Crunching sounds during joint movement not unusual

DEAR DR. ROACH » I am a 64-yearold female in good health, but after years at a desk I have upper back and shoulder flexibility issues. About 20 years ago I had frozen shoulder syndrome that resolved through physiotherapy and exercise. I now want to keep my upper shoulder flexibility and maybe enhance it.

I have been doing some exercises to increase the movement of my shoulder. This creates a lot of crunching sounds in my shoulder joint as I rotate the joint. There is no pain.

Am I doing damage to the joint, or loosening it up and getting rid of calcification? Should I keep crunching or stop?

— D.

DEAR READER » It’s not unusual to hear a crunching or popping sound or sensation in the joints.

There are many different causes, both in the soft tissues of the joint as well as the bones, and not all of them are concerning. In people with osteoarthritis, an examiner can feel the crunching (called “crepitus”) associated with the bone spurs (called “osteophytes”) of that condition, and often be moderately sure of the diagnosis by feel alone.

Frozen shoulder is caused by inflammation of the joint capsule, the ligaments and the lining of the joint. The mainstay of treatment is physical therapy, sometimes with joint injections and rarely requiring surgery. Regular range-of-motion exercises are wise in people with a history of frozen shoulder.

I can’t tell you for sure what is causing the crunching sounds in your shoulder. But exercise is good for both frozen shoulder and for osteoarthritis, and I would encourage you to continue them unless the exercises are causing pain. In that case, a reevaluation by the doctor who treated your frozen shoulder would be a good idea.

DR. ROACH WRITES » A recent column on chest wall syndrome motivated many readers, including some of my physician readers, to ask about costochondritis. The costochondral junction is where the rib (“costa” in Latin) meets the cartilage (“khondros” in Greek), and that area can become inflamed and painful. Acute costochondritis is most commonly caused by a virus, especially Coxsackie B viruses. The pain can be exquisite, but it is usually shortlived.

In my recent column, the pain had been going on five months, so the diagnosis is likely chest wall syndrome, which is more a syndrome than a specific diagnosis. Costochondritis is a more specific diagnosis, unlikely in this case due to the longer time course.