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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 (bone tumors or soft tissue tumors). In this pictorial essay, we review the main causes of snapping scapula syndrome, exemplified by a collection of didactic cases.
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Carvalho SC et al. / Snapping scapula syndrome
262 Radiol Bras. 2019 Jul/Ago;52(4):262–267
Pictorial Essay
Snapping scapula syndrome: pictorial essay
Síndrome da escápula em ressalto: ensaio iconográco
Stefane Cajango de Carvalho1,a, Adham do Amaral e Castro1,b, João Carlos Rodrigues1,c, Wagner Santana
Cerqueira2,d, Durval do Carmo Barros Santos1,e, Laercio Alberto Rosemberg1,f
1. Hospital Israelita Albert Einstein, São Paulo, SP, Brazil. 2. A.C.Camargo Cancer Center, São Paulo, SP, Brazil.
Correspondence: Dr. Adham do Amaral e Castro. Hospital Israelita Albert Einstein – Departamento de Radiologia e Diagnóstico por Imagem.
Avenida Albert Einstein, 627, Jardim Leonor. São Paulo, SP, Brazil, 05652-901. Email: adham.castro@gmail.com.
a. https://orcid.org/0000-0002-6672-6045; b. https://orcid.org/0000-0003-0649-3662; c. https://orcid.org/0000-0002-7107-2621;
d. https://orcid.org/0000-0003-0203-6376; e. https://orcid.org/0000-0002-5210-3605; f. https://orcid.org/0000-0003-4395-1159.
Received 3 December 2017. Accepted after revision 23 February 2018.
How to cite this article:
Carvalho SC, Castro AA, Rodrigues JC, Cerqueira WS, Santos DCB, Rosemberg LA. Snapping scapula syndrome: pictorial essay. Radiol Bras. 2019
Jul/Ago;52(4):262–267.
Abstract
Resumo
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 (bone tumors or soft tissue tumors).
In this pictorial essay, we review the main causes of snapping scapula syndrome, exemplied by a collection of didactic cases.
Keywords: Scapula; Joint diseases/diagnostic imaging; Shoulder.
A síndrome da escápula em ressalto manifesta-se como uma crepitação audível ou palpável durante os movimentos de desli-
zamento da escápula sobre o gradil costal. Frequentemente percebida em atividades físicas ou prossionais, as suas causas
podem ter origem na alteração morfológica da escápula e gradil costal, no desequilíbrio de forças da musculatura periescapular
(discinesia) ou ainda em tumores ósseos ou de par tes moles. O presente estudo revisou de forma ilustrativa as principais causas
da síndrome da escápula em ressalto, exemplicadas por meio de uma coletânea de casos didáticos.
Unitermos: Escápula; Doenças articulares/diagnóstico por imagem; Ombro.
consists of the serratus anterior and subscapularis muscles,
containing the infraserratus bursa, located between the
serratus anterior muscle and the rib cage, and the supra-
serratus bursa, located between the serratus anterior and
subscapularis muscles(3). Figure 1 illustrates the bursae
and their respective anatomical relationships. The control
and proper positioning of the scapula are fundamental for
the correct functioning of the glenohumeral joint. During
normal shoulder movement, the scapula needs to be prop-
erly aligned in multiple planes of motion, a situation that
depends on harmonic and synchronous actions between
the various scapular muscles. The scapula receives differ-
ent combinations of forces exerted by the muscles inserted
therein, producing movements of abduction, adduction, el-
evation, depression, and rotation (Figures 2 and 3). There
is an arc-of-motion pattern between the glenohumeral
joint and the scapulothoracic joint, known as the scapu-
lohumeral rhythm, which has a 2:1 ratio. In other words,
for every two degrees of movement of the humerus, the
scapula moves one degree(6), as depicted in Figure 4.
