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Popping and grinding of the shoulder can be painful.  Unfortunately these symptoms often times get a blank stare from physicians.  What is the Scapula?  What is Snapping Scapula?  What causes a Snapping Scapula?  How do you fix a Snapping Scapula?  Are there regenerative options?  Let’s dig in.

What is the Scapula?

Backside View

The Scapula is your shoulder blade.  It is a large triangular bone that compromises part of the shoulder joint.  The Scapula is positioned over the back chest wall and ribs where it moves in different directions with shoulder movements (1). The Scapula meets with the arm bone (humerus) to form the shoulder joint.  It also meets with the clavicle to form the AC joint.  Multiple structures attach onto the Scapula which provides important support and movement for the scapulae and shoulder joint (2).  These include:

Muscles/Tendons:  Multiple muscles attach to the Scapula which include the deltoid, supraspinatus, infraspinatus, triceps, and teres minor.  These muscles work together to coordinate a smooth sliding of the scapula on the chest wall.

Ligaments:  Multiple ligaments attach to the Scapula providing important support and movement of the scapula.  Ligaments are thick bands of connective tissue that connect one bone to another.  Major ligaments include the superior, inferior glenohumeral and coracohumeral ligaments.

Bursae:  Fluid sacs that facilitate the movement of tendons, ligaments, and muscle over the boney Scapular surface.  The scapulothoracic and subscapularis bursa and the two most commonly involved bursae.

What Is Snapping Scapula?

Snapping Scapula is a medical condition that involves the audible popping and grinding of the Scapula over the rib cage during shoulder movements.  It is also referred to as washboard syndrome.  It typically affects young, active patients (3).  Many describe audible popping and crackling with shoulder movement (4).  Common symptoms include:

  • Shoulder tenderness with restriction of movement
  • Grinding, grating and snapping sensation
  • Swelling
  • Pain during overhead activities (5)

What Causes Snapping Scapula?

The are many causes of snapping Scapula which include:

Muscle injury or Imbalance:  Scapular movement requires a coordinated balance between muscles and tendons.  When muscles weaken or tendons become inflamed, muscle imbalance can occur.  When this occurs the Scapula can not easily glide along the chest wall.  The result can be grinding and snapping of the scapula.

Bursae Inflammation:  the most commonly involved are the scapulothoracic and subscapularis bursae (6).

Irritation of Neck Nerves:  disc bulges, disc herniation, facet overgrowth and slipped discs can irritate or compress nerves.  This in turn can cause muscle weakness and scapular muscle imbalance and snapping.

Repetitive activities such as reaching overhead or throwing a ball.

Poor posture that compromises neutral spinal alignment.

Inflammatory Conditions such a rheumatoid arthritis

Bone Tumors:  the most common is an osteochondroma  which due to its mass effect can create a scapular winging along with popping and grinding (7)

Trauma:  fracture of the rib or Scapula can compromise the smooth gliding of the Scapula on the rib cage leading the grinding, snapping, and often times pain.

Nerve injury:  Injury or compression of the long thoracic nerve, dorsal scapular nerve, and spinal accessory nerve can create muscle imbalance leading to grinding and popping of the Scapula.

How Do You Fix a Snapping Scapula?

Treatment options depend upon the underlying cause of the snapping Scapulae.  In general conservative treatment is the first-line treatment.  It includes rest, safe anti-inflammatory medications, and PT.  PT focuses on muscle dysfunction, compromised posture, and improper shoulder joint mechanics (8).  When conservative therapy fails, steroid injections are often recommended. (9).  Steroids are powerful anti-inflammatory agents that deplete local stem cells and are toxic to cartilage and weakens tendons and ligaments (10).  If pain persists despite injections and conservative care, surgery is many times recommended.  There are two major surgeries.:

  • Surgical removal of an inflamed bursa and surrounding scar tissue
  • Partial removal of the Scapula to reduce areas that are rubbing on the rib cage.  Unfortunately, important muscles, tendons, and ligaments attach to the scapula.  Surgery can lead to changes in the biomechanics of the shoulder and create instability.

