It started months ago and seemed innocent. Your shoulder started popping yet there was no pain. It has progressed and is more frequent. You are concerned. Is shoulder popping with no pain serious? What are the key structures in the shoulder? What are the 6 major causes of shoulder popping without pain? How to determine if my shoulder popping with no pain is good or bad? Why not wait until the pain sets in. Who can best help me? Why surgeons are not the best option. What is a diagnostic shoulder ultrasound? Let’s dig in.
Shoulder Popping, No Pain?
Noises in the joints, such as popping, cracking, or clicking, can be quite disturbing and cause concern. That popping feeling is called crepitus. That’s something to be ignored, right? It certainly seems harmless enough—after all, there’s no pain, just that annoying popping when you move your shoulder this way or that. But just because there’s no pain doesn’t mean there’s no problem. There’s actually good news and bad news here. The good news? All that shoulder popping really could be no big deal. The bad news? That popping could be slowly chewing up your shoulder joint, and it may be a warning sign that arthritis is on its way.
So how can you tell the difference, and what can you do about it? Let’s start by taking a look at the shoulder.
Key Structures In the Shoulder
2 shoulder joints: Glenohumeral and AC joint
The shoulder is a ball-socket joint compromised of bones, ligaments, tendons, nerves, and muscles (1). Each of these structures is important to shoulder function.
Bones
The shoulder has two important joints: the AC and GH joints. The AC joint (Acromioclavicular joint) is the smaller of the two joints. It is where the collarbone meets the boney prominence on the top of the shoulder called the Acromion. It is susceptible to injury which can cause popping with and without pain (2).
The Glenohumeral joint (GH) is the larger of the two joints and is a ball socket joint. The humerus, your upper arm bone has a rounded end that connects with the boney socket thereby forming the large ball in the socket joint.
Ligaments
Shoulder Ligaments
Ligaments are thick pieces of connective tissue that connect bone to bone. There are many ligaments in the shoulder that provide stability and support (3). Examples include the superior and inferior Glenohumeral ligament.
Tendons
Tendons are thick pieces of connective tissue that connect muscle to bone. The Rotator Cuff provides important stability for the shoulder. It is composed of 4 major tendons:
Supraspinatus
Infraspinatus
Subscapularis
Teres Minor
6 Major Causes of Shoulder Popping with No Pain
There are many causes of shoulder popping. The 6 major causes of shoulder popping without pain include:
Ligament Injury Leading to Instability
Ligaments provide stability and support. They allow for proper alignment and function of the cartilage surfaces, tendons, and ligaments. Shoulder ligaments are susceptible to injury (4). Trauma is the most common cause. Injury to the ligament can cause instability of the shoulder joint such that there is micro-movement of all the structures. This mico-movement places all the shoulder structures at risk for injury. It is akin to having a loose lug nut on your car’s wheel. A loose lug nut causes the wheel to roll in a haphazard way. This can severely compromise the steering of the vehicle and wear the tire out prematurely. So too with the shoulder that has loose ligaments.
To learn more about the importance of ligaments and the stability they provide please click the video below.
Tendon Injury
Rotator Cuff tendons are susceptible to inflammation, tears, and degeneration. These injuries can compromise the proper shoulder function resulting in shoulder popping with no pain (5). To learn more about rotator cuff tears and nonsurgical treatment options please click here.
Muscle Weakness
Muscles are important to shoulder stability and function. Muscles can become weak from a variety of different conditions including injury, lack of exercise, neck nerve irritation, nerve entrapment, diabetes, neuromuscular disease, autoimmune disease, and endocrine disorders such as low thyroid. Muscles weakness can compromise shoulder function resulting in shoulder popping with no pain. It can also create popping with pain.
Osteoarthritis
There are many different types of arthritis. Osteoarthritis is the most common and involves gradual wear and tear of the cartilage that lines the joint. Over time this can cause pain, swelling, reduced range of motion. It can also cause shoulder popping.
Inflammation of Bursa (Bursitis)
A bursa is a thin fluid-filled sac that is present in most joints. A bursa provides a cushion between tendons, ligaments, muscles, and the underlying bone. It allows for smooth movement of the tendons, ligaments, and muscles. Unfortunately, the bursa can be inflamed. This condition is called bursitis and it can lead to pain, reduced movement, and shoulder popping with and without pain.
Labrum Tear
The shoulder is a shallow ball socket joint. The labrum is a thin cup-shaped piece of fibrocartilage that lines and supports the shoulder joint. It can become inflamed, irritated, or torn resulting in pain and reduced range of motion. A labral tear can also cause shoulder popping with and without pain.