ANATOMICAL VARIATIONS AND DISEASES
THAT CAN CAUSE THE SYNDROME
Superomedial angle of the scapula and anatomical
variations
The scapulothoracic joint is cushioned by the serra-
tus anterior and subscapularis muscles, as well as by the
bursae(7). The superomedial angle, inferomedial angle, and
DEFINITION AND EPIDEMIOLOGICAL ASPECTS
Snapping scapula syndrome is dened as an audible or
palpable clicking of the scapula during movements of the
scapulothoracic joint(1). It typically affects young, active
patients, who often report a history of pain, resulting from
overuse, during rapid shoulder movements or during sports
activities(2). These symptoms can have insidious onset, can
occur after a change in the pattern of physical activity, or
can be associated with trauma(3).
ANATOMY AND BIOMECHANICS
The scapula is a at, triangular bone that lies between
the second and seventh ribs. As previously described(3–5), it
has two surfaces (ventral and dorsal), three borders (supe-
rior, lateral, and medial), and three angles (superomedial,
inferomedial, and lateral).
The articulation between the scapula and the rib cage
is one of the most incongruous in the human body, be-
cause it does not have true joint structures but rather is
surrounded by a complex of muscles, which is divided into
three layers: supercial, intermediate, and deep. The su-
percial layer comprises the trapezius and latissimus dorsi
muscles, which can be accompanied by a bursa located be-
tween the inferomedial angle and supercial bers of the
latissimus dorsi muscle(3). The intermediate layer consists
of the major rhomboid, minor rhomboid, and levator scapu-
lae muscles. The trapezoid bursa lies between the trapezius
muscle and the base of the shoulder blade. The deep layer
0100-3984 © Colégio Brasileiro de Radiologia e Diagnóstico por Imagem
http://dx.doi.org/10.1590/0100-3984.2017.0226
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Radiol Bras. 2019 Jul/Ago;52(4):262–267
medial border of the scapula are relatively less protected by
underlying muscles and bursae, and the upper medial bor-
der and lower pole exhibit wide anatomical variability(4,7).
When no obvious deformity is found, one should look for
anatomical variations, such as an anomalous anterior cur-
vature of the superomedial angle of the scapula, which is
considered one of the main causes of the syndrome. The
superomedial angle of the scapula has been measured in
anatomical specimens and found to range from 124° to
162° (mean, 144.34 ± 9.09°)(7); when the angle is lower
than 142°, the chances of scapular snapping increase(8).
The superomedial angle is measured on the anterior sur-
face of the scapula, with three anatomical reference points
(Figures 5 and 6): the superior angle, the spine, and the
inferior angle. A bone projection at the lower pole is the
second most common site for symptoms(4) (Figure 7).
The Luschka tubercle
The Luschka tubercle is a hook-shaped bony protuber-
ance, located at the upper medial border of the scapula,
which can reduce the space between the scapula and the rib
cage and be a predisposing factor for scapular snapping(7).
Scapular dyskinesia, insufciency of the serratus
anterior muscle, and injury of the long thoracic nerve
Scapular dyskinesia, a common clinical nding, is
dened as abnormal movement, positioning, or function
of the scapula during shoulder movement. It can be the
cause or consequence of many forms of shoulder pain
and dysfunction. There are multiple causes of dyskinesia.
Articulatory causes include acromioclavicular joint ar-
throsis, glenohumeral joint instability, and glenohumeral
joint disorder. Musculoskeletal causes include thoracic
Figure 3. Schematic representation of the movement of the scapula, showing, from left to right, abduction/adduction, rotation, and upward/downward movements.
Figure 1. Schematic representation of the musculature and bursae involved in
snapping scapula syndrome.
Pectoralis major
Subscapularis
Trapezius
Trapezoid
bursa
Serratus
anterior
Supraserratus
bursa
Infraserratus
bursa
Figure 2. Schematic representation of the biomechanical vector of the mus-
culature involved in scapular movement. The upper and lower portions of the
trapezoid are shown in pink, and the central portion is translucent, demarcated
by the dotted line.
