Figure 13 - uploaded by Joao Carlos Rodrigues
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A 69-year-old male patient with a 90-day history of bulging, snapping, and pain in the left scapular region. The patient had engaged in weightlifting on a regular basis. Axial T1-weighted MRI of the left scapula, showing an elastofibroma deep within the serratus anterior muscle, interposed between the rib cage and the inferior angle of the scapula (arrow).
Source publication
Snapping scapula syndrome manifests as an audible or palpable crackling during the sliding movements of the scapula over the rib cage, often perceived during physical or professional activities. It can be caused by morphological alteration of the scapula and rib cage, by an imbalance in periscapular musculature forces (dyskinesia), or by neoplasia...
Citations
... Snapping Scapula Syndrome (SSS) is an intriguing yet uncommon orthopaedic disorder characterised by audible crepitations and disrupted shoulder kinematics resulting from pathological interactions within the tissues located between the scapula and the ribcage (Lazar et al., 2009;Kuhne et al., 2009;Carvalho et al., 2019;Vidoni et al., 2022). The causes of SSS are diverse and can include morphological alterations of the scapula and rib cage, an imbalance in periscapular mus-culature forces (dyskinesia), or neoplasia (bone tumours or soft tissue tumours) (Carvalho et al., 2019). ...
... Snapping Scapula Syndrome (SSS) is an intriguing yet uncommon orthopaedic disorder characterised by audible crepitations and disrupted shoulder kinematics resulting from pathological interactions within the tissues located between the scapula and the ribcage (Lazar et al., 2009;Kuhne et al., 2009;Carvalho et al., 2019;Vidoni et al., 2022). The causes of SSS are diverse and can include morphological alterations of the scapula and rib cage, an imbalance in periscapular mus-culature forces (dyskinesia), or neoplasia (bone tumours or soft tissue tumours) (Carvalho et al., 2019). This condition predominantly affects young, active individuals, often with a history of pain stemming from overuse, rapid shoulder movements, or participation in sports activities (Gaskill and Millett, 2013). ...
... Among the rare causes of SSS is the presence of Luschka's Tubercle (Carvalho et al., 2019;Gallien, 1985;Estwanik, 1989;Dietrich et al., 2017;Somerson et al., 2024). Luschka's tubercle, first described and illustrated by Gruber, Luschka and Sauser in the years 1864, 1870 and 1936, is a bony protuberance found on the costal surface of the superior angle of the scapula (Sauser, 1936 ...
Snapping Scapula Syndrome (SSS) is an uncommon orthopaedic disorder characterised by audible crepitations and disrupted shoulder kinematics due to pathological interactions within the tissues between the scapula and ribcage. One rare cause of SSS is the presence of Luschka’s Tubercle, a bony prominence located on the costal surface of the superior angle of the scapula. Diagnosis of SSS due to Luschka’s Tubercle (LT) can be challenging, often eluding conventional imaging, potentially leading to mismanagement and worsening symptoms. This case series underscores the significance of LT detection, explores its role in SSS, and discusses treatment options. This series presents five patients with posterior shoulder pain and a palpable click indicative of SSS over a six-month period. Three of these patients did not exhibit Luschka’s Tubercle (LT) on 3D CT scans, while the remaining two patients had LT detected on the imaging. Arthroscopic resection successfully resolved symptoms in one of the two patients with LT. SSS is characterised by scapular snapping during movement, often associated with anatomical abnormalities such as Luschka’s Tubercle. A comprehensive approach to diagnosis and management, including imaging, conservative measures, and, when necessary, surgery, is crucial for alleviating symptoms and enhancing shoulder function in affected individuals.
... Exostoses are also known to form less frequently, but classically, on the scapula, where they can lead to particularly painful snapping scapula syndrome if the exostosis is located on the ventral side, protruding up to the rib cage. 2 The other notable feature of this case lies in the fact that the exostosis was directly responsible for an unusual subscapularis tendon lesion. The presence of the exostosis protruding perpendicular to the anterior neck of the glenoid led to direct mechanical wear of the subscapularis tendon and eventually to the described lesion. ...
... Está dada por la coordinación de músculos ubicados en diferentes planos, además de bursas ubicadas entre los músculos subescapular, serrato anterior y la pared torácica que permiten un movimiento suave y deslizante. [1][2][3][4] Cualquier interrupción en el movimiento del deslizamiento puede causar una inflamación de las bursas, y generar que cualquier movimiento o presión directa sobre ella precipite el dolor. ...
