Over one third of shoulder movement occurs via the scapula (shoulder blade) and thoracic cage. As we’ve mentioned before, the shoulder is comprised of many intricate parts. Between these components, you’ll find bursa, fluid-filled sacs that cushion and protect body tissues from excessive friction.
The scapulothoracic bursa, the bursa between your scapula and chest wall, serves an important role within the shoulder joint by allowing smooth, pain-free movement of the scapula against the ribcage.
So, what happens when that scapulothoracic bursa becomes inflamed from repetitive overuse or injury?
Dr. Robert Rolf, a board certified orthopedic surgeon at Beacon Orthopaedics and Sports Medicine, has compiled a collection of frequently asked questions about scapulothoracic bursitis, also known as Snapping Scapula Syndrome, below. In this article we’ll go over its cause, symptoms, and treatments.
If your question is not addressed in the collection below, Dr. Rolf offers free Shoulder Talks at Beacon West. If you’re interested in joining one of his shoulder talks, RSVP here and see when the next talk will be held.
What is Scapulothoracic Bursitis?
Scapulothoracic bursitis refers to inflammation in the bursa under the shoulder blade.
Also known as Snapping Scapula Syndrome, scapulothoracic bursitis occurs when the muscles underneath the scapula weaken and lead to a closer proximity between the scapula and the ribcage at rest and in motion. When the scapula cannot easily glide along the chest wall, the bones rub together. Over repetitive movements, the bursa becomes inflamed due to the constant friction.
What are the symptoms of Scapulothoracic Bursitis?
The following is a list of symptoms associated with a snapping scapula:
- Pain/aches in the shoulder area
- Grinding, grating and snapping sensation in the shoulder blade
- A potential lump from a bone growth on the scapula
- Tissue in the affected area often feels thick
- Swelling in the shoulder area
- Shoulder instability
- Tenderness or stiffness
What causes Snapping Scapula Syndrome?
Snapping scapula is caused by problems in the soft tissues—inflammation from repetitive movements—or bones of the scapula and chest wall. In some instances, the muscles under the scapula shrink (atrophy) from weakness or inactivity, leaving the scapula bone within a closer proximity to the rib cage. The resulting friction from bones bumping and rubbing together during movement causes the syndrome to develop.
Other potential causes are:
- Changes in the alignment or contour of the bones of the scapulothoracic joint
- Abnormal curves, bumps, or ledges on the upper edge of the scapula (called Luschka’s tubercles)
- Sustained, kyphotic (forward flexed) posture
- Inflammatory conditions such as rheumatoid arthritis
- Bone tumor such as an osteochondroma
- Poor Scapular Mobility
- Trauma or injury
How is Scapulothoracic Bursitis diagnosed?
A physical examination (where the shoulder and torso are completely exposed to ensure complete visibility) is performed on the affected area to begin diagnosis:
The patient is asked to raise and lower their arm for observation. The physician notes the range of motion and location of pain as the patient moves their arm.
In order to confirm diagnosis, your physician can potentially call for the following additional diagnostic tests:
- X-rays to view the shoulder joint’s bone structures in great detail.
- MRI scan to gain a better view of the shoulder’s soft structures and confirm the diagnosis.
What are the non-surgical treatment options for Scapulothoracic Bursitis?
In sports medicine, it’s best practice to always start with a conservative approach to treatment:
- Rest and ice the affected area
- Avoid direct pressure to the affected area
- Take anti-inflammatories to stop swelling
- Talk to your physician about a corticosteroid injection
- Do range-of-motion exercises every day to prevent stiffness
- Talk to your physician about a detailed physical therapy program
- Avoid smoking
What kinds of exercises can I do at home to help relieve my Scapulothoracic Bursitis symptoms?
To Enhance Range of Motion
Shoulder Pendulum Stretch
Use a 3-5 lb. object that you can easily hold with your affected arm. Bend at the waist so that arm holding the object is dangling straight down. (You may want to hold onto or lean against a table, chair, or wall with your opposing arm for support.) While keeping your dangling arm loose, gently rotate your arm in a circular motion while keeping your arm and shoulder relaxed. Rotate clockwise for 2-3 minutes and then counterclockwise for 2-3 minutes—repeating until your shoulder loosens up.
Internal Shoulder Rotation Stretch
Roll up one of your bath towels to create a long, thick “rope.” While, holding the towel at both ends—with the hand of your better arm positioned behind your neck, and the hand of the affected arm behind your lower back—pull your lower arm up by pulling up with your higher arm slowly. Once you’ve pulled your lower arm to where you feel resistance, hold the stretch for five seconds and then slowly return to the starting position.
Shoulder Flexion Stretch
With a non-weighted bar, stand up straight (core is tight, chest is up, and shoulder blades are back and down) holding the bar shoulder-width apart with your palms down. Then, keeping your arms perfectly straight, raise the bar up directly over your head, hold for 5 seconds and then slowly bring it all the way back down to the starting position.
Standing Scapular Elevation
Using reasonably weighted dumbbells (3-5 pounds), stand up straight (core is tight, chest is up, and shoulder blades are back and down) holding your weights loosely. Steady your grip on the weights and shrug your shoulders and traps straight up, keeping your arms straight as you lift. Hold this for five seconds and then slowly lower your shoulders back down to the starting position.
Upright External Shoulder Rotation
Using reasonably weighted dumbbell (3-5 pounds), stand with the dumbbell positioned out to the side of your head, elbow bent, and shoulder height with the dumbbell directly above the elbow. Slowly lower the dumbbell forward by rotating at the shoulder until the dumbbell is in line with your shoulder. Return the dumbbell the same way back to the starting position slowly.
What are the surgical treatment options for Scapulothoracic Bursitis?
If your condition hasn’t improved, and you are still experiencing symptoms of scapulothoracic bursitis, please schedule an appointment with Dr. Rolf at Beacon Orthopaedics to get your shoulder back in working condition.
In the event Dr. Rolf advises surgery as your best option, the procedure you can expect is usually performed arthroscopically—minimally invasive, with same day discharge, and a faster recovery.
Surgery may involve one or both of the following:
- Bursectomy: Removal of the inflamed bursa and any surrounding scar tissues or bone growth and other irregularities.
- Partial Scapular Resection: Removal of any bony prominences found on the scapula that may be rubbing on the rib cage.
What will my surgery recovery look like?
Following surgery your arm will most likely be immobilized in a sling for up to four weeks to allow the shoulder to heal.
Dr. Rolf, and the team at Beacon Orthopaedics, will then help you get on a detailed physical therapy plan to keep the shoulder moving well.
After approximately four weeks you will progress to active range of motion exercises and should be able to do most of your normal daily activities. Strengthening and resistance exercises are usually introduced after around twelve weeks. For most patients, full recovery is usually within 4 months post scapulothoracic bursitis surgery.
Know When You Need Surgery: Ask the Pros at Beacon
When it comes to surgery, the best physicians will recommend procedures only if non-surgical treatments failed to relieve you of your symptoms. You deserve more than a doctor, you deserve someone who is on your team, who has a team of professionals to ensure that your diagnosis is on point, your treatments are thorough, your recovery is detailed and you are given the support you need at every turn of the treatment plan.
Wellness is a journey. Let’s get you feeling better, together.
If you think you might be suffering from symptoms related to scapulothoracic bursitis, or have already tried non-surgical treatments for your constant shoulder pain to no relief, schedule your appointment with Dr. Rolf today.