What is scapulothoracic bursitis (snapping scapula) syndrome

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snapping scapula

Symptoms of Scapulothoracic Bursitis

Scapulothoracic Bursitis is a condition that causes pain behind the shoulder blade.  It is often associated with audible cracking, grating, grinding and popping, hence the alternative name ‘snapping scapula’ syndrome.  The cause is inflammation of the bursa (bursitis) underneath the scapula. The bursa usually acts as lubricating tissue that allows the scapula to glide smoothly over the ribs during every day shoulder motion.  When the bursa becomes inflamed, it causes significant pain, and loss of function.

Scapulothoracic Bursitis is rare.

What causes Scapulothoracic Bursitis (snapping scapula)

Snapping scapula is caused by problems in the soft tissue and/or bones of the scapula and ribcage.  It usually starts when the tissues thicken from inflammation. This inflammation is usually caused by repetitive movements like throwing a ball, or overhead movements, e.g. reaching up or lifting weight overhead.  This causes changes in the normal mechanics of the shoulder and the bursa becomes irritated and inflamed.

Changes in the alignment of the bones of the Scapulothoracic joint can also cause snapping scapula.  Direct or indirect trauma,  glenohumeral joint dysfunction or inflammation  (sometimes caused by rheumatoid arthritis) and muscle atrophy are other causes.

How is Scapulothoracic Bursitis diagnosed?

scapulothoracic bursitisPatients usually complain of pain over the back and top of the shoulder, at the upper edge of the scapula, or underneath the shoulder blade.  Moving the arm often causes crepitus (grating sound or sensation between bone and cartilage) and audible popping, snapping or grinding sounds and sensation.  The scapula is usually tender to touch on examination.

Scans often aren’t necessary and X-rays often don’t show any abnormality.  If there are problems with the bones or bone alignment a CT scan will show more detail.

Scapulothoracic Bursitis treatment

Non surgical treatment

As always treatment starts conservatively.  Doctors may prescribe nonsteroidal anti-inflammatory drugs (NSAIDS) such as ibuprofen or naproxen to reduce inflammation.  Rest and ice also help reduce inflammation and ease pain.

If the pain remains, physiotherapy is recommended.  Physical therapy is aimed at strengthening the scapular muscles and correcting any mechanical dysfunction of the shoulder girdle.

If physical therapy fails a cortisone injection into the bursa can be tried.  Cortisone is a powerful anti-inflammatory and injected directly into the Scapulothoracic bursa usually gives good relief.  A cortisone injection also serves to confirm the diagnosis, because if the patient gets relief, this confirms the bursa was the cause of the pain.

Surgical Treatment

Surgery is reserved for those patients for whom pain continues to interfere with their quality of life.  Getting relief from a cortisone injection is a prerequisite for surgery, because if the patient doesn’t get relief from the injection, it’s unlikely they will get relief from surgery.

In the most common surgery for snapping scapula, the surgeon takes out a small piece of the upper corner of the scapula (near the spine).  The tendons that attach the muscles to the bone have to be cut and sewn back onto the spine of the scapula.  The surgeon also removes the inflamed bursa completely.

It is a simple surgery, usually done as a day procedure.  Recovery time can be several months however, because the tendons and muscles need time to heal where they have been reattached to the scapula.  Patients usually can begin active range of motion exercise, and normal daily activities at 4 weeks, light resistance exercise after 12 weeks, and all activities are permitted at 4 months.

 

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