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osteoarthritis

Diseases and Conditions

Is Knuckle Cracking Bad for Arthritis?

January 23, 2024

Is Knuckle Cracking Bad

The distinct pop and crack of knuckles being pulled and stretched is a familiar sound to many. You may not even realize how often you crack your knuckles until you consciously try to stop the habit. Up to 54% of people report regularly cracking their knuckles, whether for stress relief, simple habit, or just liking the sensation. But is this harmless fidgeting or is knuckle cracking bad for arthritis?

Anatomy of Knuckles

The knuckles are the joints that connect the bones of the fingers. Each finger has three joints called the distal interphalangeal (DIP), proximal interphalangeal (PIP), and metacarpophalangeal (MCP) joints 1. The thumb only has an MCP and DIP joint.

The MCP joints are where the main part of your hand meets your fingers, letting your fingers bend and straighten. The PIP joints are in the middle of your fingers, helping them to move too. The DIP joints are at the very end of your fingers and they let you bend the tips of your fingers. 2

The knuckles are covered by a special pocket of filled with a fluid. This fluid is called synovial fluid and it helps them move without any friction. There are strong bands called ligaments on the sides of the knuckles that keep them in place, and there are also protective plates in front of them. The finger bones are connected to the muscles of the hand and forearm by tendons, which help you move your fingers.

What Creates the “Cracking” Sound

The cracking or popping sound when knuckles are cracked is not caused by the bones themselves cracking, but rather by the gases being released from the fluid inside the knuckle joints. The current theory is that it is caused by the gases rapidly coming out of solution from the synovial fluid inside the joint capsules.

As Dr. Robert Klapper, an orthopedic surgeon at Cedars-Sinai Medical Center explains, “The noise of cracking or popping in our joints is actually nitrogen bubbles bursting in our synovial fluid” (source).

Similarly, according to a Scientific American article, “The cracking or popping sound is thought to be caused by the gases rapidly coming out of solution, allowing the capsule to stretch a little and decompress the joint” (source).

So in summary, the cracking sound comes from the release of gases from the joint fluid, not from the actual bones cracking or breaking.

Short Term Effects

When you crack your knuckles, you may experience some short term effects in the minutes and hours afterwards. One common sensation is a feeling of relief or release after cracking knuckles. This is likely due to the stretching and loosening of ligaments surrounding the joint during the cracking process.

Some research has found that immediately after cracking knuckles, grip strength can increase by up to 25% for a brief period. Castellanos and Axelrod (1990) measured hand strength before and after knuckle cracking and observed this temporary boost in grip force.

However, other short term effects are less beneficial. There may be some mild swelling and inflammation around the joint capsule after cracking. One study using MRI scans found more joint swelling in the knuckles of habitual knuckle crackers compared to non-crackers. This suggests frequent knuckle cracking could irritate the joint tissue.

Long Term Effects

The main question around knuckle cracking is whether or not it increases your risk of developing arthritis over time. There have been several key studies that have looked into this.

One study published in the Journal of the American Board of Family Medicine looked at 215 people ages 45-89 who had cracked knuckles on one hand for many years. They did not find any increased signs of arthritis on x-rays in the hand they cracked vs the one they did not.1

Another study followed 300 people over 50 years. Some were habitual knuckle crackers while others were not. But there was no difference in the incidence of arthritis between the two groups, leading the researchers to conclude knuckle cracking does not appear to increase arthritis risk.2

So the evidence indicates that knuckle cracking itself does not cause or worsen arthritis. However, a study in 1990 and 2018 did find that people who cracked knuckles frequently had more swollen hands and reduced grip strength compared to those who did not crack often. So while it may not directly lead to arthritis, habitual knuckle cracking can increase inflammation and impact hand strength and dexterity over time.

Other Risks

Although habitual knuckle cracking is generally harmless, there are risks with too forcefully or excessively cracking the knuckles. Cracking the knuckles with excessive force can potentially cause ligament or tendon injuries, though this is very rare. Sometimes it can it cause a finger to dislocate but this is very rare.

