Crunching in the knees when bending and straightening - causes, treatment, what to do and which doctor to go to

Most people do not pay attention to the appearance of crunching in the joints. As a rule, during a consultation with a doctor, the patient cannot even remember exactly when the first signs of movement disorders, clicking or cracking in the joints appeared.

It should be remembered that a healthy small or large joint does not make any sounds during loads or movements. If a person hears them, then a pathological process is occurring, which sooner or later will develop into a traumatological or orthopedic disease.

Causes of crunching in joints

The main factor influencing the appearance of extraneous sounds in the joints is the wear and tear of the cartilage tissue that lines the joint capsule. Other causes of crunching include:

• collapse of air bubbles that form in the synovial fluid;
• dehydration – lack of water leads to drying of the joint capsule and excessive friction of the articulation elements;
• intense physical activity without appropriate preparation;
• infectious joint lesions;
• sudden movements in the joints;
• hereditary predisposition;
• period of physiological mobility in joints at the age of 16-18 years.

Crunching in the knee joint

The knee joint may creak for no particular reason. This symptom is not dangerous if there is no pain in the knee and mobility is maintained. Healthy knees have a normal shape and there are no signs of swelling in the surrounding tissues. In this case there is no cause for concern.

Crunching in the knee joint can appear as a symptom when:

• meniscus injuries;
• dislocation of the patella;
• the formation of osteophytes - bone growths inside the joint capsule;
• damage to the cruciate ligaments;
• arthrosis, when worn-out cartilage tissue impedes movement, causing pain, friction and crunching;
• diseases related to metabolism (obesity, gout);
• chondromatosis;
• bursitis.

Cartilage destruction occurs in several stages. Degenerative changes spread throughout the joint, leading to hyperplasia of the synovial membrane and thickening of the joint capsule. In advanced disease, severe deformation of the knee and a predominance of granulation tissue in the joint are determined.

University

→ Home → University → University in the media → “I’m worried about crunching and clicking in the joints, pain in the knees.” Rheumatologists answered readers' questions

How to minimize seasonal rheumatic attacks? What complications are possible after tonsillitis and how to avoid them? What causes pain and aches in joints? What blood test indicators can indicate joint problems? Is it worth visiting a rheumatologist if someone in your family suffers from rheumatoid arthritis? The online conference “Diagnostics and treatment of rheumatic diseases in children and adults” was held on the information portals “Healthy People” (24health.by) and TUT.BY.

The questions were answered:

Irina Dmitrievna Chizhevskaya, chief freelance pediatric cardiorheumatologist of the Ministry of Health, head of the Department of Pediatrics of BelMAPO, Ph.D.;

Natalya Albertovna Martusevich, chief freelance rheumatologist of the Ministry of Health, associate professor of the Department of Cardiology and Internal Diseases of the Belarusian State Medical University, Ph.D.

— At the age of 15, I was diagnosed with chronic tonsillitis. I am worried about crunching and clicking in the joints, pain in the knees. What examinations and how often do I need to undergo?

Irina Chizhevskaya : Knee pain can occur with flat feet. If it is not corrected at an early age, it can cause joint pain and even cause osteoarthritis. Crunching and clicking in the joints is normal for a growing body, if not accompanied by pain. For chronic tonsillitis, you need to visit an ENT doctor twice a year and determine the ASL-O level at least once a year. If it is elevated, then the doctor will then give recommendations.

— A 6-year-old child is diagnosed with reactive arthritis. Compresses and non-steroidal anti-inflammatory drugs (NSAIDs) do not help. What is the reason and how to treat it? The child is often sick.

Irina Chizhevskaya : To understand what the reason is, you need to be tested for pathogens of enterocolitic and urogenital infections, for example yersiniosis, salmonellosis, chlamydia, mycoplasmosis. If positive results are obtained, antibacterial therapy is necessary taking into account the pathogen. Perhaps the dose and duration of treatment with NSAIDs was insufficient. Typically, NSAIDs are prescribed for 3-4 weeks. If symptoms of the disease persist after this course, it may no longer be reactive arthritis. And you need to see a rheumatologist.

