Snapping scapula syndrome is audible or palpable crepitus at the scapulothoracic articulation, the space between the shoulder blade and the rib cage. The crepitus can be painless and inconsequential or painful and functionally limiting. The underlying cause is often a bone spur, bursa inflammation, or soft tissue abnormality that creates abnormal contact during shoulder motion.
What Is Snapping Scapula Syndrome?
The scapulothoracic articulation is the smooth gliding space between the deep surface of the scapula and the chest wall, cushioned by three bursae. The scapula moves in coordination with the shoulder, pivoting and sliding to position the glenoid for arm motion. Any irregularity in this gliding space can produce mechanical crepitus.
Common causes include:
- Bony abnormalities such as osteochondromas or bone spurs on the undersurface of the scapula
- Bursitis from inflammation of one of the scapulothoracic bursae due to overuse
- Soft tissue thickening from fibrous masses or scarring from prior injury
- Rib abnormalities such as prominent rib angles that contact the scapula
- Poor scapular mechanics that produce repetitive irritation
Snapping without pain is common and usually requires no treatment. Painful snapping is the concern and drives evaluation and treatment.
Causes and Risk Factors
- Overhead athletic activity (swimming, throwing, racquet sports)
- Manual labor with repetitive overhead motion
- Prior scapular fracture or surgery
- Osteochondroma (a benign bony growth) on the undersurface of the scapula
- Thin body habitus with prominent rib angles
- Poor postural mechanics with forward-rounded shoulders
Symptoms
- Audible or palpable popping, grinding, or snapping with arm motion
- Pain, tenderness, or a sense of friction along the medial border or superior angle of the scapula
- Pain with overhead activity or pressing movements
- Occasional visible winging of the scapula
- Pain relieved by resting the arm
Diagnosis
Dr. Chudik’s evaluation includes the pattern and location of the snapping, the activities that provoke it, and a focused examination of scapulothoracic motion. Reproducing the snapping during active motion is a key exam finding. X-rays are often normal but can show osteochondromas or rib abnormalities. MRI or CT characterizes soft tissue masses and bony lesions when symptoms persist. The Westmont office has on-site high-field MRI and X-ray.
Treatment
Non-surgical treatment resolves symptoms in most patients. It includes:
- Activity modification to reduce provocative motion
- A targeted physical therapy program for scapular stabilizers, posture correction, and periscapular muscle balance
- Anti-inflammatory medication
- Scapulothoracic bursa corticosteroid injection for bursitis-driven symptoms
Surgery is considered when symptoms persist despite appropriate non-surgical care. Dr. Chudik performs arthroscopic scapulothoracic bursectomy and debridement, removing inflamed bursa and any irregular bone on the undersurface of the scapula. Excision of an osteochondroma is performed when a bony lesion is the specific cause.
Recovery and Outcomes
Recovery with non-surgical treatment occurs over several weeks to months depending on the underlying cause. Recovery after arthroscopic treatment typically includes a sling for one to two weeks for comfort, progressive motion from two weeks, and return to most activity by six to eight weeks. Outcomes are good when the underlying mechanism is correctly identified and addressed.
When to See Dr. Chudik
Schedule an evaluation if snapping or grinding at the shoulder blade is accompanied by pain, if it interferes with overhead activity, or if prior treatment has not resolved symptoms. Call 630-324-0402 or request an appointment online.