What is the treatment for neck crepitus?

Treatment of Neck Crepitus

The treatment of neck crepitus should focus on addressing the underlying cause, with conservative management being the first-line approach for benign cases, including physical therapy, exercise, and anti-inflammatory medications.

Understanding Neck Crepitus

Neck crepitus refers to the grinding, popping, or crackling sounds that occur with neck movement. It can be:

• Benign and asymptomatic (common)
• Associated with pain and functional limitations (requiring treatment)
• A sign of serious underlying pathology (requiring specific management)

Diagnostic Approach

Before determining treatment, it's essential to identify the cause:

1. Assess for red flags:

   • Crepitus following trauma (may indicate aerodigestive tract injury) 1
   • Associated neurological symptoms
   • Fever or signs of infection
   • History of malignancy
   • Progressive worsening symptoms

2. Key physical examination findings:

   • Location and quality of crepitus
   • Associated pain with movement
   • Limitation in range of motion
   • Presence of swelling or masses
   • Neurological deficits

3. Imaging (when indicated):

   • Standing X-rays for structural assessment
   • MRI for persistent symptoms after 6 weeks of conservative management 2

Treatment Algorithm

1. Benign Musculoskeletal Neck Crepitus

For crepitus related to degenerative changes, muscle tension, or minor joint dysfunction:

• First-line treatment:

  • Postural and scapular strengthening exercises 3
  • Neck stretching and range of motion exercises 4
  • NSAIDs for pain and inflammation 5
  • Local modalities (heat, ice) 3

• Second-line treatment:

  • Physical therapy with manual therapy techniques 4
  • Exercise combined with mobilization/manipulation (shown to have strong evidence for pain reduction) 4

2. Scapulothoracic Crepitus and Bursitis

For crepitus originating from the scapulothoracic region:

• Conservative management (highly effective for soft-tissue causes) 3:

  • Postural correction
  • Scapular strengthening exercises
  • Local modalities

• Surgical options (when conservative treatment fails or for osseous lesions) 3:

  • Partial scapulectomy
  • Open or arthroscopic scapulothoracic bursectomy

3. Temporomandibular Disorder (TMD) Related Crepitus

For crepitus associated with TMD:

• Conservative approaches (first-line) 6:

  • Reversible oral splints
  • NSAIDs (without opioids)
  • Physical therapy exercises

• Avoid discectomy and irreversible oral splints due to potential harms 6

4. Post-traumatic Neck Crepitus

For crepitus following trauma:

• High suspicion for aerodigestive tract injury 1:
  • Immediate evaluation with direct laryngoscopy and esophagoscopy
  • Broad-spectrum antibiotics (used in 95% of cases)
  • Surgical exploration may be necessary (55% of cases)
  • Non-operative approach may be appropriate in select cases (45%)

Special Considerations

1. Chronic neck crepitus with pain:

   • Nearly half of chronic neck pain patients have mixed neuropathic-nociceptive or predominantly neuropathic symptoms 7
   • Consider adjuvant medications for neuropathic component

2. Duration-based approach:

   • Acute: NSAIDs and muscle relaxants are effective 7
   • Chronic: Exercise shows strongest evidence among complementary treatments 7

3. Cervical radiculopathy:

   • Weak evidence supports epidural steroid injections 7
   • Conservative management for at least 6 weeks before considering surgical options 2

Monitoring and Follow-up

• Re-evaluate after 4-6 weeks of conservative treatment
• Consider advanced imaging if symptoms persist
• Assess for development of new symptoms that may indicate progression or different etiology

Conclusion

Most cases of neck crepitus are benign and respond well to conservative management focused on exercise, physical therapy, and anti-inflammatory medications. Surgical intervention should be reserved for cases that fail conservative management or have specific indications such as aerodigestive tract injury or persistent scapulothoracic bursitis with osseous lesions.