Crunching in the joints

Crunching in joints or joint crepitation (from the Latin crepitare - to creak, crunch) is a symptom that is manifested by a peculiar sound arising in the articulations of the bones of the skeleton. And even if the ear does not pick up this crunch or crackle, it can be felt: it is enough to put the palm of your hand on the joint when it moves.

Causes of joint crunching

Let's start with the fact that crunching in the joints without pain, which people can hear, for example, in the knee joints when they get up from a sitting position, is not associated with pathology. It is believed that this sound is the result of cavitation, i.e. The formation and bursting of gas bubbles in the synovial fluid of joints, which accumulates naturally and is expelled when the intra-articular pressure changes (when the joint is bent or flexed).

And when performing repetitive exercises (e.g., push-ups, lifting weights), such a sound when bending the limbs appears due to the friction of strained muscles or their tendons against the bone.

But if the crunching of joints when walking or hand movements is accompanied by pain, it may indicate its damage, the causes of which, in most cases, are associated with the most common joint disease of degenerative-dystrophic nature - osteoarthritis (also called deforming osteoarthritis, osteoarthritis, deforming arthrosis). All symptoms of this disease are caused by the destruction of intra-articular hyaline cartilage with the formation of osteophytes (small and large bony outgrowths on the edges of joints and joint gaps) and subsequent damage to the underlying subchondral bone of the epiphyses and joint deformity. [1]

Details in the publications:

• Risk factors and causes of osteoarthritis
• Main symptoms of osteoarthritis

In addition, joint pain and crunching when you move them can also be symptoms:

• rheumatoid arthritis:
• pyrophosphate arthropathy, chondrocalcinosis or pseudopodagra - deposition of calcium salt crystals in articular cartilage and cartilage tissue of the synovial membrane of joints (articular bag):calcium phosphate (pyrophosphate), hydroxyapatite (calcium hydrophosphate), and calcium orthophosphate; [2]
• synovial chondromatosis of the joints ("coral joint" or Lotsch syndrome).

In juvenile rheumatoid arthritis or due to osteochondropathy in children there is crunching in the child's joints.

Pathogenesis

The pathophysiologic mechanism of crunching in joints that occurs during movement in patients with degenerative-dystrophic joint lesions is attributed to friction of their articulating articular or extra-articular surfaces, deprived of the protection provided by hyaline cartilage.

Cartilage, tightly adhering to the bone and thickened on the convex parts of joints, provides a smooth surface for articulating parts of the joint (low friction) and facilitates load transfer to the bone.

The extracellular matrix of articular cartilage consists of layers of collagen fibrils of different types, parallel or perpendicular to the articular surfaces - to resist shear forces and absorb compression loads. The main cells of articular cartilage are chondrocytes, which are found in the matrix, clustered together and firmly anchored by collagen fibers. When the hyaline cartilage matrix is lost and the number of chondrocytes in it is reduced, osteoarthritis or deforming osteoarthritis develops.

For more information see. - Osteoarthritis: how is articular cartilage organized?

The formation of osteophytes along the edges of the joint and joint gap occurs at the border of the cortical layer of bone and cartilage covering the articular surface and is associated with its degenerative-dystrophic changes or damage. This process is based on the development of a protective and compensatory reaction to the thinning of articular cartilage in the form of cartilage overgrowths with their subsequent ossification (ossification).

And the pathogenesis of hydroxyapatite crystals deposition in the articular cartilage, in all probability, is caused by the increase in the level of bone resorption factors in the articular fluid: proinflammatory cytokine IL-1β (interleukin-1β) and matrix metalloproteinase MMP-1 (interstitial collagenase) - a proteolytic enzyme produced by the synovial membrane.

In which joints does crunching occur and why?

Crunching in the hip joint occurs in osteoarthritis of the hip joint (coxarthrosis) and deforming osteoarthritis of the hip joint. There may be crunching in the joint after endoprosthetic replacement.

Crunching in the knee joint is one of the symptoms:

• osteoarthritis of the knee or gonarthrosis;
• deforming osteoarthritis of the knee;
• knee ligament sprains (leading to instability);
• patellar ligament rupture.

Crunching in the ankle joint may be the result of subluxation, dislocation or sprain of the ligaments; subluxation of the tendons of the peroneal muscles of the tibia; occurs in deforming osteoarthritis of the joints of the foot, and in patients with diabetic foot [3] or increased thyroid hormone production (thyrotoxicosis) - in Charcot osteoarthropathy.

Hand joint crunching also has several causes and affects almost all articulating bones of the upper extremities.

Crunching in the shoulder joint can be caused by:

• deforming osteoarthritis of the shoulder;
• calcifying shoulder tendonitis - inflammation of the tendons of the rotator (rotator) cuff of the shoulder with deposition of hydroxyapatite crystals and calcification of damaged connective tissue.

Crunching in the elbow joint occurs when it is dislocated, arthritis or osteoarthritis.

Crunching of the wrist joint etiologically can be associated with pathologies such as:

• formation of a false joint after improper fusion of a fracture of the navicular bone of the wrist;
• inflammation of the inner synovial membrane lining the joint capsule - chronic synovitis wrist joint;
• Acute crepitating tendovaginitis (inflammation of the synovial sheath of the tendon).

Crunching of the finger joints (metacarpophalangeal or interphalangeal) is most often due to either rheumatoid arthritis or deforming osteoarthritis of the interphalangeal joints of the hands. In rare cases, it is one of the arthritis symptoms of Still's syndrome.

Crunching in the mandibular joint, more specifically the temporomandibular joint (art. Temporomandibularis) can be associated with:

• mandibular subluxation;
• contracture of the masseter muscles;
• protruding lower jaw - progenia or mesial bite.

Also see. - Why does my jaw crunch and what to do?

Crunching in joints throughout the body may indicate polyarthritis or polyosteoarthritis of the joints.

Diagnosis

Joint diagnostics are performed to detect joint pathologies. All details in the materials:

• Clinical diagnosis of osteoarthritis
• Instrumental diagnosis of osteoarthritis
• Diagnosis of osteoarthritis: MRI of articular cartilage
• Laboratory diagnosis of osteoarthritis (primarily intra-articular fluid analysis)
• Differential diagnosis of osteoarthritis

Treatment of joint crunching

Articular cartilage does not usually regenerate after injury or disease resulting in loss of extracellular matrix. When joint crunching is associated with degenerative and dystrophic joint diseases, these diseases are treated. Read more in the publications:

• Drug treatment of osteoarthritis
• Local treatment of osteoarthritis
• Treatment of osteochondropathy
• Rheumatoid arthritis: treatment
• Treatment of synovitis

Drugs for joint crunch in osteoarthritis are drugs for joint pain. There are also no ointments for crunching in knee joints, and apply ointments for joint pain.

Physiotherapy treatment - Physiotherapy for joint diseases

Exercises for crunching joints - Physical therapy for osteoarthritis

Surgical treatment for deforming osteoarthritis of the knee or hip joint consists in replacing the joint with an implant - endoprosthesis. In cases of synovial chondromatosis of joints, therapeutic arthroscopy (washing of the joint capsule and joint sanation) is used.