My daughter (7 years old) has juvenile rheumatoid arthritis. The disease began in February 2021. Takes the drug intramuscularly once a week. Since May 2021, she has been in remission (this is according to the documents; in fact, the last exacerbation was in September 2017). The attending doctors say that the injections will continue until adolescence. Although they previously said that the drug would be discontinued after 3-4 years of remission. She is having a hard time with the treatment (her hair is falling out, she vomits on the day of the injection). How do you know when to stop taking the drug? The child is in a state of stress due to the injections and their consequences. Is it possible to switch to tablet form? Isn't this dangerous?

Irina Chizhevskaya : There is no consensus in the world when to stop the drug. The general recommendation for the earliest discontinuation is 2 years of stable remission, confirmed by laboratory and radiographic research methods. We can talk about the state of remission only after 6 months after the last exacerbation of the disease. And then we count down the drug remission. After discontinuation of the drug, an exacerbation of the disease is possible, which can occur at different times. If symptoms of the disease return, all therapy should be returned. It has been proven worldwide that subcutaneous administration of the drug is more effective than tablets. But since the child is in remission of the disease and does not tolerate injections well, you can switch to the tablet form. This is not dangerous.

— A daughter with JRA (juvenile rheumatoid arthritis) from twins, is there a risk of the twin sister or older sister getting the disease? Is it possible to somehow prevent the development of the disease? Can healthy sisters get vaccinated?

Irina Chizhevskaya : There is a risk, since JRA has a genetic predisposition. But this does not mean that all family members will have this disease. Among all the children we see with JRA, there are only two familial cases. There is no prevention. Lead a healthy lifestyle and avoid stress. Healthy sisters definitely need to be vaccinated.

My son is 2.5 years old. After an acute respiratory viral infection (there was only a runny nose, no fever), I could not step on my foot in the evening for half an hour, and the next day I could not do so for about 3 hours. No pain was detected upon palpation. This is an isolated case; after the next ARVI, this did not happen again. What could be the reason for this, and what tests need to be done?

Irina Chizhevskaya: It’s difficult to answer unequivocally. But since this was an isolated incident, there is no need to worry. If this happens again, you should consult a rheumatologist.

“Blood biochemistry showed an increase in uric acid”

- I am 36 years old. Blood biochemistry showed an increase in uric acid - 371 (normal 155-357), a year ago it was 365. For the last six months, my right knee has hurt when I squat completely, both knees crunch, my lower back hurts when I walk for a long time. I changed my diet, completely gave up white and red meat, and started drinking more water. A month later I did biochemistry again, uric acid was 247! Is it possible to reduce this indicator with diet and so quickly? Should this kind of nutrition become a way of life? Can the knee be checked using an ultrasound or is an MRI necessary? How often should uric acid levels be monitored? (all other indicators are normal, antistreptolysin - 131, creatinine - 65).

Natalya Martusevich : The diet could reduce the level of uric acid, since it is the end product of protein metabolism. And reducing meat consumption reduces uric acid levels. The level of 371 is not significant from the point of view of assessing the level of uric acid, since even with very serious disorders of purine metabolism, the target level during treatment is the level of 360. 371 - can be regarded as a slight excess only if the analysis is carried out correctly (within three days the patient does not should take meat foods or a lot of protein foods).

Without knowing the concomitant diseases and without seeing the type of constitution, it is impossible to answer the question of whether it is necessary to continue to adhere to this way of eating. For people with a thin build, eating meat, on the contrary, can be a way to improve their well-being. An MRI of the knee is ideal because it will give you information about the condition of the subchondral bone and structural changes in the joints.

On the right is Natalya Martusevich

I am 50 years old. The disease is ankylosing spondylitis, third group of disability. Six years ago I underwent treatment with Remicade. There was a remission for 2 years. After a new exacerbation, the hospital prescribed Humira. After the second injection, an allergic reaction occurred. Humira was discontinued and Enbrel was recommended. We have been purchasing Enbrel in Moscow for about 2 years now with our own money. Helps great. Is it possible to get Enbrel for treatment at the expense of the budget and where to go for it?

Natalya Martusevich: Enbrel or any genetically engineered immunobiological drug can be prescribed to a patient at the expense of the state budget in a situation where he has exhausted all possible methods of treating this disease with standard drugs used for this disease, which have shown ineffectiveness/intolerance. In this case, the patient continues to have high disease activity or has developed life-threatening complications (amyloidosis). The decision is made by a special commission of the Ministry of Health, which is appointed by order of the ministry. The patient is sent to this commission on the recommendation of the chief rheumatologist of the region (Minsk).

