What is a snapping scapula?

Snapping scapula is characterized by a snapping of the shoulder blade (scapula) that can be heard by the athlete and, often, others; this may be due to one of many causes. The snapping may be normal and not cause any problems or pain. On the other hand, it may be painful and affect shoulder function.

The snapping is caused by grating or rubbing of the scapula against the chest wall, or more specifically, the ribs. Some areas of the scapula are not well cushioned against the ribs and the bony prominences of the scapula snap over the ribs. Bursae exist to help reduce friction between the scapula and the chest wall. These bursae may become inflamed (bursitis).

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How does a snapping scapula occur?

This condition may be caused by bony alterations of the scapula or soft tissue growths (normal variants or benign or malignant tumors); muscle atrophy, producing an imbalance, may cause the shoulder blade to snap or grate. This may be accentuated by repetitive motion causing inflammation of the bursae as the scapula passes the bony prominences of the ribs, leading to thickening and scarring of the bursa. Potentially, direct injury may result in bursal inflammation.

What increases the risk?

• Contact or collision sports, especially when there is inadequate protection of exposed areas
• Poor physical conditioning (strength and 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

What are the symptoms of snapping scapula?

• Snapping, grating or popping of the shoulder or scapula, often without discomfort; felt on the back or chest wall; sometimes scapula feels like it is jumping out of place
• Bump felt on the scapula
• Affected scapula may be more prominent; may hurt to sit on a chair with a high back

How is snapping scapula treated?

Non-operative treatment is indicated for most patients, who are able to successfully resume all pre-injury activities.

Non-operative treatment: Initial treatment consists of medication and ice to relieve the 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.

Operative treatment: Surgery to remove the bursa or bony prominence or soft tissue mass may be recommended; this is usually only considered after at least 6 months of conservative treatment.

What are the complications of treatment?

Possible complications of operative treatment include:

• Surgical complications not specifically associated with shoulder repair/reconstruction, such as pain, bleeding (uncommon), infection (<1percent), nerve injury (uncommon), stiffness, problems with anesthesia, and inability to return to previous level of pre-injury activity.

How can snapping scapula be prevented?

• Wear appropriate protective equipment and ensure correct fit
• Appropriately warm up and stretch before practice or competition
• Allow time for adequate rest and recovery between practices and competition
• Maintain appropriate conditioning:
  • Capsular muscle strength
  • Endurance and flexibility
  • Cardiovascular fitness