Shoulder Clicking: Understanding Causes, When to Worry, and How to Address It

How Do I Stop My Shoulder From Clicking When I Rotate?

Shoulder clicking during rotation is often a benign phenomenon caused by gas bubbles within the joint, but it can sometimes indicate underlying issues with joint mechanics, tendon health, or stability; addressing it involves understanding the cause and implementing targeted mobility, strengthening, and movement pattern adjustments.

Understanding Shoulder Clicking: Is It Normal?

The sensation or sound of a "click," "pop," or "grind" in a joint is medically termed crepitus. In the shoulder, crepitus is quite common during rotation. It's crucial to differentiate between two primary types of clicking:

• Benign (Physiological) Crepitus: This is the most common type and is generally harmless. It often results from the rapid release of gas bubbles (nitrogen, oxygen, carbon dioxide) within the synovial fluid of the joint capsule, similar to cracking knuckles. It can also occur when tendons or ligaments momentarily shift or "snap" over bony prominences. This type of clicking is typically painless and does not limit your range of motion or function.
• Pathological Crepitus: This type of clicking is a cause for concern. It is usually accompanied by pain, weakness, limited range of motion, a sensation of catching or locking, or instability. This suggests an underlying structural issue within the shoulder joint.

Anatomy of Shoulder Rotation and Clicking

To understand why your shoulder might click, it's essential to appreciate the complex anatomy involved in its remarkable range of motion:

• Glenohumeral Joint: This is the primary shoulder joint, a ball-and-socket articulation between the head of the humerus (arm bone) and the glenoid fossa of the scapula (shoulder blade). Its design prioritizes mobility over inherent stability.
• Rotator Cuff: A group of four muscles (Supraspinatus, Infraspinatus, Teres Minor, Subscapularis) and their tendons that surround the glenohumeral joint. They are vital for dynamic stability and precise control of arm movements, especially rotation.
• Labrum: A ring of fibrocartilage that deepens the glenoid fossa, providing additional stability and attachment points for ligaments and the biceps tendon.
• Biceps Tendon: The long head of the biceps tendon runs through a groove in the humerus and attaches to the superior aspect of the labrum.
• Bursae: Fluid-filled sacs (e.g., subacromial bursa) that reduce friction between tendons, muscles, and bones.
• Scapula: The shoulder blade's position and movement on the rib cage (scapulothoracic rhythm) are critical for optimal shoulder function and avoiding impingement.

Clicking can arise from issues with any of these structures during the intricate movements of rotation.

Common Causes of Shoulder Clicking (and Potential Underlying Issues)

While benign gas release is frequent, persistent or painful clicking warrants investigation into these potential causes:

• Gas Cavitation: The most common and harmless cause, as described above.
• Tendon Subluxation/Snapping:
  • Biceps Tendon: The long head of the biceps tendon can snap in and out of its bicipital groove, especially if the retinaculum (a fibrous sheath holding it in place) is compromised.
  • Triceps Tendon: Less common, but the triceps tendon can snap over the olecranon (elbow bone) during certain arm movements.
• Bursitis: Inflammation of the subacromial bursa can cause a grinding or clicking sensation, often accompanied by pain, particularly during overhead movements.
• Labral Tears: Tears in the labrum (e.g., SLAP tears, Bankart lesions) can cause clicking, catching, locking, and pain, especially during specific rotational movements or when the arm is abducted and externally rotated.
• Osteoarthritis: Degeneration of the articular cartilage within the glenohumeral joint can lead to bone-on-bone friction, resulting in a grinding sensation or crepitus, often with pain and stiffness.
• Rotator Cuff Tendinopathy or Tears: Degeneration, inflammation, or tears in rotator cuff tendons can cause clicking, pain, and weakness due to altered mechanics or impingement.
• Scapular Dyskinesis: Abnormal movement or positioning of the scapula can disrupt the smooth rhythm of shoulder movement, leading to altered mechanics and potential clicking or impingement.
• Shoulder Instability or Hypermobility: If the shoulder joint is excessively loose (due to ligament laxity or previous dislocation), the humeral head may move abnormally within the glenoid, causing clicking or a sensation of shifting.
• Post-Surgical Adhesions: Scar tissue formation after surgery can restrict movement and cause clicking as tissues rub or pull.

Strategies to Address Non-Painful Shoulder Clicking

If your shoulder clicking is painless and not associated with other symptoms, the focus is on optimizing shoulder joint health, stability, and movement patterns. This is a proactive approach to prevent future issues.

