Shoulder Crepitus: Not improving. Ideas for next steps?

July 27, 2009 7:21 AM

Shoulder crepitus: when I roll my shoulders back, they pop and click many times, like crunching. It has worsened over the past seven years or so that I've worked at a desk. I've tried a few things and have had no relief, although it doesn't seem to be worsening any more. What should I try next?

YANMD: I'm looking for ideas for next steps.

Possible causes: it's far worse in my right side, and I am right handed. I think it's caused by using a mouse, driving, or carrying heavy bags on my right side. I stopped carrying heavy bags, moved for a shorter commute (now i take the bus or bike), and have tried ergonomic mice without much luck. Maybe it's bad sitting posture, sleeping posture, something genetic, I don't know.

Stuff I've tried:
Lots of stretching, movement, shoulder-rolling.
YANAD: Primary doc: "take ibuprofin for two weeks and stretch". I already stretch my shoulder about 5 - 10 times daily. No improvement with this approach.
Second doctor's opinion: "take yoga." Maybe I need more yoga, but it hasn't been improving.
Acupuncture and accupressure: 4 sessions, no real improvement on the shoulder (though my meditation improved. Too costly to continue.)
I'm getting back into lap swimming to see if backstroke will help it.

Stuff I haven't tried but heard/read might work (mostly guesses by people I know):
Physical therapy exercises for the rotator cuff.
Fasting. (Seems hard to follow for the length of time required. I think i heard 40 days or so.)
Chiropractor.
Physical therapist.
Heavy massage because there has been some kind of 'fusing' that needs to be broken up (although this seems too costly for the number of sessions needed, and not covered by insurance.)

I haven't found much info on this topic online. I've been searching terms like shoulder clicking/crunching/crepitus, so search term suggestions are welcome. The professionals I've asked about it don't seem to be very familiar with the problem. It's not terribly painful, but it's rather uncomfortable. Others can hear it (so it's not just loud to me by bone conduction), and if you place a hand on my moving shoulder, you can feel the crunchiness.

Has anyone heard of this and its causes? Or better yet, fixed/improved it? What kind of professional would know about this?

posted by degrees_of_freedom to health & fitness (23 comments total)

Does it happen every single time? Mine do this pretty predictably if I haven't been moving them much for a while, but I usually get one good pop or crunch and then nothing for an hour or two.
posted by restless_nomad at 7:29 AM on July 27

It's not just me? Awesome! Well, not awesome, but at least now I know I'm not alone. Like you, I hear several pops and clicks when I move my shoulders - it feels like it's in the center of my upper back, and is audible to others.

My back crunching tends to subside if I get a good massage, but it always returns by the next day. I haven't found anything yet that helps in a more permanent fashion. I've started sitting on an exercise ball instead of in a desk chair, so I'm curious to see if the resulting changes in my posture will help at all. No changes yet, but I only got the ball a week ago.
posted by pemberkins at 7:33 AM on July 27

Use your mouse with your left hand for a bit, and definitely do lots more yoga.
posted by ohyouknow at 7:37 AM on July 27

I have this in my knee and my physical therapist told me it was caused by wear and tear on the joint. In my case, it's because my knees don't track well, and I've had great improvement with strengthening the muscles around the joint to improve alignment and take some of the pressure off my kneecap. You don't mention how much you're working out now, but physical therapy and stepping up your upper body strength training in particular could really help.

My friend has the same thing in her shoulders (with pain) and finds swimming particularly effective.
posted by *s at 7:40 AM on July 27

I don't have crunchy shoulders but I have many shoulder and back issues as well as carpel-tunnel-ish symptoms in my right hand.

For the mouse-related stuff I started using a Wacom tablet with a pen and it disappeared within days. After 2 years I was forced back onto a mouse and within a month the symptoms were back. The second time around changing to a pen didn't help so now I mouse with my left hand instead of my right.

For the shoulder and back pain the best thing I've found is a combination of proper desk/chair/computer set up and Pilates. I've only recently started the Pilates so it might not be the magic bullet it seems right now, but I think it's certainly worth a try.

Good luck.
posted by HopStopDon'tShop at 7:42 AM on July 27

That crunching and popping sound isn't normal? I have a severe case of this, despite a lot of shoulder-rolling and stretching. I didn't know I should be concerned about it, since it's not painful and all my everything in that area works just fine.
posted by molecicco at 7:46 AM on July 27

I don't know much about your crunching and popping, but I recently had shoulder problems from bad desk posture and did lots of reading. Everyone who sits at a desk seems to have variations of the same postural issues. A couple of things that won't hurt and will probaby help:

--Stretch your pecs. Probably your shoulders slope forward all day long and your pecs and front delts tighten up. Just hold one side of a doorway and try to get your arm straight behind you, and hold it for a while.

-- Stretch your neck muscles. Probably, since your shoulder slope forward, you crane your neck back the whole time. I'd just look up "neck stretch" on youtube.

