Stop Snapping at Me: Snapping Scapula Syndrome

Are you one of these people?

I hear grinding when I move my shoulder! My shoulder blade grinds or clicks over my ribs! My shoulder pops when I move my arm! I get pain in my shoulder blade when I move!

If so you may have snapping scapula syndrome.

What is snapping Scapula Syndrome?

Snapping scapula syndrome, also known as a scapulocostal syndrome or scapulothoracic syndrome is a condition causing painful grinding, clicking, popping or snapping when the shoulder blade moves over the underlying ribs.

This disorder can range from a minor inconvenience to very disabling. It can affect anyone but is more commonly related to sports including swimming, baseball pitching and weight training.

Scapula crepitus is also present in 30% of normal asymptomatic persons. We will discuss snapping scapula syndrome including what it is, why it happens occurs and how to fix it! Firstly, some general shoulder anatomy.

The shoulder girdle is made up of 4 main joints:

• Glenohumeral joint
• Acromioclavicular joint
• Sternoclavicular joint
• Scapulothoracic joint

The grinding and clicking noises heard from snapping scapula syndrome occurs at the scapula-thoracic joint.

Shoulder girdle movement occurs at two joints, the glenohumeral joint, and the scapula-thoracic joint. Although there is a large variability between people movement occurs in a 2:1 ratio of the humerus to the scapula. Total shoulder abduction is made up of 120° of glenohumeral movement and 60° of scapula-thoracic movement.  The scapula movement over the ribs is protected by the infraserratus bursa.

The shoulder blade serves as an anchor for the subscapularis and serratus anterior muscle. It is these muscles as well as the infraserratus bursa that allow for a smooth movement of the shoulder. This smooth movement of the shoulder does help with the overall flexibility and posture of individuals.

Why snapping scapula syndrome happens?

If the muscles are weak, inactive or atrophy the scapula will rub on the ribs and produce the typical grinding and clicking noise. Other causes of snapping scapula are:

• Repetitive movements that lead to inflammation of the bursa
• Atrophy of the muscles underlying the scapula.
• Changes in movement
• Bursitis
• Osteochondroma
• Rib or scapula fractures
• Dislocation
• Nerve disorders

Patients may develop scarring and fibrosis of the bursa, as well as painful scapula crepitus when moving the shoulder blade. Differential Diagnosis: what else could it be!

As with all problems you should be aware of other causes of similar symptoms. Snapping noises may come from the long head of biceps tendon subluxation as it slips forward out of the of the bicipital groove causing snapping sensation or a labral tear which can also be associated with a clicking sound during movement of the shoulder.

Other different diagnosis that implicates the shoulder girdle:

• Bony pathology/soft tissue mass
• Osteochondroma
• Luschka’s tubercle
• Reactive bony spur
• Rib fracture
• Elastofibroma
• Chondrosarcoma
• Cervical radiculopathy
• Thoracic referred pain
• Glenohumeral pathology
• Thoracic outlet syndrome
• Neurological injuries

Home treatment of Snapping Shoulder Syndrome:

Treatment for snapping scapula syndrome will depend on of the severity and will likely start with 6 – 12 months of conservation treatment such as manual therapy that aims to improve the muscle tone and the stability and coordination of the scapula muscles. Should this fails then a hydrocortisone injection may be used. In extremely rare cases when manual therapy fails surgery may help with debridement of the bursa or removal of bony lump – either open or arthroscopically.

Rehabilitation of Scapulothoracic Bursitis involves three general phases.

Acute Phase

Goals: pain and inflammation reduction, restore normal alignment – posture

Principles: PFROM, eliminate gravity (safe co-contractions), closed chain exercises

Examples: manual therapy, thoracic mobility, sidelying flexion, stretches

Recovery Phase:

Goals: strengthening, control and motion

Principles: reproduce scapula motion using multi-plane and level, load as required

Examples: Side-lying forward flexion, side-lying external rotation, and prone horizontal abduction with external rotation

Maintenance Phase:

Goals: maintain movement and strength, scapula control

Principles: open kinetic chain, plyometric exercises, combination exercises

Examples: medicine ball tosses, walking lunges with dumbbell shoulder press

This is a general guideline and by no means patient specific.  Please get a professional assessment and diagnosis if you have any of these symptoms.