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Joints: Clinical correlations
VideosSplinting, knee exam, knee arthrocentesis, Lisfranc joint repair
Pollicization
Rotationplasty
Pain-killer pumps and chondrolysis
Joint cracking
Pronation in tennis serve
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Joints: Clinical correlationsVideos
Splintinghttp://www.nejm.org/doi/full/10.1056/NEJMvcm0801942
Knee examinationhttp://www.nejm.org/doi/full/10.1056/NEJMvcm0803821
Knee arthrocentesisLocal WMV file: NEJM 2006; online: NEJM 2006.
Lisfranc joint repairhttp://www.arthrex.com/resources/animation/HLB4TQz5uUWXAwFGSN7h3Q/cfs-lisfranc-ligament-repair
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Pollicization = Thumb-ization
Treatment for radial dysplasia: little or no thumb
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Pollicization
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Cancer of distal femur at age 5. Surgery & chemo & rotationplasty. Now 12 yrs old. Good gait, cheerleading, gymnastics. See online video.Dormans & Garg (CHoP), NEJM 2004.
Rotationplasty: Turning an Ankle into a Knee
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Joints: Clinical correlations
Pain-killer pumps and chondrolysis
Chondrolysis = loss of articular cartilage as the result of lysis or dissolution of cartilage matrix and cells.Rare. Little recovery. Why?
NYTimes Jan 27 2010. http://www.nytimes.com/2010/01/27/sports/27painpump.html
Related slide show: http://www.nytimes.com/slideshow/2010/01/27/world/20100127-PAINPUMP_index.html
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Chondrolysis and pain relief pumps
Bupivacaine (Astra-Zeneca) commonly used.Animal studies show use of a pain-relief pump with bupivacaine at glenohumeral joint for 1 week (similar to human use) causes chondrolysis.1
1. Gomoll et al. Chondrolysis After Continuous Intra-Articular Bupivacaine Infusion: An Experimental Model Investigating Chondrotoxicity in the Rabbit Shoulder. Arthroscopy 22: 813-819.
Diagram: NY Times 2010-01-27.
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Joints: Clinical correlations
Joint crackingWhat causes the sound?Bubbles (CO2, N2) forming and disappearing1
Tendons, ligaments snapping over bony prominences (e.g. neck)
Is it bad?Probably not in the short term, if no pain and no swelling.One study of habitual knuckle crackers found they had significantly less grip strength than non-crackers.2
1. Brodeur, The audible release associated with joint manipulation, J Manip Physiol Ther 18: 155-64, 1995.2. Castellanos & Axelrod, Effect of habitual knuckle cracking on hand function, Ann Rheum Dis 49: 308-309, 1990.
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Pronation Example•Video describing pronation in tennis serve
•Forearm pronation/supination in pitching• A-type pitchers have advantages* compared to B-type.
*lower humeral internal rotation torque (HIRT), lower ellbow valgus load (EVL), greater pitching efficiency, i.e. mph/HIRT or mph/EVL
Davis JT et al. (2009) The Effect of Pitching Biomechanics on the Upper Extremity in Youth and Adolescent Baseball Pitchers. Am J Sports Med 37: 1484-1491.