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Home > Crepitus – When You Hear & Feel Your Knees Go Snap, Crackle, Grind & Pop

Crepitus – When You Hear & Feel Your Knees Go Snap, Crackle, Grind & Pop

Boyd W. Haynes III, MDBoyd W. Haynes III, MD

If you know, you know!  Most anyone who suffers from osteoarthritis of the knees knows what our title is referring to – that icky, Rice Krispies® and milk sound you hear and the grindy, snapping, popping, crackling, or catching feeling you get when you bend or move your arthritic knees a certain way.  The clinical name for this phenomenon is crepitus, and it is a sound or sensation that occurs when bone surfaces move against cartilage or against one another. Tiny bubbles of nitrogen work their way through soft tissue into the joint capsule and when they get popped, you hear those tell-tale noises like someone has gotten a hold of bubble wrap and is going to town, bursting every air-filled pocket.

Recognizing Crepitus & Osteoarthritis

It can occur in any joint and the joint doesn’t have to be arthritic to make a sound or for you to feel a sensation.  When a person “cracks their knuckles,” a small bubble of nitrogen is trapped in the joint and the person forces that bubble to burst by putting pressure on the joint, making a cracking sound.  That also is a form of crepitus.  Many people are easily able to “crack” their neck, almost like a party trick.  Yep, that is crepitus too. Bursae that are inflamed can make noises, as can tendons.  All are forms of crepitus.

For our discussion today, we are going to focus on the crepitus that comes from osteoarthritis in the knees and what you should know if you have experienced crepitus. Rest assured, crepitus by itself isn’t anything to worry about.  However, crepitus that comes with stiffness, pain, and a reduction in function indicates that you may be developing osteoarthritis or may have an injury to or disease in the joint.

When to See a Doctor About Crepitus

If you start feeling pain and stiffness in your knees, likely you will try some home treatments, like ibuprofen for pain and inflammation, maybe some icing, rest, maybe a topical rub, like Icy Hot® or Bio Freeze®.  Perhaps, you’ll change your activities, lessen your workouts, or change them to give your knees a rest.  If those don’t work for you, you’ll probably seek medical attention and that is also what I would recommend at this point.

Diagnosing Osteoarthritis

When you come to see me for your knee pain and crepitus, I will first order x-rays of your knees to see if they have signs of osteoarthritis. I can see this quite well on x-ray because I order the images of you bearing weight on your knees. The bones show up bright white on the x-rays and I am looking to see if you have a nice, healthy margin of space between the bones of your knees. I can also see if the bone edges look jagged, rough, and eroded. I can see if your cartilage is healthy and plentiful, worn, or non-existent. X-rays give me a great deal of information about the health of your knees. We will review the x-rays together in the exam room and I will tell you exactly what I see.

Then I will also do a thorough examination of you, ask you to walk, bend your knees, show me your range of motion.  I’ll press and poke in different spots to try to elicit a pain response (don’t worry, it won’t be bad!) and ask you lots of questions about your lifestyle, activities, work and what you enjoy doing.  Before you know it, I’ll be ready to give you a diagnosis and let you know what I think your crepitus is telling you!

Treating Knee Pain from Osteoarthritis

Usually, I find that folks who come to see me with crepitus and pain in the knees do have osteoarthritis. Occasionally, I have someone who has torn a meniscus or some sports injury.  Treating osteoarthritis is something that I do every single day. As most patients have done most of the conservative treatments at home, I typically move them right along the therapy continuum after they have been seen in my office.

I often recommend a heavier duty anti-inflammatory medication to calm down the tenderness, swelling and joint stiffness of osteoarthritis. I may prescribe a steroid to kickstart this process, but must decide upon the delivery vehicle, whether it be a pill or injection, based upon the needs of the patient and the severity of their dysfunction. This medication also helps patients start Physical Therapy with less pain to strengthen and regain function in their legs and stabilize the knee joints.  I may also prescribe a knee brace for patients who have instability or who have an injury, while they go through the recovery process.

Patients whose osteoarthritis continues to worsen will then progress to either viscosupplementation (hyaluronic acid) injections which help to lubricate the joints, arthroscopic surgery to clean up meniscal tears or ragged knee cartilage, or eventually to partial or total knee replacement surgery.

Knowing what “it” is (crepitus) makes all the difference.

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