How to Fix Snapping Scapula Syndrome

What is Snapping Scapula Syndrome?

Snapping Scapula Syndrome is when there is a snapping, popping, clicking and/or grinding sensation (collectively known as “Crepitus”) in the area between the shoulder blade and spine.

The sound/sensation is generated as the shoulder blade rubs against the rib cage.

(Ideally – the shoulder blade should glide smoothly on top of the rib cage without causing any sounds.)

Disclaimer: The content presented on this blog post is not medical advice and should not be treated as such. It is not intended to be used as a substitute for professional advice, diagnosis or treatment. Use of the content provided on this blog post is at your sole risk. For more information: Medical disclaimer.

What causes Snapping Scapula Syndrome?

The following factors will reduce the normal gap between the shoulder blade and rib cage.

This will increase the likelihood of the bones (… and/or soft tissue in between the bones) rubbing against each other.

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a) Rounded shoulders

When your shoulders are rounded forwards, the scapula is generally in a position of Anterior Tilt.

On top of this – The weight of the arm can drag and pull the scapula down onto the rib cage.

These 2 factors brings the upper portion of the scapula closer to the rib cage which can cause grinding of the 2 bones (+/- the involvement of the soft tissue in between them).

b) Atrophy of the muscles underneath Scapula

A reduction in the muscle bulk (atrophy) of the Subscapularis and/or Serratus Anterior will reduce the gap between the scapula and rib cage.

c) Changes in bony structure

Any changes in the shape of the rib cage (eg. previous fractures) and/or scapula (eg. Luschka’s tubercles, Osteochondroma, fractures) may result in increased friction between the surfaces.

(Unfortunately – it is not likely to significantly reverse any changes in the bones without surgical intervention.)

d) Postures that affect the rib cage

The following postures may affect the ability of the shoulder blade to sit evenly onto the rib cage.

• Flat Thoracic Spine
• Hunchback Posture
• Twisted Spine

Snapping Scapula Syndrome Test

Instructions:

• Place both palms at the back of your hips.
• Slouch forwards.
• Perform shoulder rolls in a backwards direction.
• Aim to move the shoulder blade as much as possible.

Results: If there is a grinding sensation as you move your shoulder blades, then it is likely that you have Snapping Scapula Syndrome.

Is Snapping Scapula Syndrome dangerous?

Clicking between the shoulder and spine is not inherently an issue.

However – it may lead to the following:

a) Scapulothoracic Bursitis

There is a fluid-filled sac (called the bursa) that sits between the scapula and rib cage.

If these 2 bones grind against each other, it can compress the bursa and eventually lead to inflammation of the bursa (Scapulothoracic bursitis).

This can result in pain around the shoulder blade region.

b) Irritation to structures

Other structures such as the bone, tendons and muscles can also become inflamed as the bones grind against each other.

c) It’s annoying!

Although having Snapping Scapula Syndrome does not necessarily mean that there will be pain, it can still prove to be very annoying!

… Who wants a shoulder that makes a grinding noise every time you move it?

Snapping Scapula Syndrome Exercises

1. Releases

The following releases will target the muscles responsible for placing the scapula in a sub-optimal position.

(Note: If you are not sure where the following muscles are located, I recommend that you use Google to help you find out.)

a) Chest/Front of shoulder

Instructions:

• Locate the following muscles:
  • Pec Minor/Major
  • Subclavius
  • Anterior Deltoid
  • Coracobrachialis
  • Short Head Biceps
• Lie on your stomach.
• Place a massage ball underneath the target muscle.
• Apply an appropriate amount of body weight on top of the ball.
• Perform a gentle rolling motion to cover all areas.
• Continue for 1 minute per area.

b) Latissimus Dorsi

Instructions:

• Locate the Latissimus Dorsi.
• Place a foam roller underneath this muscle. (see above)
• Apply an appropriate amount of body weight on top of the ball.
• Perform a gentle rolling motion to cover the entire muscle.
• Continue for 2 minutes.

2. Stretches

These stretches will address the muscles that are pulling the shoulder blade closer to the rib cage.

a) Chest

Instructions:

• Place your hand onto a door frame. (see above)
• Lunge forward.
• Do not arch your lower back.
  • Keep the lower rib cage down.
• Aim to feel a stretch in the chest region.
• Hold for 30 seconds.

b) Front of shoulder

Instructions:

• Sit on the edge of a chair.
• Place both hands on side the of the chair.
• Pull your shoulders BACK and tip them BACKWARDS.
  • (Lock this position in throughout the stretch!)
• Keep your elbows pointing backwards.
• Slowly sink your body downwards. Your elbows should start to bend.
  • (Do NOT let those shoulders tip forwards!)
• Aim to feel a stretch at the front of the shoulders.
• Hold for 30 seconds.

c) Latissimus Dorsi

Instructions:

• Assume the position above.
• Hold onto a door frame with your hand.
• Whilst anchoring your legs as shown, aim to bend your mid section as much as possible.
  • Use your body weight to sink into the stretch
• Twist your pelvis away.
• Aim to feel a stretch on the upper side of your torso.
• Hold for 30 seconds.

