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Elbow Crepitus

Exams and Signs

Historical Overview

  • “Crepitus” is the Latin word for rattling or creaking.

Description

  • Crepitation is a creaking sound or feeling due to atypical interaction between air, fluid or bone. In the elbow, it may be the only sign of a fracture rather than a sprain.1

Pathophysiology

  • Elbow crepitus may arise from injury, osteoarthritis (OA) or rheumatoid arthritis (RA). In the early stages of OA, when the joint space is still maintained, restriction of motion at the extremes of flexion and extension is often observed. RA patients often experience pain throughout the arc of motion.2
  • In rare cases, elbow crepitus can result from synovial chondromatosis, a condition that is easily misdiagnosed. If the patient presents with synovial chondromatosis, there is a small risk of transformation into chondrosarcoma.3
  • Among adolescents, elbow crepitus may arise from osteochondritis dissecans, in which a segment of cartilage and subchondral bone can separate, forming a loose body. Osteochondritis dissecans may be caused by athletic injuries; however, certain individuals may also possess a genetic predisposition.4

Instructions

  1. Examine the upper extremity, including the cervical spine1
  2. Before examining the elbow, assess the shoulder, wrist and hand5
  3. Ask the patient if he or she experiences pain when engaged in activities and/or when resting
  4. Check for crepitus, pain and stiffness during range of motion (ROM) of the elbow. Functional ROM is considered to be an arc of motion of 100° and an arc of forearm rotation of 100°.2

Variations

  • Other symptoms to consider include locking, instability, snapping or deterioration in athletic aptitude.5
  • Arthritis symptoms may also include joint pain, tenderness, limitation of movement and varying degrees of inflammation.1

Related Signs and Tests

  • Tinel test
  • Radiographs
  • Computed tomography (CT) scan
  • Magnetic resonance imaging (MRI)

Diagnostic Performance Characteristics

  • To improve reliability, the elbow crepitus test should be used in conjunction with radiographs, CT scans and/or MRI. 
Definition of Positive Result
  • A positive result occurs when the examiner hears or feels a creaking sound and stiffness during ROM of the elbow.
Definition of Negative Result
  • A negative result occurs when the examiner does not hear or feel a creaking sound and stiffness during ROM of the elbow.
Comments and Pearls
  • Patients with RA usually experience longer durations of stiffness; patients with OA commonly experience stiffness for <30 minutes at a time.1
  • In patients with synovial chondromatosis, periosteal reaction or bone marrow invasion may be observed after resection and synovectomy. If so, the patients should be monitored vigilantly for malignant transformation into chondrosarcoma.3
Diagnoses Associated with Exams and Signs
References
  1. Culp R, Jacoby S. Musculoskeletal Examination of the Elbow, Wrist and Hand: Making the Complex Simple. New Jersey: SLACK Incorporated, 2012
  2. Papatheodorou LK, Baratz ME, Sotereanos DG. Elbow Arthritis: Current Concepts. J Hand Surg Am 2013;38(3):605-13. PMID: 23391361
  3. Ho YY, Choueka J. Synovial Chondromatosis of the Upper Extremity. J Hand Surg Am 2013;38(4):804-10. PMID: 23474166
  4. Kenniston JA, Beredjiklian PK, Bozentka DJ. Osteochondritis Dissecans of the Capitellum in Fraternal Twins: Case Report. J Hand Surg Am 2008;33A:1380-1383. PMID: 18929205
  5. Hausman MR, Lang P. Examination of the Elbow: Current Concepts. J Hand Surg Am 2014;39(12):2534-41. PMID: 25459959
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