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Joints: Clinical correlations Videos Pain-killer pumps and chondrolysis Joint cracking

Joints: Clinical correlations Videos Pain-killer pumps and chondrolysis Joint cracking Pronation in tennis serve. Joints: Clinical correlations Videos Splinting http:// www.nejm.org/doi/full/10.1056/NEJMvcm0801942 Knee examination http:// www.nejm.org/doi/full/10.1056/NEJMvcm0803821

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Joints: Clinical correlations Videos Pain-killer pumps and chondrolysis Joint cracking

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  1. Joints: Clinical correlations Videos Pain-killer pumps and chondrolysis Joint cracking Pronation in tennis serve

  2. Joints: Clinical correlations Videos Splinting http://www.nejm.org/doi/full/10.1056/NEJMvcm0801942 Knee examination http://www.nejm.org/doi/full/10.1056/NEJMvcm0803821 Knee arthrocentesis Local WMV file: NEJM 2006 Online: NEJM 2006.

  3. Pollicization = Thumb-ization Treatment for radial dysplasia: little or no thumb

  4. Pollicization

  5. Rotationplasty: Turning an Ankleinto a Knee Cancer of distal femuratage 5. Surgery & chemo & rotationplasty. Now 12 yrsold. Good gait, cheerleading, gymnastics. See online video. Dormans & Garg (CHoP), NEJM 2004.

  6. 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

  7. 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.

  8. Joints: Clinical correlations Joint cracking What 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 ManipPhysiolTher 18: 155-64, 1995. 2. Castellanos & Axelrod, Effect of habitual knuckle cracking on hand function, Ann Rheum Dis 49: 308-309, 1990.

  9. 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. 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 ellbowvalgus load (EVL), greater pitching efficiency, i.e. mph/HIRT or mph/EVL

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