소리가 나는 관절
Snapping Joint
관절을 움직일 때 소리가 난다면 통증이 없더라도 괜찮은 것이 아니다.
Tendon 이나 Ligament가 관절 사이에 끼어 미끄러지면서 소리가 나거나,
Tendon 이나 활액막 synovial membrane이 뼈의 돌출된 부분과 부딪혀서 소리가 나거나,
윤활액이 부족해지면서 연골과 연골이 부딪혀 소리가 나거나 한다.
ligament 나 근육의 tendon 이 뼈의 돌출부와 부디치는 소리이라면 ( grating, grinding sound) 근육이 굳어 있거나 빈약한 것이 원인이 될 수 있다.
지나치게 관절 범위를 넓게 움직이거나 너무 오래 동안 관절을 움직이거나 과한 부하를 주거나 하는 것이 원인이 될 수 있다.
계속적으로 소리가 나게 움직이면 염증이 생기고 통증이 오며 관절은 손상하기 쉽다. 퇴행성이 계속되면 연골이 약해지고 관절은 못쓰게 되고 만다.
관절을 급격하게 과도하게 꺾으면 저압부분에 활액낭에서 까스가 터저 들어가는 소리( popping sound) 나는 경우가 있는데 이것도 절대로 괜찮은 것이 아니다.
특히 무릎에서 소리가 나는 것은 관절을 비정상적인 위치로 움직일 때 관절 속에 일시적으로 음압이 생겨 기포가 형성 됐다가 이것이 터지면서 소리가 나는 것이다.
무릎, 엉덩이, 어깨에서 이런 소리와 함께 통증이 수반 된다면 연골 손상과 관절 변형 등 이미 병으로 진행되어 있을 수도 있다.
Popping 소리가 날 때 무언가 걸리는 듯한 기계적 탄발음(mechanical pop)으로 특히 통증을 일으키는 경우는 문제가 된다.
이를 일으키 는 흔한 원인 중 하나가 '활액막 추벽 synovial flap or plica 증후군'이라고 불리는 병이다. 무릎 관절 안에 있는 주름이 관절 사이에 끼면서 통증을 일으킨다.
또 'ilio-tibial band 또는 popliteus tendon 등의 힘줄이 걸리면서도 생기는 경우가 있고, 이렇게 통증을 유발하는 탄발음의 원인은 치료해야 한다.
탄발음의 경우 10명 중 4명 정도가 관절에 문제가 있슴이 발견되고 있단다.
Snapping joint 를 예방하거나 치료하려면
체중을 줄여야 한다.
과격한 관절운동을 하지 말아야 한다.
관절에 이상이 있다고 판단되면 우선 관절 운동을 쉬어 주어 정상으로 회복되기를 기다려 주어야 한다.
다음으로 운동 범위를 작게 하여 움직이면서 소리가 나지 않는 정도로 점차 넓혀가는 운동을 한다.
모든 운동은 천천히 느리게한다. 빠르게 움직이면 반드시 ligament tendon 관절 연골에 무리가 간다. (따라서 aerobic dance 에는 문제가 있다)
계속적 운동은 해롭다. 자주 쉬어주어 근육내 혈액공급이 원활하게 하고 원래대로 회복할 수 있게 기다려 주어야 한다.
평소에 근육강화 운동을 해 주어야 한다. 스트레칭으로 근육의 유연성을 유지해 주도록 한다.
규칙적이고 체계적 운동을 계속해서 퇴행성 관절 이상이 오는 것을 되도록 막아야 한다.
염증이 생기거나 관절에 이상이 발생하면 조기 치료를 받아야 한다.
* 아침에 막 일어나서는 가벼운 dynamic stretching(관절을 움직이면서 인대와 힘줄등을 적당히 늘려주기) 정도만 하는 것이 좋다.
잠자는 동안 모든 근육과 관절이 이완되어 있으므로 static stretching ( 큰 근육을 직접 최대한 늘려주기)은 할 필요가 없다.
