Is Knuckle Cracking Bad?

By: Doron Ilan, MD

Between 25-50% of people will crack their knuckles at some point.  In some of these people it becomes habitual. Parents across the world have been telling their kids (and spouses) “Don’t crack your knuckles. You are going to get arthritis!” Is this true? What is actually happening when someone cracks their knuckles? 

What happens when you crack your knuckles?

Our knuckle joints (metacarpo-phalangeal joints) are synovial joints. Meaning there are two cartilage covered bones that meet each other and are surrounded by a joint capsule which contains synovial fluid (lubricant). When our joints move normally the synovial fluid lubricates the ultra-smooth cartilage and the bones glide silently over each other. When someone pops their knuckle, the pressure exerted on the joint and synovial fluid forces dissolved gases out of the synovial fluid. This creates what is called a cavitation bubble. This forms very quickly and explosively. This cavitation bubble then pops. It is believed that the sound of knuckle cracking is due to the formation or popping of the cavitation bubble. This would be similar to either the opening of a champagne bottle (sound caused by formation of the bubbles) or popping bubble wrap (sound caused by popping the bubble). To this day, we are still not 100% sure which one it is. The thing we are sure about is that knuckle popping is not due to bone rubbing on bone or tendons popping.

Are all sounds coming from a joint due to gases?

No. In arthritis (loss of cartilage) you can get a crunching sound called crepitus as bone rubs on bone. Some people have loose joints and the joint can sublux or partially dislocate. A tendon can shift over a moving joint and cause a pop or clunk. A torn labrum (hip or shoulder) or meniscus (knee) can also cause popping in a joint. Note:  If you have pain associated with any noise from a joint you should consult your doctor.   

Is knuckle cracking bad for you? Does it cause arthritis?

This may come as a shocker to parents everywhere but there is no evidence that knuckle cracking is bad for you or causes arthritis. It is certainly annoying and there have been case reports where people tried to crack their knuckles with such force that they caused a sprain or fracture, but despite multiple studies it appears that routine knuckle cracking is safe. There was even one doctor (Donald Unger) who decided to do a study on himself. He cracked the knuckles on one of his hands for 50 years while not cracking the other. He found no difference between the two hands in the end.  

So go ahead and crack your knuckles.  Just don’t do it around me. 

For more from the experts at Northeast Orthopedics and Sports Medicine, feel free to contact us for a consultation.

Rise in eSports Injuries: What every gamer needs to know

Everyone knows a gamer, and chances are, it’s you. With over 164 million video game players in the US and three quarters of American households having at least one gamer, that’s a statement we can make pretty confidently.

The incredible growth of the eSports industry has cemented it as one of the biggest forms of entertainment around the world. Live gaming events bring in viewers in the hundreds of millions, and some colleges are even setting up gaming teams and offering eSports scholarships. But like any other sport, there are physical demands to achieve success as a formidable opponent.

The fact that many gamers are in a sitting position for 5-10+ hours each day while repeating the same motions with their wrists and hands is leading to an increase in cases of musculoskeletal conditions, particularly in pediatric patients.

What are common conditions associated with gaming and how can they be prevented and treated?

Common Conditions

Orthopedic surgeons, Sports Medicine professionals and Hand specialists are seeing an increase of the following conditions within the gaming community.

  • Tendonitis of the forearm muscles
  • Carpal tunnel syndrome
  • “Gamers thumb” (De Quervain’s Tenosynovitis)
  • Ulnar nerve irritation
  • Upper back and neck muscle pain
  • Poor posture, core weakness
  • Obesity and poor balance
  • Sciatica
  • Eye strain

Preventing Injury

Being sidelined due to injury can make your average gamer disgruntled, but for serious players on the eSports scene, it can mean the loss of huge winnings in major events. That’s why prevention is key to be able to complete at the highest level. Here are some tips:

Limit play time

  • The less you put yourself at risk of injury the better. Limit play time and take multiple breaks during a long gaming session. Parents and caregivers should determine an appropriate daily limit for video games for their children, and encourage alternative physical activity throughout the day.

Evaluate your set up

  • Make sure the equipment you use is as ergonomic as possible. This includes your chair, desk, keyboard and mouse. Blue light glasses can help with eye strain.

