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Knuckle knowledge comes in handy

June 20, 2007

The knuckles get quite a workout, both in the literary and physical sense. You knuckle down to perform a difficult task. If you're intimidated, you could knuckle under. Dimwits may be referred to as knuckle-walkers. Someone who takes umbrage at that description may offer their tormentor a knuckle sandwich.

Medically speaking, the knuckles are the prominently angled finger joints seen when the hand is closed in a fist. Because hands are constantly moving, opening and clenching, people normally move their knuckles countless times a day without even thinking about it. Some people have the ability to crack their knuckles. They push or pull on their knuckles to make a popping sound. This comes from the fluid surrounding knuckles, called synovial fluid. Gases, mainly carbon dioxide, are dissolved in this fluid.

When fingers are stretched to pop the knuckle, the bones pull apart, the joint cavity is enlarged and the pressure inside decreases. The decrease in pressure causes the dissolved gases to emerge as bubbles, which cause the popping noise. (When the knuckles return to their normal position, the increased pressure forces the bubbles back into the fluid.)

The creation and absorption of gas in knuckle-cracking is similar to that of "the bends," which deep-sea divers may be subjected to if they rapidly resurface. While at great depths, inhaled gas is dissolved into the blood. When the divers surface too rapidly, the gas emerges all at once, causing great pain and possible death, as the bubbles can block blood flow to the brain and other vital organs.

However, medical research says that knuckle-cracking is not in itself dangerous. It's possible to injure fingers by twisting them out of place, but that's generally associated with continual knuckle-cracking. And not everyone can crack their knuckles; it's possible that those who do so have unusual joints that are more prone to injury in the first place. A study of knuckle-cracking found no evidence that it leads to arthritis.

Knuckles can be damaged by "regular" arthritis, or osteoarthritis, in which the cartilage that lubricates the joints wear out. That results in bone grinding on bone, producing extreme pain. Knuckles are also vulnerable to rheumatoid arthritis, a disease in which the body's immune system attacks the joints.

In either case, those so afflicted think about their knuckles often, because of the pain caused by moving their fingers. Treatment can be strictly for pain relief, such as administering drugs that reduce pain and inflammation. For rheumatoid arthritis, there are drugs that suppress the misguided immune response, allowing the joints to regain normal function.

In both kinds of arthritis, gentle, regular hand exercises can ease the pain. The point of these exercises is to keep hand muscles strong so they can grip properly. The Arthritis Foundation describes these exercises on its Web site at:

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