I have adult-onset Still's disease. I take Methylprednisolone. The work often involves night shifts. I noticed that I feel worst in the evenings. If you take, in addition to the morning dose (4 mg), a small dose of methylprednisolone (1-2 mg) in the evening, then the next day I feel much better. However, everywhere they write that it is recommended to take Prednisolone only in the morning. Is it possible in my case to take a small dosage at night, at least during night shifts, or should I avoid taking it in the evening and take the entire dose in the morning?

Natalia Martusevich: Despite the fact that the classic dose is as early as possible in the morning, taking a small dose of methylprednisolone at night is possible. At night, you are awake and your biorhythms are shifted, releasing your hormones. Night work is not recommended for patients with Still's disease.

- I am 45 years old. Diagnosis: rheumatoid arthritis. What modern medicine can replace Methotrexate? It doesn’t suit me: the gastrointestinal tract is already weak.

Natalya Martusevich: You can replace it with Sulfasalazine or Leflunamite. The choice of drug is determined by the doctor and depends on the activity of the disease, concomitant pathology, seropositivity/seronegativity of the disease. Before changing methotrexate, it is usually recommended to take it subcutaneously, which has minimal complications in the gastrointestinal tract.

— Should you trust the drug Instaflex (advertised on the Internet) for the treatment of arthritis/arthrosis?

Natalya Martusevich: It’s not worth it, because the information on the Internet about this medicine is fake. If this information is discovered, the Ministry of Antimonopoly Regulation closes the site. Despite this, advertising appears again from time to time.

- I am 53 years old. I have been suffering from chronic glomerulonephritis since 2002. Over the past year, severe pain in the ankle joints and elbows has become more frequent, I regularly take blood tests, they are within normal limits. At the Central District Hospital they diagnosed arthritis of the ankle joints, prescribed melaxipol and electrophoresis, during the procedures the pain subsided, then after a while the pain returned. The central district hospital doesn’t have its own rheumatologist; I live in a small village. What do you advise?

Natalya Martusevich: I would advise you to see a rheumatologist at the regional rheumatology center, since rheumatological care is provided at the regional and republican level.

“After the fracture, all joints began to hurt”

- I am 35 years old. At the age of 30, I broke my leg in several places and had surgeries. As a result, all joints began to hurt very much - from the fingers to the ankle. They ache and twist at any time of year and weather. What doctors and what tests are needed to solve the problem?

Natalya Martusevich: If the fractures occurred as a result of a fall from the height of one’s own body, then it is advisable to perform densitometry of the axial skeleton to clarify bone mineral density. The results of the study will show the feasibility of further examination. In the case of normal bone mineral density, the emphasis should be on a non-drug treatment method (physical therapy, massage, if there are no contraindications, swimming, sanatorium treatment, physiotherapy). Because the pain syndrome is based on a change in the load on the underlying bones, muscles and ligaments.

— Are joint diseases and hereditary hemochromatosis C282Y related? How to support joints, what methods and possibilities of prevention?

Natalya Martusevich: Connected. In patients with hemochromatosis, secondary osteoarthritis develops much earlier (earlier wear of articular cartilage and intervertebral discs). This requires correction of the underlying disease, long-term use of symptomatic slow-acting drugs (chondroitin sulfate, glucosamine sulfate or chloride as monotherapy or in combination with each other. Non-drug methods: exercise therapy, spa treatment, physiotherapy, mainly thermal in the absence of contraindications.

I am 49 years old. A year ago, I started having problems with my knee: it hurts to walk, it’s difficult to bend my leg, if you put your palm on it, you feel that the sore knee is hotter than the healthy one. The scan at the clinic did not show any pathology. The therapist prescribed NSAIDs and told me to take them for life. What additional tests would you recommend and where should I go for additional testing?

Natalya Martusevich: To determine the cause of a problem in the knee joint, the following is needed: a general blood test, a biochemical blood test with mandatory determination of the level of C-reactive protein, a general urine test, an examination by a gynecologist, and an ultrasound of the knee joint. If there are no structural changes in the joint, perform an MRI of the knee joint. Examinations can be performed by a therapist in a clinic; MRI is performed if indicated, usually in a hospital setting.