Rhomboids
Trapezius
Levator scapulae
Rhomboids
Trapezius
Levator scapulae
Serratus anterior
Pectoralis minor
*Trapezius
Serratus anterior
Trapezius
Pectoralis minor
#Rhomboids
Pectoralis minor
Levator scapulae
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Figure 4. Schematic representation of the 2:1 scapulohumeral rhythm. For ex-
ample, during a 180° abduction of the arm, 60° are achieved by rotation of
the scapula and 120° are achieved by rotation of the humerus.
Figure 5. Schematic representation of the costal surface of the right scapula,
showing the ABC measurement of the superomedial angle.
Figure 6. A 42-year-old male patient with a 7-year history of intermittent left-sided scapular pain, accompanied by snapping. The patient had been swimming,
walking, and cycling on a regular basis. Sagittal MRI of the left scapula, with fat-saturated T1- and T2-weighted sequences (A and B, respectively), showing a 122°
reduction in the superomedial angle of the scapula (the black lines in A indicate how the angle is measured), with a consequent reduction in the space between
the second rib and the superior border of the scapula. Mild muscular edema and slight edema of the adjacent (second) rib (arrow in B).
A B
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Radiol Bras. 2019 Jul/Ago;52(4):262–267
kyphosis and nonunion of a clavicular fracture, as well as
shortening, rotation, or angulation of the clavicle. Neuro-
logical causes include paralysis of the long thoracic nerve,
paralysis of the eleventh cranial nerve, and cervical ra-
diculopathy(9), as depicted in Figures 8 and 9. The most
common mechanisms involve imbalances of the intrin-
sic musculature, with inexibility or inhibition of normal
muscle activation(9). Scapular snapping can be present
in dyskinesias, because the abnormal movements bring
the extremities of the scapula into closer proximity to the
rib cage. Regardless of the cause of dyskinesia, the nal
result in most cases is a scapula in pronation, which is
not conducive to optimal shoulder function and results in
subacromial space reduction with symptoms of impinge-
ment(9).
Sequelae of fractures of the scapula and rib cage
The sequelae of fractures of the scapula and rib cage
can cause bone deformities. Such deformities can increase
the friction among the structures of the scapulothoracic
joint(10).
Figure 8. A 9-year-old female patient with a 1-month history of elevation of the right scapula, unrelated to pain, trauma, or surgery. A: Three-dimensional CT
reconstruction of the rib cage showing winging of the right scapula (arrow). B: Axial CT scan, with a soft-tissue window setting, showing denervation with atrophy
and fatty replacement of the serratus anterior muscle (arrow), showing the contralateral side for comparison. There was no evidence of extrinsic compression of
the long thoracic nerve.
A B
Figure 7. An 87-year-old male patient complaining of bulging of the posterolateral thoracic wall. The patient had been swimming on a regular basis. Contrast-enhanced
axial MRI of the left scapula, with fat-saturated T1- and T2-weighted sequences (A and B, respectively), showing uid distention and parietal enhancement of the
infraserratus bursa (arrows) with a uid–uid level (arrow in A), due to a bone projection in the inferomedial angle of the scapula, as shown on a CT scan (arrow in C).
A B C
Figure 9. A 32-year-old female patient with a 3-month history of shoulder pain
and scapular asymmetry. The patient had been running on a regular basis.
Axial T2-weighted fat-saturated MRI scan of the scapulae showing denervation
and edema of the serratus anterior muscle (arrow), without signicant atrophy.
There was no evidence of extrinsic compression of the long thoracic nerve.
Bursitis
Scapulothoracic bursitis can occur after a single trau-
matic insult, as a result of repetitive movements of the
Carvalho SC et al. / Snapping scapula syndrome
266 Radiol Bras. 2019 Jul/Ago;52(4):262–267
scapulothoracic joint, or as a result of scapular dyskinesia.
Abnormal scapular movement can be caused by overuse of
the muscles, muscle imbalance, or pathological conditions
of the glenohumeral joint(3). When the muscles of the cos-
tal surface of the scapula decrease in size, the scapula ro-
tates forward, coming into closer proximity to the rib cage,
generating friction with the chest wall during movement,
causing inammation in the scapulothoracic space(3), as
shown in Figures 7 and 10.
