Shoulder clicking

[madiyaan]

Hello all:

About myself: reasonably atheletic 24 year old male.

My shoulder started clicking about 8 months back (perhaps it was clicking even before that, but I started noticing it at that time). There was no pain associated. I did suffer from two neck cricks around that time, which got over in 2 days each. One of the neck cricks was caused by me sleeping in a weird position, and the other was caused by me trying to do a military press with a lot of weight. In both these neck cricks, I felt pain in my neck and shoulder blade (towards the medial side). There was no audible pop or click.

The shoulder specifically clicks when I have my thumb pointing downwards, and do a lateral raise.

Dumbbell Lateral Raise

The amount of weight does not matter. It even clicks if I have no weight. There is a series of audible clicks sound when the upper arm makes a 120 degrees angle with my torso to about 150 degrees. If I do the same movement (i.e. raise my hands laterally) but start externally rotating my arms so that the thumbs point forward, the clicking sound decreases. If the thumbs are pointing upwards, it completely disappears.

If I instead change my arms so that they are pointing forward and raise my hands, there is no clicking. Moving my arms to my sides and doing raises gradually increases the clicking until the maximum clicking, which happens when my arms are slightly behind me.

I hope this 3D motion of when the clicking happens is clear. Note that there is no pain with the clicking. I did do heavy military and bench pressing around the time the clicking started, so it could be a repetitive injury or something.

There is no clicking in my right shoulder, which is my dominant shoulder.

I went to my GP who told me that "a lot of people have joint clicking" and that if there is no pain, just do rest and it will be fine. I have been resting for a month (normally I do pull ups and push ups daily). Can someone on this forum tell me what I may have? Also, who should I go to for a checkup? A regular doctor, a chiropractor, a sports physician, orthopedic surgeon or physiotherapist? I need to first diagnose the problem and then see my options.

Regards,

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[CenteredHealth]

From the description you have given us, it sounds like the joint that is clicking is your AC joint. It is located on top of the shoulder where the clavicle meets the scapula, a search in google will give decent diagrams and descriptions. A simple way to confirm this would be to palpate this joint during the previous described motion and see if it is in fact the joint responsible for the clicking.

Repetitive clicking can be a sign of and may lead to joint dysfunciton down the road. One thing I would suggest is to never perform lateral dumbell raises in the above described mannor (thumbs down). It puts too much stress on the AC joint and the sensitive rotator cuff underneath. There are plenty of safe exercises out there to target specific muscles without risking injury.

As far as weightlifting goes, I would play it conservatively. Powerlifting is by no means the most healthy choice of exercise as it pushes our body's structure to its limits and usually beyond. In my yonger days I was a bodybuilder myself and had sustained several injuries due to overlifting, too much weight, poor lifting mechanics, etc. I would advise perfect to near-perfect form when lifting as this will minimize any potential injury and maximize the effects of the exercise.

To see a Physio or to not to see a Physio, that is the question... There are some who will say that if there is no pain then no, you absolutely do not need to see a Physio for this problem. I am of the philosophy that an ounce of prevention is worth a pound of cure. Therefore, it may not be a bad idea to seek some professional help regarding your shoulder and neck. A Physio skilled in musculoskeletal dysfunctions and who can identify biomechanical and muscular imbalances, may be invaluable in assisting you design an appropriate routine of safe exercises and ones to avoid. Good luck

[thomas bibu]

[B][FONT="Verdana"

Hi dear,

Generally a painless shoulder click rarely indicates a shoulder pathology, though I should confess that a painful click in patients under 25, shoulder clicking is most likely related to instability problems. In normal subjects, even a strong or forceful eccentric contraction of the muscle groups can also produce an audible click.

The 3 common factors of shoulder click are;
a. thickened bursa, b. loose bodies, c. glenoid labral tear.
To ascertain, specialized clinical examination coupled with radiography (X-ray, MRI) is essential.

Since yours is a painless click, I would rather advice you to first seek the help of a professional physiotherapist and look forward to a progressive program of rotator cuff strengthening, stop all the present exercises you do.

Following a 4 to 6 week STRICT exercise regimen, if your shoulder continues to click or tends to become painful, please seek the opinion of an Orthopedic surgeon, trained in shoulder to further assess: clinical/radiological/visual-scopy.

All the best.

Cheers,

Thomas

[madiyaan]

Thank you for your replies.

