,” or “my shoulder hurts.” Orthopedic evaluation goes one level deeper.
The exact location and pattern can help narrow the possibilities.
For example, pain at the front of the knee may come from the patellofemoral joint, the quadriceps or patellar tendon, or other structures. Pain directly along the joint line may raise different questions. Pain behind the knee may come from swelling within the joint, a Baker’s cyst, tendon irritation, or another source.
Hip pain in the groin often points clinicians toward the hip joint itself, while pain over the outside of the hip may be more consistent with gluteal tendon or bursal-region problems. Buttock pain may come from the hip, sacroiliac region, or lumbar spine.
The pattern does not make the diagnosis by itself, but it helps determine what should be examined and whether imaging is likely to add useful information.
What are the most common causes of joint pain?
There is no single “joint pain diagnosis.” Common orthopedic causes include:
Osteoarthritis
Osteoarthritis is a degenerative joint condition in which cartilage, bone, and other joint structures change over time. It commonly affects the knees, hips, hands, and other joints.
Symptoms may include activity-related pain, stiffness, reduced motion, swelling, and loss of function. Some people have dramatic X-ray changes with surprisingly little pain, while others have meaningful symptoms with less severe imaging findings. Treatment decisions should be based on the patient, not the X-ray alone.
AAOS guidelines for knee and hip osteoarthritis support a range of nonoperative options, including exercise-based care and selected medications, while emphasizing individualized decision-making.[2][3]
Tendon and muscle problems
Tendons transfer force from muscle to bone. Overuse, sudden increases in activity, weakness, poor movement mechanics, or acute injury can irritate or tear tendons.
Examples include rotator cuff disease in the shoulder, patellar or quadriceps tendon problems around the knee, and gluteal tendon problems around the hip.
These conditions often behave differently from arthritis and may respond to a different rehabilitation plan.
Ligament injuries and instability
Ligaments help stabilize joints. Injuries such as an ACL tear, ankle sprain, or shoulder instability event can cause pain, swelling, and a feeling that the joint is unreliable.
Instability matters because repeated episodes can interfere with activity and may sometimes cause additional damage.
Meniscus or cartilage injury
The knee menisci distribute load and contribute to stability. Meniscus tears can occur after trauma or develop as part of age-related degeneration.
Not every meniscus tear requires surgery. Symptoms, tear pattern, arthritis severity, mechanical locking, activity demands, and response to rehabilitation all matter.
Fracture or stress injury
Not every fracture follows a dramatic accident. Stress injuries and insufficiency fractures can develop with repetitive loading or weakened bone.
Pain that becomes increasingly focal, especially after a rapid change in training or in someone with reduced bone strength, deserves evaluation.
Inflammatory or systemic disease
Some joint pain comes from inflammatory arthritis, gout, infection, autoimmune disease, or other medical conditions. These problems may require coordination with primary care, rheumatology, infectious disease, or another specialty rather than orthopedic treatment alone.
Do I need an X-ray, MRI, or ultrasound?
Imaging is most useful when it answers a specific clinical question.
X-rays
X-rays are often the first imaging study for persistent joint pain because they can show:
- Arthritis and joint-space changes
- Fractures
- Alignment
- Bone spurs
- Some signs of prior injury or deformity
For many patients with hip or knee arthritis, a properly obtained X-ray provides more useful first-line information than an MRI.
MRI
MRI can show soft tissues, cartilage, bone marrow, tendons, ligaments, and other structures in detail. It is especially useful when the diagnosis remains unclear after examination and X-rays, or when a specific soft-tissue injury is suspected.
An MRI is not automatically necessary for every painful joint. Incidental findings are common, and the scan must be interpreted in the context of symptoms and examination.
Ultrasound
Musculoskeletal ultrasound can evaluate certain tendons, fluid collections, superficial structures, and dynamic problems in real time. It can also help guide selected injections and procedures when appropriate.
The best imaging test depends on the diagnosis being considered.
What can I try before surgery?
For many musculoskeletal problems, surgery is not the first treatment.
Activity modification without complete shutdown
The goal is often to reduce the activity that is clearly aggravating symptoms while maintaining safe movement and conditioning. Complete inactivity can lead to weakness, stiffness, and loss of confidence.
Physical therapy
For many joint and soft-tissue conditions, a progressive rehabilitation program can improve strength, mobility, balance, movement control, and activity tolerance. Exercise and physical activity are central components of evidence-based osteoarthritis care.[2][4]
At Pacific Bone & Joint, physical therapy is coordinated with orthopedic and sports-medicine care when appropriate.
Medications
Depending on the diagnosis and a patient’s medical history, treatment may include topical or oral anti-inflammatory medications, acetaminophen, or other medications. The risks of kidney disease, stomach bleeding, cardiovascular disease, anticoagulation, drug interactions, and other conditions have to be considered before using NSAIDs.
Bracing or supportive devices
A brace, walking boot, cane, or other device can sometimes reduce load on a painful structure or protect healing tissue. The device should fit the diagnosis rather than being used simply because a joint hurts.
Injections
Corticosteroid, hyaluronic acid, platelet-rich plasma, or other injection options may be discussed for selected conditions. The evidence, expected duration of benefit, risks, and insurance coverage vary substantially by diagnosis and treatment.
