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Shoulder Clicking

When you move your shoulder, you might hear or feel something click or pop near where the glenohumeral joint( ball and socket joint) connects to the top of your upper arm. This shoulder popping sound is known as crepitus(1).

Occasionally, a shoulder that cracks grinds, or pops is accompanied by severe pain or warmth. This pain can be an indication of various diseases or injuries. Shoulder discomfort, stiffness, and injuries are the third most prevalent muscle and joint conditions that brings patients to the doctor.

Causes of Shoulder Clicking

There are the following common causes of shoulder clicking

Osteoarthritis

As you age, the cartilage in your joints, which absorbs shock, wears down. This condition is called osteoarthritis. This cartilage is responsible for reducing friction between the bone. In osteoarthritis, the joint loses its cushioning ability between the bones.

Osteoarthritis can make bones grind against each other, which can be heard as a grinding, clicking sound. The additional friction can cause stiffness and pain. Another major complication is that when the space between the joints gets smaller, nerves can sometimes get pinched leading to radiating pain.

Un-healed fracture

If you recently broke an arm bone( humerus), collar bone, or rib cage, and it hasn’t healed properly, you might feel like it’s producing clicking symptoms. In this case, it’s because the pieces of bone are moving against each other. This needs to be looked at by a doctor because you may need surgery to fix it.

Bursitis as a cause if shoulder clicking

The bursa is a small sac filled with fluid that sits in the joint capsule of the shoulder joint. The bursa acts as a cushion and absorbs shock, making it easier for the joints to move together. If it gets swollen because of a shoulder injury or repeated strain or stress, this is called bursitis(2).

Inflammation of the scapulothoracic bursa can cause a clicking of the shoulder. Some people may hear a snapping scapula while moving their shoulder blades. This is due to the inflammation of this bursa.

It is important to mention here when something swells, there is less room for things to move, and structures can get tight causing grinding. If you think you have bursitis, try not to do anything that makes it worse, give it time to heal. You should also follow the standard protocol for treating inflammation (ice and medication if needed).

Labral tears

The labrum is a cartilage structure that can get torn due to overuse, injury, or aging.  Labral tears are frequently extremely painful. These tears produce a clicking, grinding, or cracking sound when the shoulder is used for any purpose. Instead of causing an occasional pop or pain, labral tears cause constant pain and discomfort throughout practically all activities.

Additionally, an injury to the capsule or labrum may be experienced in situations of trauma, frequently athletic trauma and this “subclinical instability” can be accompanied by painful clicking. Moreover,  large labral tears can cause excruciating clicking without causing shoulder instability similar to knee meniscal injuries.

A diagram of a labrum tear that causes shoulder clicking.

Osteochondroma

An osteochondroma is a benign growth in the shoulder, ribs, and scapula that can cause your shoulder to crack as you raise your arm(3). These are the most prevalent types of benign bone growths. Occasionally, individuals with these growths show no other symptoms.

Biceps Subluxation or Dislocation

Most of the time, the painful “, catching, clicking, and popping noise in the shoulder is caused by the biceps tendon subluxation, or dislocation( moving out of the groove). This is named “ biceps instability. It happens when the biceps pulley or rotator interval, which is made of soft tissue, is loose or torn. This pulley can be torn by a sudden force, like when a dog pulls on a leash and jerks the arm, or it can become loose over time as someone ages or does the same thing over and over, like a competitive swimmer.

The rotator cuff tear

The rotator cuff muscles are put under a lot of stress and are very likely to tear. Age or general wear and tear can cause them to tear partially or completely.  When something is torn, the uneven surfaces can rub against each other and make cracking sounds and when you move, the pain can be very sharp.

Other causes include subacromial impingement/ shoulder impingement, degenerative lesions of the labrum, and acromioclavicular joint (ac joint ) injury. If you don’t get your shoulder problem fixed, it can turn into a long-term condition called “frozen shoulder.” This is also named adhesive capsulitis. In which the shoulder capsule and joint become adhered due to an inflammatory process resembling glue. It can be highly painful and recovery might be prolonged.

Imaging and Tests

When you go to a physiotherapist for the first time, they will test your range of motion across the joint and the strength of your muscles. During your assessment, you will be asked to do different movements. This will help the doctor figure out what kind of pain you are having, the location of the pain, and the severity.

Sometimes, you may need to take tests to find out more about the cause of the problem. Typical investigations you might come across include Magnetic resonance imaging, Ultrasound, and X-rays.  An MR-Arthrogram (MRA) is the best radiological test to investigate the structures of the capsule and labrum. Your doctor may also recommend a blood test to look for infection. Moreover, to find out if you have an auto-immune disorder, you can take an antibody test(4).

