Snapping scapula syndrome is a condition that involves the popping, grating, grinding, or "snapping" of bones and tissue in the shoulder blade area when lifting and moving the arm. It may be caused by several bone or soft tissue problems.

• Bones can be malformed from birth, or fractured, causing them to be misshapen. When the scapula moves, it may bump against a misshapen bone as it glides over it. This creates a grinding or grating feeling or sound.
• The muscles between the scapula and the rib cage can become tight, shrunken, scarred, inflamed, or weak. As a result, the scapula will become positioned too close to the rib cage. This may cause it to rub painfully on the ribs during arm movement.
• Bursae are fluid-filled sacs that act as cushions. These cushions usually reduce friction between the scapula and the rib cage, or between the scapula and the muscles. The scapula may rub and irritate a bursa cushion. Popping or snapping can occur when a bursa becomes inflamed, rolls over during shoulder motion, or fails to reduce friction properly.

Snapping scapula syndrome can be caused by:

• Repetitive activities, such as reaching overhead or throwing a ball.
• Incorrect sports training techniques, such as overtraining or training without enough prior strengthening.
• Incorrect posture.
• Weakness in the shoulder area.
• Muscle tightness in the chest, neck, shoulder, or scapula area.
• Neck conditions.
• Shoulder joint problems.
• Tumors.
• Unhealed fractures of the ribs or scapula.
• Inflammation of the muscles or bursae.
• Nerve damage in the shoulder area.

Complete recovery from snapping scapula syndrome can sometimes take many months. But you may feel improvement after just a few weeks. Healing time varies depending on the cause and severity of the condition and each person’s fitness level and goals.

A person with snapping scapula syndrome may experience:

• Pain in the back or top of the shoulder when lifting the arm overhead or shrugging the shoulders.
• A snapping, grinding, grating, or popping sensation or sound in the scapula area when lifting the arm.
• A 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 area.
• A visible difference in how the painful scapula moves.

If you see your physical therapist first, they will conduct a thorough evaluation. This will include taking your health history. Your physical therapist also will ask you detailed questions about your injury, such as:

• How and when did you first notice the pain?
• Do you hear or feel any popping, grinding, or snapping when moving your arm? What activities are you performing when you hear or feel these symptoms?
• Do you have any pain or stiffness in your neck?
• Does your shoulder area feel weak or "tired"?

Your physical therapist will perform special tests to help determine if you have snapping scapula syndrome. They also will determine whether your pain is coming from your neck, shoulder joint, or other areas, or if it is limited to your shoulder blade.

To reach a diagnosis, your physical therapist may team with an orthopedic physician or other health care provider. They may order imaging tests, such as an X-ray, to confirm the diagnosis and to rule out other damage to the spine, ribs, and scapula. An X-ray is not needed in all cases.

Your physical therapist will work with you to design a specific treatment program to speed your recovery. It will include exercises and treatments that you can do at home. Physical therapy will help you safely return to your normal lifestyle and activities.

First 24 to 48 Hours

Your physical therapist may advise you to:

• Rest the area by avoiding lifting your arm overhead or performing other movements that cause pain.
• Apply ice packs around the scapula area for 15 to 20 minutes every two hours.
• Make sure that you keep your spine in an upright posture when sitting or standing.
• Consult with a physician for further services, such as medication or diagnostic tests.

Your physical therapist will work with you to:

Reduce pain. Your physical therapist may use different types of treatments and technologies to control and reduce your pain and symptoms. These may include ice, heat, diathermy, ultrasound, laser treatment, electrical stimulation, taping, exercises, hands-on therapy, such as massage, and other treatments.

Improve motion. Your physical therapist will choose specific activities and treatments to help restore normal movement in the shoulder, neck, and spine. These might begin with "passive" motions that the physical therapist performs for you to gently move your arm, shoulder, neck, and scapula, and progress to active exercises and stretches that you do yourself.

Improve flexibility. Snapping scapula syndrome is often related to tight muscles in the chest wall, shoulder, and neck. Your physical therapist will determine if these, or any other muscles, are tight. They will teach you how to gently stretch them. Your physical therapist may apply hands-on techniques, such as massage and trigger-point release, to help loosen and stretch your muscles.

Improve strength and speed recovery time. Specific exercises will aid healing at each stage of recovery. Your physical therapist will choose and teach you the correct exercises and equipment to steadily restore your strength and agility (the ability to move quickly and easily). Your physical therapist will choose the right treatments and activities to help you heal, return to your healthy lifestyle, and reach your goals faster than you are likely to do on your own.

Return to activities. Your physical therapist will discuss your goals with you. They will work with you to set your job, sport, and homelife recovery goals. Your treatment program will help you reach those goals in the safest, fastest, and most effective way possible.

Prevent future injury. Your physical therapist can recommend a home exercise program to help prevent future injury. These exercises will help to strengthen and stretch the muscles around your shoulder and arm. They may include strength and flexibility exercises for the muscles of the neck, shoulder, arm, and scapula.

If Surgery Is Necessary

Surgery is often not needed in the case of snapping scapula syndrome. If surgery is required, you will follow a recovery program after surgery and lasts for several weeks, guided by your physical therapist. They will help you minimize pain, regain motion and strength, and return to normal activities as quickly as possible.

To help prevent a recurrence of the injury, your physical therapist may advise you to:

• Maintain upright posture and avoid slouching.
• Maintain the strength in your scapula and shoulder joint muscles.
• Use proper athletic techniques when performing sports that require overhead arm movements.

All physical therapists are prepared through education and experience to treat snapping scapula syndrome. However, you may want to consider:

• A physical therapist who is experienced in treating people with orthopedic injuries. Some physical therapists have a practice with an orthopedic focus.
• A physical therapist who is a board-certified clinical specialist, or who completed a residency or fellowship in orthopedic or sports physical therapy. This physical therapist has advanced knowledge, experience, and skills that may apply to your condition.

You can find a physical therapist with these and other credentials by using Find a PT, an online tool built by the American Physical Therapy Association. Search for physical therapists by location and experience.

General tips when you're looking for a physical therapist (or any other health care provider):

• Get recommendations from family, friends, or from other health care providers.
• When you contact a physical therapy clinic for an appointment, ask about the physical therapists' experience in helping people who have your type of injury.
• During your first visit with the physical therapist, be prepared to describe your symptoms in as much detail as possible, and say what makes your symptoms worse.

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