I have a long story to share.

I went to the doctor and he performed a few x-rays to rule out bone-on-bone grinding. Thankfully there was none. He referred me to the PT to do RC strengthening. The clicking/grinding sensation remained (it was audible but not painful). Gradually it started become painful when under weight. For example, the bottom part of wide-grip pull ups when the arm is fully extended elicited a click/grind noise along with some pain. Push-ups don't cause the click.

I got more concerned and got more tests done. A supraspinatus outlet-view x-ray of my shoulder revealed an acromion bone spur. He referred me to an MRI thinking there might be more damage. Here are the results of the MRI:

Study: MRI of the left shoulder without contrast
Findings: The acromioclavicular joint is unremarkable.

There is diffuse thickening of the posterior aspect of the supraspinatus tendon, without focal tearing. The remaining portions of the supraspinatus tendon are unremarkable. The infraspinatus, teres minor and subscapularis tendons are unremarkable. No muscle atrophy of the rotator cuff is identified.

The biceps tenon is unremarkable. There is abnormal increased signal within the anterior labrum (axial sequence, images 12, 15) of unclear etiology. Further evaluation is limited owing to lack of significant joint effusion. There is no associated Hill-Sachs deformity.

The humeral head is normally situated. Normal marrow signal intensity is seen.

Impression:
1. Abnormal signal intensity within the anterior labrum of unclear etiology. Further evaluation is limited owing to lack of significant joint effusion. An MR arthrogram is recommended for further evaulation.
2. Mild tendinosis of the posterior aspect of the supraspinatus tendon, without tearing.


According to my ortho, I have a tear in the anterior labrum, though not a major one.

My question is this: do my symptoms match those of an anterior labrum tear? I am going to get a second opinion soon, but am really concerned about labrum tears because of their notoriety of not healing properly. What are my chances of recovering from this? I want to be able to lift weights and do exercises without grinding/clicking and the slight pain when I do certain exercises.

[gabrieljosh]

Repetitive stress injuries can come from many causes. Other factors should also be considered as contributing to stress in all cases. Being overweight or pregnant or having high stress levels in general can certainly take a toll on certain joints. Once you have been diagnosed with repetitive stress injury, all of these factors must be taken into consideration before the most effective course of treatment can be prescribed by your doctor.

[dunlphysio]

Madiyaan,

Sounds as though you may have shoulder blade instability, that would explain the neck problems aswell as the fact that clicking occurs when your thumb turns down. A Physio could confirm this at a glance and give you some exercises to work on stabilizing the scapula. This would improve your overall strength and possibly stop the clicking.

[Galen Oli]

It could be a rotator cuff issue.
Firstly I'd cut back on the work until you know for sure, since the last thing you want to do is make any injury worse.
It doesn't sound like a severe injury, so if you can do some physical therapy you may be able to nip it in the bud.
Wound Dressings

[madiyaan]

Okay, so the first diagnosis was correct. I believe it started with the ac joint.

I think I suffered a separation due to repetitive movements under load (can shoulder separation happen because of repetitive stress or does it always happen due to macrotrauma?). Perhaps I also sprained some ligaments in the back area (upper traps I think) while military pressing (I did have a crick in the neck after one session I remember).

I went to not one but 3-4 orthopedic surgeons. I had an MRI/MRA done. MRI/MRA both indicated no tear in labrum but thickening of posterior supraspinatus tendon. I educated myself on the shoulder anatomy during these two years since I noticed the clicking. Interestingly, both MRI and MRA reports said that I had a normal AC joint.

However, I recently (in March 2010) had an xray taken. Attached is the xray image. I think It clearly shows separated shoulder (does it?). The ortho I showed it to just shrugged it off without even looking at it properly. He said I would be fine by strengthening the RC.

Here is my own take on the whole thing:

I have looked at quite a few xrays during my own research and I think the clavicle's distal end should be flat, not pointed. The pointed end (osteophyte) shows bone growth there which perhaps happened as a result of microtrauma? (I don't remember ac joint pain anytime in the past year). Or perhaps the growth happened with the clicking/rubbing after the separation.

In either case, I think first the separation happened, then because the scapula lowered down, the subacromial space decreased. And due to my overhead activities I developed tendonosis of the supraspinatus. I think the tendonosis of the supraspinatus is a symptom, not the main issue. The main issue is the drooping of the scapula. Note that there is an external step deformity that none of the orthos I went to bothered to examine (since I didn't report any AC pain).

