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Snap, Crackle, Pop: Interpreting Body Sounds

July 1, 2003 10:12 AM

by Dr. Jim Brown

"I felt like something had hit the back of my leg just above the heel and it sounded like a muted rifle shot." This is how Philadelphia orthopedic surgeon Angela Smith described the feeling and the sound when she ruptured her Achilles tendon. "I knew it had to be one of two things. Either my tennis shoes had split or I had torn my Achilles tendon. The pain told me it wasn't my shoes."

The kind of sound and intense pain that Smith heard and felt is very specific to a torn Achilles tendon. There are few injury-related sounds that are as noticeable and as significant as the one heard with her injury. Another is when the anterior cruciate ligament is torn or completely ruptured. That crackling sound is made by the damage to the ligament that connects the ends of the thighbone (femur) and shinbone (tibia). But the sound made when a tendon or ligament is ruptured is different from the creaking, grinding, cracking sounds that most athletes hear every day.

Painless Noise Not Bad
"Don't make too much out of sounds made by movement around a joint," warns Andrew Cosgarea, M.D., an orthopedic surgeon at Johns Hopkins. "Painless noise is normal. It could be caused by irregular surfaces rubbing against each other, pressure changes around a joint, or two ligaments coming into contact. The only time to worry about it is when the sound is accompanied by pain."

The creaking/cracking sound with which most of us are familiar is called crepitus. The noise usually goes away or is not as noticeable with exercise. But there are musculoskeletal conditions in which noise may be one of several symptoms to be considered. It is important to remember Cosgarea's warning and not to assume that the sound is synonymous with an injury.

Tendinitis Trouble
With tendinitis in any part of the body the person may hear a sound. Flexor and extensor tendinitis in the foot, for example, means that there is an inflammation of the tendons running from the muscles of the lower leg to the top of the foot. These tendons allow extension and flexion of the toes. In severe cases, a creaking sensation is felt or heard when the toes are straightened or bent. This is especially noticeable when running. Says Cosgarea, "It is true that a sound may be one of the symptoms, but only in some cases." Other examples include a creaking sensation with Achilles tendinitis and a crackling sound that can accompany tendinitis of the wrist.

Ankle Anxiety
In second and third degree ankle sprains, a tearing sensation, pop, or snap might be felt when the ankle rolls inward or outward. That, along with swelling and tenderness, happens because one or more ligaments that hold the bones of the ankle joint in place have been torn or completely ruptured. Adds Cosgarea, "You cannot make a general statement about ankle sprains and popping or snapping sounds, but they are possible when the sprain includes torn ligaments."

Knee Noises
Knees can be noisy, whether they are injured or not. Most of the time, the crunching and cracking sounds that they make are harmless. Loose fragments in the joint have been known to make noise, but the sharp pain that they sometimes cause make the noise a secondary problem.

A meniscus injury involves the crescent-shaped cartilage that is found on both sides of the knee joint. It is a shock absorber and a stabilizer. When meniscus cartilage is torn, it can catch on the end of the femur and occasionally make a clicking sound. The medial meniscus, the one on the inner side of the knee, is the one most often affected.
A crunching, crackling sound can accompany patellofemoral pain syndrome, the medical term for front-of-the-knee pain. More important and recognizable symptoms include pain in front of the kneecap, intensified pain during exercise, pain when the person sits with the knee bent for extended periods of time, and a knee that occasionally cannot support the weight of the body.

Shoulder Sounds
A snapping sound, severe pain, and a "Popeye muscle" are symptoms when a rupture of the long head tendon of the biceps has occurred. This is an injury that Denver quarterback John Elway sustained near the end of his career.

Sometimes there is a sensation of popping or tearing rather than a distinct sound. This could happen with a shoulder sprain, a dislocation, or a subluxation (when the ball of the shoulder joint moves out of the socket, then back in again), and all three conditions would cause intense pain. In a shoulder strain, crepitus is present when the injured area is pressed with the fingers.

Summing Up
Don't be alarmed by moving body parts that just make noise. That snap, crackle, and pop is pretty common, although our bodies seem to be noisier as we get older. More reliable symptoms of an injury or condition that need medical attention are tenderness, swelling, pain, loss of strength, and limited range of motion.

Jim Brown will be contributing new content to this site on a monthly basis. If you have a question for Dr. Brown please feel free to email him at sportsmed@mindspring.com.




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