ALL ABOUT CREPITUS: JOINT SOUNDS AND WHAT THEY MEAN

Medically Reviewed by Dr. Rosmy Barrios

Have you ever heard a popping or cracking sound coming from your joints? This phenomenon, known as crepitus, can occur in various body parts, including the knees, shoulders, lungs, skin, and neck. It is a clinical sign that may range from being clinically insignificant to life-threatening. While it may sound alarming, crepitus is common and not always a cause for concern.

This article focuses on musculoskeletal-related crepitus, examining myths and facts, the latest advancements in understanding joint sounds, and how to manage this condition.

What is Crepitus?

Crepitus, or crepitation, is the medical term for the crackling, popping, crunching, or grinding sounds and sensations that can occur when you move your joints. While sometimes surprising, it is usually a normal phenomenon and not a cause for immediate concern.^[1]

These sounds can result from various factors, including the movement of tendons and ligaments, rubbing bones against each other, or releasing gas bubbles in the joint fluid. A lack of lubrication is a common feature leading to crepitance.^[2] It can occur due to an underlying health condition, older age, inflammation, or wear and tear on the joint.

Symptoms & Signs of Crepitus

The most common symptom of crepitus is the production of popping or cracking sounds when moving a joint. It is usually temporary and harmless.

Typical joints affected include:

• Knee: One of the most common joints vulnerable to crepitus, especially when squatting or descending stairs.
• Knuckles: A classic example of joint cracking.
• Shoulder: Rotator cuff motion can sometimes cause these sounds.
• Hips: A less common site of crepitus, but it can occur.
• Neck: If stiff, turning your neck may produce sounds.

If the crepitus is present alongside other symptoms of swelling, pain, or stiffness in the joint, it may point towards an underlying condition and may require a medical evaluation.

Causes of Crepitus

Crepitance is often caused by friction and displacement of fluids when there is movement in any part of the joint. The joints comprise fluid-filled compartments that house bone and cartilage, surrounded by muscles, ligaments, and tendons.

Several types can occur^[3]:

• Gas Release: The synovial fluid in our joints behaves as a lubricant and sometimes houses trapped gas. When cracking a joint or moving it a specific way, it can stretch the joint capsule and lead to the rapid release of gases, which can cause a cracking sound.
• Tendon, Ligament, and Joint Movements: Surrounding a joint are tendons and ligaments that firmly wrap around and cushion the joint. Moving tendons or tensing ligaments can result in crepitus. This is a frequent occurrence in the ankle or knee.
• Coarse Surfaces: Loss of smooth cartilage in arthritic joints leads to sounds due to the surface's roughness.

Crepitus is the result of a variety of factors, including:

• Osteoarthritis: This is the most common cause of crepitus.^[4] A prevalent degenerative joint disease, osteoarthritis occurs when the cartilage in the joints deteriorates, leading to bone-on-bone contact and, in turn, crepitus.
• Fibromyalgia: Widespread pain and joint and muscle tenderness are symptoms of this condition. While uncommon, fibromyalgia can lead to crepitus due to inflammation.^[5]
• Gout: This condition is a form of arthritis that occurs from the uric acid crystal buildup in the joints, which causes irritation and damage. This inflammation can contribute to crepitus by causing swelling, allowing the tissues around the joint to rub together abnormally.^[6]
• Chronic Infections: Ailments that lead to chronic infections, like Lyme Disease, may cause joint crepitus as they can induce chronic systemic inflammation.^[7]
• Autoimmune Disease: Several autoimmune diseases, like systemic lupus erythematosus, can cause systemic inflammation and affect the lining of the joints.^[8] This inflammation can harm the cartilage and bone, leading to crepitus as the bones grind together.
• Joint injuries: A sprain, dislocation or other joint injury can cause crepitus.^[9] This is because the injury can damage the cartilage, resulting in bone-on-bone contact and the production of crepitus sounds.
• Overuse syndrome: After too much exertion, the muscles can become very tight and accumulate metabolites such as lactic acid. This can cause them to make a cracking sound when next using them.^[10]
• Aging: As we age, the cartilage in our joints can wear down, resulting in bone-on-bone contact and the production of crepitus sounds.^[11]
• Other: Many other joint disorders and injuries can lead to painful crepitus, including:
  • Patellofemoral pain syndrome
  • Torn cartilage
  • Tenosynovitis
  • Temporomandibular joint disorders
  • Scleroderma
  • Rotator cuff tears
  • Triangular fibrocartilage complex

Painful vs. Painless Crepitus

Crepitus can be either painful or painless. Painless crepitus is usually harmless.

Painful crepitus can indicate an underlying condition, such as osteoarthritis or a joint injury. If you experience painful crepitus, you must consult a doctor for proper diagnosis and treatment.

Painless crepitus can increase the risk of painful crepitus and contribute to an underlying health problem. This understanding is why people advise each other not to "crack" the knuckles, as it may contribute to arthritis in the joints.

There are two possible reasons why this is the case:

• Microtrauma Theory: This theory suggests that repeatedly creating cracks in the joints through forceful manipulation might cause tiny tears or stress in the joint structures, like cartilage and ligaments. Over time, this microtrauma could accumulate and potentially contribute to pain and damage^[12].
• Habituation and Pain Perception: Another possibility is that the constant crackling desensitizes the receptors responsible for proprioception, our sense of body awareness in the joints. This could make it harder to detect early signs of underlying issues that might eventually lead to pain.

However, research on this topic needs to be more conclusive. Some studies have yet to find a link between habitual cracking and future joint problems, while others suggest it does increase microtrauma risk and may even lead to lower hand grip strength.^[13]

If you are experiencing any discomfort or if the cracking becomes excessive, it is best to confer with a medical expert to rule out any other conditions and get targeted advice.

