This question is one of the most common we get asked in our Physiotherapy Consultations when we are dealing with shoulders. Well, today folks we deconstruct and tackle this question head on!
As with any symptom-focused question, it is always important to start with our anatomy – for our shoulder this includes your, tendons, ligaments, bursae, cartilage, bones and muscles.
As you can see by the images below there is a LOT going on in there, BUT the 2 things I want you to see is the large number of tendons (that connect muscle to bone) AND the enclosed space for it all to move in, even before the ball of the shoulder joint moves.
The ‘one-off event’
Now. There are occasions where flicking, clicking and crunching will not cause a rotator cuff injury, or lead to impingement. These one-off events, will almost certainly be a tendon flicking over the bone, like a guitar string – and happen if you grab an object of weight, or reach for something at an awkward angle.
If repeated however, it would be like rubbing a piece of string along rock… it will degrade, and eventually snap….!
What leads to me getting symptoms of flicking, clicking and crunching?
As already addressed in our previous articles, many of us do not lead lifestyles that particularly suit our complex shoulder structures, and as aforementioned, left unchecked can lead to a whole host of noises being made by our shoulders.
Very often, people report that when they do a press-up, lift something heavy, move the shoulder in a circular motion, or simply pull the shoulder blades back, they experience a pop, crunch, flicking or clicking sensation. However, they report it does not cause pain, and no swelling or issue comes about.
Although clicking, flicking and crunching is common in our day and age, it is not normal. I repeat, NOT normal!
The 5 most common causes
1. Shoulder Impingement
This is where, often due to worsening posture, there is narrowing of the (subacromial) space where the tendons pass through.
This means when the arm is lifted the tendons catch or or pinch against the acromion, or bursa.
2. Scapulothoracic bursitis (or ‘snapping scapula syndrome’)
Caused by an inflammation of the bursa, which helps glide movement between the two surfaces.
Scapulothoracic bursitis, or snapping scapula syndrome, is caused by weakening of the muscles underneath the scapula, leading to the scapula sitting in close proximity to the ribcage. The shoulder condition causes a grinding, grating, and snapping sensation of the scapula on the back area of the ribcage.
Within the shoulder complex, there is a small fluid-filled sac, known as the bursa, that sits within the joint capsule. The bursa acts as a cushion and a shock absorber, helping the joint slide together upon movement. If it becomes inflamed through trauma or repetitive stress or strain, then it is known as bursitis.
With any swelling, there’s less space for everything to move, and structures can become tight, causing grinding. If you suspect bursitis, then try and avoid any aggravating movements to give it a chance to settle, and seek medical attention, in the form of a doctor or a Physiotherapist.
4. Malunion of fractures of the scapula or ribs
If you’ve experienced a recent fracture of your shoulder or ribs and the bones do not heal properly, they can develop protrusions that will be prone to catching and making noise on moving your arm.
5. Labral Tears
The labrum is like a raised edge to the the socket where the shoulder ball joint goes into. This can be damaged to to trauma, overuse or old age, and if torn, can cause friction/flicking when the arm moves.
How can I get rid of my flicking/clicking/crunching symptoms?
Here are some general principles that will help in the first instance, but if you are experiencing these regularly, you should seek immediate attention from a GP or a Physiotherapist to discern the cause
- Identify what is causing them.
- Avoid overuse of the shoulder.
- Rest is imperative for an overworked shoulder, to allow inflammation to go down.
- Be careful about lifting weights at an awkward angle.
- Stretch the pecs and strengthen the upper back muscles… You may be getting the picture with this last one!
- Persistent flicking, crunching and clicking in your shoulder is not normal. A deeper problem is indicated and we would recommend medical attention to have a full diagnosis and plan.
- Damage is being done, regardless of pain experienced. Our bodies have protective barriers in place, but if we continue to regularly irritate, we break these barriers down.
- There is hope for you yet! Stick with our articles to stay on track with your health.
💡 If you missed it first time round, check out our article here, on ‘Your rotator cuff and how to prevent breakdown’.
References (to order and reference in-text)
- Chen AL, Rokito AS, Zuckerman JD (April 2003). “The role of the acromioclavicular joint in impingement syndrome”. Clin Sports Med. 22 (2): 343–57.
- Blaine TA, Kim YS, Voloshin I, et al. (2005). “The molecular pathophysiology of subacromial bursitis in rotator cuff disease”. J Shoulder Elbow Surg. 14 (1 Suppl S): 84S–89S. doi:10.1016/j.jse.2004.09.022. PMID 15726092.
- https://www.concordortho.com/patient-resources/patient-education/topic/c4e0ddc867e3083e0a73734645660d37 – scapulothoracic syndrome
- https://www.jshoulderelbow.org/article/S1058-2746(03)00055-7/fulltext —- Scapulothoracic bursitis (or ‘snapping scapula syndrome’)