The menisci (often called cartilages) and the main joint surfaces of the knee can be made more vulnerable to injury and damage if knee control is not good enough to prevent unplanned joint movements. Meniscal function is partly to control movement of the femoral condyles into particular paths, centring them on the upper shin bone plateau. Without the guiding help the large and strong condyles can catch the edges of the menisci as they roll across the tibial plateau and so cause tears or other damage to the menisci.

The menisci can be damaged in a variety of ways with the body of the cartilage suffering pieces out of the edge, splitting and developing tears. An example is a “bucket handle tear” which develops in the substance of the meniscus, along its circumference with the two ends remaining connected to the rest of the meniscus. Twisting or turning in a sudden action can cause meniscal damage and detach a small section which then travels about inside the joint and can jam in between the condyles of the joint. Jamming is very painful, can limit full extension, and can cause a weight bearing knee to give way suddenly.

If the menisci become damaged with the ongoing wear process there is less precise condylar control of the femur and this can generate increased forces across the joint surface to the tibia. Degeneration can also occur of the articular surfaces themselves in response to the abnormal joint forces and osteoarthritis can be the result. Prior to modern arthroscopy the surgical management of meniscal problems was to remove the whole structure which typically caused knee arthritis later in life. The medial quadriceps muscle typically wastes with any knee problem and commonly many exercises are given for this.

However, strengthening of the medial lower quadriceps will not be very effective if no attention is paid to the knee’s range of motion and its accessory movements. Restoring the accessory movements can help the knee’s overall function and if full extension is restored then the function of the medial quadriceps muscle will gradually return towards normal naturally. Without full extension then no amount of exercise will restore the muscle function. Modern arthroscopic operative techniques involve slim probes to view the interior of the knee, and the minimum is done internally to remove the troublesome parts, leaving the vast majority of structures intact.

Hundreds of millions of people in the world suffer some degree of osteoarthritis, making it the most prevalent degenerative joint condition in the world, affecting almost all the elderly in some way. It is more likely that osteoarthritis will develop if there has been damage to the joint or ligaments, surgery to the menisci or a family history. If the lateral, medial or cruciate ligaments are damaged the knee may develop unwanted extra movement and so generate excessive forces within the joint which can facilitate breakdown of the joint surfaces. The lateral stresses caused by shearing movements in the joint can be of a high level.

Early stages of knee change with age can include some clicking and grating with the knee only feeling uncomfortable if it is held in one posture for too long. If we lack the stresses at the end ranges of the joint because we do not perform vigorous activities any longer then the joint capsule can become tight. This can make it more vulnerable to injury during movement and can compress the joint to some degree, increasing the forces across the weight bearing surfaces. The cartilage can wear down and the bone underneath, which usually has some pliability, increases in density in a process known as sclerosis.

An arthritic knee can be enlarged, swollen, hot and painful with limited range of movement, crepitus on motion and a degree of disability. Pain and swelling can go through repeated cycles and gradually become worse as the joint deteriorates. Walking may be limited and the knee pain can disturb sleep due to the difficult in maintaining a position. As the inside of the joint can become very tender it does not tolerate pressure from another knee or the gapping pressure which can occur when we lie on our sides. A pillow between the knees is typically required.

Jonathan Blood Smyth is the Superintendent of Physiotherapists at an NHS hospital in the South-West of the UK. He writes articles about back pain, neck pain, and injury management. If you are looking for physiotherapists in London visit his website.

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The ability to position the fingers and thumb in precise postures is vital for the highly coordinated use of the hand and the wrist has a significant role to play in this function. The shoulder blade and the shoulder perform the gross positioning of the arm, the elbow places the hand at varying distances from the body, the forearm dictates the angle of the wrist and the wrist performs the final positioning of the hand. The closer to the hand the body parts come the more precise and fine the movement becomes.

The wrist bones are a grouping of eight small bones called the carpal bones and which are arranged in two rows between the metacarpals and the ulna and radius of the forearm. From the end row of carpal bones the metacarpals run down the hand to the junction with the phalanges at the knuckles, making a mobile central hand area. Running virtually parallel to each other and being long and narrow the metacarpals can alter their positioning, either becoming flattened to support something large or rotated round to cup the palm for increased grasping ability.

The neat, close group of carpal bones allows the wrist to perform a conical range of movement facing forwards, with a full 360 degree rotation possible. The bones can move as a group or to some degree individually to permit fine control of the thumb, fingers and hand. The rows are somewhat irregular but on average there are two bones in line with each metacarpal between it and the forearm. This pattern creates a series of joints in line with each other and permits a great variety of individual movements to translate into precise and varied positioning.

The manoeuvrability of the thumb is one of the most amazing parts of the function of the hand. The “opposable thumb” that humans possess and which apes do not is one of the defining characteristics of precision movement and control. The metacarpal of the thumb on the outside of the hand is not inline with all the others but rotated inwards, having the ability to rotate further inwards to allow the end of the thumb to participate in grasping with one of the fingers. The thumb has a very specialised joint at the junction of the metacarpal and carpal, allowing the specialised movement.

The carpal bones typically move in small motions which are reflected throughout the wrist, in other words they often move all together to accomplish a movement. There are small amounts of motion between all the carpal bones as the hand is moved, and with the ability of the metacarpals to rotate in regard to each other, this allows a cupping posture of the hand. Cupping the hand moulds the palm so that objects can be gripped and brings the fingers round to an appropriate angle to hold something. If the metacarpals lose the small accessory movements which occur between them this can affect the use of the wrist and so the ability of the hand.

Wrist function can be adversely affected by heavy work with the hands such as grasping and pulling heavy objects, pulling ropes and using vibrating machinery. When the hand is grasping something firmly the longitudinal forces this generates are very great as the carpal bones are compressed between the metacarpals and the forearm bones. This can cause a reduction in the essential accessory movements of the carpal bones. Forced extension of the wrist may wedge one of the carpal bones, the lunate, slightly forwards which causes pain and disability.

A fall on the outstretched hand (FOOSH) is the most typical reason for the wrist to be extended forcibly and a Colles fracture is a common result where the break is located in the last inch of the radius and ulna near the wrist. Older women are most likely to suffer from this fracture and although most attention is concentrated on the fracture there is often a significant soft tissue injury of the wrist bones as well. The fracture will heal in five or six weeks but pain, weakness and functional difficulty may persist for much longer, related to some extent to the loss of individual movements between the carpal bones.

Jonathan Blood Smyth, editor of the Physiotherapy Site, writes articles about Physiotherapy, back pain, orthopaedic conditions, neck pain, injury management and physiotherapists in Oxford. Jonathan is a superintendant physiotherapist at an NHS hospital in the South-West of the UK.