What those creaking joints REALLY mean!
Should you be concerned if your elbow clicks or hip grates?
‘Painless noise in or around a joint is nothing to worry about — but when the noise is persistent and there is pain accompanying then it, potentially, becomes significant,’ says Peter Brownson, an orthopaedic shoulder and elbow specialist at The Bone and Joint Centre at Spire Liverpool Hospital.
Each joint is held together by a complicated array of ligaments, tendons and muscles — and the noise each makes depends on how this is arranged. Here, we help you decipher those snaps, crackles and pops…
Each joint is held together by a complicated array of ligaments, tendons and muscles – and the noise each makes depends on how this is arranged
Any clicking sounds in the shoulder joint should be interpreted according to your age, says Mr Brownson. In the under-35s, shoulder noises can be a sign of joint instability – particularly if you have loose or double-jointed shoulders.
‘Moving the joint causes the ball part of the arm bone to partially come out of the shoulder socket or fully dislocate,’ he explains. ‘This usually causes a loud popping or clunking noise when moving the shoulder.’
In the under-35s, shoulder noises can be a sign of joint instabilityThis is often the result of an injury to the shoulder muscles and, with physiotherapy, the vast majority of cases will be corrected in four months. If you are aged from 35 to 60, clicking and grating accompanied by pain – especially when you reach over your head or behind your back – could mean you have impingement syndrome.
Here the tendons around the shoulder have become inflamed, partly because of degeneration from middle age onwards.
This can be successfully treated in the early stages with physiotherapy. In later stages, a steroid injection can reduce inflammation – but severe cases need keyhole surgery. Those older than 60 are more likely to hear and feel a painful grating sensation in the shoulder with all shoulder movement. ‘This is often caused by arthritis and requires an X-ray to determine the exact cause and extent of the condition,’ says Mr Brownson.
Racquet sports athletes and contact sportsmen, such as footballers, often complain of a clicking in the shoulder with pain, causing reduced performance. This could be superior labrum anterior to posterior lesions (SLAP), where the biceps tendon partially detaches as a result of repetitive use. ‘Unfortunately the only treatment is keyhole surgery,’ says Mr Brownson.
Does your elbow click and make grating noises? If this is uncomfortable and the elbow gets stuck in a bent position (for anything up to a few minutes), you could have a loose piece of bone or cartilage floating around in the joint.
‘A small piece of detached cartilage can calcify, much like a grain of sand in an oyster turns into a pearl,’ says Mr Brownson. ‘This causes the joint to lock. As the joint unlocks there is usually a distinctive popping and clicking.’
A popping or clicking sensation on the inside of the elbow is likely to be a subluxing ulnar nerve – something around one in ten people are born with.
‘The ulnar nerve is responsible for the “funny bone” sensation when you knock your elbow,’ says Mr Brownson. ‘If it keeps flipping in and out of the groove where it’s supposed to sit you can hear a pop.’
This can bruise the nerve, causing a tingling in the ring and little fingers. It is easily treated, with a simple operation on the nerve.
The old wives’ tale about cracking your knuckles giving you arthritis is little more than that
The old wives’ tale about cracking your knuckles giving you arthritis is little more than that, according to Mike Hayton, consultant orthopaedic hand and wrist specialist at BMI The Alexandra Hospital, Cheadle in Manchester.
‘There’s no evidence to suggest it causes harm,’ he says.
‘When you stretch or pull your knuckle joint, you are stretching a small bag of protective fluid inside, which alters the pressure in the fluid.
‘This releases bubbles of natural gases, making the cracking noise.’ Indeed, a U.S. survey of 300 people found that the joints of habitual knuckle-crackers were no more damaged than those of people who never cracked.
The second most common hand noise is De Quervain’s tenosynovitis, Mr Hayton says.
‘It’s where you flex your thumb towards your palm and hear a sound like a door creaking.
‘The noise happens because the tendons that bend the thumb back run down a smooth tunnel which has lost fluid and the tendons rub against the tunnel walls.’
This can occur at any age, but is common in pregnant women or those with young children, due to constant lifting of the child. Steroid injections can treat the inflammation, although occasionally a small operation under local anaesthetic is needed to trim the tendon. A creaking at the base of the thumb, combined with sharp pain, could be arthritis.
The noise is caused by the two worn ends of the bone rubbing together, as the cartilage has been worn away. It can be treated with a steroid injection or surgery to replace the joint entirely.
