Why is my shoulder cracking?
Cracking (crepitating) in a joint occurs frequently and in most cases has no significance. However, it can be a sign of osteoarthritis.
The shoulder
The shoulder consists of four different joints:
- gleno-humeral = the actual shoulder joint
- acromio-clavicular = the acromioclavicular joint, at the top of the acromion to the clavicle
- hinsterno-clavicular = the sternoclavicular joint between the collarbone and the sternum
- scapulo-thoracic = the mobility of the shoulder blade on the rib cage
The latter is not an actual joint because there is no bony connection between the two partners. However, the mobility is that of a joint.
Origin of cracking
The cracking always occurs when two originally movable parts rub against each other:
- two joint partners that have "stuck" together a little
- in the case of bursitis
- the pleura in the case of inflammation
- when a joint is worn out due to osteoarthritis
Acromio-clavicular joint (AC joint)
Cracking in the acromioclavicular joint
The so-called AC joint is a small joint at the top of the acromion. It is quite variable in its shape, which is quite unusual, as the joint partners normally match perfectly. To compensate for the differences in shape in the AC joint, it has its own intervertebral disc. The joint moves very little, but when the arm is raised above the horizontal, it makes a small rotation of about 30°. This rotation, together with the pressure that then acts, is poison for the intervertebral disc. That's why it wears out quickly and many people get a crack in the AC joint.
Causes and symptoms
Cracking alone is not a cause for concern and does not require treatment. If it starts to hurt, an investigation should be considered. Osteoarthritis is then suspected. Sometimes the pain exists independently of the cracking, which is also a sign of osteoarthritis. In rare cases, the arm may lock when lifted.
Diagnosis
As the joint is located directly under the skin, it is easily accessible for physical examination. An X-ray is taken to confirm the diagnosis and rule out other causes of pain, such as calcification. A shoulder can also have multiple problems, so an MRI (Magnetic Resonance Imaging) should also be performed.
Conservative treatment for osteoarthritis of the AC joint
Painkillers are helpful for severe pain. As the joint lies directly under the skin, pain ointments can also be used. Physiotherapy helps to regain mobility and perform movements without pain. An injection of cortisone can also provide relief.
Surgical treatment for osteoarthritis of the AC joint
As the collarbone is firmly attached to the shoulder blade at several points, the AC joint can be surgically removed without damaging the shoulder. Today, this operation is often performed arthroscopically, as a keyhole operation, because the shoulder can also be viewed and treated if necessary.
Aftercare
Follow-up treatment often takes time and can be associated with pain. The chances of recovery after AC joint removal are very good. Most people are pain-free afterwards and can return to sport.
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PD Dr Andreas L. Oberholzer
FMH specialist in orthopaedics and trauma surgery. Areas of specialisation: Knee, hip and foot surgery.