3. Increase The padding behind scapula

These exercises are aimed at increasing the size of the muscles that are located between the scapula and rib cage. This will minimize friction between the surfaces.

a) Serratus Anterior

Instructions:

• Lie on your back with your knees bent.
• Whilst holding onto a weight, lock your arms straight in front of you.
  • Use a weight that you are able to control properly.
• Push the weight up towards the sky whilst keeping the arm completely straight.
• The scapula should tilt backwards and wrap around your rib cage.
• Hold for 5 seconds.
• Make sure you can feel the Serratus Anterior engaging throughout the exercise.
• Return to starting position.
• Perform 10 repetitions/3 sets.
• Progression: Use a heavier weight.
• (For more exercises: Serratus Anterior exercises.)

b) Subscapularis

Instructions:

• Anchor the resistance band at elbow height.
• Hold onto the band and stand side ways to the door.
• Tilt your shoulder blade backwards.
  • Do NOT allow your shoulder to tip forwards during this exercise.
• Pull the band towards your body.
• Keep your elbow in contact with the side of your body throughout the movement.
• Repeat 10 times.
• Perform 3 sets.

4. scapula control

If you do not have control of the scapula, then it will be challenging to position the shoulder into a more optimal position.

a) Posterior Tilt

Instructions:

• Maintain wide and long shoulders.
• Perform a Posterior tilt: (see above)
  • “Rotate the shoulder blade BACKWARDS.”
  • Imagine the bottom of your shoulder blade digging into your ribs.
  • This movement can also be described as a “back flip of the scapula”.
• Aim to FEEL the muscles contract at the base of the scapula.
• Hold for 30 seconds.
• Repeat 3 times.

b) Retraction

Instructions:

• Maintain wide and long shoulders.
• Perform a Posterior Tilt FIRST.
• Perform Retraction: (see above)
  • “Pull your shoulder blades together.”
  • Do not allow your shoulders to tip forwards.
• FEEL the contraction between the shoulder blades.
• Hold for 30 seconds.
• Repeat 3 times.

c) Elevation

Instructions:

• Position your scapula in a Posterior tilt and Retraction.
• Perform Shoulder Elevation.
  • “Shrug your shoulders.”
• Feel the contraction of the upper trapezius.
• Hold for 30 seconds.
• Repeat 3 times.

5. Strengthening exercises for Snapping Scapula Syndrome

The following strengthening exercises will help engage the appropriate muscles that help place the scapula into the correct position.

a) Elbows flares

Instructions:

• Position the scapula:
  • Perform Posterior Tilt, Retraction and Elevation.
• Place both hands (with elbows forward) on the sides of your head. (see Start position)
• Bring your elbows all the back. (see End position)
• Do not allow your shoulders to tip forwards!
• Feel the contraction between the shoulder blades.
• Hold for 5 seconds.
• Repeat 20 times.

b) Hand lifts off wall

Instructions:

• Place both hands high up on a wall in front of you.
• Lean firmly into your hands.
• Position the scapula:
  • Perform Posterior Tilt, Retraction and Elevation.
• Lift your hands off the wall without moving your torso.
• Aim to feel the muscular contraction between your shoulder blades.
• Hold for 30 seconds.
• Repeat 3 times.

c) Wall push

Instructions:

• Stand with your back to a wall.
• Position the scapula:
  • Perform Posterior Tilt, Retraction and Elevation.
• Place the back of arms along the wall to the over head position. (see above)
• Push the arms into the wall.
• Hold for 30 seconds.
• Repeat 3 times.
• Note: If you are having difficulty with this exercise, you can perform the same action whilst lying down on the floor.

d) Shrugs over head

Instructions:

• Assume the 4 point kneel position.
• Position the scapula:
  • Perform Posterior Tilt, Retraction and Elevation.
• Lift and reach out a straightened arm in front of you so that your hand is pushing and holding a ball against the wall. (see above) 
  • Try to be as far away from the wall as possible.
• Roll the ball in a circular motion.
• Keep your neck relaxed.
• Continue for 30 seconds.
• Repeat 3 times.

6. What Is The Correct Shoulder Position?

The shoulder blade position is important! Here’s a quick way to place your shoulders in a better position.

Shoulder reset

Instructions:

1. Elevation

• “Gently float/hover your shoulder blade on top of your rib cage.”
• Imagine that air can be blown in between the scapula and rib cage.
• Do not let the weight of you arms drag your your shoulders downwards.

2. Serratus Anterior activation:

• Reach and stretch out your hands as far to opposite sides as possible. (see above)
• “Keep your shoulders wide and long.”

3. Retraction

• Bring your arms slightly backwards.
• Aim to feel a gentle contraction between your shoulder blades.
• (Do NOT over squeeze your shoulders back together.)

4. Posterior Tilt

• Rotate your arms backwards as far as you can so that your thumbs are almost pointing towards the floor.

Final step:

• Whilst maintaining this new shoulder position, slowly lower the arms by your side.
• Perform this reset technique as often as required.

7. surgery For Snapping Scapula Syndrome

If the cause of the Snapping Scapula Syndrome is due to structural changes to the bony surfaces of the rib and/or scapula, surgery can be used to smooth out the contact points.

The most common surgeries performed:

• Resection of the bone that is involved with the grinding.
• Removal of the bursa that is getting irritated (Bursectomy).

8. How long does it take for Snapping Scapula Syndrome to heal?

My recommendation: Persist with the exercises mentioned in this blog post for at least 3-6 months before considering surgery.

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Conclusion

Although clicking between the shoulder blade and spine does not always mean that there will be pain present, it can lead to eventual irritation of the structures in the region.

Persist with these Snapping Scapula Syndrome exercises for at least 3-6 months before considering surgery!

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