Additionally, the sound of knuckle cracking can be annoying or disruptive to those around you, especially if done frequently throughout the day. While not inherently dangerous, the noise and habit can be bothersome. According to a study cited by Harvard Health, knuckle cracking is associated with other habits like nail biting, smoking, and drinking alcohol 3.

Conclusion

Overall, research indicates knuckle cracking is not inherently dangerous or harmful when done in moderation. While the sound may be disconcerting, studies show it does not do damage to the joints or increase risk of arthritis. However, those who crack habitually and aggressively should exercise caution, as this can irritate the joints and tendons and lead to reduced grip strength.

Though not conclusively proven to be benign, cracking knuckles generally does not cause serious issues for most people. It appears to be more of an annoying personal habit than a major health concern. However, moderation is still advisable, as excessively forceful cracking could potentially injure joints and ligaments.

Medical Disclaimer

This information is offered to educate the general public. The information posted on this website does not replace professional medical advice, but for general information purposes only. There is no Doctor – Patient relationship established. We strongly advised you to speak with your medical professional if you have questions concerning your symptoms, diagnosis 

Diseases and Conditions Journal Club

Osteoarthritis and the Weather: What the Research Shows

January 9, 2024

Does the Weather Affect Your Joint Pain?

We’ve all felt the pain of osteoarthritis before – that aching knee pain that flares up right before a big storm. Or those creaky hips that seem to get worse when the humidity is high. It’s a common belief that changes in the weather can influence joint pain, especially for people with arthritis and other joint conditions. But is this just a myth or is there real science behind the connection?

Researchers conducted a study and found that certain weather conditions can worsen joint pain. The study provides interesting insights into this common belief. It shows that there are connections between specific weather conditions and increased pain levels. This could have implications for managing joint symptoms.

Study Overview

Osteoarthritis is a common joint disease that causes pain and stiffness, especially in the knees, hips, hands, and spine. Many people with osteoarthritis feel that their pain gets worse depending on the weather. Researchers looked at previous studies to see if certain weather conditions like cold temperatures, rain, and humidity are really linked to worse osteoarthritis pain. The analysis combined data from quality studies that looked at connections between weather and osteoarthritis symptoms. By putting together information from these studies, the analysis was able to provide stronger statistical evidence about possible links between weather and osteoarthritis pain. Overall, they found evidence that lower temperatures and higher humidity are connected to worse osteoarthritis pain. The connections were small but still important statistically.

Study Methods

The researchers ultimately identified 14 eligible studies involving a total of 2,194 osteoarthritis patients from 5 different countries. Most studies relied on patient self-reports of osteoarthritis pain severity, often using standardized scales. Local meteorological agencies provided the weather data.

By looking at the data from these 14 studies altogether, the researchers could see general trends and patterns in how the weather is linked to osteoarthritis pain. This type of method allows for stronger conclusions by addressing the issues of smaller individual studies.

Key Findings

The meta-analysis found that there was a significant association between worse osteoarthritis pain and lower temperatures. Across the studies analyzed, each 10°C decrease in temperature was associated with patients reporting a 1.3 unit increase in joint pain on a 0-10 scale.

The research showed that when the air pressure drops, people with arthritis tend to feel more pain. For example, when the air pressure dropped by 10 hectopascals, the pain levels increased by 0.6. It’s like how you might feel more achy when a storm is about to hit.

Therefore, the findings indicate that colder temperatures and drops in atmospheric pressure tend to coincide with worsening osteoarthritis symptoms. Patients with osteoarthritis may be able to use local weather forecasts to anticipate bad pain days and plan accordingly.

Possible Explanations

Physiologically, there are several reasons why changes in weather may exacerbate osteoarthritis pain.

  • Barometric pressure changes – Drops in barometric pressure are associated with storms and rain which have been shown to increase joint pain. Some hypothesize that lower atmospheric pressure allows tissues to expand, putting pressure on joints.
  • Temperature changes – Cold weather causes blood vessels to constrict, likely decreasing blood flow and nutrient supply to joints. This may limit the joint’s ability to heal microtraumas. Heat and humidity can cause swelling and inflammation in joints.
  • Humidity – Higher humidity prevents joints from releasing heat as effectively. This heat buildup can increase inflammation and swelling.
  • Solar and geomagnetic activity – Some research indicates solar flares and geomagnetic storms may impact pain perception thresholds and inflammation. The exact mechanisms are unknown.
  • Vitamin D levels – Less sun exposure in winter can lower vitamin D levels which play a role in pain, inflammation and bone health.

