What is crepitus?
Crepitus is the cracking, popping or grinding noise that occurs when joints are moved. It’s caused by the bones rubbing together, or the joints rubbing against tissues like tendons or cartilage. Crepitus can occur in any joint, but is most common in the knees, shoulders, neck and hips. In most cases, crepitus is harmless and just a sign of normal wear and tear as we age. However, sometimes it can indicate an underlying joint problem that may require medical attention.
What causes crepitus?
There are a few potential causes of crepitus:
Arthritis
Osteoarthritis is the most common cause of crepitus, especially in the knees. As the cartilage wears down over time, the space between the bones decreases. This allows the bones to rub together and cause that grinding or crunching noise. Rheumatoid arthritis can also lead to crepitus as it causes inflammation and damage to the joint tissues.
Injuries
Previous injuries like fractures or dislocations can alter the structure of a joint. This may lead to uneven surfaces that rub together with movement. Torn cartilage, tendons or ligaments from an injury can also get caught between the bones and make noise.
Mechanical problems
Issues with the mechanical structure or alignment of a joint can result in crepitus. For example, a kneecap that doesn’t glide smoothly over the knee joint can cause crunching with motion. Loose bodies or bone fragments floating in a joint space can also get caught between moving bones.
Fluid accumulation
Build up of excess fluid in or around a joint may lead to noisy, creaky movement. This could be from inflammation, bleeding into the joint, or joint effusion from conditions like arthritis or injury. The fluid essentially turns the joint into a squishy, noisy space.
When is crepitus concerning?
In most cases, joint crepitus is not a major concern. It’s typically worse after rest or inactivity, and may go away once the joint is warm and lubricated. However, there are some instances when crepitus warrants medical evaluation:
Persistent crepitus
If the grinding or popping noises don’t lessen with movement and warm up, it could signify an underlying problem. Persistent crepitus, especially if it’s getting worse, should be evaluated.
Pain
Crepitus accompanied by swelling, stiffness, tenderness or pain in the joint points to a possible pathological condition like arthritis. The crepitus itself may not be directly causing pain, but rather is a symptom of a disorder leading to pain.
Trauma
Crepitus that begins after an injury like a fracture, dislocation or ligament tear could indicate mechanical joint damage. It’s important to get it checked to make sure no structures are displaced or loose within the joint.
Loss of function
If the crunching noise is associated with impaired joint mobility, weakness or instability, it’s worth getting examined. Something like a cartilage tear could be interfering with normal joint function.
Swelling/warmth
Crepitus along with joint swelling, warmth or redness can be a sign of inflammatory arthritis. Rheumatoid arthritis or gout may cause these symptoms.
Diagnosing the cause of crepitus
If crepitus is ongoing or accompanied by other symptoms, see your doctor for an evaluation. They will ask about your medical history and do a physical exam of the joint. They may also recommend imaging tests to identify potential causes:
X-rays
Plain x-rays can help detect osteoarthritis, fractures, loose bodies or other bone abnormalities that could lead to noisy joints.
MRI
An MRI scan gives a more detailed look at the soft tissues around joints. It can reveal cartilage, tendon or ligament tears that may cause crepitus.
CT scan
A CT scan can provide a 3D imaging of bone structures. It may assist in identifying subtle fractures or alignment issues.
Joint fluid analysis
Drawing fluid from the joint with a needle and examining it can help diagnose inflammatory types of arthritis.
Arthroscopy
Inserting a tiny camera into the joint allows direct visualization of joint structures. This can help identify cartilage, tendon or ligament tears as sources of crepitus.
Nonsurgical treatment for crepitus
If the crepitus is mild or due to general wear and tear, nonsurgical measures may help:
Activity modification
Avoid movements that cause painful popping or grinding. Alter activity to protect the joint.
Assistive devices
Braces, splints, or ambulatory aids like canes or crutches can reduce discomfort from crepitus.
Physical therapy
PT focuses on flexibility, strengthening, and restoring normal joint mechanics. This helps take pressure off damaged structures.
Medications
Nonsteroidal anti-inflammatories (NSAIDs), analgesics, or steroid injections can relieve pain and inflammation.
Viscosupplementation
Lubricating injections of hyaluronic acid may provide cushion and smooth joint motion.
Weight loss
Slimming down reduces stress on weight-bearing joints affected by crepitus.
When is surgery needed for crepitus?
If nonsurgical options don’t provide lasting relief, surgery may be warranted. Indications include:
Locking or catching
Loose bodies, torn cartilage, or bone fragments catching in the joint may require arthroscopic removal.
Significant arthritis
For moderate to severe osteoarthritis, joint replacement may be necessary to smooth the damaged surfaces.
Unstable joints
Ligament reconstructions or joint fusions can stabilize excessively loose joints causing crepitus.
Misaligned joints
Realignment osteotomies surgically reposition bones causing abnormal wear and crepitus.
What does crepitus surgery involve?
The specific surgery depends on the joint involved and underlying problem:
Arthroscopic surgery
Arthroscopy allows minimally invasive cleaning out of loose cartilage, debris, inflammatory tissue, or bone spurs causing crepitus.
Joint replacement
This removes damaged arthritic joint surfaces and resurfaces them with synthetic implants to allow smooth motion.
Ligament/tendon repair
Tears or laxity can be addressed by tightening or reconstructing damaged ligaments and tendons around creaky joints.
Osteotomy
Making calculated cuts in bones can realign joints and redistribute forces to reduce crepitus.
Joint fusion
Fusing bones together eliminates painful motion between severely damaged joints.
Recovery after crepitus surgery
Rehabilitation after surgery focuses on:
Joint protection
Avoiding certain movements and using assistive devices can protect healing tissues.
Swelling management
Compression, elevation, ice/heat help control post-op swelling and inflammation.
Mobility restoration
Gentle stretching and exercises strengthen the joint and improve mobility.
Functional retraining
Therapy focuses on safely returning to daily activities like walking, climbing stairs, driving, etc.
Pain and inflammation control
Medications, injection, electrotherapy or alternative methods help manage surgical pain.
Full recovery time varies based on the extent of surgery but generally takes at least several weeks to months. Activity is gradually increased to allow proper healing. Pain and crepitus often improve significantly after surgical repair and joint stabilization.
Conclusion
In many cases, crepitus can be managed nonsurgically with activity modification, physical therapy, anti-inflammatories or injections. But if nonsurgical treatment fails to provide lasting relief, surgery may be an option. Procedures like arthroscopy, replacement, realignment or fusion can smooth damaged joint surfaces and remove sources of painful popping or grinding. Surgery aims to restore stability and free motion to the joint. With proper postsurgical rehabilitation, function can typically be regained and crepitus discomfort reduced.