Bone tumors
Osteochondroma, also known as exostosis, is the
most common benign primary bone tumor of the scapula,
being solitary in approximately 90% of cases and multiple,
in the form of hereditary multiple exostoses, in approxi-
mately 10%. Such tumors are considered alterations of
the growth plate, specically its failure to increase in size
during skeletal maturation(11). They usually involve the
metaphysis of long bones and, more rarely, the scapula (in
4–6% of cases). An osteochondroma can be symptomatic,
mainly due to its mass effect, creating the appearance of
scapular winging, together with crackles, and altering the
scapulothoracic movement. It can also cause neurovascu-
lar compression, fractures, inammation of the bursa, or
malignant transformation(11) (Figures 10–12). Although
scapular chondrosarcoma is rare, the scapula is the sec-
ond most common site of involvement of this disease, es-
pecially among men between 40 and 70 years of age(3,4).
Elastobromas
An elastobroma is a benign soft tissue tumor with
slow growth and a prevalence rate of up to 24% in the
elderly, being most common among women between 55
and 70 years of age. Elastobromas are believed to occur
Figure 10. A 46-year-old female patient, in follow-up for osteochondroma for 8 years and presenting with a 7-month history of constant pain. CT of the scapula, in
coronal and axial slices (A and B, respectively), demonstrates pedunculated osteochondroma in the anterior superior aspect of the scapula, in close proximity to
the posterior border of the rst and second ribs on the left (arrow in A). Marked uid distention in the region of the supraserratus bursa (arrow in B).
BA
Figure 11. A 14-year-old male patient with a 6-month
history of bulging and discomfort in the left scapula.
The patient had been playing water polo on a regular
basis. MRI of the left scapula, with a sagittal slice
and a fat-saturated T2-weighted sequence, show-
ing osteochondroma in the superomedial angle of
the scapula, with a thin cartilaginous layer, invading
the space between the rst and second ribs (arrow).
Edema of the musculature between the osteochon-
droma and the rib cage, suggesting friction.
Figure 12. An 18-year-old male patient with pain
in his right arm. X-ray showing broad-based exos-
tosis in the lower third of the scapular body (sub-
scapular fossa, arrow).
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in response to repetitive microtrauma caused by friction
between the scapula and the chest wall. An elastobroma
is typically located at the lower pole of the scapula, deep
within the serratus anterior and latissimus dorsi muscles.
It can manifest as an increase in subscapular or infra-
scapular volume, moderate discomfort or pain, crackles,
clicking (snapping), or a blocked scapula(12), as depicted
in Figures 13 and 14.
CONCLUSION
Although snapping scapula syndrome is rare, it can
cause severe pain and functional limitation. Therefore, ra-
diologists should be able to recognize its imaging ndings.
In this pictorial essay, we have illustrated the main causes
of the syndrome, using imaging examinations.
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Figure 13. A 69-year-old male patient with a 90-day history of bulging, snap-
ping, and pain in the left scapular region. The patient had engaged in weightlift-
ing on a regular basis. Axial T1-weighted MRI of the left scapula, showing an
elastobroma deep within the serratus anterior muscle, interposed between
the rib cage and the inferior angle of the scapula (arrow).
Figure 14. A 55-year-old male patient with increased volume in the left scapu-
lar region. Ultrasound (A) showing a predominantly hypoechoic, heterogeneous
formation (arrow), located between the scapula and the rib cage. On CT (B), the
formation presents soft-tissue density and brofatty striae, with a well-dened
location between the costal grating and the ventral portion of the anterior ser-
ratus muscle, at the subscapular and infrascapular level, consistent with dor-
sal elastobroma.
A
B
... 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 ...
Article
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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.
... 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. ...
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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. ...
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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.
... Many causes have been attributed to SSS, one of which being repetitive above-shoulder movement activities, which result in microtraumas and local bursitis that can generate a bony spur at the level of muscle attachment on the scapula [7]. In severe cases of SSS, this constellation of pathologies may result in SICK scapula (scapular malposition, inferomedial prominence of scapula, coracoid tenderness, and scapular dyskinesia) [8]. ...