How to cure it? I don't know. I need to somehow raise the scapula back in line with the clavicle. In doing so, I think the subacromial space will increase and impingment will not happen anymore. I really want to return to going back to the gym and doing heavy upperbody work which I have not done since 8 months into the clicking.

Personally I also think orthos didn't guide me properly and didn't even bother to notice this separation until 2 months after the clicking. Perhaps a screw would have prevented this situation.

That's my own theory (ortho still thinks I need to keep doing PT on the rotator cuff that I have been doing for the past 2 years). Does someone have differing opinions?

I am pretty sick of the shoulder being the way it is (pain when doing overhead activities deep within the shoulder, lots of instability, clicking, popping, etc. ) and want a normal shoulder now!

[mb1945]

hey sorry for writing on here , but I have this click in my shoulder , I have no idea for how long I had it but i noticed it about last month , it was then when I did shoulders workout and I was in pain , didn't go to the gym for two weeks pain stopped , went to the doctors he then checked me and said its nothing serious I shoulder worry about it so I went back to the gym , training , not heavy easy and light , I still have that shoulder click , its not loud nor does it hurt , just after I trained my shoulders in my right shoulder/biceps have a little pain there i have no idea what to do ?

[hgnarroway]

Hey madiyaan,

Just writing to express my frustration as well.

I believe I have an almost identical problem with my shoulder.

I'm 21. When I was 14 I fell into a river on an outstretched arm. I did not rest/rehab my shoulder in any way at the time, ignoring it thinking it would recover. In hindsight, my symptoms match a bad grade 1 separation as the AC joint is slightly deformed but still attached.

I have done lots of weights training over the years. I too had MRI/MRA and they found supraspinatus/infraspinatus tendinosis but don't believe this is the underlying problem. My AC joint looks like yours, hence the doctors have ignored it.

I won't go into further details as it is a rehash of your symptoms but like you I am STUCK on how to resolve this (and the loud clicking!). No one has an answer. Let me know if and when you have one.

Thanks

[jjaayy]

I have a similar problem too. The clicking started 18 months ago and i do Karate, so while training this can be quite painful. I also recently had a car crash which has made the shoulder injury a lot worse, when i went to the doctor 6-8monts ago, they turned around and said i was just round shoulders and gave me stretches that did nothing. i went back again three months later to see a different doctor and he said that it's to do with the muscles and that I over use the muscles and that i would need to get a personal trainer and just build up the muscles and the pain will go away as the muscles will get stronger and then he also suggested that i give up karate for around three-six months and the pain will go away, however i'm closed to my blackbelt and i didn't want to do this. I started training myself with light weights, as i cannot afford a personal trainer and it started to improve very slightly, and then someone crashed into the back of my car and it has made the injury worse and i had to take around two months out from karate as it was that painful.I am recieving physio for it now but it does not seem to be helping the shoulders much! I believe i am being refered to an otherpedic surgeon aswell just to check that the joint is not damaged or out of place.

[billy9000]

Since no one gave any feedback on this issue, I will. I'm just an athlete, not a doctor.

Painless shoulder clicking is often a sign of slight muscular imbalance or joint instability. I, and many people I have spoken with, have had success beating the clicks by strengthening the muscles that keep the shoulder pressed into the glenoid. Here is what I did:

1) Reduce weight and focus on strict, slow form. If your joints are complaining, it's often a sign that you're using too much weight.

2) perform prehab "injury prevention" exercises that strengthen the rotator cuff. Internal and external shoulder rotation with VERY LIGHT WEIGHT. I hear that "Cuban press" and push-ups w/plus (scapular retraction) work wonders also. Watch and learn: Shoulder Stabilizing Exercises - Reduce Injuries with innies and outies - YouTube

3) Listen to your body and be smart about your routine. Dumbell flies, reverse flies, pec dec.. these exercises may not be for you.

4) Spend several hours reading everything you can about shoulder function and prehab techniques. Read the rotator cuff horror stories too. It will motivate you to take care of your shoulders!

And, on a final note, it is my opinion that doing pull-ups and push ups every day is a bad idea. The shoulders already get hit with nearly every workout. When do you expect to recover? I understand the whole "greasing the groove" theory, but I don't think it's a good idea if you're already worried about your shoulder!!!