The body’s complex response to weather changes likely involves multiple biological mechanisms that can influence osteoarthritis pain and inflammation.

Study Limitations

This systematic review was based on observational studies, which have inherent limitations compared to experimental studies like randomized controlled trials. The authors note some key limitations of the observational studies included:

  • Confounding factors – There may have been confounding variables that influenced the association between weather and osteoarthritis pain that were not measured or accounted for. Things like mood, activity levels, and use of pain medications could all impact pain levels.
  • Reporting/recall bias – Most studies relied on self-reported pain scores, which can be influenced by recall bias. People may not accurately remember and report their daily pain levels over time.
  • Small sample sizes – Many of the individual studies had relatively small sample sizes, limiting their statistical power to detect associations. Larger studies are needed to confirm findings.
  • Variability in methods – There was heterogeneity in the study designs, pain measurement tools, statistical analyses, and weather data collection. Standardized methods could improve consistency.
  • Limited weather data – Localized weather data may not fully reflect individuals’ actual exposure to weather conditions. More precise measurement tools could improve accuracy.
  • Population specificity – Most studies focused on patients in a single geographic area. Findings may not be generalizable to osteoarthritis patients worldwide exposed to different climates and weather patterns.

Additional Research Needed

This systematic review and meta-analysis provides important insights into the relationship between weather conditions and osteoarthritis pain. However, researchers need to conduct more studies to fully understand this connection.

Some key questions that require further investigation include:

  • What specific weather conditions have the biggest impact? This review looked broadly at temperature, precipitation, and barometric pressure. More studies on the effects of particular weather elements (heat, cold, humidity, etc.) could uncover more nuanced relationships.
  • How do weather changes trigger osteoarthritis pain? The mechanisms and pathways are still unclear. Understanding the biological processes involved could reveal potential treatment targets.
  • Can weather forecasts be used to predict and manage osteoarthritis pain? If robust predictive relationships can be established, weather-based pain forecasting models could help patients and doctors better manage symptoms.
  • What interventions can help? Beyond predicting pain, research should explore what coping methods or treatments could help osteoarthritis patients during weather changes known to worsen symptoms.
  • How do effects differ across demographics? More studies are needed on how factors like age, gender, ethnicity, and osteoarthritis subtype influence weather-pain connections.
  • Can location-specific research provide more insights? Larger studies across diverse geographic regions may uncover location-specific relationships and climate patterns that impact osteoarthritis pain.

Further research to address these key questions can lead to a more meaningful understanding of weather-osteoarthritis links, enabling better prediction, management and treatment for osteoarthritis joint pain during problematic weather conditions.

Takeaways for People

Many patients with osteoarthritis experience increased joint pain and stiffness when the weather changes. While the exact mechanisms behind this phenomenon are still unclear, here are some tips that may help ease discomfort during weather fluctuations:

  • Stay active and keep moving. Low-impact exercises like walking, swimming, or biking can help keep joints mobile. Avoid inactivity which can make stiffness worse.
  • Dress appropriately. Layer clothing and wear warm covers over painful joints to avoid getting chilled. Consider wearing compression sleeves or gloves.
  • Use heated pads or cold packs. Apply whichever one gives you relief – heat opens up blood vessels, while cold reduces inflammation.
  • Consider over-the-counter pain medication. Acetaminophen, NSAIDs, or topical creams/gels can provide some symptom relief. Consult your doctor first before starting any medication or supplement.
  • Adjust your environment. Increase humidity with a humidifier. Move painful joints closer to heat vents or fans.
  • Stay hydrated and eat a healthy diet. Drink plenty of water and consume anti-inflammatory foods like fatty fish, fruits, vegetables, and nuts.
  • Practice stress management. Pain can worsen with anxiety and tension. Try relaxation techniques like meditation, yoga, or deep breathing.
  • Get a massage or gentle stretch. This may loosen up tense muscles and decrease joint pain.
  • Communicate with your doctor. Report worsening pain and discuss treatment adjustments or assistive devices.

