Snapping Shoulder – Causes & Management

Snapping scapula syndrome (SSS) is characterized by a distinctive snapping or grinding sensation in the shoulder region. This condition can cause pain and discomfort due to the abnormal movement of the scapula (shoulder blade) over the ribcage. The snapping sound is often produced by friction between the scapula and the ribcage or cavitation of air bubbles in the joint fluid. This condition is most commonly seen in individuals who engage in repetitive overhead activities or have certain anatomical abnormalities.

How Common It Is and Who Gets It? (Epidemiology)

Snapping scapula syndrome is relatively uncommon but can affect individuals who participate in activities that involve repetitive shoulder movements, such as overhead sports. It is most frequently observed in young adults, particularly those in professions or sports that require repetitive shoulder motion, like baseball pitchers, swimmers, and racquet sports players. The condition can also occur in people who have sustained injuries to the ribcage or shoulder.

Why It Happens – Causes (Etiology and Pathophysiology)

Snapping scapula syndrome can result from various causes, including overuse injuries, trauma, or anatomical abnormalities. Inflammation of the bursae (fluid-filled sacs) due to repetitive overhead motion is a common cause. Trauma, such as fractures of the ribcage or scapula, can also lead to misalignment and subsequent snapping. Additionally, conditions like osteochondromas (benign bone tumors) can physically obstruct the smooth movement of the scapula, leading to a snapping sensation. Muscle atrophy or tightness, particularly in the subscapularis and serratus anterior muscles, can also contribute to this condition.

How the Body Part Normally Works? (Relevant Anatomy)

The scapula is a triangular bone located on the back of the ribcage. It plays a crucial role in shoulder movement and stability. The scapula glides over the ribcage during arm movements, supported by various muscles and ligaments. The subscapularis and serratus anterior muscles help stabilize the scapula and enable smooth motion. The scapula also forms joints with the humerus (upper arm bone) and clavicle (collarbone), which are essential for arm mobility.

What You Might Feel – Symptoms (Clinical Presentation)

The most common symptoms of snapping scapula syndrome are pain, a grinding or snapping sensation, and weakness in the shoulder. The snapping sound may be audible or felt as a clicking sensation during movement. Patients often report pain in the shoulder blade area, which may worsen with activities involving overhead arm movements. Swelling and inflammation of the affected area may also occur.

How Doctors Find the Problem? (Diagnosis and Imaging)

The diagnosis of snapping scapula syndrome is made based on a thorough physical examination and medical history. Physicians will often ask about the patient’s activity levels and any history of trauma or repetitive shoulder movements. Imaging techniques, such as X-rays, CT scans, and MRI, are used to evaluate bone structure, detect fractures, and assess soft tissues like muscles, tendons, and bursae. X-rays may reveal bone malformations, while CT scans and MRIs provide more detailed images of the shoulder structures.

Classification

Snapping scapula syndrome can be classified based on the underlying cause. It can be due to musculoskeletal issues, such as muscle weakness or tightness, or it may result from structural abnormalities, such as osteochondromas or fractures. The severity of the condition may vary depending on the degree of joint dysfunction, inflammation, or anatomical abnormality.

Other Problems That Can Feel Similar (Differential Diagnosis)

Conditions that may present similarly to snapping scapula syndrome include shoulder impingement, rotator cuff injuries, and shoulder arthritis. Other causes of shoulder pain, such as tendonitis, bursitis, or muscle strain, can also mimic the symptoms of SSS. A detailed evaluation is necessary to rule out these conditions.

Treatment Options

Non-Surgical Care
Non-surgical treatments are often the first line of treatment for snapping scapula syndrome. Rest and avoiding activities that exacerbate the symptoms are crucial for allowing the affected area to heal. Ice therapy can help reduce inflammation and pain. Physical therapy is often recommended to strengthen the muscles around the shoulder and improve the scapula’s movement. Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, can help manage pain and inflammation.

Surgical Care
When conservative treatments fail to provide relief, surgical intervention may be considered. In cases where bursitis is present, the inflamed bursa may be surgically excised. Arthroscopic surgery is commonly used to remove damaged tissues, while traditional open surgery may be required for more extensive cases. In some instances, a portion of the shoulder blade may be excised to facilitate smoother scapular movement.

Recovery and What to Expect After Treatment

Recovery from snapping scapula syndrome depends on the treatment approach. Patients who undergo non-surgical treatments generally experience improvement within a few weeks to months. However, if surgery is performed, recovery may take several months, with physical therapy playing a critical role in restoring shoulder function. After surgery, most patients achieve pain-free movement and full range of motion.

Possible Risks or Side Effects (Complications)

While the surgical treatment of snapping scapula syndrome is generally successful, there are potential risks, including infection, nerve injury, and complications related to anesthesia. There is also a risk of recurrence if the underlying cause is not fully addressed. Non-surgical treatments may also have limited effectiveness in some cases, leading to persistent symptoms.