• Improve Thoracic Spine Mobility:
  • A stiff upper back can force the shoulder to compensate, leading to altered mechanics.
  • Exercises: Thoracic extension exercises over a foam roller, cat-cow stretches, seated rotation stretches.
• Enhance Shoulder Capsule Mobility:
  • Gentle stretches can improve the glide and slide of the humeral head within the glenoid.
  • Exercises: Sleeper stretch (for internal rotation), doorway stretch (for external rotation), pendulum swings. Perform these gently and without pain.
• Address Pectoralis Minor Tightness:
  • A tight pec minor can pull the scapula into an anterior tilt, affecting posture and shoulder mechanics.
  • Exercises: Doorway pec stretches, foam roller chest opener.
• Strengthen the Rotator Cuff:
  • Strong and balanced rotator cuff muscles are crucial for dynamic stability and centering the humeral head.
  • Exercises:
    • External Rotations: With a light resistance band or dumbbell, keep elbow at your side, rotate forearm outwards.
    • Internal Rotations: Opposite of external rotations, rotate forearm inwards.
    • Scaption (Y-raises): Raise arms to about 30 degrees forward of your body, thumbs up, forming a 'Y' shape.
    • Face Pulls: Using a cable machine or resistance band, pull towards your face, squeezing shoulder blades.
• Improve Scapular Stabilization:
  • Proper scapular control ensures the glenoid is in the optimal position for humeral movement.
  • Exercises:
    • Rows (Cable/Dumbbell): Focus on squeezing shoulder blades together.
    • Push-up Plus: At the top of a push-up, push further to protract the shoulder blades.
    • Wall Slides/Angels: Slide arms up a wall, keeping lower back pressed against it.
• Integrate Core Stability:
  • A strong core provides a stable base for the shoulders to operate from.
  • Exercises: Planks, bird-dogs, dead bugs.
• Optimize Movement Patterns:
  • Pay attention to form during exercises, especially overhead movements (e.g., overhead press, pull-ups) and pressing movements (e.g., bench press). Avoid shrugging or excessive arching of the back.
  • Ensure adequate warm-up before activity and a cool-down/stretch afterward.
  • Avoid consistently pushing into end-range movements under heavy load if it elicits clicking.

When to Seek Professional Medical Advice

While many clicks are benign, it's imperative to consult a healthcare professional (e.g., orthopedic surgeon, physical therapist, sports medicine doctor) if your shoulder clicking is accompanied by any of the following:

• Pain: Any new or persistent pain associated with the clicking.
• Weakness: Difficulty lifting or moving your arm, or a noticeable loss of strength.
• Limited Range of Motion: Inability to move your arm through its full range.
• Catching, Locking, or Grinding Sensation: A feeling that something is getting stuck in the joint.
• Instability: A sensation that your shoulder is going to "pop out" or is loose.
• Swelling or Bruising: Visible signs of injury around the shoulder.
• Sudden Onset: Clicking that starts abruptly after an injury or trauma.
• Worsening Symptoms: If the clicking or associated symptoms progressively worsen over time.

Diagnostic Approaches a Clinician Might Use

A healthcare professional will conduct a thorough evaluation, which may include:

• Detailed Medical History: Asking about your symptoms, activities, and any previous injuries.
• Physical Examination: Assessing your range of motion, strength, stability, and palpating for tenderness. Specific orthopedic tests may be performed to pinpoint the source of the clicking.
• Imaging Studies:
  • X-rays: To assess bone structure, arthritis, or fractures.
  • MRI (Magnetic Resonance Imaging): Gold standard for visualizing soft tissues like tendons, ligaments, labrum, and cartilage. An MRI with contrast (arthrogram) may be used to better visualize labral tears.
  • Ultrasound: Can assess dynamic movement of tendons and identify fluid collections (bursitis).

Conclusion and Proactive Shoulder Health

Shoulder clicking, particularly without pain, is often a normal physiological occurrence. However, adopting a proactive approach to shoulder health is always beneficial. By consistently incorporating exercises that promote mobility, strengthen the rotator cuff and scapular stabilizers, and refine movement patterns, you can optimize your shoulder joint mechanics and potentially reduce benign clicking while simultaneously safeguarding against future injuries. Always listen to your body; if clicking is accompanied by pain or other concerning symptoms, professional medical evaluation is the safest and most effective course of action.