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Crepitations

What is it that happens when we hear cracking and scraping from the joints while moving? Are these sounds, generally called crepitations, dangerous, and when? This is one of the most common questions people ask their physical therapists or orthopedists.

An important question is whether these sound effects are followed by pain? If so, then it is time to visit a doctor or physical therapist. If there is no pain present, most likely some of the following processes are happening (and are not a cause for alarm):

The most frequent sound effects happen with cracking of finger joints and are often quite loud, but they do not lead to significant joint structure changes. The sound is generated by balancing the pressures in the joint socket. Also, there is no evidence that frequent cracking leads to any painful syndromes or degenerative changes in the hand. Knee crepitations, especially while squatting, are often caused by patellar cartilage damage. Even though damaged cartilage can present a problem, if it is not painful then there is no cause for alarm. Cracking while moving the feet, especially in circular motion, is most likely a result of thickening of one of the tendons near the foot. But smaller cartilage injuries can also be loud. Sound coming from near the hip are almost always caused by scratching of a long ligament over a certain protruding bone structure. This condition is rarely painful. Shoulder crepitations are usually a sign of cartilage damage. In the neck area, sounds similar to movement of sand on the bottom of the sea usually signify the beginning of degenerative changes in the cervical spine.

All in all, what is important is the pain and not the sound. A funny story says that 30 and more years ago orthopedists examined the knee with stethoscopes and allowed the sounds of certain movements decide about way of treatment. Today we know that this meant a lot of mistakes and unnecessary surgeries. There was no arthroscopy then, and all surgeries were performed as open procedures, leading to a long and difficult recovery. On the other side, today certain sounds in physical examination still represent a confirmation of some damages. If the knee is concerned, then a very specific crack almost certainly confirms a damage of one or both menisci.

Finally, sounds occurring in spine stretching or chiropractic treatments do not always have a simple cause. It is generally believed they are a result of small intervertebral joint movements. However, other theories talk of ligament and tendon systems as main cause of sounds. Still, the relief patients feel after this suggests they are positive in their nature. We must note that sometimes sudden pain in the neck or lower back can be followed by a certain „click“, which almost always points to nerve (or some other soft tissue near the spine) clamping.

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