Article
Introduction: Snapping scapula syndrome (SSS) is a rare pathological condition characterized by palpable and/or audible crackling sensation during scapulothoracic movements. Scapulothoracic bursitis with or without osseous lesions is commonly associated with this syndrome. The initial management is always non-operative methods with anti-inflammatory medications and physiotherapy modalities. However, if the symptoms persist beyond 3–6 months of non-surgical treatment, it should be categorized as refractory or recalcitrant bursitis and necessitate either open or arthroscopic surgical excision of the lesion. Case Report: We successfully managed five patients with SSS with arthroscopic scapulothoracic bursectomy. Conclusion: Arthroscopic scapulothoracic bursectomy is a successful surgical intervention for patients with scapulothoracic bursitis who do not respond to the conservative mode of management. Keywords: Scapula dyskinesia, scapulothoracic bursitis, snapping scapula syndrome
... 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. ...
... 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. ...
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Variation in normal anatomy of costal surface of scapula may disrupt smooth scapulothoracic movements and may cause snapping scapula. The aim of this study was to assess variable anatomy of costal surface of scapula and its role in etiopathogenesis of snapping scapula syndrome. Superomedial angle, depth of costal surface, forward angulation of root of coracoid process and thickness of superior and inferior angles of 92 dry intact adult scapulae of unknown sex were studied. Superomedial angle ranged from 124° to 162° (144.34° ± 9.09°). The forward angulation of root of coracoid process ranged from 120° to 160° (141.60° ± 6.53°). Depth of costal surface at the level of root of spine varied widely between 10.5 and 26.7 mm (16.73 ± 3.367 mm). Thickness of superior and inferior angles measured 3.34 ± 0.87 and 6.71 ± 1.18 mm, respectively. Forwardly bent rhinoceros-horn-like projection at the lateral border of scapula was seen in 2.17% of specimens. Variation in anatomy of costal surface of scapula observed in this study may be clinically significant with respect to snapping scapula syndrome.
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The snapping scapula, also called "washboard syndrome" is a controversial condition attributed to bony and soft tissue abnormalities. The syndrome was understimated for long time and often associated only with specific osseous abnormalities. The nodal point in the overview of the syndrome is that crepitus associated with symptomatic bursitis may be physiologic and is not uncommon a clinical presentation without any form of crepitus or craquement. In the current rewiew we analyzed the current concepts in the conservative and surgical management of snapping scapula syndrome, preceded by a description of scapular anatomy, pathophysiology of scapulothoracic articulation and clinical features of snapping scapula.
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As a largely under-recognized problem, snapping scapula stems from the disruption of normal mechanics in scapulothoracic articulation. It is especially common in the young, active patient population, and symptoms are frequently seen with overhead and throwing motions. Understanding the anatomy of the scapula and surrounding neurovascular structures is crucial in making a differential diagnosis and providing both nonoperative and surgical treatments. Common causes of snapping scapula include bursitis, muscle abnormality, and bony or soft-tissue abnormalities. Anatomic variations, such as excessive forward curvature of the superomedial border of the scapula, may also be a cause for snapping. Benign tumor conditions of the scapula can also predispose one to snapping scapula syndrome and should be thoroughly investigated during the course of treatment. Patients with snapping scapula syndrome typically present with a history of pain with overhead activities. Snapping scapula is associated with audible and palpable crepitus near the superomedial border of the scapula. Various imaging studies may be used to rule out soft-tissue and bony masses, which may cause impingement at the scapulothoracic articulation. In most cases nonoperative treatment is curative and includes physical therapy for scapular muscle strengthening and nonsteroidal anti-inflammatory medications. Corticosteroid injections may also be used for therapeutic and diagnostic purposes. In most cases overuse injuries and repetitive strains respond well to nonoperative treatments. When nonoperative measures fail, surgery is a proven modality, especially if a soft-tissue or bony mass is implicated. Both open and arthroscopic techniques have been described with predictable results.