Working Diagnosis:
Snapping Scapula Syndrome

Treatment:
The patient underwent a stepwise progression in treatments to include oral non-steroidal anti-inflammatory medications, stretching and strengthening exercises, physical therapy, and an ultrasound guided kenalog-lidocaine injection directed at the scapulothoracic articulation.

Outcome:
The patient did not get relief from non-steroidal anti-inflammatories, stretching and strengthening exercises, or physical therapy. The ultrasound guided injection conferred complete resolution of the pain for two months with return to full activity. The pain control gradually wore off with complete return of his previous pain and symptoms. The patient was eventually referred to orthopedics for surgical intervention. Case Photo #2
Case Photo #3

Editor's Comments:
This case reminds us to always evaluate painful crepitus, grinding, popping that is elicited on physical exam. Ultrasound, when utilized by an experienced operator, can be invaluable in the diagnosis and treatment in musculoskeletal conditions.

References:
1.Carlson HL, Haig AJ, Stewart DC. Snapping scapula syndrome: Three case reports and an analysis of the literature. Arch Phys Med Rehabil 1997;78:506-511.
2.Ruland LJ III, Ruland CM, Matthews LS. Scapulothoracic anatomy for the arthroscopist. Arthroscopy 1995;11:52-56.
3.O'Holleran JD, Millett PJ, Warner JJP. Arthroscopic management of scapulothoracic disorders. In: Miller MD, Cole BD,eds. Textbook of arthroscopy. Ed 3.
4.Safran MR. Management of scapulothoracic problems. Curr Opin Orthop 1997;8:67-74.
5.Takahara K, Uchiyama S, Nakagawa H, Kamimura M, Ohashi M, Miyasaka T. Snapping scapula syndrome due to malunion of rib fractures: A case report. J Shoulder Elbow Surg 2004; 13:95-98.
6.Oizumi N, Suenaga N, Minami A. Snapping scapula caused by abnormal angulation of the superior angle of the scapula. J Shoulder Elbow Surg 2004;13:115-118.
7.Edelson JG. Variations in the anatomy of the scapula with reference to the snapping scapula. Clin Orthop Relat Res 1996:111-115.
8.Lesprit E, Le Huec JC, Moinard M, Schaeverbeke T, Chauveaux D. Snapping scapula syndrome: Conservative and surgical treatment. Eur J Orthop Surg Traumatol 2001;11:51-54.
9.Manske RC, Reiman MP. Nonoperative and operative management of snapping scapula. Am J Sports Med 2004;32:1554-1565.
10.Kuhn JE, Plancher KD, Hawkins RJ. Symptomatic scapulothoracic crepitus and bursitis. J Am Acad Orthop Surg 1998; 6:267-273.
11.Lintner D, Noonan TJ, Kibler WB. Injury patterns and biomechanics of the athlete's shoulder. Clin Sports Med 2008; 27:527-551.
12.Seol SJ, Han SH. Scapulothoracic Bursitis in a Patient with Quadriparesis: A Case Report. Medicine. 2015 Apr; 94(16): e752.
13.Owens B, Kilcoyne K. Snapping scapula. OrthopaedicsOne Articles. In: OrthopaedicsOne - The Orthopaedic Knowledge Network. http://www.orthopaedicsone.com/x/dIARAw
14. Kuhne M et al. The Snapping Scapula: Diagnosis and Treatment. Arthroscopy. 2009 Nov. 25(11):1298-311.

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