Dr. Roach: Crunching sounds during joint movement not unusual

Keith Roach
To Your Health

Dear Dr. Roach: I am a 64-year-old 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 D.: 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.

Dr. Keith Roach

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.

Dear Dr. Roach: My husband wants to rent a van so that a group of friends can visit together while touring the local sights. I am very reticent to say yes because we would be in close quarters for an hour or more. If you say no, it will help me convince him this is not a good idea. He thinks everyone in the group is “being careful” and I shouldn’t worry. I hate to disappoint my husband, but we’re both over 65.

M.J.

Dear M.J.: Please, please do not do this. As you say, being in a closed, confined environment for a prolonged time is a very effective way to spread COVID-19. People can be infectious with no symptoms, and there are many infected people in the country now. Your friends may indeed have been careful, but maybe one of THEIR friends hasn’t been, and infected one of them. Why not drive your own cars and follow each other?

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 short-lived.

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.

Readers may email questions to ToYourGoodHealth@med.cornell.edu.