Exercise

  • Build core strength to support proper posture. Stretching loosens the muscles to reduce risk of kyphosis (rounding of the back). Stretch your wrists, fingers and thumbs before playing and during breaks. Go on walks, runs, swim or engage in other sports.  It is important in all sports (even eSports) to cross train. 

Don’t play through pain

  • Continuing to play video games while in pain will make the condition worsen and take longer to heal.

Treatment

Some serious conditions caused by continuous gaming may require surgery, but most can be treated through a combination of activity modification, ergonomic adjustments, physical and occupational therapy, massage, devices/braces and medical injections or prescriptions.

If you or someone you know is experiencing a gaming-related injury, the specialists at Northeast Orthopedics and Sports Medicine are skilled in providing the custom treatment plan you need to get back to the sport you love. Reach out to one of our offices to make your appointment today.

Hit the Pavement, Avoid Injury

With the weather turning warmer and warmer, the joy of taking an outdoor run is here. Taking in the fresh spring air and hitting the pavement or trail has never felt more freeing. Before venturing out, though, be sure to think ‘safety first’ in order to enjoy those runs well into the summer and fall. Here are some important precautions to follow from Healthline.com*:

  • Don’t wear headphones when running on roads. You need to be able to hear traffic around you and remain aware of your surroundings.
  • Run against traffic.
  • Follow all rules of the road. Look both ways before crossing a street.
  • Run in well-lit, safe areas. Wear reflective gear in the early morning or evening hours.
  • Bring water with you when you run, or run on a route with water available, so you can stay hydrated as you train.
  • Carry identification with you when you run. Tell a friend, roommate, or family member where you’re going.
  • Run with a family member or dog, when possible.
  • Wear sunscreen when running outdoors.
  • Run in loose, comfortable clothing and appropriate running shoes.
  • Switch out your running shoes every 300 to 500 miles.
  • Warm up before running and stretch afterward.
  • Cross-train once or twice per week to mix up your routine and keep your muscles challenged.

Should you find yourself in the unfortunately position of having an injury, be sure to pay attention to your body. Rest and seek medical attention if necessary. The skilled physicians at Northeast Orthopedics and Sports Medicine are here to provide treatment and get you back out on the road. Find the office nearest to you at neosmteam.com/locations.

*Source: https://www.healthline.com/health/average-mile-time#precautions

NEOSM Resumes Elective Surgery

We’re pleased to share that restrictions on elective surgery in our area have been lifted and all NEOSM surgical locations are now cleared for surgery. The team of skilled orthopedic surgeons at NEOSM are prepared to provide the surgical needs of our patients while maintaining the highest level of safety precautions.

Scheduling surgery

  • If you had a surgery scheduled and it was postponed, the NEOSM team will be contacting you to reschedule your procedure.
  • If you have recently seen one of our doctors and were indicated for surgery but did not schedule, please call your doctor’s surgery coordinator to schedule your procedure.
  • If you believe you need surgery, but have not scheduled a date previously, please call one of our offices for an appointment.

Please feel free to contact us with any questions.

Sincerely,

Northeast Orthopedics & Sports Medicine

6 Helpful Tips to Stay Active at Home

The benefits of physical activity are undeniable. Consistent exercise helps reduce your health risks,
strengthen your bones and muscles, and even reduce feelings of anxiety. With many gyms and exercise facilities currently closed, here are a few easy tips to help you stay active from home.

