Injury Overview
The scapulothoracic joint is located in an area where the shoulder blade (scapula) meets and moves along the chest wall. The motion of the scapula is normally smooth because of the underlying scapulothoracic bursa, a fluid filled sac that aids in the movement of the scapula against the ribcage. If the bursa becomes inflamed from injury or overuse, a condition known as scapulothoracic bursitis may develop.
Scapulothoracic bursitis, also referred to as snapping scapula syndrome, is most often seen in young athletes who participate in repetitive overhead activities. However, the condition may develop in patients of any age. This syndrome is fairly rare and can also occur in individuals who sit or stand in a abnormal position for long periods of time and/or in patients whose shoulder movement was altered for long periods of time, such as in the setting of a shoulder injury.
Symptoms
Symptoms associated with a snapping scapula include pain located near the middle of the upper back (the top inside border of the shoulder blade) with movement of the shoulder. During shoulder movement, snapping, grating, and/or grinding noise is present. This is often accompanied by a dull ache in the shoulder blade and ribcage area. These symptoms may steadily progress with time.
Diagnosis
The most common physical exam finding in patients with this problem includes a grinding or snapping sensation over the inner aspect of the shoulder blade when the arm is moved. Dr. Anz will perform movement tests involving the shoulder joint to assess these symptoms. If he suspects that scapulothoracic bursitis is the condition causing the symptoms, he will most likely require an X-ray and MRI to confirm his diagnosis and to rule out any alternative abnormality. Once snapping scapula has been diagnosed, Dr. Anz will begin discussing treatments options according to the severity of the injury.
Treatment
Dr. Anz will prescribe a course of physical therapy to improve shoulder kinetics as the first line treatment for this condition. To manage pain during this recovery process, he may use a corticosteroid injection to the scapulothoracic bursa to relieve pain and allow further progress with physical therapy. Rehabilitation will focus on restoring normal scapular motion, eliminating positions which cause symptoms, and strengthening the musculature around the shoulder blade.
Surgical Treatments
If conservative treatments fail to ease the symptoms of snapping scapula syndrome and restore shoulder function, Dr. Anz may recommend surgery. In most cases, a minimally invasive arthroscopic approach can be used. This involves tiny keyhole incisions, a miniature camera, and surgical tools to assess and treat the bursitis. During the surgery, Dr. Anz will remove the inflamed scapulothoracic bursa, as well as areas of bone which may be attributing to the bursitis. These procedures are typically successful in relieving pain, eradicating symptoms of rubbing and snapping, and removing the areas of inflammation to restore shoulder motion.
Post-Operative
Dr. Anz will require patients to adhere to a strict rehabilitation program following arthroscopic surgery. Detailed guidelines, rehabilitation progression, and expectations for each of his patients will be outlined so that a full recovery can be achieved. Therapy is a vital part of the recovery process following a shoulder injury and is a partnership between the patient, Dr. Anz, and the physical therapy team.
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For more information on snapping scapula syndrome or for additional resources on shoulder pain or scapulothoracic bursitis symptoms, please contact the Gulf Breeze, Florida orthopedic surgeon, Dr. Adam Anz located at the Andrews Institute.