When the scapulothoracic joint, located where the shoulder blade (scapula) and chest wall (thorax) meet, causes sounds of popping, clicking, or grinding, doctors refer to it as snapping scapula syndrome.
Overall it is a pretty rare condition. It happens when the soft tissues between the scapula and the chest wall become irritated or inflamed for one of several reasons. This condition can also occur if the bones of the shoulder blade or rib cage rub against each other creating friction.
This article will help you understand:
What parts of the body are involved?
There are three main bones that make up the shoulder joint. These are the humerus (upper arm bone), the clavicle (collarbone), and the scapula (shoulder blade). Resting against the chest wall are two large muscles which attach to the front portion of the scapula; The subscapularis muscle attaches over the front of the scapula where it faces the chest wall and is responsible to keeping the arm attached to the shoulder joint as it rotates, and the serratus anterior muscle attaches along the scapula’s edge closest to the spine, passing in front of the scapula, wrapping around the chest wall, and connecting the ribs on the front of the chest.
Sitting between the two muscles of the scapula as well as the space between the serratus anterior muscle and the chest wall is a fluid-filled sac called a bursa, which cushions the body tissues from friction. When this sac becomes inflamed or irritated, it’s called bursitis.
The most common type of bursitis is a condition called scapulothoracic bursitis, which refers to inflammation in the bursa underneath the shoulder blade – most commonly the bursa in the upper corner of the scapula nearest the spine, however it can also occur in the scapula’s lower tip. Regardless of the location, this condition can cause the irritation and sounds associated with snapping scapula syndrome. Although it is possible for a person to have bursitis in a joint without experiencing these symptoms.
What causes this condition?
Repetitive movements are usually the cause of snapping scapula syndrome. Think about the prevalence of joint issues with athletes like a baseball pitcher. Certain motions of the shoulder done over and over again like pitching a baseball can cause the soft tissues of the shoulder joint to become inflamed and thicken as a result.
In other cases this syndrome is caused by the scapula rubbing against the ribs during certain movements as a result of the muscles under the scapula having shrunk (atrophied) from weakness or inactivity. This causes the scapula bone to ride closer to the rib cage.
Snapping scapula syndrome can also happen when a fractured rib, scapula, or other bone of the scapulothoracic joint isn’t correctly aligned. This can cause a bumpy ridge which produces the “grinding” or “snapping” sound associated with this
Anytime there is an abnormality in a bone, whether it be a bump, curve, or ledge, one of the most common reactions of the body is to form a bursa, which may then become inflamed thereby causing the symptoms of bursitis. Those grinding or snapping sounds can occur with one of these abnormalities on the upper edge of the scapula closer to the back’s center (Luschka’s tubercles.)
Snapping Scapula Symptoms
Crepitus is a grinding sensation, sometimes also described as a snapping or grating sensation, which may be felt or even heard along the edge or underside of the scapula as it moves along the chest wall. In some cases this occurs during movement, and usually without any pain.
On the other hand, scapulothoracic bursitis is painful whether or not there is crepitus in the affected joint. The tissue in the area usually feels thick, and the bursa feels sore and tender to the touch.
Our goal at Hicksville Physical Therapy is to identify treatment options for you that will speed your recovery so you can quickly return to your active lifestyle. During your visit, our physical therapist will ask you several questions about your medical history and current symptoms. This is so we can find out if you have had similar issues in the past regarding your scapula, or if any of your usual activities involve repetitive shoulder movements.
You will also be asked to do a physical examination where your scapula’s alignment will be checked, and your shoulder and scapula will be listened to with a stethoscope. By feeling the tissues around the scapula we can more accurately determine if the bursa is inflamed. You may experience some discomfort as you move but this is important, as our physical therapist must know exactly where the discomfort is originating from.
Depending on the results of this initial assessment, you may be referred to a doctor for further diagnosis. Once this is complete, the physical therapists at Hicksville Physical Therapy can provide you with treatment options specific to your case.
Non-surgical Rehabilitation
Your physical therapist at Hicksville Physical Therapy may recommend you nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin or ibuprofen, as a method for reducing inflammation and easing pain. In fact, nonsurgical treatments like these medications, rest and icing are almost always preferred for patients with snapping scapula syndrome.
Your posture will also be evaluated by a physical therapist to ensure that your spine and shoulder bones are aligned correctly. A strengthening program may also be prescribed to help bulk up muscles underneath the scapula, which can help pad and cushion the tissues between the scapula and rib cage.
Post-surgical Rehabilitation
Surgery will only be recommended by a doctor if a bone abnormality is the cause of the issue at hand and nonsurgical treatments have failed. In most cases of surgery for snapping scapula syndrome, the surgeon will remove a small piece of the scapula’s upper corner nearest to the spine.
At Hicksville Physical Therapy, we want to help you achieve a fast recovery so you can quickly return to your everyday activities. This will most definitely involve physical therapy post-operation. In addition to wearing a sling following the procedure, your physical therapist will have you perform passive shoulder movements almost immediately. However there should be no active exercise for about eight weeks after the surgery to ensure that the muscles are fully healed. In most cases our patients can start doing resistive exercises and activities after 12 weeks in recovery.
Once you are far along in your recovery process, regular visits to our office will no longer be necessary. However we will continue to be a resource while you perform your home exercise program.
TIn the surgical procedure to remove a small piece of scapula, the surgeon will make a small incision just below the scapula’s top edge, pulling aside the tissue to show the prominent section of the bone, called the:
Surgeons sometimes perform a bursectomy, a type of arthroscopic surgery, to remove an inflamed scapulothoracic bursa. Two small incisions are made during this procedure. One incision allows the surgeon to insert a small TV camera called an arthroscope into the joint. Through the other the surgeon uses special instruments to remove the inflamed bursa, using the arthroscope to see what is happening.