Is there a regenerative option? YES

SANS

At the Centeno-Schultz Clinic, we are experts in shoulders, tendons, and ligaments.  We utilize a comprehensive approach to a given joint,  It stands for Stability, Articulation, Neurologic and Symmetry.  Using ultrasound we can evaluate the ligaments, tendons, muscles nerves, and bursa of the shoulder.  Ultrasound can identity ligament laxity, nerve compression, and tendon tears. Treatment options include PRP and stem cells.  PRP is rich in growth factors that can increase blood flow and decrease inflammation.  The injections are demanding and can not be performed by your PCP or orthopedic surgeon.  To learn more about stem cell and PRP injections into the shoulder please click on the video below.

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In Conclusion

The Scapula is your shoulder blade.  It is a large triangular bone that resides on the back chest wall and ribs and moves in different directions with shoulder movements.  Muscles, tendons, ligaments, and bursa attach to the Scapula providing important support.   Snapping scapula is a medical condition that involves audible popping and grinding over the rib cage during shoulder movements.  Symptoms include shoulder tenderness, swelling, and pain during overhead activities.  Causes of snapping scapula include muscle injury and imbalance, inflamed bursa, irritation of neck nerves, poor posture, inflammatory conditions, bone tumors,  trauma, and nerve injury.  Conservative care is the first line of treatment.  Steroid injections are powerful anti-inflammatory agents that deplete local stem cells and are toxic to cartilage, tendons, and ligaments and therefore should be avoided. Surgery is recommended if pain persists despite conservative care and injections.  Surgery focus on the removal of an inflamed bursa or a portion of the boney Scapula which can compromise the stability of the shoulder.  A novel technique at the Centeno-Schultz Clinic utilizes the SANS approach where the stability, articulation, symmetry, and neurologic components are assessed.  Ultrasound is a powerful technology that allows muscles, tendons, ligaments, and bursa to be visualized during an in-office evaluation.  This approach is superior to toxic steroids and surgery which can permanently change the mechanics of the Scapula and the stability of the shoulder.  If you are limited by Snapping Scapula please schedule a Telemedicine evaluation where board-certified, fellowship-trained physicians can review your history, imaging and discuss treatment options.  Don’t be sidelined by scapular pain as natural, nonsurgical options exits.

 


1.Paine R, Voight ML. The role of the scapula. Int J Sports Phys Ther. 2013;8(5):617-29.

2.Kamkar A, Irrgang JJ, Whitney SL. Nonoperative management of secondary shoulder impingement syndrome. J Orthop Sports Phys Ther. 1993;17:212–224

3.de Carvalho SC, Castro ADAE, Rodrigues JC, Cerqueira WS, Santos DDCB, Rosemberg LA. Snapping scapula syndrome: pictorial essay. Radiol Bras. 2019;52(4):262-7.

4.Kouvalchouk JF. Subscapular crepitus. Orthop Trans. 1985;9:587–588

5.Kuhn JE, Plancher KD, Hawkins RJ. Symptomatic scapulothoracic crepitus and bursitis. J Am Acad Orthop Surg. 1998;6:267–273.

6. Snapping scapula syndrome. Lazar MA, Kwon YW, Rokito AS J Bone Joint Surg Am. 2009 Sep; 91(9):2251-62.

7..Delayed Presentation of Osteochondroma at Superior Angle of Scapula-A Case Report.Jindal M. J Orthop Case Rep. 2016 Jul-Aug; 6(3):32-34.

8. Manske RC, Reiman MP. Nonoperative and operative management of snapping scapula. Am J Sports Med. 2004;32:1554–1565.

9.Symptomatic scapulothoracic crepitus and bursitis. Kuhn JE, Plancher KD, Hawkins RJ J Am Acad Orthop Surg. 1998 Sep-Oct; 6(5):267-73.

10.Wernecke C, Braun HJ, Dragoo JL. The Effect of Intra-articular Corticosteroids on Articular Cartilage: A Systematic Review. Orthop J Sports Med. 2015;3(5):2325967115581163.

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