아침 기상 즉시 부하를 주는 weight exercise 근력운동은 하지 않는 것이 좋다.
웨이트 운동이나 강렬한 운동은 준비운동으로서 동적스트레칭을 먼저하여 충분히 worming up 을 한 다음에 해야 한다.
Static stretching 은 운동을 한 다음이나 일과를 마무리한 저녁무렵에 하는 것이다.(yoga exercise 는 static stretching에 속한다.)
(참고로 yoga 라는 말은 초월적 신과 연결한다 the mystical union of the self with the Supreme Being in a state of complete awareness and tranquility 는 뜻을 기지고 있으며 명상을 의미하기도 한다. 우리가 말하는 요가운동은 명상에 들어가지 전에 준비 단계로서 몸을 이완시키고 호흡을 고르는 하나의 과정에 불과한 것이다. 이것이 무슨 health exercise로 착각하고 있는것 같은데 그런것은 아니다.)
2012. 4 .21.
hanngill
http://youtu.be/-W3o_WADI1M
[Snapping scapula syndrome]
Snapping Scapula Syndrome, also known as scapulocostal syndrome or scapulothoracic syndrome, is described by a “grating, grinding, popping or snapping sensation of the scapula onto the back side of the ribs or thoracic area of the spine” (Hauser).
Disruption of the normal scapulothoracic mechanics causes this problem.
The most common cases are found in young, active patients who tend to excessively use the overhead or throwing motion.
Cause
One source of snapping scapula is when the muscles underneath the scapula (the subscapularis muscle) atrophies.
This causes the scapula to become very close the rib cage, eventually causing rubbing or bumping during arm/shoulder movement.
Another cause is bursitis, which is when the tissues between the shoulder blade and scapula inflame. Muscle and bone abnormalities in the shoulder area can also contribute to the pain.
Treatment
Non-Surgical
Doctors often recommend physical therapy in order to strengthen the subscapular muscle, and prescribe anti-inflammatory medications.
For extreme cases, cortisone injections would be utilized.
Surgical
Surgery is usually only used if the non-surgical treatments have failed.
Bone abnormalities may need surgical attention. The most common surgery for snapping scapula requires the surgeon to “take out a small piece of the upper corner of the scapula nearest to the spine.”
[Snapping hip syndrome]
Snapping hip syndrome (also referred to as coxa saltans, iliopsoas tendinitis, or dancer's hip) is a medical condition characterized by a snapping sensation felt when the hip is flexed and extended. This may be accompanied by an audible snapping or popping noise and pain or discomfort.
Pain often decreases with rest and diminished activity.
Snapping hip syndrome is classified by location of the snapping, either extra-articular or intra-articular.
Symptoms
An audible snapping or popping noise as the tendon at the hip flexor crease moves from flexion (knee toward waist) to extension (knee down and hip joint straightened). After extended exercise pain or discomfort may be present caused by inflammation of the iliopsoas bursae.
Pain often decreases with rest and diminished activity. Symptoms usually last months or years without treatment and can be very painful.
Extra-articular
Lateral extra articular
The more common lateral extra articular type of snapping hip syndrome occurs when the iliotibial band, tensor fascia lata, or gluteus medius tendon slides back and forth across the greater trochanter. This normal action becomes a snapping hip syndrome when one of these connective tissue bands thickens and catches with motion. The underlying bursa may also become inflamed, causing a painful external snapping hip syndrome.
Medial extra-articular
Less commonly, the iliopsoas tendon catches on the anterior inferior iliac spine (AIIS), the lesser trochanter, or the iliopectineal ridge during hip extension, as the tendon moves from an anterior lateral (front, side) to a posterior medial (back, middle) position. With overuse, the resultant friction may eventually cause painful symptoms, resulting in muscle trauma, bursitis, or inflammation in the area.
