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Video
Overview
Multiple different definitions of the word 'crepitus' exist but share the common concept of a grinding, grating or crackling sound or sensation.
- Merriam-Webster (2019) identifies it as "a grating or cracking sound or sensation (as that produced by the fratured ends of a bone moving against each otther or as that in tissue affected with gas gangrene)"
- Wiktionary (2019) "grating, cracking or popping sounds and sensations experienced under the skin and joints"
Causes for crepitus include movement of two rough body surfaces coming in contact, bubles of nitrogen forming in synovial fluid, and when gas in introduced in an area where it is not usually present (gas gangrene, air trapped in subcutaneous tissue as after trauma or surgery).
The majority of publications addressing 'neck crepitus' are about subcutaneous emphysema (Kiraly 2017,Tessler 2017) - and therefore differ in focus from the more common use of the term 'crepitus' when applied to the knee or the temporomandibular joint.
A focus of study of crepitus occurring in the knee has identified that 'in most cases the noise is physiological, and it is sufficient to explain the couse of the noise to patients and reassure them' [that it is not pathological in most cases] (Song 2018). Song et al (2018) identified noises and clicking sensations about the knee can be associated with degenerative arthritis and patellofemoral pain syndrome - and have used terms "clunking, clicking, grinding, grating, popping, snapping, catching, crunching, cracking, crackling, creaking", and other terms to correlate differing sounds/sensations with specific processes. They relate these distinct joint sounds/sensations are most commonly grouped with the nonspecific label of 'crepitus' - and attributed its use to doctors' familiarity with this term used commonly in describing lung sounds.
Lo et al (2018) defined subjective crepitus as 'the complaint of hearing grating, cracking or popping sounds in and/or around a joint'. A multi-center study with three year followup evaluating only the right knee offered the question 'Do you feel grinding, hear clicking or any other type of noise when your right knee moves?" - and from 3,495 participants without symptoms of knee arthritis - identified frequency prevalence as: none (65.1%), rarely (10.8%), sometimes (15.1%), often (5.6%) and always (3.4%). The subjective report of having crepitus was found to be associated with a higher risk of subsequently developing symptomatic knee osteoarthritis.
Iodice (2019) in an effort to sample the general Italian population employed 'casual recruitment of subjects from public spaces' to provide a questionaire resulting in analysis of 4,299 responses to identify TMJ clicking ('a precise clean sound like a snap') to be present in 30.7% and TMJ crepitus ('light noise protracted in time, similar to sandpaper' in 10.3%. TMD-pain (temporomandibular disorder pain) was reported by 16.3% at some point in their past (a history of TMD pain)
Less has been published about the 'clicking larynx'.
Heuveling et al in 2018 (Heuveling 2018) identified successful surgical treatment of 'a clicking larynx' occuring on the right side during swallowing and associated with a sore throat. They offer a nice review of the literature identifying 16 previously reported cases with 12 receiving surgical treatment. Nicely illustrated diagrams and surgical photos identify their proposal that possible causes for 'clicking larynx' include: a short distance between hyoid bone and superior part of the thyroid cartilage; displaced superior cornu; enlarged greater horn of hyoid bone; and abnormal bone formation in the thyrohyoid ligament.
A good discussion about the variability in the hyo-laryngeal anatomy focussed on embryonic development is offered by de Bakker et al (ed Bakker 2018).
Refererences
Grace H. Lo, MD MSc,1,2 Michael T. Strayhorn, MPH,1,2 Jeffrey B. Driban, PhD,3 Lori Lyn Price, MAS,4,5Charles B. Eaton, MD MS,6 and Timothy E. McAlindon, MD MPH3: Subjective Crepitus as a Risk Factor for Incident Symptomatic Knee Osteoarthritis: Data from the Osteoarthritis Initiative Arthritis Care Res (Hoboken). 2018 Jan; 70(1): 53–60. Published online 2017 Dec 8. doi: 10.1002/acr.23246
Song SJ, Park CH, Liang H, Kim SJ.Noise around the Knee.Clin Orthop Surg. 2018 Mar;10(1):1-8. doi: 10.4055/cios.2018.10.1.1. Epub 2018 Feb 27.
Turkmen S, Cansu A, Turedi S, Eryigit U, Sahin A, Gunduz A, Shavit I. Age-dependent structural and radiological changes in the larynx. Clin Radiol. 2012;67(11):e22-26
Smith ME, Berke GS, Gray SD, Dove H, Harnsberger R. Clicking in the throat: cinematic fiction or surgical fact? Arch Otolaryngol Head Neck Surg. 2001;127(9):1129-1131.
Avrahami E, Harel M, Englender M. CT evaluation of displaced superior cornu of ossified thyroid cartilage. Clin Radiol. 1994;49(10):683-685.
Nadig SK, Uppal S, Back GW, Coatesworth AP, Grace AR. Foreign body sensation in the throat due to displacement of the superior cornu of the thyroid cartilage: two cases and a literature review. J Laryngol Otol. 2006;120(7):608-609.
Piotr Wojtowicza, Tomasz Szafarowskia, b, Wojciech Kukwaa, Ewa Migacza, Antoni Krzeskia: Extended Superior Cornu of thyroid Cartilage Causing Dysphagia and Throat Pain. Journal of Medical Cases Vol 6, Number 3, March 2015, pages 134-6
Shiozawa T, Epe P, Herlan S, Müller M, Tropitzsch A, Tsiflikas I, Hirt B. Clinically relevant variations of the superior thyroid cornu. Surg Radiol Anat. 2017 Mar;39(3):299-306. doi: 10.1007/s00276-016-1735-5. Epub 2016 Aug 29.
Heuveling DA, van Loon MC, Rinkel RNPM: A Clicking Larynx: Diagnostic and Therapeutic Challenges. Laryngoscope 128:697-700, 2018
Hirano M, Kurita S, Yukizane K, Hibi S (1989) Asymmetry of the laryngeal framework: a morphologic study of cadaver larynges. Ann Otol Rhinol Laryngol 98:135–140
de bakker BS, de Bakker HM, Soerdjbalie-Maikoe V, and dikkers FG: The Development of the Human Hyoid-Larynx Complex Revisited Laryngoscope, 128:1829-1834, 2018
Merriam-Webster on line - accessed 4-22-2019 for 'crepitation' (https://www.merriam-webster.com/medical/crepitation)
Wiktionary on line - accesse 4-22-2019 for crepitus (https://en.wiktionary.org/wiki/crepitus)
Kiraly B.Neck Crepitus in a Runner.Am Fam Physician. 2017 Jan 15;95(2):113-115.
Tessler RA, Nguyen H, Newton C, Betts J.Pediatric penetrating neck trauma: Hard signs of injury and selective neck exploration.J Trauma Acute Care Surg. 2017 Jun;82(6):989-994.
Iodice G, Cimino R, Vollaro S, Lobbezoo F, Michelotti A.Prevalence of temporomandibular disorder pain, jaw noises and oral behaviors in an adult Italian population sample.J Oral Rehabil. 2019 Apr 16. doi: 10.1111/joor.12803