Scapulothoracic Friction Syndrome / Scapulothoracic Bursitis

July 16, 2016 | By | Reply READ MORE...

– Dr. Indrayani Harchekar

INTRODUCTION
Chronic pain or discomfort in the nape of the neck or upper back with acute exacerbations, arising from friction of the shoulder blade over the thorax is defined as Scapulothoracic Friction Syndrome. It is usually misdiagnosed and treated as neck pain.

ANATOMY
The shoulder blade (scapula) is an amazing anatomical structure. It suspends over ribs between the spine and the arm by a group of muscles called the scapular stabilizers they are as follows.
Trapezius, Serratus-Anterior, Subscapularis, LevatorScapulae, Rhomboids, Latissimus. There isn’t a real bony joint between the scapula and the trunk.

Scapulothoracic Friction Syndrome

The bursae are fluid-filled sacs designed to reduce friction between muscle or tendon and bone. These layers form a smooth surface for the scapula to move over the rib cage.

INCIDENCE

Usually seen on the dominant side in young adults to middle age people, with no gender variability.

CAUSES

  • Malunion of scapula or rib fractures
  • History of resection/removal of 1st rib for thoracic outlet syndrome
  • Inflammation or overuse results in chronic inflammation causing bursal fibrosis, bursitis, snapping
  • Bony or soft tissue masses
  • Scoliosis (sideways curvature of the spine)
  • Kyphosis (increased hump of the upper and mid back), duskiness (altered movement of the shoulder blade)

PRESENTATION

1. HISTORY:

Scapulothoracic Friction Syndrome

  • Patients complain of popping/clicking of the scapula
  • Pain in the shoulder blade area or side of the neck
  • Ranges from mild discomfort to significant disability
  • Painful clicking over the shoulder blade with elevation of arm
  • Trauma or overuse
  • Usually patients have slouched postures, despite scapular and neck strengthening they fail to maintain a good posture
  • Worse with any kind of upper body exercise, lifting heavy weights or bags, working on the computer for prolonged periods with no proper arm rest.

2. COMMON FINDINGS ON PHYSICAL EXAMINATION:

On Observation:

Scapulothoracic Friction Syndrome

Downward sloping of affected shoulder

  • Fixed or postural kyphosis may be present
  • Forward head posture or downward sloping of the affected shoulder blade may be seen
  • Forward or anterior tipping of the affected shoulder may be evident.
  • Swelling may or may not be present
Scapulothoracic Friction Syndrome

Forward or anterior tipping of the affected shoulder

Scapulothoracic Friction Syndrome

Forward or anterior tipping of the affected shoulder

On Examination:

  • Neck movements are full and free and do not reproduce scapular pain
  • Passive motion of the scapula over the ribcage may reproduce crepitus(grinding)
  • Scapular dyskinesis/winging may be present on movement
  • Shoulder range of motion is usually full and free except internal rotation i.e. hand behind back may be minimally restricted as compared to the normal side
Scapulothoracic Friction Syndrome

Scapular dyskinesis/winging

On Palpation:

  • Tenderness or fullness of symptomatic bursa
  • Trigger points may be present in the Rhomboids, Levator Scapule muscles

3. INVESTIGATIONS:

  • Consultation of a shoulder specialist is needed
  • Radiograph: AP, lateral and axillary view may or may not show osseous/bony abnormalities/swelling
  • CT scan: indications – osseous lesions on plain radiographs
  • MRI: indications – Soft tissue masses. Inflamed bursae

TREATMENT:

Non operative:

  • NSAIDs (Non Steroidal Anti Inflammatory Drugs)
  • Scapular strengthening exercises, postural training, activity modification
  • Local corticosteroid injections
  • In some cases, dynamic taping helps correct scapula position.

Operative:

  • Bursectomy/removal of the inflamed bursa (open or arthroscopic), resection of osseous lesion, and resection of scapular border is considered if all treatments fail.

We at PHYSIOREHAB work towards making a tailor made program for the treatment of Scapulothoracic Friction Syndrome.

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