  • Set an intention for the day
    When you rise in the morning, set your goal for physical activity for the day. However big or small, identifying what exactly you’d like to accomplish will make it more likely for you to achieve it. It could be as simple as “I will take the dog for a 20-minute walk”, or more challenging like committing to a 40-minute workout. It’s up to you, just let yourself know and plan your day accordingly.
  • Take advantage of free resources
    If you have WiFi, you have access to a huge library of workouts for all fitness levels. YouTube is a great resource, and many home workout apps are offering free content, like Peloton, Nike and Planet Fitness. And it’s always free to go outside! Adding some fresh air to your physical activity helps clear your mind and connects you to the world around you.
  • Find a partner
    It’s easier to achieve your goals if you have a partner to motivate you and keep you accountable.
    Maybe someone in your home can join you on your walks, or you can text your friend your morning goals and have them check in on you. Any way you choose, having support makes all the difference.
  • Practice safety
    Aside from safe social distancing practices, make sure you take all the necessary safety precautions during your activity, like wearing your helmet during your bike ride, warming up your muscles before your workout and practicing good form when lifting heavyweights. You’ll hear many workout instructors advise you to substitute hand-held weights with household items. If you do, make sure to choose wisely and avoid items that could slip your grasp and cause an injury. Simply, be careful and move smartly to minimize your risks.
  • Don’t ignore an injury
    Be mindful not to aggravate a potential injury further. It’s common to feel muscle fatigue and soreness after a strenuous workout, but if you are experiencing acute pain or pain that won’t go away, you may need to be evaluated. The physicians at NEOSM are available for telemedicine appointments and our offices are open for necessary in-person visits. Don’t wait for an injury to get worse – we can accommodate same-day or next-day appointments, just call any of our offices to schedule.
  • Be kind to yourself
    The motivation you have today may not be the motivation you had yesterday and that’s ok! Be kind to yourself and commit to even the smallest amount of physical activity to help get your blood flowing. You never know, once you get moving, you may feel inspired to do more!

We hope these tips have inspired you to set your activity goals and get moving. Stay safe and stay healthy.

What to do if you get hurt during COVID-19

By: Dr. Doron Ilan

It is distressing enough to get hurt during normal times, but getting hurt during the COVID-19 pandemic can cause immense additional stress and fear. What should one do if injured during this difficult time?
Should I go to the ER and risk being infected with Coronavirus? Should I go to urgent care? I have heard there are a lot of coronavirus cases there too. Should I go to my doctor’s office? Are they open? Is it safe?


First of all, you should get medical care for your injury. We see that many patients are not getting the care they need because they are afraid to leave the house or go to a medical facility. This is turning injuries that could be treated easily right away into more serious conditions. If you are seriously injured (crooked limb, excessive bleeding, head injury, etc), without question, you should call 911 and go to the ER. Otherwise, there are probably better options. The first step would be to call your doctor’s office (primary care or specialist depending on the condition) and see if they are available to see you. If they are unavailable, an urgent care office is probably your best option. You should avoid visiting the ER unless you are seriously injured, as most are currently overwhelmed.


If you have an Orthopedic injury or develop a musculoskeletal condition, Northeast Orthopedics and Sports Medicine is available to treat your condition in a safe environment. We are open for Orthopedic Urgent Care, regular in-person office visits, and Telemedicine visits with onsite x-ray and ultrasound. Your safety is our priority. Many patients can be seen from the comfort of their home via Telemedicine, and for in-office visits, we have taken significant steps to keep you safe in all of our offices including: limiting the number of patients and staff in the office; prescreening patients for any signs of illness or contact with coronavirus – and keeping them away from the office; separating waiting room chairs; providing the opportunity to wait in your car until your doctor is ready for your visit; providing the option to fill out forms online prior to visiting; offering minimal wait times to see a doctor; ensuring all staff are in proper Personal Protective Equipment (masks, etc); wiping down/sanitizing all patient areas after each patient; making certain all staff sanitize hands before and after each patient; requiring all patients to wear a face-covering; making hand sanitizer available throughout offices; providing priority scheduling (first hour of day) for older patients and immunocompromised patients, and restricting office to the patient only (unless a minor or disabled patient who can bring one parent or aide).


To see one of our specialists, please call any of our offices and you will be given the option to be seen the same or next day in the office or via telemedicine. Stay safe!

What is Telemedicine? We answer your questions.

While our nation confronts the spread of the coronavirus, Northeast Orthopedics and Sports Medicine (NEOSM) is now offering Telemedicine appointments to continue our commitment to provide exceptional care for our patients and community. Although Telemedicine has been around for years, the recent COVID19 pandemic has taken Telemedicine from a rarely used mode of seeing your doctor to a necessity of social distancing. With Telemedicine, you have access to NEOSM’s team of orthopedic specialists from the comfort of your home. 

What exactly is Telemedicine? And what can you expect from your virtual appointment? Here are some answers to commonly asked questions. 

What is Telemedicine?

