Physical Therapist's Guide to Snapping Scapula Syndrome
Snapping scapula syndrome is a condition that involves the popping, grating, grinding, or "snapping" of bones and tissue in the scapula (shoulder blade) area when lifting and moving the arm. The snapping symptoms may be painful, and are sometimes audible. Snapping scapula syndrome is most commonly diagnosed in young, active individuals who perform repetitive overhead movements, such as stocking shelves at the local store, or engaging in sports like weight-lifting, swimming, or baseball. Other causes can include scapula or rib-cage bone conditions, such as fractures, muscle weakness or atrophy, or tumors. Snapping scapula syndrome is usually the result of overuse of the arm, poor posture during sport activities, or incorrect joint motion, but can also be caused by a single episode of trauma to the scapula area. A physical therapist treats the pain, muscle weakness, loss of arm motion, and swelling of soft tissue that can occur with snapping scapula syndrome.
What is Snapping Scapula Syndrome?
Snapping scapula syndrome is a condition that involves the popping, grating, grinding, or "snapping" of bones and tissue in the scapula area when lifting and moving the arm. It may be caused by a number of bone or soft tissue problems.
- Bones can be malformed from birth, or fractured, causing them to be misshapen. When the scapula moves, it may bump against a misshapen bone as it glides over it, causing a grinding or grating feeling, or sound.
- Soft tissues include muscles and bursae. The muscles between the scapula and the rib cage (subscapularis and serratus anterior) can become tight, shrunken, scarred, inflamed, or weak. As a result, the scapula will become positioned too close to the rib cage, and may rub painfully on the ribs during arm movement.
- Bursae are fluid-filled sacs that act as cushions and normally reduce friction between the scapula and the rib cage, or between the scapula and the muscles. The scapula may rub and irritate a bursa cushion. Popping or snapping can occur from a bursa becoming inflamed, from being rolled over during scapula motion, or from inadequate reduction of friction by a bursa.
Snapping scapula syndrome can be caused by:
- Repetitive activities, such as reaching overhead or throwing a ball
- Incorrect sports training techniques, such as overtraining, or training without enough prior strengthening
- Incorrect posture
- Weakness in the shoulderarea
- Muscle tightness in the chest, neck, shoulder, or scapula area
- Neck conditions
- Shoulder joint problems
- Unhealed fractures of the ribs or scapula
- Inflammation of the muscles or bursae
- Nerve damage in the shoulder area
Complete recovery from snapping scapula syndrome can sometimes take 3 to 6 months, although improvement is often felt after just a few weeks. Healing time varies, depending on the cause and severity of the condition and each individual's fitness level and goals.
How Does it Feel?
A person with snapping scapula syndrome may experience:
- Pain in the back or top of the shoulder when lifting the arm overhead or shrugging the shoulders
- A snapping, grinding, grating, or popping sensation or sound in the scapula area when lifting the arm
- A feeling of weakness in the arm
- "Winging" of the scapula, which makes it appear as if 1 edge is poking out away from the body
- Difficulty performing overhead arm motions due to pain or weakness in the scapula area
- A visible difference in how the painful scapula moves
How Is It Diagnosed?
If you see your physical therapist first, your therapist will conduct a thorough evaluation that includes taking your health history. Your therapist will also ask you detailed questions about your injury, such as:
- How and when did you first notice the pain?
- Do you hear or feel any popping, grinding or snapping when moving your arm? What activities are you performing when you hear or feel these symptoms?
- Do you have any pain or stiffness in your neck?
- Does your shoulder area feel weak or "tired"?
Your physical therapist will perform special tests to help determine the likelihood that you have snapping scapula syndrome. Your physical therapist also will determine whether your pain is coming from your neck, shoulder joint, or other areas, or if it is limited to your scapula.
To provide a definitive diagnosis, your therapist may collaborate with an orthopedic physician or other health care provider, who may order further tests, such as an x-ray, to confirm the diagnosis and to rule out other damage to the spine, ribs, and scapula. An x-ray test is not required in all cases.
How Can a Physical Therapist Help?
Your physical therapist will work with you to design a specific treatment program that will speed your recovery, including exercises and treatments you can do at home. Physical therapy will help you return to your normal lifestyle and activities.
The First 24 to 48 Hours
Your physical therapist may advise you to:
- Rest the area by avoiding lifting your arm overhead or performing other movements that cause pain.
- Apply ice packs around the scapula area for 15–20 minutes every 2 hours.
- Make sure you keep your spine in an upright posture when sitting or standing.
- Consult with a physician for further services, such as medication or diagnostic tests.
Your physical therapist may use different types of treatments and technologies to control and reduce your pain and symptoms, including ice, heat, ultrasound, diathermy, laser, iontophoresis, electrical stimulation, taping, exercises, and hands-on therapy, such as massage.
Your physical therapist will choose specific activities and treatments to help restore normal movement in the shoulder, neck, and spine. These might begin with "passive" motions that the physical therapist performs for you to gently move your arm, shoulder, neck, and scapula, and progress to active exercises and stretches that you do yourself.
Snapping scapula syndrome is often related to tight muscles in the chest wall, shoulder, and neck. Your physical therapist will determine if these, or any other muscles, are tight, and teach you how to gently stretch them. Your physical therapist may apply hands-on techniques, such as massage and trigger-point release, to help loosen and stretch the muscles.
Improve Strength and Speed Recovery Time
Certain exercises will aid healing at each stage of recovery; your physical therapist will choose and teach you the correct exercises and equipment to steadily restore your strength and agility. Your physical therapist is trained and experienced in choosing the right treatments and exercises to help you heal, return to your normal lifestyle, and reach your goals faster than you are likely to do on your own.
