Physical Therapy for Snapping Scapula Syndrome
Snapping scapula syndrome involves popping, grating, grinding or snapping of bones and tissue in the shoulder blade when lifting or moving the arm. It is most common in young, active people who perform repeated overhead movements. Snapping scapula syndrome can start when the tissues between the scapula and shoulder blade thicken from inflammation which results from repetitive movements that irritate the muscles, tendons, and bursae surrounding the scapula. Physical therapy is an effective way to treat snapping scapula syndrome, reducing pain and soft tissue inflammation and addressing loss of motion and muscle weakness through therapeutic exercise, strengthening, and manual therapy.
Anatomy of the Scapula
The scapulothoracic joint is located where the scapula (shoulder blade) glides along the chest wall (thorax). The scapula is a flat triangular-shaped bone that lies between the second and seventh ribs that give the shoulder a stable base from which to move and operate.
The scapula is connected to the shoulder via the AC joint and three out of the four muscles of the rotator cuff originate at the scapula. The scapula’s stability depends on the surrounding musculature. There are three layers to the muscles supporting the scapula: the superficial layer (trapezius and latissimus dorsi muscles), the intermediate layer (major and minor rhomboid and levator scapulae muscles), and the deep layer (serratus anterior and subscapularis muscles).
The subscapularis muscle attaches over the front of the scapula where it faces the chest wall, while the serratus anterior muscle attaches along the edge of the scapula near the spine, passing in front of the scapula, wrapping around the chest wall, and connecting to the ribs on the front part of the chest. There are also two major and four minor bursae that surround the scapula, acting as cushions to reduce friction between muscle or tendon and bone.
During normal shoulder movement, the scapula needs to be properly aligned in multiple planes of motion, which depends on the synchrony of various scapular muscles. There is an arc-of-motion pattern between the glenohumeral joint and the scapulothoracic joint, known as the scapulohumeral rhythm, that is a 2:1 ratio. This means that for every two degrees of movement of the humerus, the scapula moves one degree. Scapulothoracic movement requires proper length-tension ratios between the scapular bone and the muscles around it. Any change in the glenohumeral-to-scapulothoracic ratio can result in altered or compromised shoulder motion.
What is Snapping Scapula Syndrome?
Snapping scapula syndrome involves popping, grating, grinding, or snapping of bones and tissue in the shoulder blade when lifting or moving the arm. It is most common in young, active people who perform repeated overhead movements like throwing a baseball, swimming, weightlifting, or stocking shelves.
Snapping scapula syndrome can start when the tissues between the scapula and shoulder blade thicken from inflammation which results from repetitive movements that irritate the muscles, tendons, and bursae surrounding the scapula. In other cases, the muscles under the scapula can shrink or atrophy due to weakness or inactivity which causes the scapula to ride more closely to the rib cage and bump or rub against the rib bones during movement.
Common symptoms of snapping scapula syndrome include:
Pain in the back or top of the shoulder when lifting arms overhead or shrugging the shoulders
Snapping, grinding, grating, or popping sensation or sound in the scapula area when lifting the arm
Feeling of weakness in the arm
Winging of the scapula, which makes the shoulder blade appear as if one edge is poking out away from the body
Difficulty performing overhead arm motions due to pain or weakness in the scapula
Visible difference in how the painful scapula moves
Snapping scapula syndrome can be caused by a variety of factors:
Repetitive overhead activities like reaching overhead or throwing a ball
Incorrect sports training techniques, e.g. overtraining or training without enough prior strengthening
Incorrect posture
Muscle weakness in the shoulder area
Muscle tightness in the chest, neck, shoulder, or scapula
Neck conditions
Shoulder joint problems
Tumors
Unhealed fractures of the ribs or scapula
Inflammation of muscles or bursae
Nerve damage in the shoulder area
Physical Therapy for Snapping Scapula Syndrome
Physical therapy is an effective way to treat snapping scapula syndrome, reducing pain and soft tissue inflammation and addressing loss of motion and muscle weakness through therapeutic exercise, strengthening, and manual therapy. The physical therapist considers the entire kinetic chain during treatment, strengthening the head, neck, shoulder, scapula, and core through a progressive program with the goal of restoring dynamic scapular control, muscle endurance, and a return to the normal 2:1 glenohumeral-scapulothoracic rhythm.
Physical therapy treatment for snapping scapula syndrome can include:
Pain management using ice, heat, ultrasound, or electrical stimulation to minimize swelling and inflammation in the scapular area.
Flexibility training to gently stretch the chest, shoulders, neck, and upper back. The therapist may use manual therapy or dry needling to loosen and stretch tight muscles.
Range of motion exercises to restore normal movement in the neck, shoulder, and spine.
Targeted strengthening of the scapular muscles, particularly the serratus anterior and subscapularis to enhance the stability of the scapula and be able to maintain correct scapular positions. The therapist also implements endurance training of these muscles through low-weight, high-repetition strengthening exercises.
Core strengthening for a stable, strong trunk from which power moves from the legs through the trunk to the shoulder and scapula
Posture training to correct improper positioning that contributed to the syndrome, promote upright posture, and strengthen upper thoracic muscles.
Manual therapy that involves soft tissue mobilizations to improve movement in the scapular region.
Functional training to prepare for work, sport, and home life demands on the scapular complex.
Home exercise program to prevent future injury through regular strengthening and stretching of the scapular muscles.
Are you experiencing scapular pain and loss of function? Work with a physical therapist to address snapping scapula syndrome and restore strength and movement safely!