How to Determine if My Shoulder Popping with No Pain Is Good or Bad? (History of Prior Shoulder Trauma)
Do you have the it’s-no-big-deal shoulder popping, or do you have the it’s-chewing-up-my-shoulder-joint shoulder popping?
To answer this question you will need to think hard about your medical history as it is important in determining whether shoulder popping with no pain is good or bad. Have you had a shoulder “separation” in the past? Has your shoulder popped out of the socket, or been dislocated, in the past? Have you had shoulder trauma, perhaps due to a car accident or sports injury, where you had significant pain and then you assumed it healed because, there’s been no pain over the past 5, 10, or even 20 years? Think way back. Remember that mountain bike injury when you went over the handlebars? How about the mogul injury in Vail? If so, then this popping may be a big deal. Alternatively, if you’ve never had any of these past traumas, then chances are, the popping is no big deal.
Don’t Wait For the Pain to Set In
If you have a prior history of shoulder trauma and injuries but currently have shoulder popping with no pain it is important to have your shoulder evaluated. Unfortunately, most family medicine or internal medicine physicians will not recommend treatment or in-depth evaluation due to the absence of pain. Many will discount the complaint of shoulder popping and recommend that you return when it becomes painful. Unfortunately by that time, you may have already developed shoulder arthritis, a labral tear, rotator cuff injury, or inflammation of the bursa?
Orthopedic surgeons are trained and dedicated to the surgical model. Their treatment recommendations are biased towards surgery and not always in your best interest. For example, Rotator Cuff surgery has a significant number of complications the most important of which is a high number of retears. To learn more about the different types of Rotator Cuff tears and nonsurgical treatment options please click here. Surgery for shoulder instability due to ligament injury can be a major surgery requiring extensive rehabilitation and time. Results can be disappointing and complications can occur.
Is There a Better Option?
Absolutely! An interventional orthopedic physician is an expert in the non-surgical treatment of orthopedic injuries. They are not surgeons but rather are board-certified physicians in Physical medicine and rehabilitation (PM & R) or Anesthesiology who have spent additional years of training. Interventional orthopedic physicians use image-guided injections to treat common orthopedic injuries in the neck, shoulder, elbow, knee, hip, ankle, neck, and lower back. Common examples include knee meniscus tears, ACL tears, low back disc herniations, and plantar fasciitis. To learn more about interventional orthopedics please click on the video below.
Your Local Experts
The Centeno-Schultz Clinic team are experts in the diagnosis and treatment of shoulder injuries. All physicians are board-certified and fellowship-trained in Interventional Orthobiologics. All are involved in teaching both locally and on a national basis. All are instructors for the Interventional Orthobilogics Foundation which is the only nonprofit organization that provides training to physicians on precise injections using the healing agents from the patient’s own body, like PRP and bone marrow concentrate. At the Centeno-Schultz Clinic, the evaluation and examination are performed by a physician. We have no Physician assistants or mid-level nurses. During the evaluation, an ultrasound of the shoulder is performed. Ultrasound is in-office imaging that uses sound waves to produce images of the shoulder. For example, the Rotator Cuff tendons and the Biceps tendons are easily seen on ultrasound. Treatment options include PRP and bone marrow-derived stem cells. The procedures are complex and can not be performed by your PCP or orthopedic surgeon. To watch one of my shoulder injections please click on the video below.
In Conclusion
Popping, clicking, and cracking of the joint is known as crepitus and can be concerning.
Shoulder popping may be innocent or maybe a warning sign that you are slowly chewing up your shoulder joint.
The key structures in the shoulder are the bones, ligaments, and tendons.
Tendons are thick pieces of connective tissue that connect muscle to bone. The Rotator Cuff is compromised of 4 major tendons that provide stability to the shoulder joint.
There are 6 major causes of shoulder popping no pain.
A history of previous shoulder trauma or injury is important. If present your shoulder popping without pain is a warning sign that you have a problem that warrants further investigation
Waiting for the pain to set in can be a costly mistake as additional injury to tendons, ligaments and cartilage may be occurring. In fact, you may silently be chewing up your shoulder joint.
Orthopedic surgeons have surgical solutions which are not always in your best interest.
An Interventional Orthopedic physician is an expert in the non-surgical treatment of orthopedic injuries.
The Centeno-Schultz Clinic are experts in the treatment of shoulder injuries. They are leaders in Interventional Orthopedics both locally and on a national basis.
If you or a loved one have shoulder popping or dysfunction please schedule a telemedicine schedule new patient consultation where you can learn what regenerative treatment options are best for you. We are experts in the field and will compassionately listen to you and your loved ones. Act now because if ignored you may be silently chewing up your shoulder with progressive injury to your tendons, ligaments, and cartilage.