“Knee pain bothers me in spring and autumn”

— All my muscles hurt, I constantly take painkillers, constantly go to doctors, undergo tests and everything else doesn’t help. Tell me what to do, where to go, tell me possible causes or a presumptive diagnosis. Natalia Alexandrovna, born in 1954

Natalya Martusevich : The causes of muscle pain are varied. They can be caused by problems in the muscles, nervous system, or be the result of side effects of drugs, most often statins (drugs to lower cholesterol). To determine the cause, you need to consult a therapist and carry out the following examinations: determine the level of C-reactive protein, creatine phosphokinase, the level of vitamin D, thyroid-stimulating hormone of the pituitary gland, and a general urine test for inflammatory changes. You should also look into the side effects of the medications you are taking. If there are no changes in the tests, the general practitioner will refer you to a neurologist to rule out a neuropathic cause of the pain syndrome.

— Knee pain bothers me in spring and autumn. Should you visit a rheumatologist? If yes, what examinations do you need to come with? Victoria, 35 years old

Natalya Martusevich: Consultation with a rheumatologist is necessary, since some diseases can begin with joint pain without swelling. It is necessary to perform a general blood test, a biochemical study, C-reactive protein levels, a general urinalysis and an examination by a gynecologist. Before examining a gynecologist, you need to undergo an immunological study and determine ASL-O, antibodies to cyclic citrullinated peptide, RF (rheumatoid factor).

Photo: Healthy People portal

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Crunch in the shoulder joint

Clicks and crunches in the shoulders are a dangerous symptom of a number of pathological changes:

• humeroscapular periarthritis, affecting ligaments, muscles, and synovial bursa;
• tenditis – inflammation of the tendons of the shoulder joint;
• osteoarthritis, characterized by degenerative and dystrophic changes;
• cervical osteochondrosis of II-III degree, increasing static and dynamic tension in the shoulder joints;
• bursitis accompanied by pain;
• arthrosis with the proliferation of osteophytes.

The intensity of the pain syndrome and limitation of mobility depend on the root cause of the crunch in the shoulders and the severity of the disease.

Crunching in the hip joint

Problems with mobility of the hip joint are often accompanied by a characteristic crunching or clicking sound. This symptom appears when:

• mechanical damage;
• arthritis and arthrosis;
• Bekhterev's disease;
• rheumatoid arthritis;
• spondylitis;
• osteoarthritis, which is most severely manifested in the hip joint;
• inflammatory processes – bursitis, tenditis;
• gout;
• endocrine disorders.

At the beginning of pathological changes, the patient notices weakness and stiffness in the morning. Later, a crunch begins to appear when moving in any direction, then the symptom is observed even with minimal mobility without tension. In the future, pain and discomfort occurs, which goes away after the click. Severe joint changes are accompanied by skin hyperemia and soft tissue swelling.

When your knees creak

If your knee joints crunch when walking, then it’s time to take care of them. All their lives they are exposed to serious stress, from the fact that they hold the weight of almost the entire body, ending with overloads during active movements (running, jumping). The knees are one of the most vulnerable parts of the skeleton.

When all the joints of the legs click and crunch, at best, the cause of the pathology lies in wearing incorrectly selected shoes or being overweight. Shoes can be changed and weight can be reduced. It's worse if the problem is salt deposits. Although in this case, at the initial stage, you can still improve your health by adjusting your diet.

If the joint is very crunchy in only one knee, they look for damage to the bones or cartilage tissue. If pain is added to this symptom, the patient is checked for the presence of flat feet or osteophyte. Obesity can also trigger this problem.

In cases where, in addition to the indicated symptoms, swelling appears, you need to make sure that the inflammatory process has not begun. If you miss it, rheumatism, chondromatosis, bursitis or tendonitis may develop over time.

Clicking in the hip joint

Athletes and dancers, people engaged in physical labor, often hear their hip joints crunching. The sound occurs when the tendons come into contact with bone tissue during movement. But the problem also arises from dehydration or excess protein. In such cases, doctors will look for arthritis, arthrosis or other inflammatory processes.

