Have you had a patient with Popping, Snapping, Catching, Clicking, Crunching, Cracking, Creaking, Grinding, Grating, or Clunking at their stifle joint? It MIGHT be an issue or it might not! A human research study gives some advice on when to worry!
Let’s dive in!
Song et al. 2018. Noise Around the Knee. Clinics in Orthopedic Surgery 2018;10:1-8.
The authors reviewed the noise characteristics according to sound nature and onset as well as factors for differentiation between physiological and pathological noises.
Sounds were described as above. Now, the most important part. Let’s say the ‘common sense’ part to the study was that in order to differentiate between physiological noise and pathological noise was to check for pain and swelling/effusion in the knee joint, as this is often associated with pathological noise. A loud “pop” with pain at the time of injury usually indicates damage to the ligaments or the meniscus. Crepitus, in the absence of any history of injury, may indicate cartilage lesions in osteoarthritis or inflammatory arthritis.
Physiological noise, on the other hand varies and includes:
• Buildup or bursting of tiny bubbles in the synovial fluid.
• Snapping of ligaments.
• Catching of the synovium or physiological plica.
• Hypermobile meniscus or discoid meniscus.
• Perception of previous noise after knee surgery due to emotional concerns.
What’s important here? If there is no pathological condition, there is no need to be concerned about the noise!
A topic for another day is when a 4-month post-operative cruciate case comes back with sudden lameness that makes one think, “Gotta be meniscus”. However, when there is no click, clunk, catch, snap, etc and the owner comes to rehab after the surgeon says, “Can’t be meniscus”, then to know the McMurray test, quadrant tests, Cyriax D strokes, and such, can be useful. Yes, this is a case I’ve got on my plate right now… we’ll see if the surgeon believes me or not!
On that note! Happy snapping this week!