Snapping Scapula

Description

Snapping scapula is characterized by a snapping of the shoulder blade (scapula) that can be heard by the athlete and often by others. This condition may be due to a number of causes, and pain may or may not be associated with the snapping, or the snapping may not cause any problems. On the other hand, it may be painful, and it may affect shoulder function. The snapping is caused by grating or rubbing of the scapula against the chest wall or, more specifically, against the ribs. Some areas of the scapula are not well cushioned against the ribs, and the bony prominences of the scapula may snap over the ribs. Bursas, which are like water balloons, help reduce friction between the scapula and the chest wall; these bursas may also become inflamed (bursitis).

Common signs and symptoms

• Snapping, grating, or popping of the shoulder or scapula may occur, often without discomfort.

• Snapping may be felt on the back or chest wall.

• The scapula may feel as if it is jumping out of place.

• A bump may be felt on the scapula.

• The affected scapula may be more prominent, and it may hurt to sit in a chair with a high back.

Causes

Snapping scapula may be caused by bony alterations of the scapula or by growths of soft tissue that are either variations of normal tissue or benign or malignant tumors. Snapping may also result from muscle atrophy that produces an imbalance, which may cause the shoulder blade to snap or grate. This may be accentuated by repetitive motion, causing inflammation of the bursas as the scapula passes the bony prominences of the ribs, leading to thickening and scarring of the bursas. Direct injury may also result in bursal inflammation.

Factors that increase risk

• Contact or collision sports, especially with inadequate protection of exposed areas

• Poor physical conditioning (strength, flexibility)

• Inadequate warm-up before practice or play

• Muscular imbalance or atrophy of the muscles of the scapula

• Previous fracture of the scapula or ribs

Preventive measures

• Wear appropriate protective equipment, and ensure a correct fit.

• Appropriately warm up and stretch before practice and competition.

• Allow time for adequate rest and recovery between practices and competition.

• Maintain appropriate conditioning that includes capsular muscle strength, endurance and flexibility training, and cardiovascular fitness.

Expected outcome

Snapping scapula is usually curable with time and appropriate treatment.

Possible complications

• Prolonged healing time if not appropriately treated or if not given adequate time to heal

• A chronically inflamed bursa, causing persistent pain with activity that may progress to constant pain, even at rest

• Recurrence of symptoms if activity is resumed too soon, with overuse, with a direct blow, or when using poor technique

General treatment considerations

Initial treatment consists of medication and ice to relieve pain, stretching and strengthening exercises, and modification of the activity that initially caused the problem. These all can be carried out at home, although referral to a physical therapist or athletic trainer for further evaluation and treatment may be helpful. An injection of cortisone into the inflamed bursa may be recommended. Surgery to remove the bursa, bony prominence, or soft tissue mass may be recommended; this is usually only considered after at least 6 months of conservative treatment.

Medication

• Nonsteroidal antiinflammatory medications, such as aspirin and ibuprofen (do not take for 7 days before surgery), or other over-the-counter pain relievers, such as acetaminophen, are often recommended. Take these as directed by your physician, and contact your doctor immediately if any bleeding, stomach upset, or signs of an allergic reaction occur.

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