Most people have aches and pains that come and go. Pain behind the shoulder blade (the bone known as the scapula) is quite common, but can be debilitating. There are a number of possible causes, so a careful physical examination and detailed information from each individual patient is vital for me to be able to make the correct diagnosis. A crunching sensation and sometimes an audible noise (aka crepitus) is often present in a diagnosis of snapping scapula, also known as scapulothoracic bursitis with crepitus.
With a diagnosis of snapping scapula, pain will be present in the back along the border of the shoulder blade closest to the spine and midline and will present upon movement of the arm. When we move the arm from the side of the body to a position above our head, 2/3 of that motion comes from the shoulder but the other 1/3 actually comes from rotation of the shoulder blade. Therefore, if you have inflammation in the scapulothoracic bursa (a bursa is a fluid filled sac normally present to decrease friction in an area of movement) that exists between the shoulder blade and the rib cage, it will cause pain and potentially the crunching sensation upon movement of the arm. Sometimes, patients can also develop bone spurs in this area which can aggravate the situation.
Most of the time, treatment for snapping scapula is non-surgical and I generally approach it using anti-inflammatory medication, injections into the bursa (which really helps and also can be of diagnostic value), and physical therapy. Physical therapy is of the utmost importance in treating this condition as it focuses on your posture, making sure the kinetics for the shoulder is correct, and strengthening the muscles around this area.
Other conditions, including neck pain radiating to the shoulder, shoulder pain radiating to the area, compressed peripheral nerves, and very rarely musculoskeletal tumors can mimic the symptoms of snapping scapula. A thorough physical examination and history of the complaint will rule the other conditions out.
If conservative measures have been exhausted, a minimally invasive procedure using a small camera and instruments can be used to remove the inflamed tissue and any bone spurs. This is called endoscopic scapulothoracic bursectomy and partial scapulectomy. It can be done as an outpatient procedure in the vast majority of cases. Most people recover within a few weeks, but many feel better after only a few days. Even after surgery, though, physical therapy is of the utmost importance to ensure the musculature around the shoulder and the posture is corrected so that the shoulder area remains healthy.
Dr. Christian Balldin is an orthopaedic surgeon, fellowship trained in sports medicine, with The San Antonio Orthopaedic Group. He treats patients aged 3 years and up for all orthopaedic conditions with the exception of the spine. To learn more about Dr. Balldin, visit his web page here. To schedule an appointment with Dr. Balldin, please call 210.281.9595.