Additionally, different clinical tests for generalized ligamentous laxity, labral tears,  apprehension, and shoulder laxity are used to find out what’s causing shoulder clicking.  When a patient has subclinical instability with painful clicking, the apprehension tests may not be positive or may only be slightly positive. For this reason, more dynamic assessments are helpful. Other tests that can be performed to confirm shoulder clicking include the Kilber clunk test for labral tears,

How is shoulder clicking treated?

Home treatment

If you hurt yourself or are in pain, you should immediately follow the RICER principle for at least 48 hours.

Rest

Ice

Compression

Elevate

Referral

The goal of RICER is to try to reduce swelling and provide pain relief(5). It will also make you feel better if you are in pain. Even though swelling hurts and is annoying, it is your body’s way of keeping the injured joint from moving and protecting it.

Once the first 48 to 72 hours of the acute phase are over, you can move on to the recovery and rehabilitation phases.

You might also find these other treatments helpful: Foam rolling is a way to loosen up tight muscles. The rollers are cheap to buy, and you can do the treatment at home.

Furthermore, yoga can help in several ways. Yoga is known for making you more flexible, which is why most people who do it look like pretzels. But it can also make your joints stronger and more stable. It also helps with breathing and relaxation and improves posture, which is all-important benefits. These are important for neck, shoulder pain, and back pain caused by stress(6).

Other treatment options include gel, hot packs, and the use of braces. Gels and hot packs can help in relieving muscle tension and reducing pain. Sports tape or braces can be used to strap the shoulders and give support for sports and other activities. However, in the long term to strengthen the muscles themselves. You can also use tape to maintain good posture. The tape is placed on your shoulder to keep it in the right place, and if you move, like slouch against it, the tape pulls.

Medical Treatment for shoulder clicking

Your orthopedic doctor may prescribe anti-inflammatory drugs to reduce pain and inflammation. The most commonly prescribed anti-inflammation medications include Ibuprofen and Naproxen. Sometimes, your doctor may recommend corticosteroid injections to reduce inflammation around the joint.

Physical therapy/physiotherapy treatment will include a range of motion exercises to regain range of motion and muscle strengthening exercises to increase muscle strength. A lot of people also apply massage to loosen up tight muscles. Just remember that the muscles will get tight again if the root cause isn’t fixed.

Ultimately, if the injections do not provide long-term relief, which is sometimes the case, a surgical repair may be required. This is especially true for people with extremely unstable biceps or those who engage in numerous repeated activities (serving tennis balls).

For some individuals, repairing the biceps instability surgically is the best option in order to recover their sports passion or movement quality. In severe cases, surgery such as arthroscopic surgery to repair tears and complete shoulder replacement will be required.

Conclusion

Shoulder clicking, popping, or cracking is typically not a cause for concern. Consult a physician if the sound is accompanied by discomfort, swelling, or other symptoms.

Shoulder injuries frequently heal with the use of physical therapy and home remedies. If these treatments are insufficient, surgery and other options are possible.

Frequently Asked Questions

Should I be worried about shoulder clicking?

Shoulder clicking is typically not a cause for concern. Consult a physician if the sound is accompanied by discomfort, swelling, or other symptoms.

Why does my shoulder click when I rotate?

As we age, the soft cartilage that cushions our bones deteriorates, forcing them to rub against one another. This friction generates not just shoulder pain but also, clicking popping, and cracking sounds when the shoulder joint is moved.

Can the rotator cuff heal on its own?

Tears of the rotator cuff do not heal on their own without surgery, but by strengthening the shoulder muscles, many patients can experience functional improvement and a reduction in pain without surgery. Not necessarily does the presence of a tear necessitate surgical intervention?

References

  1. Crepitus: Joint popping. (n.d.).
    aurorahealthcare.org/services/orthopedics/conditions/crepitus
  2. Hammer, Warren. “The Clicking Shoulder.” Chiroweb. 3rd (2003).
  3. Tandogan, R. N., Yücetürk, A., Hücümenoğlu, S., Benli, T., & Aydm, E. (1997). Unusual causes of scapular clicking. Archives of orthopaedic and trauma surgery, 116(8), 516-518.
  4. Pandya, N. K., Colton, A., Webner, D., Sennett, B., & Huffman, G. R. (2008). Physical examination and magnetic resonance imaging in the diagnosis of superior labrum anterior-posterior lesions of the shoulder: a sensitivity analysis. Arthroscopy: The Journal of Arthroscopic & Related Surgery, 24(3), 311-317.
  5. Block JE. (2010). Cold and compression in the management of musculoskeletal injuries and orthopedic operative procedures: a narrative review. 
    ncbi.nlm.nih.gov/pmc/articles/PMC3781860/
  6. Eyigor S, et al. (2018). Can yoga have any effect on shoulder and arm pain and quality of life in patients with breast cancer? A randomized, controlled, single-blind trial. DOI:
    10.1016/j.ctcp.2018.04.010

 

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