An injection should not replace making the correct diagnosis.
What if the pain has been there for months or years?
Long-standing pain deserves thoughtful evaluation, but it does not automatically mean the joint is “too far gone.”
One of the most useful questions is: what is driving the limitation right now?
For some people, weakness, stiffness, and loss of conditioning become major contributors on top of the original joint problem. For others, advanced structural disease is the main reason walking or sleep has become difficult. Sometimes both are true.
The treatment plan may therefore include several layers:
- Identifying the structural diagnosis
- Improving strength and motion where possible
- Managing inflammation or pain appropriately
- Addressing body weight, bone health, sleep, or other factors that affect recovery
- Determining whether surgery would meaningfully improve function when nonoperative care is no longer enough
Chronic pain can also affect mood, sleep, work, relationships, and confidence in movement. Those effects are real and should be part of the treatment conversation rather than dismissed as “just stress.” Pain Awareness Month is partly about improving that understanding.[1]
How do I know if arthritis is becoming “bad enough” for joint replacement?
There is no single X-ray threshold, pain score, or age that determines when someone should have a hip or knee replacement.
Joint replacement becomes more relevant when several things line up:
- The diagnosis is advanced arthritis or another condition that can reasonably be improved with replacement
- Pain and loss of function are substantial
- Symptoms are affecting quality of life
- Appropriate nonoperative options have not provided enough relief
- The expected benefits outweigh the risks for that individual
A person with severe X-ray arthritis who is still hiking comfortably may not need surgery. A person with advanced arthritis who cannot sleep, walk through a grocery store, or perform necessary work may reasonably be at a different point.
The decision should be based on function, symptoms, goals, medical risk, and informed preference.
What should I expect at an orthopedic evaluation?
A good joint-pain visit usually starts with the story.
Your clinician may ask:
- Where exactly is the pain?
- When did it start?
- Was there an injury?
- What movements aggravate it?
- Is there swelling, catching, locking, or instability?
- Does it wake you at night?
- What treatments have you already tried?
- What activities are you trying to get back to?
The physical examination may assess motion, strength, tenderness, stability, gait, neurologic function, and nearby joints. Imaging is then selected based on what needs to be clarified.
The point is to build a diagnosis and treatment plan, not simply to order every available test.
Joint pain in Hawai‘i: when access and travel matter
Living in Hawai‘i adds practical considerations to orthopedic care. Patients may be balancing neighbor-island travel, work schedules, sports, caregiving, and limited access to subspecialty services.
That makes early triage useful. A stable overuse problem may be appropriate for physical therapy or a scheduled sports-medicine visit. A suspected fracture, dislocation, or rapidly swollen joint may need same-day evaluation. Advanced hip or knee arthritis may benefit from a joint-replacement consultation rather than months of repeating treatments that have already failed.
The best care pathway is the one that gets the right patient to the right level of care without unnecessary delay.
Questions to ask about persistent joint pain
Useful questions include:
- What is the most likely diagnosis?
- Is the problem coming from the joint, tendon, ligament, bone, or somewhere else?
- Do I need imaging, and what question will the imaging answer?
- What can I safely keep doing?
- Would physical therapy help?
- What treatments have the strongest evidence for my condition?
- What are the downsides of waiting?
- What symptoms should make me seek urgent care?
- If surgery is an option, what specifically would it improve?
The bottom line
Pain deserves to be taken seriously, but pain alone does not tell us the diagnosis.
Persistent or recurrent joint pain should be evaluated when it begins to limit movement, sleep, work, sport, or daily life, especially when it is associated with swelling, instability, mechanical symptoms, or a significant injury. Many orthopedic problems can be treated without surgery, and evidence-based rehabilitation is often an important first step. Other conditions need imaging, a procedure, or surgical discussion.
The most useful goal is not simply to make pain quieter for a few days. It is to understand why the joint hurts and what gives you the best chance of getting back to the activities that matter.
If joint pain is limiting your life or you are not sure what the next step should be, request an orthopedic evaluation so the diagnosis, imaging needs, and treatment options can be reviewed together.
Sources and Further Reading
- U.S. Pain Foundation. Pain Awareness Month 2026: #OneVoiceForPain. https://uspainfoundation.org/pain-awareness-month-2026testing/
- American Academy of Orthopaedic Surgeons. Management of Osteoarthritis of the Knee (Non-Arthroplasty), Third Edition. Published August 31, 2021. https://www.aaos.org/quality/quality-programs/osteoarthritis-of-the-knee/
- American Academy of Orthopaedic Surgeons. Management of Osteoarthritis of the Hip Clinical Practice Guideline. Published December 1, 2023. https://www.aaos.org/quality/quality-programs/osteoarthritis-of-the-hip/
- Kolasinski SL, Neogi T, Hochberg MC, et al. 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee. Arthritis Care Res (Hoboken). 2020;72(2):149-162. doi:10.1002/acr.24131. https://pubmed.ncbi.nlm.nih.gov/31908149/
This article is educational and is not a substitute for individual medical advice. Treatment depends on the diagnosis, examination, imaging when appropriate, medical history, and patient goals.