The most common complaint is a ‘snapping’ noise, says Alasdair Santini, consultant hip and knee surgeon at The Bone And Joint Centre at Spire Liverpool Hospital.
It occurs when the thick band of fibrous tissue that supports the leg muscles catches on the outside of the thigh bone.
‘It’s very rarely painful and almost always is nothing to worry about,’ he says. It is particularly common in young women and can be eased by stretching exercises. A grinding noise accompanied by pain is likely to be a tear of the labral tissue around the joint socket.
‘It’s a natural wear and tear phenomenon and can settle on its own,’ says Mr Santini. But it can also herald the onset of arthritis, so should be expertly monitored.
The loudest noise any human joint is likely to make is when the Achilles tendon ruptures or tears – it can sound like a gun being fired. The noise is due to extremely high tension in the tendon making a bang when it is released.
‘But often there is no noise and people don’t realise it’s happened until the pain hits a few moments later,’ says Rohit Madhav, consultant orthopaedic surgeon at the London Orthopaedic Centre.
‘It feels like someone has whacked the back of your heel.’
Treatment is either surgery to stitch the two ends back together or a below-knee cast, with the toes pointing down so that the tendon ends re-join naturally.
A quieter snap could mean you have damaged the tendons around the ankle -usually caused by a jerking injury, such as falling off a horse or a bicycle.
These tendons are on the outside of the joint – unlike the Achilles, which is on the back.
As a result of the injury, every time you move the ankle, the tendons dislocate and relocate, hence the snapping sound. Surgery is the only option.
If you twist your ankle and hear a pop (like a champagne cork), it is probably a sprain.
‘It’s the classic injury when you step off the edge of a kerb and your ankle turns. Then 30 seconds later it is too painful to stand on and, in a few hours, is swollen to the size of a tennis ball,’ says Mr Madhav.
It is caused when a ligament, which joins bone to bone, ruptures. ‘The popping noise happens because the palus bone in the ankle joint temporarily dislocates away from the shinbone, creating a vacuum in the surrounding fluid.’
Strains shouldn’t make any noise, as the ligament has just stretched.
More than 85 per cent of sprains and strains heal without surgery – they simply need rest, ice, compression and elevation.
If it is difficult to put weight on your knee and it makes a clicking noise when you move it, you may have torn the cartilage
Why do knees – and hips – crack when you squat?
‘You’re putting up to seven times your body weight through the full range of movement of your knees and the noise is the tissue’s way of protesting,’ says Mr Santini.
If you knock or twist your knee, it will be painful. But if it is difficult to put weight on it and it makes a clicking noise when you move it, you may have torn the cartilage.
This happens to young athletes twisting and turning, when playing football or hockey.
A clicking inside the joint with a dull pain and a grinding sensation is likely to be arthritis.
‘When the cartilage in the knee is worn away, there is often bone-on-bone contact, which feels like rubbing pieces of sandpaper together,’ says Mr Santini.
‘It is a question of managing the joint and considering a knee replacement in future.’
The most common noise in feet is clicking between the toes, caused by a condition called Morton’s Neuroma, says Mr Madhav.
‘It’s a progressive condition, linked to running or walking, that results in trauma and the swelling of the nerve in the ball of the foot.’
As well as the sporadic clicking – often between the second and third or third and fourth toes – patients liken the feeling to walking with a pebble in their shoe, with searing pains in the toes.
‘The theory is that the nerve between the ends of the bones in the balls of your feet has been crushed and is swollen,’ he says. The clicking is the swelling on the nerve sliding between the bones.
It may be caused by tight shoes. The condition is more common in women, with up to 15 per cent suffering at some point.
Treatment involves specialist inserts to support the ball of the foot – helping it heal on its own – steroid injections to shrink the swelling or the removal of the nerve swelling.
Up to ten per cent of people have a clicking jaw, says Dr Tom Kennedy, consultant in rheumatology at Royal Liverpool and Broadgreen University Hospitals.
This is caused by the cartilage between the bone of the jaw and the skull popping back into position. However, if you notice pain in the jaw when it clicks you may have temporomandibular joint (TMJ) dysfunction.
‘This is often due to tension in the muscle, which causes people to grind their jaw at night as a reaction to stress,’ says Dr Kennedy.
‘Occasionally, TMJ is due to poor alignment of the teeth or natural wear and tear to the jaw joint.’
See a dentist to check your teeth are properly aligned, otherwise physiotherapy and tablets can help relax the jaw muscle.