Snapping scapula is a general term applied to a range of disorders that can result in a painful clicking or snapping sensation in the shoulder blade (scapula). It has been given a number of names over the years including scapulothoracic syndrome, rolling scapula, snapping scapula and grating scapula.
Why does snapping scapula happen?
Snapping scapula can occur for a variety of reasons. It can be a secondary symptom to shoulder instability, such as a dislocation, or nerve disorders leading to weakened muscles. It can be caused by a bony lump (exostosis) at the top of the shoulder blade, or by a fracture to either the shoulder blade or the ribs.
Snapping scapula can also be caused by problems with the bursae. These are fluid-filled sacs which sit between certain bone joints to help the shoulder move smoothly. Muscle tears around the scapula's bursa, soft tissue lumps near the bursa or inflammation of the bursa itself, caused by diseases such as rheumatoid arthritis or rubbing against a bony spur, could all lead to snapping scapula symptoms.
Occasionally the clicking sensation felt in the shoulder blade has been transmitted from problems that originate in the shoulder's ball and socket joint. When examining your shoulder blade, Mr. Cole will look at your shoulder to eliminate the possibility of problems elsewhere.
Causes of Snapping Scapula
Muscle / soft tissue
Spurs and tubercles of bone
Thoracic spinal problems
How common is it?
Snapping scapula can often be under recognised by health professionals. It is especially common in young and active patients, including professional athletes, as the symptoms are frequently seen with overhead and throwing motions.
The symptoms vary a little according to what is causing the problem. However, common to each of the disorders is pain and the snapping or grinding sound when the shoulder blade (scapula) is moved. Most commonly, patients with snapping scapula syndrome typically complain of pain with overhead activities. The patient may be able to identify the precise position of the ‘snapping’ or crepitus. A history of overhead activity or trauma may be present.
Investigating the problem
Mr. Cole will talk to you about your shoulder symptoms and history. He will examine your shoulder, looking to assess your range of movement and listening for any audible clicking or grinding sounds. He will look for the potential causes of the problem.
If Mr. Cole suspects you have a bony lump, or a fracture, he may request an x-ray for confirmation. X-rays are particularly good at showing pictures of your bones. They are not so good, however, at showing soft tissue problems.
In some circumstances a CT scan will be necessary. CT stands for computerised tomography. A CT scanner uses a series of x-rays taken at slightly different angles of your body, to produce very detailed pictures. It is a non-invasive and painless procedure. It is particularly good at defining bony causes such as bone spurs or osteochondromas.
If Mr. Cole suspects you have a problem with the bursa, he may request an MRI. MRI stands for Magnetic Resonance Imaging. It uses a powerful magnet to obtain three-dimensional pictures of body structures. Like the CT scan, this is a non-invasive and painless procedure.
It is important to realize that scapulothoracic crepitus is not necessarily a pathological condition. It has been found in approximately 35% of normal asymptomatic individuals.
If no lump or lesion is found, then physiotherapy and injections are the main treatments for snapping scapula.
Physiotherapy will include exercises aimed at retraining the normal movement of your scapula. Strengthening the muscles around your shoulder blade will also help you with its stability.
If you have a swollen bursa or another area of inflammation, steroid injections will help to reduce the swelling and minimise the rubbing or irritation.
If you have a bony lump or other problem requiring surgery, Mr. Cole will advise you on the best course of treatment. This is rare, however, as most snapping scapula problems are resolved without the need for surgery. Should you require an operation, it could be an arthroscopic (camera) keyhole procedure or open surgery. It would normally be completed as day surgery and you should be able to go home on the same day.
Following your surgery, your team of physiotherapists will work with you to devise an exercise programme. This will be designed with advice from Mr. Cole to help you recover as quickly and efficiently as possible.