---- There are several possible causes for these poppings/clickings. The cause for these sounds often cannot be diagnosed
with certainty. A torn meniscus is one possibility, but there are also several other possible causes for these sounds. Even
if there is a torn or damaged meniscus, that does not mean surgery is necessarily appropriate.
---- Some vets will tell a client that noises from a dog's stifle joint mean there is meniscal injury and that this means
surgery is necessary. A vet who claims to be certain that clicking/popping noises mean your dog needs surgery is at
least injudicious, and possibly dishonest.
---- If you or I went to a good orthopedic specialist because we had clicking/popping in our knee but no other symptoms
(such as locking-up of the joint), this would not be seen as justification for surgery.
----- Here below is a clip from the 'Johns Hopkins' website. 'Johns Hopkins' is highly respected among medical schools
in the United States.
Patient Guide
to Joint Cracking and Popping
Edward G. McFarland, M.D.
Andrew Cosgarea, M.D.
Brian J. Krabak, M.D.
Is cracking and
popping of joints normal?
Cracking and popping of joints is usually normal and most
of the time is nothing to be concerned about. Strangely enough the exact reason joints pop and snap is not totally understood.
One theory is that the ligaments (tethers that hold the bones together) make these noises as they get tight rapidly when the
joint is moving. In some instances, popping may be due to a tendon snapping over or around the joint. Another theory is that
nitrogen bubbles in the fluid inside the joint are rapidly brought into or out of solution when the joint is manipulated,
such as cracking the knuckles in the hand. These noises with movement of a joint, particularly the knee, may sound like folding
stiff paper, and are called "crepitus". These
noises are increased frequently after surgery on a joint, although the exact reason is not clear.
Do these sounds need to be treated?
Whatever the
cause, these sounds do not need to be specifically treated. There are no long term sequelae of these noises, and they do not
lead to future problems.
When should I
worry about the cracking and popping of a joint?
The only time to worry about cracking or popping of a joint is
if there is pain when the joint pops. Swelling is not normal and should be evaluated if it accompanies the noises. If the
joint gets locked or stuck when it pops or cracks then it may indicate a joint problem that should be evaluated. If you are
losing motion of the joint, if it is swelling or if you are losing function of the joint, then you should seek medical treatment.
These noises are
increased frequently after surgery on a joint, although the exact reason is not clear. ..."
****************
Notice that the Hopkins' doctors say in that clip that
"...These noises are increased frequently after surgery on a
joint, although the exact reason is not clear..."
---- Since a surgical procedure can reasonably be seen as a form of trauma, it seems to me that it is not too much of
a leap to suppose that other traumas to the joint could also lead to an increase in these joint noises. So it would not be
surprising to find people and dogs with ligament injuries developing knee/stifle clickings and poppings without necessarily
having meniscus damage. Interestingly, many dogs seem to develop these noises not at the very beginning of recovery just after
the injury/surgery, but weeks or months later during their recovery. The clickings/poppings could be a
normal part of the recovery process rather than a new injury. Possibly a result of looseness in the joint after swelling
reduces but before scar tissue development tightens the joint to a more near-normal condition.
The Hopkins'
docs write "...Swelling is not normal... " but remember that
in that phrase they are writing about an uninjured joint that develops these noises. A joint which became swollen without
a known cause along with clicking/popping would be a cause for concern. But in a situation where a dog is recovering
from a ligament injury, we know the reason for swelling is the original ligament injury.
Also, the
stifle naturally enlarges as the new supporting tough fibrous scar tissue develops. This could be mistaken for swelling due
to some other cause, but it is a normal part of the recovery process which nearly universally leaves dogs with the recovered
stifle permanently larger.
Even if the
clicking/popping were somehow known to be the result of a damaged meniscus, that does not lead to the conclusion that surgery
is necessarily required. When the popping or clicking in a person's joint is caused by a damaged meniscus, human docs don't
usually recommend surgery in the absence of symptoms in addition to the clicking / poppings sounds.
---- This little clip is from http://www.emedx.com/
<<< Meniscus tears are typically associated with pain along the inner
side or outer side of the knee. Mild to moderate swelling will accompany this pain. Clicking, catching or locking of the knee
may also be present.
Many meniscus tears will respond to rest, anti-inflammatory medication and physical therapy. >>>
***************
So, if a clicking/popping sound developed in my
dog's stifle(knee) after ligament injury,
--and he was
not slowly improving with properly restricted activities,
--and there were other symptoms such as locking up of the joint,
then I would be thinking that the noise could be an indication of a damaged meniscus causing a problem inside the
joint, and that surgery could be appropriate if rest, anti-inflammatory medication, and physical therapy were ineffective.
That is, the clicking/popping
combined with other symptoms and an inability to improve would point to surgery as appropriate.
----
Not that popping/clicking = Surgery is necessary
If my dog were slowly improving after his injury I would
consider surgery to be a very bad idea. Letting a vet open up the joint is not without risk. Dogs come out of
surgery with maimed joints everyday.
