147: SNAPPING SCAPULA SYNDROME

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.