The scapula, more commonly known as the shoulder blade, connects to the humerus (upper arm bone) and the clavicle (collar bone), and it helps stabilize and support the shoulder joint. Snapping scapula is a condition that involves the grinding, popping, or snapping of bones and tissue around the scapula when moving the arm.
The space between the shoulder blade, its muscles, and the ribs is called the scapulothoracic joint. In order for the scapula not to rub against the ribs, there are fluid-filled sacs, called bursae (singular, bursa), that lie between these structures to help them glide over each other smoothly.
Snapping scapula is a condition that can include a variety of symptoms, most often feeling or hearing clicking or grinding of the shoulder blade with movement. The condition can present with pain only, with discomfort underneath or along the inner edge of the scapula.
Snapping scapula is most commonly associated with overuse of the arm, incorrect joint motion, and poor posture during sports activities. Athletes like baseball players and swimmers may experience this syndrome. Workers who stock high shelves or perform overhead activities are also at risk. It can also be caused by trauma to the shoulder blade area.
This condition is most commonly seen in young adults. It can also occur in older adults, however, or individuals with weaker shoulder muscles. In these cases, the muscles weaken, and cannot properly support the scapula, so it tends to rub against the ribs. In any case, with repetitive use, tissues like muscles and tendons can become thickened and rub together more. Even bones can overgrow into sharp projections. This can cause clicking or grinding sensations. Over time, it can also cause inflammation of the bursa underneath the shoulder blade, which is known as scapulothoracic bursitis.
In order to diagnose a snapping scapula, a doctor will first perform a physical examination, looking for any changes in posture or asymmetry from one side to the other. Afterward, x-rays and MRIs may be used to further confirm the diagnosis of this condition.
Nonsurgical treatment options
Initial treatment for this problem includes extensive physical therapy, and oftentimes a cortisone injection into the space underneath the scapula where the inflammation occurs. If symptoms continue despite this more conservative treatment, then surgery is an option.
How surgery is performed
A scapulothoracic bursectomy with medial angle resection is an arthroscopic procedure that is done using two to three small incisions around the shoulder blade, one used to insert a camera (arthroscope) and the others used to insert small surgical tools and instruments. The surgery involves removing the inflamed bursa located between the ribs and scapula and shaving off the bony prominence (medial angle) located on the undersurface of the scapula.
This surgery is performed on an outpatient basis, which means you will be able to go home that same day. Your arm will be placed in a sling for the first four weeks after surgery and will only be allowed to move your elbow, wrist, and hand during this time.
Physical therapy protocols: Snapping Scapula
Four weeks after your surgery, the sling is removed and you will begin physical therapy, first to work on motion and eventually strengthening. A typical recovery time for this surgery is four to six months.
How common is snapping scapula?
Snapping scapula is a fairly rare condition, making it difficult to diagnose at times. Because of this, a number of tests (mentioned above) may be used to help doctors diagnose this condition.