Joints: Clinical correlations

VideosSplinting, knee exam, knee arthrocentesis, Lisfranc joint repair

Pollicization

Rotationplasty

Pain-killer pumps and chondrolysis

Joint cracking

Pronation in tennis serve

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

Pollicization = Thumb-ization

Treatment for radial dysplasia: little or no thumb

Pollicization

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

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

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.

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.

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.