Our scapula (scapula) is quite an interesting bone. The spine is held in place by only two ligaments between the rib cage and the arm bone. There is no true joint between the scapula and the trunk. Instead, three layers of muscle support the scapula. The scapula acts as a solid support for arm movements. For each degree we lift our arm off the shoulder, our scapula rotates half a degree on the chest wall. This is called the scapulohumeral rhythm. A problem in the structures that provide stability and movement of the scapula may lead to the complaint of sound from the scapula.
Raising our arm above shoulder level requires the shoulder joint, collarbone and scapula to work in harmony. Our shoulder joint is held together with the help of muscles, tendons and ligaments called ligaments. Protective pads called bursa allow muscles and tendons to slide and move freely over each other and bones.
Sometimes grinding, crackling, crackling, or crackling sounds may occur with movements of the shoulder or scapula. These sounds can be so intense that they can be noticed by people around. The sound of the scapula as it slides along the chest wall is called scapulothoracic crepitus or snapping scapula.
Pain and limitation of movement along with the sound coming from the scapula can lead to serious limitations in the person’s life. In people who are involved in sports such as basketball, which involves throwing the arm by raising the head above the head, noise from the scapula and related problems can negatively affect sports life.
What causes scapular crepitus, or scapula sound?
Variations in the shape of the scapula that may normally exist can cause muscles and tendons to rub in the wrong directions. There are protective pads called bursae that prevent the muscles from rubbing against the bone and each other. If there is an extra protrusion on the scapula, the wear and tear on this protrusion due to the constant movement of the muscle or tendon can cause crepitus, that is, a friction sound.
Scapular crepitus can be confused with a similar problem called scapulothoracic bursitis. Crunching of the scapula is not usually a problem. Some crackling, grinding or crackling sounds may occur when moving the arm in one-third of adults. It usually does not cause any pain or loss of function. However, sometimes due to trauma or excessive use of the arm (repeated injury to the bursa), inflammation of the bursa, or bursitis, may occur. Crepitus may occur due to healing of the soft tissue injury with scars or fibrous bands.
There are other rarer causes of scapulothoracic bursitis other than trauma and overuse. Bone tumors (for example, osteochondroma) or bony spurs can lead to a “reactive bursa.” Reactive bursa means the formation of a bursa in a place where there is no normal bursa. Muscle tears, muscle atrophy, structural spinal disorders such as scoliosis, ribs or scapula fractures that do not heal properly can cause this problem. Muscle wasting due to nerve damage may also be the initiator. Even breast implants and cosmetic breast surgery can cause changes in muscle tissue and initiate scapular crunch.
While the causes are varied, the result is impaired movement of the scapula along the chest wall. This movement disorder is called scapular dyskinesia. Diagnosis is difficult because there is no single test or imaging method that can show what is going on. Of course, a physical examination is done first. Some things can be understood just by looking. Do you have posture disorder? Is there right and left asymmetry? How does the scapula move on the chest wall as the arm is raised? Is there anything that happens that is different from the normal course of action? Are the muscles too tight, limp, or weak? Imaging and electrodiagnostic tests may complement the examination of motion, flexibility, and strength. If there is an abnormal protrusion or mass in the bone, it can be seen on X-ray film or three-dimensional computed tomography. Soft tissue problems such as bursitis may show up on magnetic resonance imaging. If muscle weakness and wasting are due to nerve damage, it can be detected by EMG.
Treatment of sound from the scapula
Non-surgical approaches are generally the first choice in the treatment of scapular noise, pain and limitation of movement. If there is a bad posture, it is corrected, if the movements of the scapula are restricted, the movement is opened with mobilization and stretching techniques, and if there are weak muscles, they are strengthened. In the kinetic chain rehabilitation approach, the connection of the spine with the shoulder and the connection of the shoulder with the arm is considered as a chain. With kinetic chain exercises, the natural movement rhythm of the scapula is tried to be recreated. Abdominal muscles, called core muscles, should also be strengthened. Sometimes a few months of physical therapy and exercise may be required to ensure the movement of the scapula in harmony with the shoulder. If there is scapulothoracic bursitis, cortisone injection (corticosteroid injection) can be treated.
If physical therapy methods are insufficient, surgical options come to the fore. The inflamed bursa and even the problematic part of the scapula can be surgically removed. Thus, the stress that the compressed, rubbing soft tissues are exposed to is reduced. While some surgeries can be performed with closed technique, some surgeries require open technique. The success of the operation is high in terms of returning to the former functional state. However, it carries risks such as recurrence of the disease and damage to the nerves in that area during the surgery. After the surgery, there is usually a rest period, which is inactive for a few weeks. Meanwhile, the soft tissues heal. Then the rehabilitation period begins to restore shoulder and scapula movements.