Intra-articular
Causes of Injury
Athletes are at special risk for snapping hip syndrome due to repetitive and physically demanding movements. In athletes such as ballet dancers, gymnasts, horse riders, track and field athletes and soccer players, military training, or any vigorous exerciser[3], repeated hip flexion leads to injury. In excessive weightlifting or running, the cause is usually attributed to extreme thickening of the tendons in the hip region.[4] Snapping hip syndrome most often occurs in persons who are 15 to 40 years old.
Extra-articular snapping hip syndrome
Extra-articular snapping hip syndrome is commonly associated with leg length difference (usually the long side is symptomatic), tightness in the iliotibial band (ITB) on the involved side, weakness in hip abductors and external rotators, poor lumbopelvic stability and abnormal foot mechanics (Overpronation). Popping occurs when the thickened posterior aspect of the ITB or the anterior gluteus maximus rubs over the greater trochanter as the hip is extended.
Intra-articular snapping hip syndrome
Similar causes as extra-articular snapping hip syndrome but often with an underlying mechanical problem in the lower extremity. The pain associated with internal variety tends to be more intense and therefore more debilitating than the external variety.[3] Intra-articular snapping hip syndrome is often indicative of injury such as a torn acetabular labrum, recurrent hip subluxation, ligamentum teres tears, loose bodies, articular cartilage damage, or synovial chondromatosis (cartilage formations in the synovial membrane of the joint).
Treatment
This condition is usually curable with appropriate treatment, or sometimes it heals spontaneously. If it is painless, there is little cause for concern.
Correcting any contributing biomechanical abnormalities and stretching tightened muscles, such as the iliopsoas muscle or iliotibial band, is the goal of treatment to prevent recurrence.
Referral to an appropriate professional for an accurate diagnosis is necessary if self treatment is not successful or the injury is interfering with normal activities. Medical treatment of the condition requires determination of the underlying pathology and tailoring therapy to the cause. The examiner may check muscle-tendon length and strength, perform joint mobility testing, and palpate the affected hip over the greater trochanter for lateral symptoms during an activity such as walking.
Self-treatment
A self-treatment recommended by the U.S. Army for a soft tissue injury of the iliopsoas muscle treatment, like for other soft tissue injuries, is a HI-RICE (Hydration, Ibuprofen, Rest, Ice, Compression, Elevation) regimen lasting for at least 48 to 72 hours after the onset of pain.
"Rest" includes such commonsense prescriptions as avoiding running or hiking (especially on hills), and avoiding exercises such as baseball, jumping, sit-ups or leg lifts/flutter kicks.
Stretching of the tight structures (piriformis, hip abductor, and hip flexor muscle) may alleviate the symptoms (see link, pg. 3, for examples) The involved muscle is stretched (for 30 seconds), repeated three times separated by 30 second to 1 minute rest periods, in sets performed two times daily for six to eight weeks. This should allow the soldier to progress back into jogging until symptoms disappear.
Diagnostic Imaging
Ultrasound during hip motion may visualize tendon subluxation and any accompanying bursitis when evaluating for iliopsoas involvement in medial extra-articular cases.
MRI can sometimes identify intra-articular causes of snapping hip syndrome.
Injection Based Treatments
Injections are usually focused on the iliopsoas bursa. Corticosteroid injections are common, but usually only last weeks to months. in addition, corticosteroid side effects can include weight gain, weakening of the surrounding tissues, etc. Cellular based therapy may have a role in future injection based treatments, though there is no current research proving the effectiveness of these therapies.
Surgical Treatment
If the patient does not respond well to medicine or physical therapy, or abnormal structures are found, surgery may be recommended.
Surgical treatment is rarely necessary unless intra-articular pathology is present. In patients with persistently painful iliopsoas symptoms surgical release of the contracted iliopsoas tendon has been used since 1984.
Rehabilitation
Patients may require intermittent NSAID therapy or simple analgesics as they progress in activities. If persistent pain caused by bursitis continues a corticosteroid injection may be beneficial.
Physical Therapy
or Athletic Training
Therapy and Rehabilitation
Both active and passive stretching exercises that include hip and knee extension should be the focus of the program.
