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Many definitions of joint manipulation have been proposed. [1] The most rigorous definition, based on available empirical research is that of Evans and Lucas: [2] "Separation (gapping) of opposing articular surfaces of a synovial joint, caused by a force applied perpendicularly to those articular surfaces, that results in cavitation within the synovial fluid of that joint."
The synovial membrane or "synovium" encloses each joint and also secretes a lubricating fluid that allows different joint motions such as rolling, folding and stretching. When the synovium becomes inflamed or irritated, it increases fluid production, resulting in warmth, tenderness, and swelling in and around the joint.
Cavitation of the synovial fluid within the facet joints is responsible for the popping sound associated with manual spinal manipulation, commonly referred to as "cracking the back." The facet joints, both superior and inferior, are aligned in a way to allow flexion and extension, and to limit rotation.
Synovial fluid cavitation has some evidence to support it. [11] When a spinal manipulation is performed, the applied force separates the articular surfaces of a fully encapsulated synovial joint, which in turn creates a reduction in pressure within the joint cavity.
Aspiration of synovial fluid in cases of joint effusion or hemarthrosis can help reduce pressure around the joints, thus providing pain relief. Corticosteroid medications may also be injected into the joint capsule to provide pain relief and anti-inflammatory effects, especially for rheumatoid arthritis and less commonly osteoarthritis.
Synovial fluid, also called synovia, is a viscous, non-Newtonian fluid found in the cavities of synovial joints. With its egg white –like consistency, [ 1 ] the principal role of synovial fluid is to reduce friction between the articular cartilage of synovial joints during movement. [ 2 ]
Sodium hyaluronate is a component of the normal synovial fluid that fills the joint spaces in health. Its function is to lubricate and maintain the internal environment of the joint. It has been used for arthritis in the knee and hip joints, and it was first used for TMD in 1985.
A bursectomy is the removal of a bursa, which is a small sac filled with synovial fluid that cushions adjacent bone structures and reduces friction in joint movement. This procedure is usually carried out to relieve chronic inflammation or infection, when conservative management has failed to improve patient outcomes.