Shoulder Clicks, Pops, and Clunks: When to Ignore Them and When to Act

The shoulder is a mechanically complex structure traversed by multiple tendons, crossed by bursae, and surrounded by a capsular-ligamentous envelope that moves through an enormous arc with every arm movement. Given this anatomy, some degree of audible noise during shoulder motion is nearly universal and carries no inherent clinical significance. The challenge is distinguishing the noise that reflects normal tissue movement from the noise that signals pathological contact, labral tearing, or early degenerative change.

The Four Types of Shoulder Noise

1. Crepitus: A grating, grinding, or crackling sensation — often felt more than heard — produced by roughened articular surfaces moving against each other. Crepitus in the glenohumeral joint suggests articular cartilage irregularity. At the acromioclavicular joint, it is extremely common and usually benign. Crepitus alone, without pain, rarely requires evaluation.

2. The click or clunk with a distinct arc: A reproducible click at a specific point in the arc of shoulder motion — particularly an anteriorly felt click with forward flexion and internal rotation — is the most characteristic finding of a superior labral tear (SLAP lesion). If this click is accompanied by a deep pain or catching sensation, evaluation is warranted.

3. The snapping or clunk with overhead movement: A palpable and audible clunk felt at the front of the shoulder during overhead activity is often the biceps tendon subluxating in and out of its groove on the anterior humerus — biceps tendon instability, usually associated with a partial or complete subscapularis tear. This is a specific finding that requires evaluation.

4. Scapulothoracic crepitus: Grinding or snapping felt at the back of the shoulder along the scapular border with arm movements. Usually caused by muscle imbalances producing abnormal scapular kinematics, or by bursal irritation between the serratus anterior and the chest wall. This is frequently benign but responds well to scapular stabilization exercises.

The SLAP Question

Superior labral anterior-posterior (SLAP) tears — tears of the superior labrum at and around the biceps anchor — are among the most commonly discussed shoulder diagnoses in active adults and overhead athletes. They produce the arc-specific catching and clicking described above, along with deep shoulder pain provoked by overhead activities and a positive compression rotation test (O'Brien test). Diagnosis requires MR arthrogram, as standard MRI misses a significant percentage. Management has evolved considerably toward non-operative care in recent years: the evidence for SLAP repair surgery producing consistent, durable outcomes is modest, and physical therapy focused on rotator cuff and periscapular strengthening produces meaningful improvement in the majority of cases. Surgery is reserved for younger athletes with clear instability and failed rehabilitation, not for all confirmed SLAP lesions.