Physiotherapy in North America for Shoulder

Welcome to Trainer's Choice's patient resource about Snapping Scapula Syndrome.

The scapulothoracic joint is located where the shoulder blade (also called the scapula) glides along the chest wall (the thorax). When movement of this joint causes feelings or sounds of grating, grinding, popping, or thumping, doctors call it snapping scapula syndrome.

Snapping scapula syndrome is fairly rare. When it happens, the soft tissues between the scapula and the chest wall are thick, irritated, or inflamed. Snapping scapula syndrome can also happen if the bones of the shoulder blade or rib cage grate over one another.

This article will help you understand:

• what causes snapping scapula syndrome
• how doctors treat this condition

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What parts of the body are involved in this condition?

The shoulder is made up of three bones: the humerus (upper arm bone), the clavicle (collarbone), and the scapula (shoulder blade). Two large muscles attach to the front part of the scapula where it rests against the chest wall. One of them, called the subscapularis muscle, attaches over the front of the scapula where it faces the chest wall. The serratus anterior muscle attaches along the edge of the scapula nearest the spine. It passes in front of the scapula, wraps around the chest wall, and connects to the ribs on the front part of the chest.

Scapula Muscles

A bursa is a fluid-filled sac that cushions body tissues from friction. A bursa sits between the two muscles of the scapula. There is also a bursa in the space between the serratus anterior muscle and the chest wall. When bursa sacs become inflamed, the condition is called bursitis.

Bursa

Scapulothoracic bursitis refers to inflammation in the bursa under the shoulder blade. This type of bursitis is most common in the upper corner of the scapula nearest the spine. It also occurs under the lower tip of the scapula. In either case, it can cause the sounds and sensations of snapping scapula syndrome. A person can have bursitis in the joint without any grinding or popping.

Inflammation

Related Document: A Patient's Guide to Shoulder Anatomy

What causes this condition?

Snapping scapula is caused by problems in the soft tissues or bones of the scapula and chest wall. It can start when the tissues between the scapula and shoulder blade thicken from inflammation. The inflammation is usually caused by repetitive movements. Certain motions of the shoulder done over and over again, such as the movements of pitching baseballs or hanging wallpaper, can cause the tissues of the joint to become inflamed.

In other cases, the muscles under the scapula have shrunk (atrophied) from weakness or inactivity. The scapula bone then rides more closely to the rib cage. This means the scapula bumps or rubs on the rib bones during movement.

Changes in the alignment or contour of the bones of the scapulothoracic joint can also cause snapping scapula. When a fractured rib or scapula isn't lined up just right, it can cause a bumpy ridge that produces the characteristic grind or snap as the scapula moves over the chest wall.

Grinding and snapping can also happen if there are any abnormal curves, bumps, or ledges on the upper edge of the scapula closer to the center of the back. (These abnormalities are called Luschka's tubercles.) Any time there is an abnormality in the bone, one of the body's possible responses is to form a bursa. The new bursa may then become inflamed, causing the symptoms of bursitis.

What symptoms does snapping scapula cause?

Grating, grinding, or snapping may be heard or felt along the edge or undersurface of the scapula as it moves along the chest wall. These grinding sensations are also called crepitus. Sometimes the joint pops or thumps during movement. Often, these sensations cause no pain.

Scapulothoracic bursitis, on the other hand, is painful whether or not there is any crepitus in the joint. The sore bursa is usually tender to the touch, and the tissue in the sore area often feels thick.

When you visit Trainer's Choice, our physiotherapist will ask many questions about your medical history. Our goal is to find out if you've had similar problems in the past, if you've injured your scapula, and if any of your activities require repetitive shoulder movements.

Our physiotherapist will also do a physical exam. He or she will check the alignment of the scapula, and will listen with a stethoscope while you move your shoulder and scapula. You may feel pain as you move, but it is important that our physiotherapist knows exactly where your problem is coming from. By feeling the tissues around the scapula, we can find out if the bursa is tender or thickened from inflammation.

Some patients may be referred to a doctor for further diagnosis. Once your diagnostic examination is complete, the physiotherapists at Trainer's Choice have treatment options that will help speed your recovery, so that you can more quickly return to your active lifestyle.

Trainer's Choice provides services for physiotherapists in North America.

Non-surgical Rehabilitation

Nonsurgical treatment is preferred for patients with snapping scapula. These types of treatments are generally successful, especially when the problem is coming from soft tissues. Your physiotherapist at Trainer's Choice may start by recommending nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin and ibuprofen. Rest and ice also help reduce inflammation and ease pain.

Our physiotherapist will also evaluate your posture to make sure that your spine and shoulder bones are in their best alignment. We may also have you do a strengthening program to bulk up the muscles under the scapula. This can help pad and cushion the soft tissues between the scapula and rib cage.

Post-surgical Rehabilitation

Therapy is more involved after surgery. Patients wear a sling following scapula surgery. Your physiotherapist will have you begin passive shoulder movements soon after surgery. But there should be no active exercises for about eight weeks, to make sure the muscles are firmly healed where they were sewn back into the drill holes in the scapula. Our post-surgical patients usually start doing resistive exercise and activities after 12 weeks.

At Trainer's Choice, our goal is to help speed your recovery so that you can more quickly return to your everyday activities. When your recovery is well under way, regular visits to our office will end. Although we will continue to be a resource, you will be in charge of doing your exercises as part of an ongoing home program.

Trainer's Choice provides services for physiotherapy in North America.

Doctors usually recommend surgery only if nonsurgical treatments have failed. Surgery may be needed if the problem is caused by a bone abnormality. In the most common surgery for snapping scapula, the surgeon takes out a small piece of the upper corner of the scapula nearest to the spine.

Bone Resection

To remove a small piece of the scapula, an incision is made just below the bone's top edge. The surgeon pulls aside the tissues to show the prominent section of the bone, called the:

Spine of the Scapula

The tissues that attach muscles to the upper part of the scapula are carefully detached and moved out of the way. Then the surgeon uses a special tool to:

Remove the Corner of the Scapula

Drill holes are made into the spine of the scapula. Then the ends of the upper scapular muscles are:

Sewn Back

onto the spine of the scapula, and the incision is closed up.

Arthroscopic Bursectomy

Surgeons sometimes do arthroscopic surgery to take out an inflamed scapulothoracic bursa. Removing a bursa is called bursectomy. Small incisions allow the surgeon to insert a small TV camera, called an arthroscope, into the joint. Through another small incision, the surgeon uses special instruments to remove the inflamed bursa while the arthroscope shows what is happening.

Portions of this document copyright MMG, LLC.