While it can be frustrating dealing with arthritis pain fluctuations, being proactive with self-care and talking to your provider can help you better manage symptoms

References

Wang L, Xu Q, Chen Y, Zhu Z, Cao Y. Associations between weather conditions and osteoarthritis pain: a systematic review and meta-analysis. Ann Med. 2023 Dec;55(1):2196439. doi: 10.1080/07853890.2023.2196439. PMID: 37078741; PMCID: PMC10120534.

Medical Disclaimer

This information is offered to educate the general public. The information posted on this website does not replace professional medical advice, but for general information purposes only. There is no Doctor – Patient relationship established. We strongly advised you to speak with your medical professional if you have questions concerning your symptoms, diagnosis 

Overcoming Inflammation

Exercises to help hand osteoarthritis

November 21, 2017
Exercises to help hand osteoarthritis

Osteoarthritis is the most common joint disease.  Unlike rheumatoid arthritis, osteoarthritis is not an autoimmune disease.  Osteoarthritis mainly affects the fingers, knees, hips, as well as the spine.  Today, I would like to talk about hand osteoarthritis, which is much more common in women and particularly women above the age of 50.

We like to think of osteoarthritis as a wear-and-tear arthritis, however, this is somewhat adopting a limited view.  Osteoarthritis certainly has to do with wear-and-tear, however, there are several biochemical and genetic factors that play a crucial role in the pathogenesis of the condition.

Because osteoarthritis is not an autoimmune disease, medications that we use for rheumatoid arthritis that deal with the immune system like methotrexate, are generally not effective in either alleviating pain or stop progression.  Currently there are no disease modifying medications that significantly alter the progress of the disease.  Typically, treatment relies on analgesic medications, both topical and oral, splinting, steroid injections, and surgery.

Although there are no medications that alter the progress of osteoarthritis, hand exercises play a major role in improving function and alleviating pain.  The aim is to strengthen the muscle surrounding the joints to act as cushion to reduce the pressure on the joints.  This will have the effect of improving grip strength, range of motion, and help with pain.

Here’s some evidence.

Hand anatomy

First let’s refresh our anatomy.

First of all, here we have a picture that illustrates the various bones that make up your hand.

  • Carpals
  • Metacarpals
  • Proximal phalanges
  • Intermediate phalanges
  • Distal phalanges

Distal phalanges, intermediate phalanges, proximal phalanges, metacarpals, carpals

And then we have the joints that make up your hand.

  • Midcarpal joint
  • 1st carpometacarpal (CMC) joint
  • 1st interphalangeal (IP) joint
  • Metacarpophalangeal (MCP) joints
  • Proximal interphalangeal (PIP) joints
  • Distal interphalangeal (DIP) joints

DIP, PIP, MCP, IP, and CMC joints

Finally, your hand needs to adapt to do everyday tasks.  Below you will find a picture that demonstrates the arches of the hands.  Basically, these are the different ways your hand can move – range of motion.

Arches of the hand

Improved hand function, self-rated health and decreased activity limitations – results after two month hand osteoarthritis group intervention

A recent study aimed to study the effect of exercise and paraffin wax therapy on osteoarthritis.  They wanted to see if their intervention would improve hand function, activity limitation, and self-rated health in people suffering from hand osteoarthritis.[1]

This was a prospective cohort study which consecutively recruited people in a primary care clinic in Sweden.  They included people who were symptomatic or had radiographically verified and osteoarthritis.  Finally, they excluded people who had other types of hand diseases, like rheumatoid arthritis or had undergone hand surgery.

Intervention

The intervention consisted of both an educational and exercise component.  People received two group sessions lasting an 1 ½ each.  During the educational piece, they discussed osteoarthritis in general, as well as guides to treatment.  They also discussed why exercise is important for rehabilitation and how to perform exercise as well as how to modify exercise due to pain.

The exercise component started after two educational sessions.  They were held twice weekly over a six-week period.  These were spearheaded by occupational therapists.  Each session started with 20 minutes of paraffin wax therapy followed by 25 minutes of hand exercises.  Typically these included 14 different types of exercises performed at least five times during the 25 minute.

