Scapular (Shoulder Blade) Disorders

Understanding Scapular (Shoulder Blade) Disorders

The scapula, or shoulder blade, glides along the back of the rib cage and positions the shoulder socket under the arm. Seventeen muscles attach to it, and they must work together for the shoulder to move smoothly and powerfully.

Scapular disorders occur when that motion is abnormal. Scapular dyskinesis is altered shoulder blade movement, often from muscle weakness, imbalance, poor posture or overuse, and is common in overhead athletes. Scapular winging, where the inner edge of the shoulder blade sticks out, is often caused by injury to the long thoracic or spinal accessory nerve. Snapping scapula is a grinding or popping under the shoulder blade, sometimes from an inflamed bursa or a bony prominence.

Most scapular disorders are treated with targeted physical therapy. Nerve injuries are monitored for recovery, and surgery such as muscle transfer, bursectomy or removal of a bony prominence is considered for persistent symptoms.

Causes & Risk Factors

• Muscle weakness or imbalance and poor posture
• Repetitive overhead activity
• Injury to the long thoracic or spinal accessory nerve
• Bursitis or bone prominences under the scapula
• Associated shoulder problems such as instability or impingement

Symptoms

Common signs and symptoms of Scapular Disorders include:

• Pain around the shoulder blade or neck
• A shoulder blade that sticks out, especially when pushing
• Popping, grinding or snapping under the shoulder blade
• Fatigue or weakness lifting the arm

Treatment Options

Treatment for Scapular Disorders depends on the severity of your condition and may include:

• Physical therapy focused on scapular strength and control
• Posture correction and activity modification
• Injections for scapulothoracic bursitis
• Observation and monitoring of nerve recovery
• Muscle transfer for permanent nerve-related winging
• Arthroscopic or open bursectomy for snapping scapula