Investigating the presence of an intra-articular gas bubble after an adjustment

• Main Author: Jones, Allan Ray
• Published: 2012
• Subjects: Physical therapy; Manipulation (Therapeutics); Chiropractic
• Online Access: http://hdl.handle.net/10210/5032

M.Tech. === This study aims to, using diagnostic musculoskeletal ultrasound, investigate the presence of intra-articular gas bubbles in the trapeziometacarpal (TMC) joint cavity in the absence of an axial distractive load, after a high velocity low amplitude (HVLA) Chiropractic adjustment and assess the state of the gas bubble after a 20 minute refractory period. Using plain film radiography, several authors, (Roston and Wheeler Haines, 1947, Semlak and Ferguson, 1970, Unsworth, Dowson and Wright, 1971 and Watson, Kernohan and Mollan, 1989) have consistently demonstrated the presence of an intra-articular radiolucent space in an MCP joint after cavitation. The MCP joint was always manipulated with an axial distractive load. The singular radiolucent cavity was shown to be visible only if an axial distractive force was acting across the joint at the time of the post-manipulation radiograph. Cramer, Tuck, Todd Knudsen, Fonda, Schliesser, Fournier and Patel, (2000), have used magnetic resonance imaging (MRI) to demonstrate a significant increase in the lumbar zygapophyseal joint spaces (0,7 mm) after an adjustment versus the control group (0,0 mm increase). The observed increase in joint space was the primary aim of their research and no reference is made to the presence of an intra-articular gas bubble or any apparent changes in joint space density on post-adjustment MRI scans. They attribute this increase in joint space to breaking of intra-articular adhesions. Using computed tomography (CT) and Radiography, Cascioli, Corr and Till, (2002), reported that no gas bubbles were visualised in the cervical facet joints after an adjustment, with and without traction. This study consisted of 18 participants between the ages of 21 and 26. A pertinent physical examination and a regional examination of the forearm hand and wrist were conducted to ensure no significant pathologies would exclude them from the study. The TMC articular cavity was scanned by an experienced musculoskeletal ultrasonographer at three intervals: pre-adjustment, directly post-adjustment, and at 20 minutes post- adjustment. The ultrasonograms were saved as digital copies for subsequent reports which were correlated with reports compiled during dynamic visualisation of the articular cavity at the time of scanning. The TMC joint was scanned in a physiological position i.e. there was no axial distractive load acting across the joint during any of the three scans.