Why Does My Elbow Pop and Should I Worry?

Causes of Elbow Popping or Cracking

The causes of elbow popping include the following: 

Normal joint Mechanics 

One of the most common reasons for elbow popping is normal joint movement, which we call benign crepitus. This often occurs when tendons and ligaments move over bony structures or when tiny gas bubbles burst within the joint’s synovial fluid. It is usually painless and does not indicate an elbow problem. There is no risk of long-term damage. 

Ulnar Nerve Dislocation 

The ulnar nerve runs inside the elbow in the cubital tunnel. It can become unstable, snapping over the medial epicondyle during bending and straightening movements, causing an elbow-popping sensation. Sometimes, the nerve can become inflamed, leading to pain inside the elbow, often accompanied by tingling or numbness in the ring and little fingers. Individuals who frequently bend and straighten their elbows, such as baseball pitchers, gymnasts, and weightlifters, are more prone to this condition. 

Often, the diagnosis is evident in clinical assessment, with popping on the inside of the elbow and movement of the elbow. However, ultrasound can visualise the nerve dislocation with elbow bending. 

Elbow Ligament Damage

Ligament injuries can cause elbow popping, particularly damage to the radial (RCL) and ulnar (UCL) collateral ligaments. These ligaments play a role in stabilising the joint. When they become stretched or torn, instability can result in popping or clicking sensations. MCL injuries are more common in overhead-throwing athletes who place significant stress on the elbow, while RCL injuries can occur following trauma or repetitive stress. RCL injuries can cause posterolateral elbow instability. 

Ligament injuries are diagnosed through the history of an injury and laxity on ligament testing. 

Osteochondritis Dissecans

This condition, OCD of the elbow, occurs when tiny fragments of cartilage and underlying bone become loose within the joint, leading to mechanical symptoms such as clicking, popping, or even locking. It primarily affects young athletes involved in repetitive throwing or weight-bearing activities.

Individuals with OCD often report pain on the outside of the elbow, associated with clicking, popping, and restriction in movement. There is tenderness on palpating the radiocapitellar joint. 

Loose Bodies

Loose bodies within the elbow joint can also contribute to popping or clicking sensations. These tiny fragments of cartilage or bone can break off due to trauma, arthritis, or chronic instability. Sometimes, they become trapped between joint surfaces. These fragments can lead to intermittent mechanical symptoms, such as popping, and may require surgery if they cause persistent discomfort or restricted movement.

Triceps Snapping Syndrome

This condition occurs when the medial aspect of the triceps tendon dislocates over the elbow’s inside. It is often accompanied by ulnar nerve dislocation. Weightlifters, climbers, and throwing athletes are particularly at risk.

Often, ultrasound can confirm the dislocation of the medial triceps tendon when the elbow is flexed. 

Elbow Arthritis

Elbow arthritis can cause degenerative changes in the joint, leading to irregular joint surfaces and the formation of bone spurs. As the cartilage wears away, movement may become less smooth, resulting in popping or cracking sounds. 

Elbow Tendon Instability

Tendon instability, particularly involving the biceps and brachialis tendons, can cause elbow popping. These tendons insert near the elbow and sometimes shift over bony structures, creating a snapping or clicking sensation. This instability is more common in individuals with hypermobility or previous tendon injuries. In some cases, inflammation can develop, leading to tendonitis and pain with elbow movement. 

Elbow Plica Syndrome 

A synovial plica is a thickening of a standard fold in the elbow joint. Sometimes, the plica can become inflamed, leading to pain and mechanical symptoms such as popping or cracking. We call this condition elbow plica syndrome. 

Often, this condition can be diagnosed with ultrasound or MRI scans. 

How to Investigate Elbow Popping or Cracking

If structural damage is suspected, imaging may be required. X-rays can help detect joint arthritis or loose bodies. An MRI provides a more detailed evaluation of soft tissue injuries, including ligament tears, tendon instability, and cartilage damage. Ultrasound helps assess tendon snapping, nerve instability, and ligament injuries in real time. Sometimes, a CT scan may detect subtle bone abnormalities or loose bodies that are not visible on standard X-rays.

When to Seek Medical Attention for Elbow Popping 

Elbow popping or cracking that occurs infrequently and without pain is usually harmless. However, if the popping is accompanied by pain, swelling, weakness, numbness, or locking, you should see a sports medicine doctor for assessment. These extra symptoms may indicate an underlying ligament, tendon, or cartilage injury that requires treatment. 

Final Word from Sportdoctorlondon about Elbow Popping or Cracking 

Elbow popping or cracking can result from various causes, from normal joint mechanics to nerve, ligament, tendon or joint damage. While some cases are harmless, others may indicate pathology that requires medical attention. A detailed clinical assessment, supported by imaging when necessary, helps determine the cause and appropriate management.