Crunching in the hands

Those who have a habit of cracking their fingers should forget about it as soon as possible. A crunch initially indicates the presence of pathology. If you continue in the same spirit, you can injure the joint or damage the periarticular tissue. Sometimes inflammation even develops. The latter is especially dangerous, since the inflammatory process from the fingers will quickly spread up the arms. The more joints that make the sound, the worse it is.

Crunching in joints throughout the body

The appearance of specific sounds in various joints of the body can accompany intense physical activity, sudden weight gain or loss. Changes associated with weight cause transformations in the volume of adipose tissue, fluctuations in homeostasis and intra-articular pressure.

The main causes of crunching in all joints of the body are:

• chondrocalcinosis, in which calcium salts affect cartilage tissue and promote its mineralization;
• osteoarthritis that developed against the background of a hormonal disorder;
• bone tuberculosis;
• Bekhterev's disease;
• rheumatoid arthritis.

Each of these diseases begins asymptomatically. Over time, pathological changes worsen. Lack of timely treatment leads to disability of the patient.

Which joints can crack?

Crunching occurs in almost all types of joints, even in intervertebral ones. Some joints have a special axis of rotation and are actively loaded, so dry crunching is considered normal for them. Let's look at individual cases in more detail.

Hip joint . The so-called snapping hip syndrome is quite common among dancers, athletes, and representatives of professions associated with physical labor. The joint clicks due to the rolling of tendons over the bone surface. The causes of crunching can be excess protein, dehydration, arthrosis, arthritis, and other inflammations.

Knee-joint . A clicking or cracking sound can occur when you put physical stress on your knees, squat, use a seat that is too high/low, or frequently tuck your legs. All this disrupts the blood circulation process and leads to stagnation. This is not considered a pathology, but can lead to cartilage degeneration. If the joint is destroyed, swelling, discomfort during movement, and pain will appear.

Shoulder joint . Characteristic sounds in the shoulders occur only after injuries and in the presence of arthritis. There is no crunching in healthy shoulder joints.

Fingers . These joints are considered the “crispiest”. They are very mobile, tendons and ligaments have to constantly rub against the bones, so crunching is normal. If your fingers begin to bend poorly or swell, you should pay attention to this.

What to do if you have cracking joints?

If you notice the appearance of crunching in your joints, you should monitor your condition. If possible, make notes indicating how, when and with what movements the extraneous sound occurs. Crunching in the joints can occur during bending, rotation, or physical activity. This information will be important for the doctor you need to contact.

For medicinal purposes the following is prescribed:

• correction of the diet with minimal consumption or complete elimination of salt;
• increasing the volume of fluid consumed;
• non-steroidal anti-inflammatory drugs that are taken orally and externally (in the form of ointments, gels, creams);
• chondroprotectors, which improve the quality of hyaline cartilage, prevent their destruction, and promote the regeneration of the inner lining of the joint capsule;
• complexes of minerals and vitamins that help eliminate deficiency conditions, normalize bone mineralization, and restore metabolism;
• preparations based on hyaluronic acid - help restore damaged cartilage, improve the elasticity of osteochondral joints;
• angioprotectors - to improve blood supply to the soft tissues surrounding the joint.

If indicated, it is possible to prescribe corticosteroids and anti-gout drugs that inhibit the synthesis of uric acid and eliminate acute manifestations of gouty arthritis.

People suffering from cracking joints should remember that without adequate physical activity and physiotherapy, taking medications will not lead to the desired result.

Methods of physical therapy and physiotherapy must be used:

• gymnastics that improves motor activity, sprains;
• swimming in the pool;
• exercise on an exercise bike;
• magnetic therapy;
• UHF;
• electrophoresis with anti-inflammatory, painkillers;
• shock wave therapy;
• laser treatment;
• barotherapy;
• mud therapy.

In some cases, the use of orthopedic devices, orthoses, and bandaging the limb with an elastic bandage is recommended.

A well-designed course of therapy helps eliminate inflammatory foci, improve local blood supply and tissue trophism, and relieve pain. Patients are recommended to undergo special therapy at least twice a year to maintain long-term remission.

Why do my joints crack?

First of all, you will need to understand the reason for the crunch. The method of treatment, if it is required at all, will depend on this.