Painful Crepitus: When to See a Doctor

If you experience painful crepitus, it is essential to opt for a proper diagnosis to make sure it is not related to an underlying condition.

Seek medical attention if you experience any of the following symptoms:

• Severe pain in the joint
• Swelling or redness in the joint
• Difficulty moving the joint
• Fever or chills
• Numbness or tingling in the joint

Treatment for Crepitus

Treating crepitus centers on managing associated discomfort and addressing any underlying causes. Treatment typically begins with non-invasive options and, if necessary, progresses to more involved interventions.^[14]

Note: Crepitus originating from the lungs is a separate condition that requires specific medical evaluation and treatment.

Non-Invasive Treatments

• Rest and Ice/Heat: Resting the affected joint and using ice or heat packs over the area can lower swelling, inflammation, and pain.
• Physical Therapy: A personalized physical therapy program concentrating on stretching, strengthening, and range-of-motion exercises can improve joint function and reduce symptoms.
• Weight Management: If overweight or obese, weight loss can significantly decrease stress on joints.
• Bracing/Splinting/Orthotics: These devices can support the affected joint and improve alignment, reducing crepitus^[15].

Medication

• Over-the-counter Pain Relievers: NSAIDs (Non-steroidal Anti-inflammatory Drugs) like ibuprofen or naproxen can help to keep pain and inflammation under control.
• Prescription Medications: If over-the-counter medications do not provide enough relief, your doctor might prescribe more potent pain relievers or medications targeted at an underlying condition.

Injections

• Steroid Injections: For significant pain and inflammation, a doctor may suggest a corticosteroid injection into the afflicted joint for temporary relief.
• Hyaluronic Acid Injections: These can improve joint lubrication and may help with crepitus associated with osteoarthritis^[16].
• Platelet-Rich Plasma (PRP) Injections: PRP therapy involves injecting concentrated platelets from your blood into the joint. Platelet extractions contain growth factors that may promote tissue regeneration. PRP may aid in managing crepitus associated with early signs of cartilage damage or tendon issues^[17].

Surgery

• Arthroscopic Surgery: This minimally invasive technique can diagnose and sometimes repair joint injuries or damage that contribute to crepitus.
• Debridement: Removal of damaged cartilage or tissue to improve joint function.
• Joint Replacement: A last resort for severely damaged joints and significant pain.

It is essential to have an appointment with your doctor to determine your crepitus's underlying cause and discuss the most appropriate treatment plan for your individual needs.

Living with Crepitus

If you experience painless crepitus, there is no need to worry. However, if you experience painful crepitus, it is necessary to see a doctor.

In the meantime, you can remain proactive by following some steps you can take to ease your symptoms and enhance your overall joint health:

• Stay active: Regular exercise is necessary for keeping your joints healthy, building surrounding muscles to protect them, and reducing the risk of developing osteoarthritis. Warming up the joints is crucial before exercise^[18].
• Maintain a healthy weight: Excess weight can stress your joints, giving rise to joint pain and damage.
• Use proper form when exercising: Make sure to use proper form when exercising to avoid joint injuries.
• Eat a balanced diet: A diet rich in vegetables, fruits, and lean proteins can help keep your joints healthy.
• Keep hydrated: Most joints capable of crepitus require fluids to remain well-lubricated and mobile^[19].
• Avoid repetitive movements: Repetitive movements can stress your joints, leading to joint pain and damage.

Myth vs. Fact: Is Crepitus Good or Bad?

There are many myths surrounding crepitus, and it can be challenging to determine what is true and what is not. Let us look at some common myths and the facts behind them.

Myth: Crepitus is always a sign of arthritis.

Fact: While crepitus can be a symptom of arthritis, it is not always the case. Painless crepitus is usually just the movement of gas bubbles in the synovial fluid and is not a sign of arthritis.

Myth: Crepitus is always a sign of joint damage.

Fact: Painless crepitus is usually harmless and is not a sign of joint damage. However, if you experience painful crepitus, it could indicate an underlying condition, such as osteoarthritis or a joint injury.

Myth: Crepitus can be cured with supplements or home remedies.

Fact: No evidence supports the claim that supplements or home remedies can cure crepitus. Daily movement, hydration, and minimal inflammation are some of the best remedies. If you experience painful crepitus, consult your doctor for advice.

Latest Advancements in Understanding Joint Sounds

Researchers are actively exploring new treatment approaches for arthritis and joint conditions that cause painful crepitus. Here's a glimpse into those advancements:

• Targeted Therapies: New medications are being developed to block specific inflammation pathways and address the underlying mechanisms of arthritis^[20].
• Stem Cell & Gene Therapy: Research aims at using stem cells to regenerate cartilage and potentially employing gene therapy to alter disease processes within the joints.^[21]
• Biomaterials & Immune Modulation: Scientists are working on biomaterials for cartilage support^[22] and investigating ways to "re-train" the immune system in autoimmune arthritis.
• Surgical Advancements: The focus is on minimally invasive techniques^[23], improved implant materials, and personalized surgical approaches for joint repair and replacement, potentially leading to better outcomes and faster recovery.

Conclusion

Crepitus is common and not always a cause for concern. Painless crepitus is usually harmless and nothing more than a dislodged gas bubble in the joint fluid. However, if you experience painful crepitus, it is essential to attend an appointment with a doctor to obtain a diagnosis and treatment plan. By understanding the causes and symptoms of crepitus, you can effectively manage your symptoms and enhance the health of your joints.

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