Assessment

Everyone who participated in the study saw one of three occupational therapists at baseline, after three months (after the end of the intervention), and after 12 months (long-term follow-up).  During each visit, the occupational therapist measured hand function, activity limitation, as well as self-rated health.

Hand function

  • Range of motion
  • Grip force
  • Hand pain
  • Grip ability

Activity limitations

Self-rated health

Results

A total of 49 people participated in the study: 5 were men and 44 were women.  There weren’t any significant differences between the participants who completed study versus those who dropped out, except that the people who dropped out were more likely to be working and the people who completed the study were more likely to be retired.

Hand function

  • Grip ability improved significantly from baseline to three months, p<0.001. There was no difference between three months and at 12 months.
  • Range of motion improved significantly from baseline to three months, p= 0.011. There was no difference between the results at three months and 12 months.
  • Grip force improved significantly from baseline to three months, p<0.001 in the right-hand as well as in the left-hand, p=0.008. The left-hand continued to improve between three months and 12 months but not the right hand.
  • Hand pain at rest also significantly reduced after 3 months, p<0.001. There was no difference between the results at three months versus 12 months.

Activity Limitations

  • Activity limitations in all three activities improved significantly from baseline to three months, p=0.008, p=0.001, p=0.004. There was no change between three months and 12 months.
  • Activity limitations using the Quick-Dash improved significantly from baseline to three months, p=0.001.

Self-rated health

  • Self-rated health also improved significantly between baseline and three months, p=0.039, and the results remained stable at long-term follow-up.

Limitations

The study had multiple limitations:

  • Small sample size
  • Based on the study design, it was impossible to tell whether the improvement in activity and self-rated health leads to improve hand function or vice versa.
  • This was not a randomized control trial.
  • Unable to distinguish the results of the separate parts of the intervention.

Conclusion

People who suffer from osteoarthritis appeared to improve when it comes to hand function, activity limitations, as well as overall self-rated health when they combine education as well hand exercises.  The improvements were also sustained at 12 months!

In this study, the participants also started their exercise program with a paraffin wax bath.  The European league against rheumatism (EULAR) recommends local application of heat, light, paraffin wax therapy, for the treatment of osteoarthritis as a short-term treatment option to decrease pain and to support muscle strength.  There is ample evidence supporting that hand exercises independently improve pain and function in osteoarthritis.  That being said, it’s safe to say that the improvement seen during the course of this study were not solely caused by paraffin wax therapy.  Although, who would ever say no to a nice relaxing paraffin wax bath?

Hand osteoarthritis program

Now that we have evidence that exercise supporting the role of exercises to improve hand osteoarthritis, it’s time to start the healing process.  Now not all of us either has resources or the time to see an occupational therapist twice a week, but here are a few interventions that you can do in the comfort of your home.

Remember, hand exercises for osteoarthritis should include flexion and extension of the DIP, PIP, and MCP joints, opposition of the index and middle fingers, and well as an opening grip movement – like opening up a door handle.

Please leave your comments below!

References

[1] Bjurehed L, Brodin N, Nordenskiold U, Bjork M. Improved hand function, self-rated health and decreased activity limitations – results after a two month hand osteoarthritis group intervention. Arthritis Care Res (Hoboken). 2017 Oct 3. doi: 10.1002/acr.23431. [Epub ahead of print]

Scheme human hand bones, Mariana Ruiz Villarreal (LadyofHats); retouches by Nyks

Human-Hands-Front-Back, by Evan-Amos

Hand-arches, Drawn freely (OK, crappy) from Physiology of the Joints, I.A. Kapandij 1982, p. 169. Made in Inkscape. |Source={{own}} |Date=January 2013 |Author= [[User:Fama Clamosa|Fama Cl…

Medical Disclaimer

This information is offered to educate the general public. The information posted on this website does not replace professional medical advice, but for general information purposes only. There is no Doctor – Patient relationship established. We strongly advised you to speak with your medical professional if you have questions concerning your symptoms, diagnosis and treatment.