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  • Scapulothoracic crepitus

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  • 726.10 Disorders of bursae and tendons in shoulder region unspecified

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  • M75.50 Bursitis of unspecified shoulder

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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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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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  • Diagnosis made based on orthopedic special tests, signs and symptoms, imaging studies, and exclusion of differential diagnosis.
    • Push-ups test
    • Serratus wall test

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Medications

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  • NSAIDs

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  • Radiologist for imaging, ...

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