Is a "clicking" sound in the joint a problem?

Bone and joint

When we sit for a long time or maintain the same posture for a long time, we can often hear a "click" sound coming from our knees, shoulders or spinal joints when we suddenly stand up, shrug or stretch; or, the martial arts masters in the movies also make a few "click" sounds when they turn their necks or snap their fingers before a fight.

Some people may ask if the "clicking" sound of joints like this will affect health. Some may even worry: "Is my bone broken? Is there something growing inside it?" "My joints hurt a lot when they click, so there must be something wrong with them?"

In fact, the "clicking" sound made by various joints of the body is called "joint popping". According to its occurrence mechanism, joint popping is medically divided into two categories: physiological and pathological.

First, let us understand the structure of the joints.

The articular surface constitutes the contact surface of the related bones; the joint capsule composed of the outer fibrous membrane and the inner synovial membrane is attached to the bone surface around the joint, tightly wrapping the joint like a "sleeve"; at this time, the joint capsule surrounds the joint into a cavity, namely the joint cavity, which contains a small amount of synovial fluid, and the cavity is in a negative pressure state, which helps to stabilize the joint.

Physiological snapping is the snapping of the normal structure of the joint. When the joint is suddenly stretched or flexed, the joint capsule is stretched and expanded, which leads to an increase in negative pressure in the joint cavity. The gas around the joint and in the synovial fluid is precipitated, making a crisp sound. The snapping sound is actually the vibration sound of the gas diffusion wave in the joint cavity. Simply put, it is like the "pop" sound heard when the thermos cap is pulled off after the hot water is cooled down after the hot water is filled in a thermos bottle. As a result of gas diffusion, the pressure in the joint cavity tends to be balanced again, the distribution of synovial fluid increases, and the flexibility of the joint increases. The transition from static balance to dynamic balance is the condition for the coordinated contraction and relaxation of muscles to complete voluntary movements.

Therefore, physiological snapping will not affect our health, so don’t worry! Some people also like to bend their fingers, and they feel much more comfortable after making a “clicking” sound. Will this damage the joints? There is no need to worry. Professor Deweber of the United States has conducted research on this and found that bending fingers will not cause finger osteoarthritis [1]. Of course, you should also be moderate when bending your fingers. Excessive force may also cause damage to the interphalangeal joint ligaments or tendons, which will harm your body!

How do you identify common physiological snaps? There are four main points[2]:

1. The "click" sound only occurs when the joint is suddenly stretched or flexed;

2. The snapping always occurs after our joints have been stationary for a period of time;

3. The sound is crisp and discontinuous, and there must be a period of time between two sounds;

4. After the joints "click", there is no discomfort feeling, but the joints feel much more relaxed and flexible.

So what are the pathological joint popping?

1. Abnormal increase in pressure in joints: joint swelling, joint inflammation, etc. cause abnormal sounds when the joints move;

Abnormal friction of tendons on bone surfaces, such as snapping hip, sliding of iliopsoas muscle on iliopectineal eminence; iliotibial band spasm, snapping occurs when knee joint is extended, but painless;

Abnormal friction and impact between bones. If the force line of the lower limb is not correct or the position of the patella is abnormal, the patella will impact or rub against the femur;

Changes in cartilage, meniscus, etc.

Osteoarthritis patients have damaged bone cartilage surfaces, and bone-to-bone friction during activities produces a dull, frequent sound, accompanied by local swelling and pain. Patients with meniscus injury or discoid meniscus experience a "clicking" sound in the joint space, often accompanied by joint locking.

Loose bodies in joints, etc. The occurrence site is not fixed, irregular, with a small snapping sound and joint locking;

Stenosing tenosynovitis. The tendons of the hand are covered with tendon sheaths. When the fingers move, the tendons slide in the sheaths. If the tendons are strained due to excessive movement and repeated friction, the tendon sheaths may become inflamed and narrow, and the tendons may swell like a thin gourd. The fingers cannot move after a certain degree of movement. If they move with force, the fingers may bend suddenly and make a sound. This is more common in people who move their fingers more.

In addition, in addition to these physiological and pathological causes of joint clicking, various surgical operations on the joints may also cause postoperative joint clicking.

For example, after anterior cruciate ligament reconstruction, the infrapatellar contracture syndrome that may occur can also cause crepitus; patients who undergo total knee and hip replacements may experience a "clicking" sound when the joint prosthesis moves after surgery.

Of course, medicine is complicated, and all kinds of joint popping have their own special reasons. Some popping sounds are difficult to judge without a detailed doctor's examination and comprehensive medical history, physical signs and imaging analysis. Therefore, after excluding physiological factors, be sure to consult a doctor in time!

References:

[1] Deweber K, Olszewski M, Ortolano R. Knuckle cracking and hand osteoarthritis[J]. Journal of the American Board of Family Medicine: JABFM, 2011, 24(2): 169–174. [2] Huang Juanjuan, Yi Aichun. Is there any disease when joints crack?[J]. Journal of South Central Pharmacy (Medication and Health), 2017(10):83. / /

Recommended experts:

Chief physician, associate professor, graduate tutor, doctor of medicine.

Member of the Science Popularization and Health Education Working Committee of China Medical Education Association

Member of the Bone Tumor Group of the Orthopedic Committee of the Sichuan Medical Association

Member of the Sarcoma Committee of Sichuan Anti-Cancer Association

Member of the Tumor Minimally Invasive Therapy Group of Sarcoma Committee of Chinese Anti-Cancer Association

He has been engaged in clinical, teaching and scientific research work in orthopedic surgery for more than 20 years. He has published more than 30 papers in domestic and foreign journals as the first author/corresponding author.

He is good at the diagnosis and treatment of joint diseases and bone tumors, and has rich experience in joint replacement (including complex hip and knee revision surgery, DAA anterior minimally invasive hip replacement, unicompartmental knee replacement, etc.), limb deformity correction and limb-saving surgery for malignant bone tumors.