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CONDITION/DISORDER SYNONYMS

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  • Scapulothoracic crepitus

  • Scapulocostal syndrome

  • Scapulothoracic syndrome

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ICD-9-CM CODE1

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  • 726.10 Disorders of bursae and tendons in shoulder region unspecified

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ICD-10-CM CODE2

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  • M75.50 Bursitis of unspecified shoulder

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PREFERRED PRACTICE PATTERN

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  • 4E: Impaired Joint Mobility, Motor Function, Muscle Performance, and Range of Motion Associated with Localized Inflammation3

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PATIENT PRESENTATION

A 19-year-old male semi-professional tennis player presents with a chief complaint of a grinding sensation when he moves his right shoulder, especially with overhead and reaching motions. Other symptoms include pain in the lateral and anterior shoulder and crepitus about the scapula. The patient’s primary concern is that his tennis serve is limited due to the grinding and posterior shoulder pain.

Examination reveals significant scapular protraction and increased thoracic kyphosis (combination of structural and postural), positive impingement test on the right, muscle weakness of the serratus anterior, middle and lower trapezius as well as gross weakness of the rotator cuff musculature. Examination of flexibility reveals shortening of anterior chest musculature, especially pectoralis minor on the right. Joint mobility of the thoracic spine is moderately hypomobile, and the glenohumeral (GH) joint is mildly limited in inferior glide and moderately limited in posterior glide. Joint mobility of the ribcage reveals a bucket handle exhaled fifth rib. There is a positive scapular retraction test on the right, negative on the left. During functional activities, he demonstrates overuse of scapula upward rotators during GH elevation. Activities such as performing a overhead tennis serve reproduce his symptoms of both crepitus and shoulder pain. Patient’s score on the DASH Sports/Performing Arts Module is 50. Your screening examination is negative for neurologic causes and the cervical spine is cleared.

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FIGURE 147-1

Superior aspect of the shoulder showing angle of scapula. (Reproduced with permission from Morton DA, Foreman KB, Albertine KH. The Big Picture: Gross Anatomy. New York, NY: McGraw-Hill, 2011.)

Graphic Jump Location
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KEY FEATURES

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Description
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  • Scapulothoracic joint is not a true synovial joint

  • Scapulothoracic motion produces a snapping, popping, crepitus sound

  • Scapula has the greatest number of muscles attached to it than any other bone

  • Scapula dysrhythmia can cause friction along the muscles and ribs

  • Can be a result of serratus anterior muscle dysfunction

  • Injury to the long thoracic nerve

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Essentials of Diagnosis
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  • Often asymptomatic

  • Winging can help identify a dysfunction possibly occurring in the shoulder

  • Symptoms of pain and weakness

  • Can be a result of a brachial plexus injury

  • Parsonage–Turner syndrome (brachial neuritis) underlying

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General Considerations
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  • Postural changes of the thoracic spine and ribcage: Scoliosis

  • 2:1 ratio of GH elevation to scapulothoracic elevation4

  • Loss of serratus anterior muscle

  • Weakness of trapezius strength, scapular stabilizers

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