Stretching the hip into extension and limiting excessive knee flexion avoids placing the rectus femoris in a position of passive insufficiency, thereby maximizing the stretch to the iliopsoas tendon.
Strengthening exercises for the hip flexors may also be an appropriate component of the program.
Education, a non-steroidal anti-inflammatory drug regimen, as well as activity modification or activity progression (or both) may be used. once symptoms have decreased a maintenance program of stretching and strengthening can be initiated.
Light aerobic activity (warmup) followed by stretching and strengthening of the proper hamstring, hip flexors, and iliotibial band length is important for reducing recurrences.
Conservative measures generally resolve the problem in 6 to 8 weeks.
[ Knee Snapping]
When you're working out, or playing your favorite sport, a snapping sensation within your knee can cause pain and frustration, and can lead to buckling or giving way, falling, and eventually, damage to the cartilage surfaces of the joint.
The snap results when some structure within the joint is momentarily caught between the moving bones, tension is applied and is then suddenly released, much like plucking a guitar string.
The three most common causes for the painful snap are synovial flaps, torn menisci and loose bodies.
The most frequent source of snapping is a synovial flap or plica.
The inside of every synovial joint is lined by a normally thin and pliant membrane, called synovium. Synovium produces a drop or two of joint fluid, which nourishes the articular cartilage and provides lubrication for the joint surfaces. This membrane often has a few small thin folds, left over from embryonic development, which can grow larger, thicker and stiffer to become larger structures, fibrous flaps or shelves, that get can get caught and stretched between the moving parts.
Pain is caused by traction, pulling on the nerves of the surrounding tissues, and the snap is due to the sudden release of tension, when it breaks free.
A torn meniscus can also cause a snap. The two tough, crescent-shaped meniscal fibrocartilages, medial (inner side) and lateral (outer side), that cushion and guide the knee, are often torn in athletic activities, especially the sudden twisting or cutting maneuvers in soccer, football, or basketball.
But tears can also occur by degeneration, just from getting older. Here, the substance of the cartilage becomes softer and begins to shred and fragment, eventually evolving into a tear, especially when repetitively crushed as with deep squatting. The meniscus tear fragment, like the flap of synovium, can displace and get caught between the moving femur and tibia, causing pain by traction, like a hangnail does, then snap when suddenly released.
Loose bodies are little pieces of cartilage and/or bone that are knocked out with trauma, fall out from a joint surface due to disease (osteochondritis dessicans), or are actually grown, like pearls, within the synovial membrane (synovial chondromatosis/osteochondromatosis), and then break free inside the joint. Like the synovial flaps and meniscal tears, these fragments can get caught between the moving parts.
Regardless of cause, significant snapping within the knee is always abnormal and needs to be addressed.
Above all, don't ignore it. You want to identify the source with an accurate diagnosis and prevent permanent damage to the joint. But in the short term, you can try some conservative measures to try to resolve the snapping.
Here's what you can do:
1. STOP whatever activity causes painful, recurrent snapping.
2. REST the knee in extension, that is, out straight. Every snap can potentially damage the articular cartilage, so that can be prevented by avoiding, or minimizing joint motion.
3. Apply moist HEAT a few times a day, for 15-20 minutes each time. If the snapping is of sudden onset, apply ICE for the first 48 hours, THEN begin to apply heat.
4. Try some OTC anti-inflammatory (NSAID), like Advil (2 tabs, 4X/day) or Aleve (2 tabs, 2X/day), provided you have no stomach problems, like ulcers, or a history of GI bleeding, and be sure to take it WITH FOOD OR MILK. If inflammation has caused a synovial plica to swell and thicken, this regimen should shrink it, by reducing inflammation.
5. If you don't get relief within a few days to a week, then it's probably not from acute inflammation and the snapping structure is now fibrous tissue, or cartilage, which will not shrink, even with reduced inflammation. Then, you need to SEE AN ORTHOPAEDIST, for definitive evaluation and treatment. Don't be afraid--it's what you DON'T know that will hurt you and no one can force you to have surgery. But if someone is trained to DO surgery when it's needed, then you will be getting a complete picture of your condition, including ALL your options.
