Shoulder popping and grinding
Popping and grinding isn't normal. Some crepitus may never go away but it should be a warning sign of dysfunctional movement or instability. Often the popping and grinding noise is accompanied with a deep achy feeling in the front top or back of the shoulder and is frequently diagnosed as scapular dyskinesia.
Scapular dyskinesia is also referred to as SICK scapula. The acronym refers to the physical findings often presented:
- Scapular malposition
- Inferior medial border prominence
- Coracoid pain and malposition
- Dyskinesia of scapular movement.
Yeah, they reached a bit with the K but you get the point.
QUICK ANATOMY REVIEW
The shoulder joint is a complicated one. It is a ball sitting in a shallow socket, often described as a golf ball on a tee. The ligaments, glenoid labrum, and rotator cuff musculature help support the joint but even with all of these supporting structures accounted for, the majority of shoulder injuries or pain can be attributed to a loss of stability.
Patients with scapular dyskinesia often complain of grinding at the shoulder blade, pain in the front of the shoulder or both. Often the patient also presents with pain and tightness in the chest musculature. This finding is usually indicative of chronically shortened positioning with the shoulders rounded and inhibited antagonists.
As you look at a patient with scapular dyskinesia it is helpful to notice the resting position on the thorax but keep in mind the magic really happens during movement, so be careful about just treating what you see statically. Often dyskinesia is associated with a prominent inferior angle of the scapula. This finding can indicate excessive upward scapular rotation and anterior tilt, or excessive thoracic kyphosis. Also, it can be helpful just to look at the two scapula and determine symmetry. A qualified clinician should be able to deduce which muscles are tight, or which are inhibited leading to the scapula sitting in an asymmetrical resting position.
Dyskensia! Imagine that. Simply put, you will see abnormal movement. To know what abnormal is you need to know what normal is and normal shoulder movement is very hard to nail down, so seek a qualified clinician for this part. Easy things to spot are no scapular movement as the arms elevate overhead, or excessive winging in the same movement.
A qualified clinician should help you deduce exactly which muscles need work as manual therapy is often the first stage of treatment. Using a proper movement assessment (SFMA for example) this clinician should also be able to point to specific movement dysfunction outside of the shoulder that may be playing a roll in altered shoulder movement including the neck, thoracic spine, and frequently the opposite hip! After manual therapy is used to help down regulate tight muscles and facilitate those that are weak we jump straight to therapeutic exercises. Beginning with classic push up plus and rotator cuff isometrics is a solid start, but the exercises need to progress to promote functional stability about the joint. My personal all time favorite shoulder stability exercise in such a population is rhythmic stabilization drills. Often I will begin with the patient supine with the shoulder at 90° (as in the video below), progressing to half kneeling, then elevating the shoulder, and finally to standing until the patient is able to stabilize in standing with full arm elevation and no pain. This takes work on the patients part but it will help build that strong stabile shoulder.
In summary, no, grinding and popping generally is abnormal and pain most definitely is abnormal. If you are feeling this sensation in your shoulders or have been diagnosed with SICK scapula reach out! We would love to help you get back pain free movement!