As people get older, they may start to notice that their joints make sounds, which is medically called crepitus. Crepitus occurs as part of normal movement or when you specifically move a joint. While it can occur at any age, it is more common in older patients. Crepitus describes a wide range of joint sounds including:
These sounds can be muffled and sound “soft” or they can also be loud enough for people to hear. Patients tend to notice these sounds mostly in their knees, though they can also strike in other joints including those in the shoulder, elbow or neck. The sounds are particularly noticeable when you do the following things:
- Bend your knee or elbow
- Go up or down stairs
- Move your shoulder
Causes of crepitus or 'cracking and grinding' joints
Crepitus can often simply be the result of air moving into the joint or into the soft tissue around the joint (such as the knee). Hence, when you bend the joint with the air, the air bubbles burst, causing a cracking sound. This process is harmless and does not cause pain. Another reason why you may have crepitus is when your tendons or ligaments snap over the joint’s bony structures, which causes pain.
Arthritis, a disease that is characterized by the inflammation of joints, is composed of several different subtypes. However, crepitus is mostly attributed to two different types of arthritis, osteoarthritis and rheumatoid arthritis. In osteoarthritis, which is also called wear and tear disease, the cartilage starts to rub away, causing the region to become inflamed. When the cartilage is gone, that leaves the bones unprotected and they start to rub and grind, causing pain and stiffness when you engage in activities. The joint in which the cartilage has worn out is no longer protected against friction and impact. Hence, arthritis can lead to the development of crepitus. However, crepitus does not develop in all patients with arthritis.
Patellofemoral pain syndrome
Patellofemoral pain syndrome, also called runner’s knee, causes crepitus as well as pain behind the knee cap. It typically happens when you go from being sendentary to being quite active — by running, squatting or jumping. It tends to be more common in women compared to men.
While playing sports, experiencing a fall or an accident, you can develop a tear in the cartilage. Once the cartilage has torn, that causes bones to rub together and cause crepitus. Hence, cartilage damage is another cause of crepitus.
Diagnosis: How does your doctor determine the cause of crepitus?
In order to diagnose the cause of crepitus, your doctor will examine the affected region of your body. They will ask you to describe, in detail, your symptoms and any recent activity. They will also ask you how your joint feels when you undergo different movements. You should make sure to describe the pain as clearly as possible and mention whether you have experienced any recent changes in activity. This can help determine whether you have arthritis.
For the diagnosis of patellofemoral pain syndrome, the doctor will be able to diagnose the disease based on an office examination. However, they are likely to order an X-ray or another imaging test to see exactly what is going on inside the joint.
Treatment: How is crepitus managed?
Crepitus does not usually have to be treated or be a cause for concern. In fact, for most people, their joint’s crack regularly and it is a normal part of life, particularly for people that are older. However, crepitus is a cause for concern when it is accompanied by other symptoms that indicate the presence of a disease. These symptoms include:
- Joint pain
- Joint swelling
- Redness or warmth of joint
- Joint stiffness, particularly in the morning
- Pain after a long period of rest or after a period of activity
In extreme cases, you may choose to undergo surgery to eliminate pain-causing crepitus. However, there are only a few causes of crepitus that would qualify you to undergo surgery. It is best to choose the least invasive treatment that will relieve joint pain as well as reduce future damage to the joint. These are the surgeries you can undergo.
This is a minimally invasive surgery that makes use of small instruments that are inserted by tiny small incisions to access the joint. For treatment of patellofemoral pain syndrome, the surgeon will take out regions of damaged tissue as well as reposition tendons that can help improve knee movement.
Many PFS and arthritis symptoms improve with debridement, a minimally invasive surgery in which the surgeon smooths out the damaged cartilage, causing there to be a reduction in rubbing.
When the arthritis or joint damage becomes advanced and there are no other options, you may consider joint replacement, which involves implanting an artificial joint in place of the damaged one.