Let's get a hand on this: Review of the clinical anatomy of “knuckle cracking”

doi:10.1002/ca.23243

Paper

Let's get a hand on this: Review of the clinical anatomy of “knuckle cracking”

Published Sep 1, 2018 · Asad A. Rizvi, M. Loukas, R. Oskouian

Clinical Anatomy

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Abstract

Knuckle cracking refers to the characteristic sound produced when joints are moved or distracted, and there is considerable interest in the mechanism and the clinical associations of knuckle cracking. Different mechanisms for knuckle cracking have been proposed over a century, and some have speculated that it can lead to deleterious effects on the joints. Herein, we review the literature on the mechanism and clinical associations of knuckle cracking. There is agreement in the literature regarding the formation of a bubble as part of the mechanism of knuckle cracking; however, the process by which the bubble is formed and the source of the cracking sound is not clear. The evidence for the association of knuckle cracking and osteoarthritis comes mainly from observational studies that have failed to show an association. Fewer studies report other associations mainly through descriptive, small or cross‐sectional studies. Clin. Anat. 31:942–945, 2018. © 2018 Wiley Periodicals, Inc.

Literature Review

Rigorous Journal

Study Snapshot

Knuckle cracking involves the formation of a bubble in the joint, but its mechanism and potential association with osteoarthritis remain unclear.

PopulationOlder adults (50-71 years)

Sample size24

MethodsObservational

OutcomesBody Mass Index projections

ResultsSocial networks mitigate obesity in older groups.

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Let's get a hand on this: Review of the clinical anatomy of “knuckle cracking”

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References

A Mathematical Model for the Sounds Produced by Knuckle Cracking

Cavitation bubble collapse in the synovial fluid inside a metacarpophalangeal joint during articular release is the source of the knuckle cracking sound, supporting experimental data and allowing for bubble persistence.

Beliefs in the population about cracking sounds produced during spinal manipulation.

High prevalence of unfounded beliefs about cracking sounds during spinal manipulation, highlighting the need for healthcare providers to address these misconceptions.

Effects of habitual knuckle cracking on metacarpal cartilage thickness and grip strength.

Habitual knuckle cracking does not affect grip strength but is associated with increased metacarpal head cartilage thickness.

“Knuckle Cracking”: Can Blinded Observers Detect Changes with Physical Examination and Sonography?

Habitual knuckle cracking does not significantly affect QuickDASH scores, joint laxity, grip strength, or ROM, and only slightly increases ROM in joints that crack during manipulation.

Osteoarthritis

Osteoarthritis is a complex, multifactorial disorder with limited treatment options, requiring early detection and prevention through lifestyle modification, pharmaceutical, and surgical interventions.

Real-Time Visualization of Joint Cavitation

Joint cracking is caused by cavity formation rather than bubble collapse, as demonstrated by real-time magnetic resonance imaging in human synovial joints.

Knuckle cracking: secondary hyperparathyroidism and what your mother did not tell you

Knuckle cracking can be restored in 67% of dialysis patients with secondary hyperparathyroidism after surgical parathyroidectomy, potentially providing emotional relief and motivation for patients to adhere to complex parathyroid regimens.

Knuckle Cracking and Hand Osteoarthritis

Habitual knuckle cracking does not appear to be a risk factor for hand osteoarthritis.

Presumed intraarticular gas microbubbles resulting from a vacuum phenomenon: visualization with ultrasonography as hyperechoic microfoci

Intraarticular hyperechoic microfoci may be produced and persist in normal joints after a traction maneuver, likely due to microbubbles created by a transient vacuum phenomenon.

Citations