Return to Activities
Your physical therapist will discuss your goals with you and use them to set your work, sport, and home-life recovery goals. Your treatment program will help you reach those goals in the safest, fastest, and most effective way possible.
Prevent Future Injury
Your physical therapist can recommend a home exercise program to strengthen and stretch the muscles around your shoulder and arm to help prevent future injury. These may include strength and flexibility exercises for the muscles of the neck, shoulder, arm, and scapula.
If Surgery is Necessary
Surgery is not frequently needed in the case of snapping scapula syndrome. If surgery is needed, you will follow a post surgery recovery program over several weeks guided by your physical therapist. Your therapist will help you minimize pain, regain motion and strength, and return to normal activities in the speediest manner possible after surgery.
Can this Injury or Condition be Prevented?
To help prevent a recurrence of the injury, your physical therapist may advise you to:
- Maintain good, upright posture and avoid slouching.
- Maintain the strength in your scapula and shoulder joint muscles.
- Use proper athletic techniques when performing sports that require overhead arm movements.
Real Life Experiences
Paul is a 25-year-old competitive swimmer who lifts weights as part of his training regimen. He recently increased his swimming practice times and weight training in order to get ready for upcoming competitions. The day after a particularly hard training session, Paul noticed pain and popping sensations when he lifted his arm overhead. He tried to ignore it and work through it for 4 days, but the condition worsened. He decided to ask his physical therapist for help.
Paul's physical therapist noticed that his posture was slumped forward, although he could straighten up easily when asked to do so. She observed Paul as he lifted his arm, and saw that his was winging: 1 side flared out away from his spine. When she placed her hand lightly on the scapula, she could feel the popping as it moved. She performed special tests on the bones, tendons, muscles, and soft tissues of the shoulder, scapula, neck, and upper back. She concluded Paul was experiencing snapping scapula syndrome.
Paul's physical therapist taught him gentle strengthening exercises for specific muscles that did not cause movement of the scapula, and exercises to restore his posture. She instructed him to sit and stand very straight so his scapula could move with less pain. She applied ice and electrical stimulation to the area for 20 minutes, and applied tape to gently support the affected muscles. She instructed Paul on how to perform the exercises, posture correction, and icing at home, and advised him to avoid overhead or repetitive shoulder activities until the pain and popping had greatly improved.
When Paul returned for his next visit, his physical therapist performed hands-on stretching of the tight chest muscles. In subsequent visits, she added exercises that included new movements, weights, and resistive bands. She taught him to recognize the signs of fatigued muscles, and to not overwork his muscles.
Paul underwent physical therapy treatment for 2 weeks, at which time he felt about 75% pain free, and he rarely experienced the popping and snapping sensations. His physical therapist added swimming-specific exercises to Paul’s treatment program, and worked with his swimming coach to design a return-to-swimming program. By the fifth week, Paul was swimming at near-normal capacity and was preparing to head to his next competition. He added several of the physical therapy exercises into his daily training regimen to maintain his muscular strength, and to prevent a recurrence of his symptoms.
What Kind of Physical Therapist Do I Need?
All physical therapists are prepared through education and experience to treat snapping scapula syndrome. However, you may want to consider:
- A physical therapist who is experienced in treating people with orthopedic injuries. Some physical therapists have a practice with an orthopedic focus.
- A physical therapist who is a board-certified clinical specialist, or who completed a residency or fellowship in orthopedic or sports physical therapy. This therapist has advanced knowledge, experience, and skills that may apply to your condition.
You can find physical therapists that have these and other credentials by using www.FindaPT.us, the online tool built by the American Physical Therapy Association to help you search for physical therapists with specific clinical expertise in your geographic area.
General tips when you're looking for a physical therapist (or any other health care provider):
- Get recommendations from family and friends or from other health care providers.
- When you contact a physical therapy clinic for an appointment, ask about the physical therapists' experience in helping people who have your type of injury.
- During your first visit with the physical therapist, be prepared to describe your symptoms in as much detail as possible, and say what makes your symptoms worse.
The American Physical Therapy Association (APTA) believes that consumers should have access to information that could help them make health care decisions and also prepare them for their visit with their health care provider.
The following articles provide some of the best scientific evidence related to physical therapy treatment of snapping scapula syndrome. The articles report recent research and give an overview of the standards of practice both in the United States and internationally. The article titles are linked either to a PubMed* abstract of the article or to free full text, so that you can read it or print out a copy to bring with you to your health care provider.
Merolla G, Cerciello S, Paladini P, Porcellini G. Snapping scapula syndrome: current concepts review in conservative and surgical treatment. Muscles Ligaments Tendons J. 2013;3(2):80–90. Free article.
Gaskill T, Millett PJ. Snapping scapula syndrome: diagnosis and management. J Am Acad Orthop Surg. 2013;21(4):214-224. Article Summary on PubMed.
Conduah AH, Baker CL III, Baker CL Jr. Clinical management of scapulothoracic bursitis and the snapping scapula. Sports Health. 2010;2(2):147–155. Free Article.
Kuhne M, Boniquit N, Ghodadra N, Romeo AA, Provcher MT. The snapping scapula: diagnosis and treatment. Arthroscopy. 2009;25(11):1298–1311. Article Summary on PubMed.
*PubMed is a free online resource developed by the National Center for Biotechnology Information (NCBI). PubMed contains millions of citations to biomedical literature, including citations in the National Library of Medicine’s MEDLINE database.
Authored by Andrea Avruskin, PT, DPT. Reviewed by the MoveForwardPT.com editorial board.
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