... Las diferentes causas del dolor en el hombro especialmente en la escápula deben hacer pensar en un posible síndrome de fricción escapulotorácica y, de esta manera, orientar el examen clínico, seleccionar estudios complementarios e indicar conductas que favorezcan la rehabilitación. 3,5,17 Hay diferentes causas que tratan de explicar la etiología. Esta se puede clasificar en tres grandes grupos que se correlacionan entre sí: inflamación de las bursas serosas escapulotorácicas, anomalías musculares y anomalías óseas. ...
El síndrome de fricción escapulotorácica, resalto o chasquido escapular es un cuadro poco frecuente, descrito, por primera vez, por Boinet, en 1867. Se produce por una incongruencia en la articulación escapulotorácica, asociada a múltiples causas, como bursitis, exostosis, masas óseas, tejidos fibrótico o muscular anómalos, consolidación defectuosa de fracturas o variaciones de la anatomía costal o escapular. El propósito de este artículo es comunicar un caso clínico de una adolescente con dolor incapacitante y deformidad en la región escapular derecha, de más de cuatro años de evolución. Los estudios diagnósticos revelaron una masa ósea única subescapular sugestiva de un osteocondroma de gran tamaño, más de 2,5 cm x 4 cm x 4 cm. También, se presenta una revisión y actualización de la bibliografía sobre el diagnóstico y el tratamiento actual de esta enfermedad.
... Scapular snapping can also be associated with scapular dyskinesia, which can have articular, musculoskeletal, and neurological causes (12). Regardless of the original condition causing dyskinesia, the snapping of the scapula is generated when abnormal movement brings the extremities of the scapula into closer proximity to the rib cage, leading to a scapula in pronation, which is not conducive to optimal shoulder function and results in subacromial space reduction with symptoms of impingement (9). Other common causes include incorrect posture and incorrect training techniques during sport activities (overtraining or training before strengthening). ...
... Clinical diagnosis heavily relies on physical examination, which is also crucial in informing following steps in the diagnostic process. Physical examination is supplemented by advanced imaging such as magnetic resonance imaging (MRI) and/or computed tomography (CT) to assess for potential bony or soft tissue aetiologies of snapping scapula (9,14). Physical examination should evaluate for spinal deformities, palpable crepitus, point tenderness, and scapular winging. ...
Snapping results from an abrupt displacement of an anatomic or pathologic structure during the movement of a closely related joint. Snaps are audible, palpable, and often, visible. Snapping phenomena are common within the general population and, in most cases, are associated with mild symptoms. However, especially in athletes, snapping could determine pain and functional impairment that may severely affect their sport activities. We focus on three major types of snapping occurring at specific joints of the upper limbs: the shoulder, the elbow, and the wrist. Here, we provide a comprehensive overview of major advances in the aetiology, pathophysiology, diagnostic imaging, and treatments of these specific snapping phenomena.
... One factor causing undesired variation in the crosssectional contour is the position of the arms relative to the trunk resulting from the scapula bone movement during arm elevation, known as scapula rhythm [6] adding lateral bulges at the dorsal region by rotating outwards. Seven patients were removed as they did not meet this criterion with their arms placed beside their bodies. ...
Objective
This study investigates the development of the thoracic cross-section at the nipple line level during the early stages of life. Unlike the descriptive awareness regarding chest development course, there exist no quantitative references concerning shape, circumference and possible dependencies to age, gender or body weight. The proposed mathematical relations are expected to help create guidelines for more realistic modelling and potential detection of abnormalities. One potential application is lung electrical impedance tomography (EIT) monitoring where accurate chest models are crucial in both extracting reliable parameters for regional ventilation function and design of EIT belts. Despite their importance, such reference data is not readily available for the younger age range due to insufficient data amid the regulations of neonatal imaging.
Results
Chest circumference shows the highest correlation to body weight following the relation f x = 18.3735 ln 0.0012 x + 2.1010 where x is the body weight in grams and f(x) is the chest circumference in cm at the nipple line level. No statistically significant difference in chest circumference between genders was detected. However, the shape indicated signs of both age and gender dependencies with on average boys developing a more rectangular shape than girls from the age of 1 years and 9 months.
Disorders of the scapulothoracic articulation can cause significant pain, as well as an audible "snapping" or crepitus in advanced cases. Although radiography, CT, and MRI are used in the diagnosis of these conditions, little is known about their manifestations on nuclear imaging. We present a case of symmetric uptake at the inferior scapulothoracic articulations mimicking metastatic disease on a staging bone scan. Recognition of this pattern of activity is not only important to accurately exclude malignancy, but also to aid referring providers in addressing potential causes of patient morbidity.