Most often, joints crack for the following reasons :

• Congenital specificity of connective tissues . Some people have joint hypermobility, while others have insufficient joint lubrication.
• Anomalies in development . Mismatch of joint surfaces occurs due to the fact that the ends of the bones protrude beyond the limits of the joint capsule. Most of these pathologies are detected before the age of 7 years.
• Tendon displacement . It moves during operation of the joint, and when it returns to its place, a click may be heard. This phenomenon occurs more often in patients 10-19 years of age.
• Fast growth . The spasmodic growth of a teenager's body may be accompanied by a temporary imbalance in proportions. If some joints have not had time to adjust, they may crack. This will disappear by age 20-24.
• Gas bubbles . Dioxide bubbles form in the joint fluid; they collapse under sudden stress (for example, when walking). This phenomenon is harmless.
• Hormonal imbalances , metabolic disorders. The elasticity of joints changes during menopause and thyroid diseases. Gout, arthropathy, and other metabolic disorders can lead to the deposition of uric acid in the joint.
• Use of hormonal drugs . Crunching may appear during the use of oral contraceptives, drugs from the group of glucocorticosteroids, but will disappear after stopping them.
• Injuries . High physical activity can lead to a lack of synovial fluid washing the joint.
• Prolonged immobility . As a result of physical inactivity, the ligamentous apparatus weakens and the joint glides worse. In order for joint lubrication to be produced normally, the joint requires physical activity.
• Age-related changes . Starting from the age of 60, people are susceptible to degenerative-dystrophic phenomena, various inflammatory diseases in the joints themselves and in the muscles adjacent to them.

Crackling and clicking noises may appear due to excess weight, uncomfortable shoes, or an uncomfortable seat where the load is not distributed correctly.

Diagnostics

Before prescribing treatment, a traumatologist or orthopedist needs to find out the root cause of the appearance of crunching in small or large joints. For this purpose, hardware types of diagnostics are prescribed:

• Ultrasound of joints;
• MRI;
• CT;
• radiography;
• scintigraphy.

To exclude or confirm the infectious nature of the disease, puncture the affected joint, conduct a laboratory test of blood (clinical and biochemical analysis), and synovial fluid.

Specialists of the direction

Artem Naumenko

Expert in the treatment of knee injuries and back pain. Work experience 14 years

Oleg Loskutov

President of the Association of Foot Surgery, expert in the field of foot surgery and endoprosthetics. Work experience 14 years

Artem Naumenko

Expert in the treatment of knee injuries and back pain. Work experience 13 years

Oleg Loskutov

President of the Association of Foot Surgery, expert in the field of foot surgery and endoprosthetics. Work experience 14 years

Treatment of cracking joints

At the Center for Restorative Medicine in Naberezhnye Chelny, an experienced orthopedist treats cracking joints of various origins. You can read more about the specialist at the link.

The clinic’s specialists use a comprehensive, systematic approach to the treatment of joint pathologies. The medication program is compiled individually for each patient. Modern physiotherapeutic procedures are widely used, which can be found here. Various massage techniques described here are used specifically to restore elasticity and mobility of joints. Prices for all services provided at the clinic are indicated on the page.

If crunching occurs in the joints, it is important to consult a doctor in time and prevent the development of severe pathologies that threaten limited mobility and disability.

Do not ignore the first symptoms, call the Center for Restorative Medicine by phone and sign up for a consultation.

What to do if the joint is already worn out

Unfortunately, a knee joint that is too worn out cannot be restored and requires surgical endoprosthetics with a difficult recovery period. It lasts more than one month and does not always end as we would like - the limitation of mobility remains with the patient forever. That is why this approach is not acceptable for young and middle-aged people who want to lead an active lifestyle.

If your knee joint no longer functions as well as before, you have noticed characteristic signs of wear, but are not ready to take drastic measures, you can always find a compromise solution. The main thing is not to waste time and get diagnosed as early as possible, and then begin treatment.

In the early and moderate stages of osteoarthritis, intra-articular injections of the synovial fluid substitute Noltrex help well. The liquid endoprosthesis is evenly distributed over the surfaces of the cartilage, separates them and stops friction. It will not be possible to completely restore a worn-out joint using this method, but for some time it is quite possible to return to a normal lifestyle, without pain and with adequate physical activity.