Long-Term Outlook (Prognosis)

The prognosis for individuals with snapping scapula syndrome is generally good, especially if treated early. Most patients experience significant relief following either conservative or surgical treatment. In cases of osteochondroma or other structural abnormalities, surgical excision typically results in complete resolution of symptoms. Long-term outcomes are favorable, with most patients able to return to their normal activities after recovery.

Out-of-Pocket Cost

Medicare

CPT Code 23130 – Open Scapulothoracic Bursectomy (Most Common for Snapping Shoulder Syndrome): $148.40

CPT Code 29825 – Arthroscopic Lysis/Resection (Intra-articular) for Snapping Shoulder Syndrome: $140.04

Medicare Part B typically covers 80% of the approved cost for these procedures once your annual deductible has been met, leaving you responsible for the remaining 20%. Supplemental Insurance plans such as Medigap, AARP, or Blue Cross Blue Shield generally cover the remaining 20%, minimizing or eliminating out-of-pocket expenses for Medicare-approved surgeries. These plans coordinate with Medicare to fill the coverage gap and reduce patient financial responsibility.

If you have Secondary Insurance such as TRICARE, an Employer-Based Plan, or Veterans Health Administration coverage, it acts as a secondary payer. These plans generally cover any remaining balance, including coinsurance or small deductibles, which typically range from $100 to $300, depending on your plan and provider network.

Workers’ Compensation

If your snapping shoulder syndrome or scapulothoracic bursitis is work-related, Workers’ Compensation will cover all associated medical expenses, including surgery, rehabilitation, and follow-up care. You will not have any out-of-pocket expenses, as the employer’s insurance carrier covers all approved treatments directly.

No-Fault Insurance

If your shoulder condition was caused or aggravated by an automobile accident, No-Fault Insurance will generally cover the full cost of treatment, including the bursectomy or arthroscopic procedure. The only potential out-of-pocket cost may be a small deductible or co-payment, depending on your insurance policy.

Example

Rachel White had chronic shoulder pain due to snapping shoulder syndrome and underwent open scapulothoracic bursectomy (CPT 23130). Her estimated Medicare out-of-pocket cost was $148.40. Since Rachel had supplemental insurance through AARP Medigap, her remaining balance was fully covered, leaving her with no out-of-pocket expenses for the procedure.

Summary and Takeaway

Snapping scapula syndrome is a condition that causes pain, snapping, or grinding in the shoulder area due to abnormal scapular motion. It is most commonly seen in individuals who engage in repetitive overhead activities or have structural abnormalities like osteochondromas. Treatment options range from conservative measures such as rest and physical therapy to surgical interventions when necessary. With appropriate treatment, most individuals can expect significant improvement and a return to normal function.

Clinical Insight & Recent Findings

A recent study explored scapular orientation and its impact on diagnosing Snapping Scapula Syndrome (SSS), a condition often causing crepitus and pain in the shoulder. The study used 3D imaging to analyze the medial scapula corpus angle (MSCA) in both healthy controls and SSS patients, finding that the MSCA varied significantly depending on the scapular orientation relative to the imaging plane. Notably, differences in MSCA measurements between patients with SSS and healthy individuals were most pronounced when the scapula was assessed in modified planes above the supraspinatus fossa. These findings highlight the challenges in using MSCA as a reliable diagnostic tool and suggest that adjusting imaging perspectives may improve the specificity and sensitivity of diagnosing SSS. (“Study on Snapping Scapula Syndrome – see PubMed.“)

Who Performs This Treatment? (Specialists and Team Involved)

Treatment for snapping scapula syndrome is typically managed by orthopedic surgeons, particularly those specializing in shoulder and sports medicine. Physical therapists may also be involved in non-surgical care to help strengthen the shoulder muscles and improve movement.

When to See a Specialist?

If you experience persistent pain or snapping sensations in the shoulder, or if conservative treatments do not provide relief, it is important to see a specialist for further evaluation and management.

When to Go to the Emergency Room?

Seek emergency care if you experience severe shoulder pain following an injury, or if there are signs of nerve damage, such as numbness or weakness in the arm.

What Recovery Really Looks Like?

Recovery from snapping scapula syndrome depends on the severity of the condition and the treatment approach. With non-surgical treatment, recovery may take weeks to months. Surgical recovery can take several months, and physical therapy is essential for restoring full function.

What Happens If You Ignore It?

If left untreated, snapping scapula syndrome can lead to chronic pain and reduced shoulder function. In some cases, the condition may worsen, potentially leading to long-term disability.

How to Prevent It?

Preventive measures include avoiding repetitive overhead activities that strain the shoulder, improving posture, and strengthening the muscles around the shoulder joint. Regular stretching and conditioning exercises can also help maintain flexibility and muscle balance.

Nutrition and Bone or Joint Health

A diet rich in calcium, vitamin D, and other essential nutrients is important for maintaining bone health and preventing joint issues. Weight-bearing exercises can also help keep the bones and muscles strong.

Activity and Lifestyle Modifications

Avoid activities that exacerbate shoulder pain or contribute to muscle imbalances. Regular shoulder exercises and stretching can help improve scapular movement and prevent recurrence of snapping scapula syndrome.

Read more about Shoulder Treatment here.