--Strengthen the muscles between your shoulder blades. This will make them want to shorten, thus pulling your shoulders back more. You can do it like this.

--Hang yourself from a pull-up bar to decompress your spine. This may have nothing to do with your problem, but it seems to be good on general principles. When I do it my shoulders make little popping noises and they feel better afterwards.

--Do "shoulder dislocations" to stretch your shoulders. They're just called "dislocations" and they look like this.

In my case, I thought I had torn a rotator cuff because I couldn't move my right arm behind my back at all, so I stopped working out, and it kept getting worse. When I was finally told it was just postural problems, I started working out again and stretching more conscientiously and it all went away pretty quickly. My impression is that with shoulder problems, unless you have actual tissue damage, staying active is pretty much always a good idea.
posted by creasy boy at 8:04 AM on July 27 [3 favorites]

I'm pretty sure what you are experiencing is normal for someone who spends their workday at a desk. Probably in a standard office chair...and not always in a perfect posture. Your joints settle into position and then you force then back to where they belong...you get snap, crackle, pop.
>insert "wait til you get old" comment here<>
posted by Thorzdad at 8:04 AM on July 27

A few answers...
It cracks everytime, about 4-6 very loud pops and countless mini-pops.
I work out, but it's mostly lower body (street biking, elliptical, jogging, walking). Good call on upper body strength. I used to surf more, but even that develops the upper body front more than the back.
I'll try left mouse and wacom tablet! Left mouse is certainly cost effective.
I'm not sure that it' is a problem... I was under the impression that many shoulder surgeries could have been prevented by earlier non-surgical interventions. Does anyone know if this can develop into something more serious?
posted by degrees_of_freedom at 8:16 AM on July 27

Rotator cuff exercises are easy and I don't imagine they'd cause any harm (in moderation), so I'd suggest giving them a try for a while.

OTOH, I have this in one shoulder, as well as occasional pain in that shoulder that my doctor prescribed rotator cuff exercises for, and the doc didn't imply there was any connection between the two.

and if you place a hand on my moving shoulder, you can feel the crunchiness
I used to go ballroom dancing and my partners sometimes found the crunching very disturbing.
posted by hattifattener at 8:18 AM on July 27

I have this, too. I have had it for most of my adult life and can make horrible crunching noises with my shoulders on demand. I don't think it's necessarily normal. Most of my friends life lives in office chairs, but no one has quite the shoulder issues that I do.

Over the years, it has gotten worse, so I've asked doctors about it. They usually just shrug it off or make an offhand comment that my muscles are just tight. When I was going through physical therapy for an unrelated problem, I asked my PT about it while emphasizing that I didn't think it was normal tightness and explained in detail what was going on. She simply shrugged and said that it was because I was double-jointed in my shoulders. What? She didn't really explain. This didn't make any sense to me, but she was extremely knowledgeable about everything else, so maybe this is a lead to go off of?

I make a point to get regular massages. I avoid the chiropractor, but just because I've seen too many people hurt by bad experiences and I don't agree with a lot of the holistic approaches that our area chiropractors have. I have asked massage therapists about my shoulders and they never really have a definite answer either, but hint that maybe there are tight tissues deep down under my muscles that they are just never able to get to that stay tight all the time.

Recently, I picked up this book, which I am hoping might have some answers and tips: Strong Women, Strong Backs It does have a full exercise regimen. I have no idea if there is an equivalent for men.

I will be watching this thread with interest!
posted by bristolcat at 8:20 AM on July 27

Also, FWIW, a Wacom tablet didn't really help my issues but it is probably worth a try.
posted by bristolcat at 8:21 AM on July 27

Yeah, welcome to a desk job. If I roll my neck and shoulders around it sounds like someone walking on bubble wrap.

It's worse when overworking or stressed, and I find that I sometimes sleep in some bad positions that are not kind to my neck... which makes it worse all week, since that means the neck and shoulders never get a chance to relax.

I have one of those sexy recurved neck-pillow things now, which has helped. It still gets stiff and poppy when sitting/typing during the week, but at least I can sometimes get it relaxed enough to 'reset' at night.
posted by rokusan at 8:38 AM on July 27

i have this too. after a few years, i got used to the popping. however, i have also discovered that my shoulders are now a lot more sensitive to injuries. i am just now getting over major rotator cuff pain from when i fell on my right shoulder when skiing. another time, i had the same kind of injury when playing volleyball, and i went to set a ball.

i saw a doctor--he poked around for a bit and then told me i have arthritis.
posted by lester at 8:48 AM on July 27

Seconding creasy boy re the doorway stretch and shoulder dislocations. For the latter, make sure to start with your hands as wide as you need in order to complete the movement without bending your elbows, and then gradually move your hands inwards as you become more flexible. The stick-up is another good stretch.

I'd also recommend learning to overhead press with a barbell. Start light and work your way up. I've heard that pressing overhead has helped a lot of folks with shoulder issues.
posted by ludwig_van at 9:03 AM on July 27

I have had the popping and cracking in only my right shoulder since I was a small kid. It's not painful and isn't associated with anything from what doctors have told me.
I play goalie\player in hockey regularly at a high level and it has never caused any performance problems.

