Management of Scapulothoracic Roughness.
Last updated Thursday, January 27, 2005
About scapulothoracic roughness
Usually, scapulothoracic roughness or snapping can be managed by
avoiding making the shoulder snap on purpose, improving posture and
strengthening the scapular muscles.Primary treatments Rarely, roughness in the scapulothoracic motion interface is caused
by an anatomic abnormality such as a malunited fracture or an
osteochondroma on the anterior undersurface of the scapula.
These unusual causes can often be diagnosed on a lateral radiograph
of the scapula. Most commonly, scapulothoracic crepitus or "snapping
scapula" is caused by altered scapulothoracic posture and mechanics.
Using a skeleton the clinician can demonstrate to the patient how
drooping of the scapula produces contact between the superior medial
angle of the scapula and the rib cage. Thus, the primary treatments of
this condition are reassurance, restoration of normal posture, and
strengthening of the serratus anterior, subscapularis, trapezius, and
rhomboids. It is essential that the patient avoid voluntary or habitual
scapulothoracic snapping. More agressive treatment More aggressive treatment is considered only in the rare patient who
has functionally significant, involuntary, nonvocationally related
scapulothoracic snapping that has failed to respond to a prolonged,
nonoperative management program. Refractory cases of snapping scapula
may respond to local injection, to bursal resection, or to resection of
the superior medial angle of the scapula. Because these procedures do
not treat the primary problem of altered scapulothoracic posture,
failure to achieve improved shoulder function is not infrequent.
Complications of surgery can be related to:
- failure to reattach securely the muscles inserting on the superior medial angle of the scapula,
- injury to the nerve to the lower trapezius,
- leaving residual prominent edges of the scapula, and
- scarring in the scapulothoracic motion interface.
Disclaimer
This resource has been provided by the University of Washington Department of Orthopaedics and Sports Medicine as general information only. This information may not apply to a specific patient. Additional information may be found at http://www.orthop.washington.edu or by contacting the UW Department of Orthopaedics and Sports Medicine.
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