When should you stop waiting and get it checked

In practical terms, stop waiting when the joint is not steadily settling. If pain keeps returning with ordinary tasks such as opening jars, turning keys, pushing off through the ankle, or throwing after a spell of rest or rehab, specialist assessment is reasonable. The same applies when function is slipping rather than improving.

• pain with normal daily tasks or sport
• repeated flare-ups after rest, physio, or activity modification
• loss of motion or increasing stiffness
• catching, clicking, or locking
• weaker grip, pinch, push-off, or throwing power
• symptoms that began after an old ankle sprain, fracture, or repetitive overhead sport

The point of getting it checked is not to rush towards surgery. In 2022 reviews of ankle and thumb arthritis, and in studies of capitellar osteochondritis dissecans in overhead athletes, the earlier question is whether the diagnosis is correct, how far the problem has progressed, and whether joint-preserving options may still be realistic. There is no single universal week-count that defines a “preservation window”. A more useful threshold is ongoing, function-limiting symptoms, especially when stiffness, weakness, motion loss, or mechanical symptoms are starting to narrow what the joint can do.

Why earlier review can matter

Earlier review can matter because it may still change the menu of options. In ankle arthritis, the 2022 review describes a clearer joint-preserving window before Takakura-Tanaka stages 3B to 4, when end-stage collapse has narrowed choices; in thumb CMC disease, the Eaton-Littler 4-stage system reflects a similar broad shift from early degeneration to more advanced wear. For a throwing elbow, the key distinction is often not a numbered stage but whether a capitellar osteochondritis dissecans lesion looks stable or unstable, because that affects healing potential and treatment planning.

What the specialist is trying to clarify is quite practical: is this mainly cartilage wear, an osteochondral injury, malalignment, post-traumatic change after a fracture or chronic instability, or something else that only mimics it? Symptoms and imaging do not always line up neatly, so scans are not a verdict on their own. Assessment usually combines the symptom pattern, any history of sprains, fracture or repetitive overhead sport, a clinical examination, plain X-rays to look at alignment and stage, and MRI when cartilage or osteochondral damage is suspected. Public evidence supports assessing these problems before severe deformity or end-stage arthritis develops, but it does not give one universal symptom-duration deadline or a single standardised “cartilage-led” pathway.

Early ankle osteoarthritis signs and stages

Ankle osteoarthritis often begins with an injury history rather than a straightforward age-related wear pattern. Orthobullets and a 2022 review both place roughly 75% to 80% of ankle OA in the post-traumatic group, commonly after an ankle fracture, repeated sprains, or long-standing instability. That helps explain why it may be missed early: a joint that keeps flaring after a “bad sprain” can look like a soft-tissue problem for quite a while.

The early symptom pattern is usually gradual and recurrent, not one isolated sore week. People often describe a deep ache in the ankle with walking, especially on uneven ground, pain with push-off, stiffness after rest, and swelling or tenderness after activity. Over time, ordinary things such as longer walks, stairs, or quick changes of direction may feel less reliable. Orthobullets and the 2022 review both list pain with motion or activity, stiffness, tenderness and swelling among the common early features.

Staging is where the picture becomes more useful. In the Takakura-Tanaka system, stages I to II generally represent earlier disease, with osteophytes, sclerosis, or medial joint-space narrowing but without the major collapse seen later. By contrast, the 2022 review describes stages 3B to 4 as advanced or end-stage disease. In that earlier window, especially when malalignment is part of the problem, joint-preserving treatment may still be considered; arthrodesis or ankle replacement is usually reserved for final stages or for joints that have already progressed despite other care.

Early thumb base arthritis first signs

For many people, thumb base arthritis first shows up in ordinary hand jobs rather than in a dramatic injury: twisting a key, opening a jar, turning a tap, fastening buttons, or gripping a kettle. AAOS and Benenden both describe the same early pattern — pain at the base of the thumb with pinching, gripping, or turning, plus tenderness, stiffness and a weaker grip. In Benenden’s Stage 1 description, the symptoms can be subtle enough to pass as simple overuse.

That is why early thumb CMC trouble is easy to dismiss. A sore thumb after gardening, typing, childcare, salon work, or tool use may settle for a day or two, then return with the next week’s hand-heavy tasks. When the pain keeps recurring, jars and lids become awkward, or grip strength is plainly dropping, it is more sensible to look beyond the idea of a short-lived strain.

The standard way of describing progression is the modified Eaton-Littler system, which divides thumb CMC arthrosis into four radiographic stages. Kept simple, lower stages reflect earlier joint change, while higher stages show more established degeneration; Stage IV includes wear in the neighbouring scaphotrapezial joint. Not every painful thumb needs immediate imaging, but persistent symptoms or declining function often justify specialist review so the stage can be defined properly. That matters because a 2022 review notes that joint-preserving treatments may be used in earlier-stage disease, whereas surgery is usually considered only after extensive non-surgical care if lifestyle-limiting pain and disability continue.

Throwing elbow pain that should not be played through

Repeated elbow pain during or after throwing deserves more caution than routine next-day soreness. In adolescent overhead athletes, one cartilage-related concern is capitellar osteochondritis dissecans, described in a 2016 PMC review as a problem linked to repetitive stress, biomechanical mismatch and limited vascular supply. In practical terms, the pattern that raises suspicion is pain with throwing, stiffness, loss of extension, swelling, or a clear drop in how freely the elbow moves. Mechanical symptoms matter even more: catching, clicking, or locking point away from simple overload and towards a joint-surface problem.

The load pattern helps explain why this happens. Overhead throwing places the elbow under medial laxity, lateral compression and posterior shear, which may contribute to capitellar cartilage injury over time in young throwers. Brian Waterman’s elbow cartilage summary and the capitellar OCD review both highlight pain with activity, reduced range of motion and mechanical symptoms as warning signs rather than something to simply “play through”.

Management depends on stability. The 2016 review notes that some stable capitellar OCD lesions may heal with non-operative care, but unstable lesions have lower healing potential. A 2024 Delphi consensus adds that MRI features are important in judging whether a lesion looks stable or unstable. Persistent throwing pain paired with motion loss or catching therefore deserves specialist review and imaging, not prolonged self-management alone.

What happens next if cartilage damage is confirmed

Once cartilage damage is confirmed, the practical decision is stage, not simply presence: is this an early, potentially preservable problem, or a late joint that has already crossed into end-stage change?

• In ankle arthritis, the 2022 review places the main preservation window before Takakura 3B-4. Early disease may still be managed with symptom-led conservative care, and malalignment can open the door to joint-preserving surgery; fusion or replacement are generally held for final-stage disease or failed preservation.
• In thumb CMC disease, the Eaton-Littler framework helps describe severity, but stage alone does not trigger surgery. The usual sequence is extensive non-surgical treatment first, sometimes with selected injection-based support, and only then surgery if pain and disability remain lifestyle-limiting.
• In capitellar OCD of the elbow, the key fork is stability. The 2016 review suggests stable lesions may start with non-operative management, while unstable lesions move the discussion towards repair or other operative options.

That is why treatment follows diagnosis, symptoms and function together. Where a focal defect is confirmed rather than end-stage collapse, specialist discussion may include joint-preserving repair options instead of jumping straight to replacement-level solutions. At the London Cartilage Clinic on Harley Street, Liquid Cartilage™ sits in that preservation tier for selected defects, and assessment can be booked via londoncartilage.com.

1. [1] Joint Preserving Treatments for Thumb CMC Arthritis. (2022). https://doi.org/10.1016/j.hcl.2022.01.002 https://doi.org/10.1016/j.hcl.2022.01.002