Clinical Inquiries

Does knuckle popping lead to arthritis?

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No, habitual knuckle popping, or cracking (over the course of several decades) isn’t associated with clinical or radiographic evidence of osteoarthritis (strength of recommendation [SOR]: B, retrospective cohort and case control studies). However, attempting to pop the knuckles can produce acute soft tissue injury (SOR: C, case reports).

Evidence summary

A cross-sectional study found no correlation between knuckle popping and osteoarthritis (OA) of the hand.1 Investigators recruited 300 consecutive patients (ages 45 years and older, mean age 63 years) and evaluated them for a history of habitual knuckle popping (74 of 300 patients, mean duration 35 years) and hand arthritis or dysfunction. Investigators excluded patients with neuromuscular, inflammatory, or malignant diseases.

Investigators found OA equally in both patients who did and didn’t pop their knuckles (12 of 74 vs 36 of 226, respectively; P nonsignificant); joint swelling was more common in participants with a history of knuckle popping (84% vs 6%; P<.01). Investigators didn’t describe how OA was diagnosed or specify which joints were affected.

Another cross-sectional study also found no correlation between habitual knuckle popping of the metacarpal phalangeal joint and the prevalence of OA in that joint.2 Investigators recruited 28 patients (mean age 78.5 years; 23 women and 5 men) from a Jewish home for the aged and asked them whether they had habitually cracked their knuckles during their lifetime. They then performed clinical and radiographic hand examinations (excluding patients with a history of ­traumatic injury, rheumatoid arthritis, gout, chondrocalcinosis, and hemochromatosis).

Knuckle popping didn’t correlate with OA of the metacarpal phalanges (1 of 15 knuckle popping patients vs 5 of 13 patients who didn’t pop their knuckles; P=.06). All 6 patients with radiographic evidence of OA showed involvement at the metacarpal phalangeal and distal interphalangeal joints, whether or not they popped their knuckles.


Evidence-based answers from the Family Physicians Inquiries Network

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