Telemedicine allows for patients to be evaluated, diagnosed and treated by a physician through video conference. By using this technology, Telemedicine allows access to care when an in-person visit is not the preferred option. This is very similar to common apps like FaceTime, but Telemedicine applications are typically HIPPA compliant and may have other features that assist in a patient visit, such as digital waiting rooms, ability to review xray/MRI images, integration with home blood pressure monitor, etc.

Why choose Telemedicine?

Several studies have shown that in many cases a Telemedicine visit is as good as an in-person visit.  While there are some elements of a physical exam that cannot be done via video, many of the elements can still be performed.  Under normal circumstances there are many benefits of Telemedicine to the patient including convenience, but during COVID19 the benefits are immense and critical to getting healthcare to the patients who need it most and who are at highest risk from COVID19. 

Do I need special equipment or technology to use Telemedicine?

All that is required is a computer, tablet or smartphone with a camera and microphone enabled. No software is needed to be downloaded and you don’t need to create an account. 

How do I make a Telemedicine appointment? 

Call any one of our locations and our staff will schedule your virtual appointment. 

I have made a Telemedicine appointment with NEOSM, what do I do next?

Prior to your appointment, NEOSM will email or text to you a ‘doxy.me’ link. At the time of your appointment, just click on the link. The first time you enter, you will be prompted to allow doxy.me access to your camera and microphone. After doing so, enter your FULL name to check-in. You’ll then enter the virtual waiting room and the doctor will be notified you have arrived. That’s it! As soon as the doctor is ready, they will start your visit. 

Does insurance cover Telemedicine visits?

Telemedicine visits are covered by insurance as a regular doctor’s visit. Co-pays, referrals, etc. would apply as normal. Some insurance companies have waived copays during the Covid-19 pandemic for telemedicine visits. Please contact your carrier for more information.

What if an in-person visit is necessary?

If during your Telemedicine appointment the doctor determines that an in-person visit is necessary, we will have you schedule an appointment in one of our offices. Please note, NEOSM is taking many precautions to make sure our patients are as safe as possible when visiting our offices, like minimizing the number of patients in our waiting rooms and increased disinfecting of surfaces, to name a few. 

If you have additional questions on Telemedicine or would like to schedule your appointment, please call our offices and we’d be happy to help!

COVID-19: NEOSM Patient Safety Measures

To our patients:

As dedicated healthcare professionals, all of us at Northeast Orthopedics and Sports Medicine (NEOSM) are committed to the health and well-being of our patients, staff and community. During the current spread of the Coronavirus (COVID-19) in our area, our focus on safety is even more paramount. We have taken the following measures to ensure that all those in need of immediate orthopedic care are able to be consulted while limiting unnecessary exposure to others. 

Visitor Policy:

All NEOSM offices are open for orthopedic appointments for patients who need to be seen in person. Priority scheduling (first hour of day) is available for older patients and those immunocompromised. Only the patient is permitted to enter our offices. If the patient requires assistance or a parent (for minors), the accompanying visitor must be in good health. All patients and visitors are required to wear a face-covering.

All visitors are pre-screened for any signs of illness or contact with coronavirus. Those who do not pass our pre-screening will be restricted from our office. All non-essential visitors are not permitted. 

In-Office:

We are limiting the number of patients and staff in each office. In our waiting rooms, we have separated chairs to allow proper distancing and are providing the opportunity to wait in your car until your doctor is ready for your visit. We are also providing the option to fill out forms online prior to visiting and minimal wait times to see a doctor.

All staff are in proper Personal Protective Equipment (masks, etc) and all staff sanitized hands before and after each patient. All patient areas are wiped down/sanitized after each patient. Hand sanitizer is available throughout our offices for use.

Telemedicine Appointments (Virtual):

We are offering all patients the opportunity to consult with our physicians virtually through telemedicine appointments. Just call our office as you would to make a regular appointment and this option will be available. A web link will be sent to you to access the virtual appointment. All you need is either a smartphone, tablet or computer, with a camera and the microphone enabled. Telemedicine appointments are covered by insurance as a regular visit and all referrals, etc, would remain the same.  Click here to learn more about Telemedicine.

We will continue to monitor the evolving situation and regulations in place during this time. We encourage you all to continue to practice social distancing, regular hand washing and sanitizing, and to remain up-to-date on and adhere to your local guidelines. 

Thank you and stay safe. 

Northeast Orthopedics & Sports Medicine

Updated April 2020