Is there a strange snapping/grinding sensation around your shoulder blade? If so, this might be the problem Scapulothoracic Bursitis Scapulothoracic bursitis, also known as “snapping scapula syndrome”, develops when there is a problem with how the shoulder blade moves over the rib cage. Shoulder blade anatomy viewed from the front. The ribcage would sit infront Inflammation of one of the two scapulothoracic bursae, that sit between the scapula bone and the subscapularis muscle, affects how the shoulder blade (scapula) moves causing friction, weakness and pain. It causes a constant, dull ache around the shoulder blade and sufferers often complain of a “snapping” or “grinding” sensation when they move their arm. Scapulothoracic bursitis is a rare condition, most commonly affecting young athletes who do lots of overhead action such as throwing or swimming. However previous shoulder problems such as ligament tears and arthritis also increase the risk of developing scapulothoracic bursitis. What Is Scapulothoracic Bursitis? All around our bodies, there are numerous bursa. These are small fluid filled sacs that act as cushions, providing lubrication between tendons and bones, allowing smooth, friction-free movement. The subscapularis muscle is a large muscle that sits between the shoulder blade and the rib cage. There are two bursa (known as infraserratus and supraserratus) that sit between the muscle and the bone allowing the shoulder blade to glide over the chest wall freely as the arm moves. One is located at the top of the shoulder blade, the other at the bottom. A large proportion of shoulder movement comes from the shoulder blade so it is really important it can move smoothly and freely. Weakness in the shoulder blade muscles leads to subtle changes in the angle of the shoulder blade which affects how it moves. It may then start to rub against the rib cage which leads to inflammation of the subscapular bursa and surrounding tissues. Causes Of Snapping Scapula Syndrome Scapulothoracic bursitis is generally caused by problems with the bones or soft tissues of the rib cage and shoulder blade. Common causes of snapping scapula syndrome include: Overuse: Repetitive friction from overhead activities such as throwing, weight lifting, tennis or swimming places irritate the bursa causing inflammation Weakness: muscle weakness means there is less bulk between the ribcage and shoulder blade so they sit closer to each other. The bones can end up rubbing against each other leading to inflammation Posture: Sustained, kyphosed (forward flexed) posture can lead to weakness of the subscapularis muscle and shift the position of the shoulder blade slightly which makes the bursa prone to friction Trauma: Injury to the surrounding area from e.g. a fall Medical Conditions: inflammatory conditions such as rheumatoid arthritis increase the risk of developing scapulothoracic bursitis Poor Scapular Mobility: Anything that affects how the shoulder blade moves can increase friction and lead to scapulothoracic bursitis. It may be muscle weakness, a nerve problem or another shoulder problem such as a frozen shoulder Bony Abnormality: If the bones are not smooth, there will be more friction on the surrounding soft tissues. There may be extra bone growth on the scapula such as a Luschka tubercle (hooked shape prominence on the inner top corner of the scapula), a bone tumour such as an osteochondroma or as a result of a previous injury such as a rib fracture Symptoms With snapping scapula syndrome pain is usually felt around the shoulder blade, particularly the upper inside border The most common symptoms of scapulothoracic bursitis are: Snapping: The most prominent feature of snapping scapula syndrome is a snapping/grating/grinding noise or sensation at the shoulder blade during arm movements Pain: Usually described as a constant, dull, aching pain around the shoulder blade and ribcage. The pain tends to get worse with arm movements, particularly when reaching above your head or when doing press ups Lump: There may be a small lump that you can feel on the shoulder blade if there is excess bone growth Your doctor will usually be able diagnose scapulothoracic bursitis by talking to you about your symptoms and observing your shoulder and scapula movements. In some cases they may do an x-ray, MRI or CT scan. Conservation Treatment In most cases, scapulothoracic bursitis can be treated conservatively (i.e. without surgery) with a combination of the following 1) Rest Avoiding aggravating activities and movements helps reduce the friction and pressure on the bursa. However, it is important to keep the shoulder moving within pain limits to prevent it from stiffening up. 2) Medication Non-steroidal anti-inflammatory medication such as ibuprofen can help to reduce pain and inflammation. Always check with your doctor before taking any medication. Physical therapy is one of the best treatments for scapulothoracic bursitis 3) Physical Therapy Working on a rehab programme with a physical therapist will help to restore normal shoulder blade movement. This will include strengthening exercises for the muscles that move and control the shoulder blade. If there are other problems affecting how the shoulder joint moves, they will be addressed too which may include stretches and further strengthening exercises for the rotator cuff muscles. You will need to work on your home exercise programme daily for a number of weeks. Your physical therapist will also be able to advise you about correct posture. Dr Ayaz Physiotherapy weight loss hair and skin clinic nallasopara