Snapping Shoulder

Shoulder snapping or popping is a very common complaint. A grinding sensation in the shoulder is even more common. The shoulder is a very complex joint so there are many structures that can snap, pop or click when they are injured or inflamed. The shoulder contains muscles, bones, tendons, cartilage, and a bursa.  Those tissues interact and move upon one another like a complex ballet.  Often times the clicking or popping you feel is simply normal because all of these structures are moving on one another.  Rest assured, the majority of sounds or sensations coming from your shoulder are often not a cause for concern.  

Can this be normal? 

Sometimes the popping or grinding in the shoulder is because something is inflamed or damaged.  When our tendons become inflamed they swell. That swelling can tighten the spaces available for all those complex structures in the shoulder which might cause popping or grinding with certain motions. 

The most common causes of painful shoulder popping include rotator cuff tears, bursitis, labral tears, biceps tendon problems, and arthritis.  I see between 5-10 patients a week who are simply in my office because they want to know – Why does my shoulder snap, click and pop? 

Most of you are worried about the sounds your joints are making. It’s a natural concern.   You’re not sure if it’s normal or not.  Some of you have pain and want to know what’s causing the pain and the new sensation. 

Read on… I’m going to try to help you sort through whether or not your popping or grinding shoulder is mostly “normal” or is it due to something that should be looked at further.  In another post, I describe the things to look for to know if you had a serious shoulder injury.  

Shoulder Anatomy

The shoulder is a very complex joint composed of bone, cartilage, ligaments, tendons, and two different tissues that line the inside of our shoulder joint. We call those tissues that line the inside of the spaces the Synovium and the Bursa. If any of these structures are injured or simply inflamed (and thus thicker), the smoothly functioning shoulder can pop, snap or click. These “injuries” can be due to everyday use, a sports injury, chronic repetitive stress due to sports, or significant trauma from a fall or accident. Most of this inflammation will subside on its own.

Should I be worried about my shoulder popping?

Most of the time the clicking or snapping in the shoulder is due to everyday use and changes that occur over time within our joints.  As we age this causes some of the surfaces to roughen —thus when they rub against one another they will snap, click, or pop within the shoulder.    For most of you, painless snapping or clicking of the shoulder is not an issue to worry about.  For many of you, the popping or clicking may eventually subside over time, or you may simply get used to it.

Painless clicking and popping usually do not require any treatment at all.

Painful shoulder popping

If your shoulder hurts when it pops, or if the popping and snapping started after an injury then you should consider an examination by an Orthopedic Surgeon.

Below is a discussion of the most common causes of painful shoulder snapping and popping.

Clicking or popping of shoulder may start soon after an injury. That might mean that you have sustained a serious shoulder injury. Here are some situations when the noise coming from your shoulder could signify a problem.

• If your shoulder was injured and it is now sliding in and out of place (dislocating), it may snap or pop.
• if the biceps tendon is moving around too much or dislocating from its groove.
• If the rotator cuff was injured or torn.
• If the labrum of the shoulder was torn.
• A piece of cartilage has torn loose and you have a “loose body” getting caught in the shoulder.
• If the snapping is in the back of the shoulder, it could be an issue (often bursitis)with your shoulder blade or scapula.
• if you have calcific tendonitis, the inflammation could make the shoulder click or grind.

Here is my latest video…

Causes of painful clicking or popping in the shoulder:

Labral Tears or SLAP lesions :

The shoulder is composed of two main bones, the ball and the socket.  The shoulder is similar to a golf ball sitting on a golf tee.  Imagine that the golf tee has a rubber washer sitting around the edge. That is exactly what the labrum is in the shoulder. It is a rim of cartilage around the socket of the shoulder. It serves as an attachment for the ligaments, and it helps the ball of the shoulder stay in position.  If the labrum or cartilage in the shoulder is torn a result of an injury or repetitive stress (pitching), then the labrum may have been torn from the bone  If the labrum is torn it can catch in the shoulder and cause a pop or a snap. People with painful popping or their shoulder dislocates due to a labral tear may respond to physical therapy.  If after therapy your shoulder continues to dislocate, or has a painful catching or popping you may consider an arthroscopic surgery on the shoulder to repair the labrum (see picture below).  A SLAP lesion is simply a tear of the top of the labrum in the shoulder. Labral tears cause different symptoms based on where the labral tear is.  For example. SLAP lesions typically do not allow the shoulder to dislocate, but it can cause popping or catching.  Tears in the front or back of the labrum can cause dislocations of the shoulder.

• Labral Tears – is Surgery Necessary
• Do Labral Tears Require Surgery?
• See this discussion to learn more about SLAP lesions.

Biceps Tendon and Snapping in the front of the shoulder.

The biceps tendon is a long tendon coming up into the front of shoulder from the arm.  It normally sits in a groove in the front of the humerus or arm bone.  Over time that biceps tendon can develop inflammation from overuse.  That might cause a feeling of grinding or pain.  Snapping in the front of the shoulder can be caused by the biceps tendon rolling out of the groove it sits in on the front of the arm bone.  Biceps instability and biceps tendonitis are very common causes of snapping and pain in the front of the shoulder.  A painful biceps tendon can usually be treated with anti-inflammatory medications or injections placed with an ultrasound machine. An unstable biceps tendon that causes painful popping may require surgery to stop the biceps from dislocating out of its groove.  

Rotator Cuff Tears

As you can see in the picture about, a rotator cuff tear can cause abnormal sensations in the shoulder. If the rotator cuff tendons are torn then there is a loose edge within the shoulder that can catch on other ligaments or structures in the shoulder. This may lead to painful snapping or popping. In addition, a rotator cuff tear, or rotator cuff tendinosis can cause a secondary inflammation in the shoulder(bursitis).  We call that inflammatory process bursitis. When bursitis is present in the shoulder then the bursa is swollen and will cause clicking or grinding.

• Click here to help determine if you have a rotator cuff tear?
• Click here to learn more about the treatment of rotator cuff tears.

Shoulder Dislocations

Shoulder dislocations are a common cause of popping in the shoulder.  Especially posterior instability where the ball is moving backward on the socket. 

If the ligaments in the shoulder were injured from an acute injury, the shoulder becomes loose and start dislocating. This can lead the ball of the shoulder to slide up or over the edge of the socket.   When the ball then falls back into place it may cause snapping or popping. This section on shoulder dislocations delves further into detail on shoulder instability.  For more information. Click here to learn more about shoulder dislocation surgery.

Loose Bodies

Shoulder Arthritis

Rest assured that the majority of shoulder snapping or clicking is *normal*.  If you have pain, or if you are concerned –or certainly if you’re snapping or popping started after an injury –you should be evaluated by an Orthopedic Surgeon trained in Sports Medicine to examine you and determine why your shoulder is popping or clicking.   An MRI might be necessary to see if the shoulder labrum is torn, if you have loose bodies floating around, if the biceps tendon is unstable or if osteoarthritis of the shoulder is present.

Video on Causes of Shoulder Snapping or Popping: