Shoulder Pain due to Snapping Scapula (bones crunching back lower should blade)

General Talk
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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.

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Physical Therapy in Corpus Christi for Shoulder

Do you suffer from painful snapping of your shoulder blade, when you move your arm? This article discusses some of the causes of shoulder blade snapping or bursitis of the the shoulder blade. A Physical Therapist at Humpal Physical Therapy & Sports Medicine Centers in Corpus Christi can examine your shoulder and may be able to help you with the relief of pain from shoulder girdle bursitis. Although most clients can benefit from conservative treatment from a Physical Therapist, occasionally surgery is indicated to remedy the problem.

You wouldn’t know it without being told, but raising the arm overhead requires complex coordinated interactions of the clavicle (collar bone), glenohumeral (shoulder) joint, and scapula. The entire scapulohumeral structure is held together by muscles, tendons, and ligaments. Protective pads called bursa (bursae when referring to more than one) make it possible for smooth, gliding movements of all the parts.

Sometimes people (especially athletes) develop grinding, snapping, crunching, or popping called crepitus that can be felt by the affected person and even heard by others. When crepitus affects the scapula as it moves over the rib cage (thorax), it is referred to as scapulothoracic crepitus or snapping scapula.

That’s the focus of this review article. The authors discuss what happens to normal anatomy to cause this problem, how it differs from another condition called scapulothoracic bursitis, and how to treat both conditions. Fortunately, these problems are fairly uncommon. But when they do occur, the pain and loss of normal movement can result in severe dysfunction of the shoulder and arm. And for anyone involved in overhead throwing sports, the symptoms can be extremely limiting.

What causes scapulothoracic bursitis or crepitus? Normal variations in the shape, size, and position of the scapula can cause muscle and tendon to rub the wrong way. There are those protective pads (bursae) to help ease the tension between muscle and bone or even muscle and muscle. But if there’s a bony bump on the scapula or an extra long end of the bone, the extra wear and tear of muscle/tendon flipping back and forth over the prominence can result in crepitus.

Now, crepitus isn’t always a problem. It turns out that one-third of all adults notice some snapping, grinding, or popping as they move their arm. It never results in painful symptoms or loss of function. What we are talking about here are those people who either suffer some injury to the arm (trauma) or overuse the arm (repetitive irritation of the bursa). Either one can cause inflammation of the bursa (bursitis) and eventually crepitus from scarring and fibrosis.

In a smaller number of people, there are other potential causes of scapulothoracic bursitis and crepitus besides trauma and overuse. For example, bone tumors or bone spurs may result in a reactive bursa. A bursa forms where no bursa normally exists. Muscle tears, muscle atrophy, structural spinal deformities like scoliosis (curvature of the spine), and rib or scapula fractures that don’t heal properly can also create these types of problems.

Whatever the cause, what can be done to fix the problem? Well, first an examination should be done to find out exactly what’s going on. How is the scapula moving over the thorax? Are there obvious alterations in the normal movement patterns and biomechanics? What muscles are too tight, too loose, or weak? Are there any changes in the person’s posture that might be contributing to the problem?

Clinical testing of motion, mobility, and strength along with imaging studies and possibly electrodiagnostic tests help confirm the diagnosis. The examiner, whether an orthopedic surgeon, sports physician, or Physical Therapist, will also check to see if the symptoms are really coming from the cervical spine (neck).

Once all the information has been collected, a program of nonoperative rehab is the first step. The Physical Therapist works with the patient to restore normal posture, scapular movement, strength, and endurance. It can take up to six months to create the form and function needed to a return to normal scapulothoracic and scapulohumeral motion. In some cases, the bursa is injected with a steroid to reduce swelling and irritation from the inflammatory process.

When conservative (nonoperative) care doesn’t solve the problem, then the surgeon gives some thought to operating. The inflamed bursae may be removed or alternately, a portion of the scapula may be cut out. Either one of these procedures takes pressure off the soft tissues that are getting pinched or rubbed against.

Some of these surgeries can be done arthroscopically, while others require open incision. The exact surgical method and technique to use for a snapping scapula that doesn’t respond to conservative care isn’t known. In fact, there’s a lot of debate over this issue.

Studies that have been done so far show equally good results no matter what surgical approach is taken. Success is defined by a pain free return to preinjury activity levels at work and in sports or recreational activities. Patients who choose surgery should be warned that there are a few potential complications such as recurrence of the same pesky bursitis and/or damage to the dorsal scapular nerve.

Reference : Augustine H. Conduah, MD, et al. Clinical Management of Scapulothoracic Bursitis and the Snapping Scapula. In Sports Health. March/April 2010. Vol. 2. No. 2. Pp. 147-155.

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Can a labrum generate a pop or snap?

The labrum, as you recall from a few paragraphs ago, is a rubbery disc.

It’s not a hard, stiff object. It’s also tiny and not subject to massive compression when you’re sitting at your computer doing a shrugging motion to test for sound effects.

Based on those two observations alone, we can basically rule it out as being a generator of the clicks and snaps.

In this video, I talk more in detail about snapping and popping in the hips and shoulders and give you a visual explanation of what we just talked about.

Basically, if the labrum is just a soft rubbery disc, it seems highly unlikely that it is responsible for generating popping and snapping. Even if it’s torn and there’s a loose flap, how exactly do we think that this rubbery flap generates audible snapping and popping sounds in the shoulder?

5 Different kinds of shoulder pops and snaps

In my experience pop and snaps can happen all around the shoulder joint and upper back. Funny story: one time, a Rolfer (think of this as a massage therapist who’s obsessed with posture) was working on my chest and anterior shoulder muscles. He snuck his fingers under my pecs and lifted the pec minor up and away from the ribs. There was a loud and audible POP!

We both found it a little disturbing—neither of us having ever heard something so loud come from directly out of a muscle. It felt as if the muscle had been stuck to my rib cage.

This experience and other similar ones make me think pops can also be the result of muscle tissue becoming “unstuck/unglued” from bones or other tendons. Of course I have no way to verify that until I can get my hands on some expensive medical devices or someone else starts doing some medical research on the topic (though, I feel like this should be pretty low on society’s medical research priority list), but there was no way it was a labrum, and there was no way it was from within the shoulder joint! Here are a few of the different places I’ve experienced shoulder pops, clicks, snaps:

1. Front of the shoulder

Sometimes I’ll get one or two loud pops or snaps in the front of the shoulder, near the anterior deltoid and pec major and pec minor attachments. Those are generally louder and have a satisfying sense of tension release. Having experienced this at least hundreds of times, at this point I can tell that this is from muscle tension build up from being at the computer for long periods.

2. Back of the shoulder

My old pops and snaps were awful, particularly on the right shoulder. Just the motion of lifting my hand and arm out to the side would result in a locking sensation at about 45 degrees. I’d have to force my way through that angle, resulting in a painful, often low-toned clunk. At higher angles, I’d also get snapping in the back of the shoulder. It was like my rotator cuff muscles were getting caught up on the scapula or on one another.

3. Inside of the shoulder

When lying on my right side, I used to get grinding sensations (not pops or snaps) at the inside of my shoulder joint.

4. In or near shoulder joint

With the sounds near the actual shoulder joint, I believe it’s tendons rubbing up against bone and other tendons.

5. Top of the shoulder blade or between the shoulder blades

If you get noises near the top of the shoulder blade or between the shoulder blades, it’s from the scapulae actually rubbing against the ribs and/or tendons around the scapulae.

2 Keys to getting rid of shoulder pops & snaps

This is the big question for people with popping and snapping in the shoulders: How do you get rid of it?

1. Keep muscles pliable with self-massage.

When your shoulders are NOT aligned well, popping and snapping is the norm. Making sure you keep muscles pliable helps maintain good alignment. Doing that requires you to put in a little maintenance work with self-massage techniques. This is particularly important if you are someone who trains a lot.

2. Build strength and control around shoulders and thoracic spine.

The other key is learning to control your thoracic spine, shoulder blade, and shoulder joint properly. You need to have good strength and coordination all around those areas to ensure smooth overall movement with a minimum of popping and snapping.

When you have trained the muscles of the shoulder to allow for good, smooth movement, the popping and snapping is transitory and is not accompanied by pain. These kind of noises do generally go away as the muscles that control the shoulder blades get used to moving the shoulder blades along an efficient path. Next up: How to do that.

What kinds of exercises can you do to improve your shoulder joint positioning?

We get a lot of clients who have issues with popping and snapping in the shoulder. It’s pretty common, so it’s important to remember that it’s not a sign that you’re hopelessly broken.

One of the first steps is to start restoring your ability to control your shoulder blades. The most common missing ability is scapular retraction, and that’s the one I would generally focus on first. There’s a lot of bang for the buck when you improve scapular retraction, so if you’re looking for some quick ideas, you’ll find helpful exercises in our Stubborn Shoulder Pain Secrets eBook (you can sign up below).

Teach Your Shoulders To Feel Good!

Learn simple exercises, stretches, and massage techniques to relieve tension and strengthen your shoulders with our exclusive Shoulder Tips!

self-massage against wall for shoulders
self-massage against wall for shoulders606×533 204 KB

What if the shoulder snaps and pops still don’t go away?

If they don’t go away with increased strength training and massage, there’s often too much kyphosis (c-curve) or possibly rotation in the thoracic spine. That can cause the shoulder blades to slide in an awkward path over the ribs that guarantees excess friction and poor shoulder kinematics.

If you know you have a ton of kyphosis, check out some of these videos to help you out:

Final words on snapping shoulders

If you’re trying to silence your snapping shoulders, it’s important to do two things.

  1. Stay calm. It’s highly unlikely surgery is a good answer for the problem. Also, know that you may never get your shoulders TOTALLY silent! Even babies have noise in their shoulders!
  2. Start experimenting with different exercises to increase overall control of your shoulders. This may mean learning how to retract your scapula. This may mean doing more massage work. This may mean learning how to improve your thoracic kyphosis.

We’ve seen a lot of different kinds of issues in our personal training clients, so we know that there’s a lot of ground for you to cover! Just be patient. Keep exploring and learning how to move and control your shoulders with confidence!