I've never seen any need to try to get rid of it. It only happens when I try to make it happen or roll my shoulder very hard. It's more of a, "hey come feel my weird shoulder" than anything else for me.
posted by zephyr_words at 9:13 AM on July 27

Go see an orthopedist. Get some baseline Xrays on file. Unless there is something very wrong (and there's probably not), a good orthopedist will suggest PT, yoga, and other work.

An orthopedist should give you some exercises/stretches that you can do a few times during the day.

Anyone who wants you to have back surgery without six months - or more - trying to manage this with exercise should have a darn good reason.
posted by Lesser Shrew at 11:35 AM on July 27

I have this but for my hips, which pop like crazy. I've noticed that since I started doing strength training (all muscle groups, including lower body/legs/thighs etc) the popping and crunching has decreased substantially.

Also, my middle-back used to pop if I simply inhaled deeply-- my personal trainer at the time had me start doing weights exercises that strengthened my back muscles, and now the inhaling--> popping doesn't happen anymore. I don't know why exactly this is, but it's helped me with this problem. YMMV
posted by np312 at 12:18 PM on July 27

The Wall Shoulder Girdle stretch has been extremely helpful in rehabbing my tweaked trap/crackling shoulder. I personally wouldn't waste your time and money with a fancy doctor, I had an acute pain in that region and my well-credentialed sports medicine guy looked at it for maybe 30 seconds and told me that if I were one of his players, he would tell me to get back on the court.
And since no one else has mentioned it yet, foam roll the shit out of that shoulder. If nothing else, it really feels great.
posted by ch1x0r at 7:45 PM on July 27

If you haven't seen a physical therapist yet, try getting a recommendation for the best one locally and see that one. Around 10 years ago now I was having awful, but awful pain up and down both arms and I was sure I was getting carpal tunnel, which sucked because I was a programmer. I went to see a physical therapist and 10 years later I can still type.

This guy really knew what he was doing and, more importantly, knew what was going on in my body and how to fix it. A good PT should be able to explain why your shoulder is doing this, or if not why s/he doesn't know. They will certainly be able to suggest exercises for it.

Same thing when I went to a different guy, also acclaimed, after my hip started hurting real bad after doing 10 hours of catering work with lots of walking back and forth. He did some sort of tweaking of my leg, the pain was gone, and later that fall I walked around 9km of an extremely broken down section of the Great Wall of China with no noticeable discomfort.
posted by Deathalicious at 8:51 PM on July 27

My shoulder hurt for a long time and my PT recommended:
(1) Strengthing exercises repeated 3 times / day
(2) Attempt yoga, massage, and/or acupuncture
(3) Consciousness of good posture / avoiding bad posture

Of those, the exercises helped the most - when I consistently repeated my exercises my pain eased and the cracking decreased. Like the mention of someone with "double jointed" shoulders, my PT said I was VERY flexible and this allowed me to accommodate my weak muscles by making others work harder ... I'm a fairly muscled guy but when my PT had be do these exercises using only these muscles, I immediately started shaking and realized how weak some of those muscles really are.

My exercises included the foam roll ch1x0r mentioned and some of the other stretches mentioned by others. But they also included pulling and holding a long piece of surgical tubing wrapped around a door knob and several others. Consistency was the main problem - exercise and I felt better, forget/get lazy and it came back.

I'd say you've done most the reasonable, cost effective things, EXCEPT going to a PT for analysis and recommendations (like specific exercises) - that would be a reasonable next step. Good luck!
posted by unclezeb at 7:36 AM on July 28

Thank you so much! In just a day and a half I have had much relief using the above advice. The crunchiness is less crackly and more dull sounding.

Some findings:
- LHS mouse was surprisingly easy. It's the RHS hot keys that are proving tricky!
- I can tell the exercises will be helpful because they're so much harder than they look. Now the really hard part is developing a routine.
- I'd guess that most of this immediate relief is due to the new stretches. Using the door frame as a stretching tool is blowing my mind. I'm trying new angles/positions, and keep finding these new tender spots that are oddly, deeply satisfying to stretch.
- Stuff: foam roller, stretchy bands, back knobber - no longer in my closet. I'm sitting on an exercise ball with lovely posture because i put my monitor on a stack of books to raise the viewing angle. I'll probably get a doorway pull-up bar.
- Next trip to the doc, I'll ask for a referral to an orthopedist or PT.

After years of irritation and dead end efforts, the prospect of improvement is really exciting.
posted by degrees_of_freedom at 4:43 PM on July 28 [2 favorites]

You know, I've found that doing those shoulder dislocation stretches with a band has helped. Like this guy does, except you don't have to look like this guy.

Also, if you're already going to the gym and you have access to a squat cage, you might want to learn the overhead squat. But be warned that it is very difficult.
posted by creasy boy at 3:11 AM on July 29