Crepitus

Crepitus is the sophisticated medical term used to explain the popping, grating or cracking sensation that can be heard or felt upon percussion of joints or skin, which indicates the presence of air accumulation inside the closed and compact subcutaneous tissue or joint surface. This article will entail basic and relevant information about this condition.

Symptoms of Crepitus

Associated Symptoms

The symptoms of crepitus are dependent upon the primary cause and underlying pathology of the condition. The symptoms of crepitus are classified as:

• Pain in the joint that may involve surrounding area of joint surface.
• The stiffness or rigidity of joints that is most severe in the morning hours or after periods of prolonged inactivity
• Signs of inflammation over joint surface like redness, increased temperature and swelling over joint surface
• Limitation of joint motion and physical mobility due to pain and stiffness
• When crepitus involves soft tissues, the movement and activity across the tissue may get affected with resultant increase of perforation, infection and hemorrhage in the tissues.

Serious Symptoms

Certain sign and symptoms indicate a more serious or grave pathology suggesting a need to seek immediate medical intervention. These danger signs are:

• Discoloration of skin (bluish tint especially pronounced on lips and extremities indicate a state of hypoxia or decreased oxygen saturation of blood).
• Severe pain in the chest or discomfort.
• Alterations in the level of consciousness or changes in the behavior
• High grade fever associated with rigors, chills and other signs of infection.
• Nausea, vomiting or other signs of gastrointestinal upset

Complications

Depending upon the site and severity of crepitus, appropriate management options are needed to prevent complications like:

• Development of chronic pain, discomfort and breathing difficulties
• If the primary site of infection is not controlled, chronic inflammation may lead to incomplete healing that may present as limitation of physical activity (in case of primary joint involvement) or respiratory discomfort (in case of mild pneumothorax)
• The site of localized crepitus may get secondarily infected by bacterial or fungal agents.

Causes of Crepitus

Common Causes

Crepitus is observed in situations when hard tissues like bone, rub against the soft tissues. For example:

• Moderate to severe damage to joint cartilage
• Tearing or erosion of cartilage
• Damage to articulating surfaces of joint due to wear and tear damage (e.g. Arthritis)

Severe Causes

Crepitus may be a consequence of severe or life threatening complication of soft tissue damage that should be promptly evaluated in order to minimize the risk of sudden death. Some life threatening causes of crepitus are:

• Puncturing or penetrating injuries to abdominal cavity or chest cavity that creates a state of air lock
• Infection with gas forming bacteria like clostridium perfringens.
• Perforation or puncture wound of gut (due to gas production as a result of abnormal digestion or decomposition of food)
• Injury or trauma to lung (leading to pneumothorax)

Remedies for Crepitus

In order to decrease the risk of complications discussed above, following remedies must be adopted in order to resolve the symptoms.

Home Remedies

Home remedies are mostly employed in the management as well as prevention of crepitus. Before employing surgical management of crepitus, most healthcare providers advice home remedies or non-surgical remedies that are listed below:

• Elastic Supports. Elastic supports are helpful in managing the pressure related trauma or damage to sensitive sub-cutaneous tissue. It also help in preventing recurrent episodes of crepitus
• Ice Packs. Make sure to apply ice packs on the involved joints after an episode of exercise or stressful activity
• Medications. Medications like non- steroidal anti-inflammatory drugs are helpful in alleviating the symptoms of infection and inflammation. These include Advil and aspirin (these agents reduce pain, inflammatory swelling and secretion of inflammatory fluid).
• Certain Styles. It is recommended to use knee braces that are helpful in transferring the weight of the body from knee cartilage to the brace. In addition, certain exercises and maneuvers can also be adopted that can decrease the risk of grating sensation and resulting irritation.
• Avoid Stress. Avoiding excessive stress and strain on knee joints by decreasing the intensity and frequency of activities like climbing stairs, performing exercises that involve joints (like aerobics, sports activities, jumping and hopping) and lifestyle modification (avoiding high heeled or uncomfortable shoes).
• Weight Loss. Weight loss is advised to reduce the stress and strain from the articular cartilage thereby decreasing the risk of developing recurrent crepitus and other wear and tear changes due to obesity. If your total body weight is above the reference range, moderate diet control and exercise may be sufficient to induce remission.
• Nutritional Supplements. A number of nutritional supplements can also be consumed that are helpful in improving cartilage strength and bone remodeling.

Medical Treatments

Medical treatments are needed in individuals who do not respond to home remedies. A few options are:

• Chondroplasty. Chondroplasty is a medical treatment that aims at removing or shaving the rough edges of the cartilage (thereby reducing the bone erosion).
• Bone Abrasion. In some cases, surgeons may also perform bone abrasion (that involves scraping the edges of rough bone to stimulate the formation of scar cartilage as a result of mild bleeding)
• Replacement. Often times, replacement of certain cartilages and menisci can also improve the symptoms of crepitus or bone erosion that leads to crepitus.