Joint Sounds

 When moving peripheral joints , the examiner will feel /hear

unusual joint sounds which may or may not indicate joint pathology.

 Causes of joint sounds:

- Escaping gases
- Movement of joints, tendons and ligaments
- Rough surfaces

 Types of joint sounds:

a) Crepitus
b) Clicks
c) Snapping
d) Cracks
a) Crepitus on movement:

- Crepitus is a symptom characterized by a crackling

or grating feeling or sound under the skin, around
the lungs or in the joints. In soft tissues, crepitus is
often due to gas, most often air, that has
abnormally penetrated and infiltrated an area (for
example, in the soft tissues beneath the skin).

- Can occur with or without pain.

- May vary from a loud grinding noise to a squeaking

noise.
- Best detected by active movement testing with the forces
of weight-bearing or muscle contraction maintaining
compression of joint surfaces
- May be noted on passive movement as well.

- Crepitus usually indicates :

1) Roughening of joint surfaces/cartilage wear in joint

space
2) Increased friction between a tendon and its sheath due
to swelling
3) Roughening of either the tendon or the sheath.
- Fine crepitus at a joint suggest early wearing /
roughening of articular cartilage or tendinous problems.

- Coarse crepitus implies badly damaged articular

cartilage and bone .

- A creaking, leathery (snowball) crepitus is sometimes

perceived in pathologies involving the tendons.

- Soft tissue crepitus maybe palpable in patients with

degeneration of the rotator cuff and a bony crepitus
(creaking sound like large tree swaying in wind) will be
evident in patients with osteoarthritis.
 Clicks:
- Normal vacuum click seen in joints - e.g.: click on
knee extension.

- Particularly common in hyper mobile joints in which

laxity of ligaments enables a bone to click as it
moves in relation to its fellow bone.

- Common in joints unsupported by muscles or when a

loose bode lies inside a joint.

- Sometimes heard in opening and closing of TMJ due

to meniscus click, maybe indication of early
nonsymptomatic pathology.
 Snapping :
- Maybe heard or felt around joints as ligaments or
tendons catch and then slip over a bony prominence.

- Less common causes of a pathologic nature are:

- A coarse clunking type of noise accompanying

joint subluxation or instability ( e.g., rotatory instability of
the knee due to ligamentous damage, anterior
instability shoulder testing or degenerative changes in
the joint)
- A semi membranous bursa may snap as it jumps
from one side of the tendon to the other, as the knee
extends
- A trigger finger is often released into extension with a
snap.

 Cracking / Popping sound:

- Occur when traction is applied to a joint.

- Synovial fluid found in a joint cavity contains 15% gas,

and the crack is thought to be caused by a bubble of
gas collapsing.
- E.g.: Knuckle cracking, back and neck vertebrae,
elbow, wrist, ankle etc.
 Conclusion:

- Sounds by themselves do not indicate

Pathology.
- Sounds on movement only become
significant when they are related to the
patients symptoms like pain, swelling
etc.