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Condition/Disorder Synonyms

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  • Scapulothoracic crepitus

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ICD-9-CM Code

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  • 726.10 Disorders of bursae and tendons in shoulder region unspecified

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ICD-10-CM Code

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  • M75.50 Bursitis of unspecified shoulder

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Preferred Practice Pattern1

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Key Features

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Description

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  • Scapulothoracic joint not a true synovial joint

  • 2:1 ratio of glenohumeral (GH) elevation to scapulothoracic elevation

  • 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 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

  • Loss of serratus anterior muscle

  • Weakness of trapezius strength, scapular stabilizers

  • Commonly associated with presence of other orthopedic pathologies such as subacromial impingement syndrome, rotator cuff pathology, and labral pathology.

  • Creates an abnormal scapulothoracic rhythm

  • Commonly associated with repeated overhead or overuse activities

  • Full history of symptoms, medical history screening, and differential shoulder orthopedic examination will ensure appropriate diagnosis.

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Demographics

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  • Non-specific

  • Overhead athletes

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Clinical Findings

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Signs and Symptoms

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  • Pain

  • Symptoms of bursitis

  • Crepitus

  • Muscle spasm along rib cage

  • Weakness is commonly noted with functional reaching tasks

  • Scapula instability, moving away from rib cage

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Functional Limitations

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  • Inability to raise or lower arms without the scapula's inferior angle tilting away from rib cage

  • Pain/limitation with:

    • Overhead activities

    • Reaching

    • Lifting

    • Dressing and grooming

    • Sustained or repetitive shoulder activities

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Possible Contributing Causes

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  • Increased thoracic kyphosis and sub-optimal posture

  • Luschka tubercle

  • Sprengel's deformity

  • Abnormally shaped rib cage: scoliosis

  • Repetitive overhead activities

  • Posterior shoulder capsule tightness

  • Inferior angle tilting of the scapula

  • Instability of the scapula to the thoracic wall

  • Muscle atrophy

  • Pectoralis minor tightness

  • Poor neuromuscular control: nerve injury

  • Non-traumatic injury to the long thoracic nerve

    • Influenza

    • Drug overdose

  • Traumatic injury to the long thoracic nerve

    • Impact injury

    • Stretch to cervical spine

    • Electrical shock

    • Mastectomy with axillary node dissection

  • Brachial neuritis (Parsonage-Turner syndrome)

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Differential Diagnosis

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  • Winging scapula

  • Scapula alata

  • Facioscapulohumeral muscular dystrophy (FSH)

  • Serratus anterior palsy

  • Cervical radiculopathy, C5-8

  • Referred pain from lungs or diaphragm

  • Rotator cuff pathology (tendonitis, full- or partial-thickness tear)

  • GH instability

  • Labral tear

  • Rib fracture

  • Neuropathy

  • Internal impingement

  • Chondrosarcoma

  • Elastofibroma

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Means of ...

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