6. If you don't see a doctor at this point, the repetitive snapping of an internal derangement can damage the articular cartilage of the joint and eventually result in arthritis. Therefore, if conservative treatments fail to promptly relieve pain and snapping, to prevent permanent joint damage, arthroscopic surgery is usually required, to remove the source of the snapping.
Dr. Bill is the on-line handle for William Thomas Stillwell, MD, FACS, FICS, FAAOS, FAANAOS, FAAPGS, board certified orthopaedic specialist, Chairman Emeritus, Department of Orthopaedic Surgery, St. Catherine of Siena Medical Center, Smithtown, NY and Associate Professor of Clinical Orthopaedic Surgery, SUNY at Stony Brook, NY; President & CEO of Dr. Bill's Clinic, Inc. and author of DR. BILL'S LITTLE GREEN BOOK FOR ELIMINATING KNEE PAIN, DR. BILL'S PAIN-FREE PROGRAM: EXERCISES TO PREVENT OR ELIMINATE KNEE PAIN and HOW TO AVOID KNEE SURGERY.
For a FREE report: SECRETS TO RELIEVING KNEE PAIN, go to http://www.drbillsclinic.com/
Article Source: http://EzineArticles.com/1712231
[Popping and Snapping]
Definition:
The symptom of popping or snapping in the knee can be a sign of a few different problems.
One of the key distinguishing factors is whether or not the popping or snapping causes or is associated with pain.
Popping or snapping not associated with painful symptoms is often not a sign of a significant problem.
"Mechanical" Popping
Patients may experience a symptom of popping called a "mechanical symptom."
This may feel as though something is caught within the knee and is popping as the knee bends back and forth.
This type of mechanical symptom is often a sign of a meniscus tear or a loose piece of cartilage within the joint. The torn meniscus or loose cartilage may catch in the knee as it moves back and forth causing a popping sensation.
"Crepitus"
Crepitus is the word used to describe a crunching sensation as the knee bends back and forth. Crepitus can be seen in patients with cartilage irritation, as is the case in chondromalacia, or in patients with cartilage wear, such as knee arthritis. Unlike a mechanical popping where there is a sensation of something getting caught
in the knee, the sensation of crepitus is a more constant problem.
Crepitus can often be felt more easily than heard. Sit on the edge of a table with your knee hanging down. Then gently bend your knee back and forth with your palm resting over the front of the knee. Crepitus can be felt as a crunching sensation under your hand.
Osteoarthritis
degenerative joint disease
Osteoarthritis is the most common form of arthritis. It can affect both the larger and the smaller joints of the body, including the hands, feet, back, hip or knee.
The disease is essentially one acquired from daily wear and tear of the joint; however, osteoarthritis can also occur as a result of injury.
Osteoarthritis begins in the cartilage and eventually causes the two opposing bones to erode into each other.
Initially, the condition starts with minor pain while walking but soon the pain can be continuous and even occur at night.
The pain can be debilitating and prevent one from doing some activities.
Osteoarthritis typically affects the weight bearing joints such as the back, spine, and pelvis. Unlike rheumatoid arthritis, osteoarthritis is most commonly a disease of the elderly. More than 30 percent of females have some degree of osteoarthritis by age 65. Risk factors for osteoarthritis include: prior joint trauma, obesity, and a sedentary lifestyle.
Osteoarthritis, like rheumatoid arthritis, cannot be cured, but one can prevent the condition from worsening.
Physical therapy to strengthen muscles and joints is very helpful.
Pain medications are widely required by individuals with osteoarthritis. For some patients, weight loss can reduce the stress on the joints. When the disease is far advanced and the pain is continuous, surgery may be an option. Unlike rheumatoid arthritis, joint replacement does help many individuals with osteoarthritis.
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