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Scapulothoracic Disorders

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Conditions affecting the movement and stability of the shoulder blade against the rib cage

Scapulothoracic disorders refer to conditions that affect the movement and alignment of the scapula (shoulder blade) as it glides over the thoracic (chest) wall. Proper scapular function is essential for shoulder stability and smooth motion. When this movement is disrupted, it can lead to pain, weakness, and reduced shoulder mobility. Dr Ben McGrath, an orthopaedic specialist, provides expert diagnosis and treatment options to help patients manage scapulothoracic disorders and restore optimal shoulder function.

What are Scapulothoracic Disorders?

Scapulothoracic disorders are conditions that affect the smooth movement of the scapula over the thoracic wall. The scapulothoracic joint, although not a true anatomical joint, plays a crucial role in shoulder function by allowing coordinated motion between the scapula, shoulder, and thoracic spine. When disrupted, it can lead to pain, impaired movement, and shoulder instability.

Common Symptoms of Scapulothoracic Disorders

Patients with scapulothoracic disorders may experience:

  • Shoulder or Upper Back Pain: Pain may be localised between the shoulder blade and spine or radiate to the shoulder.
  • Snapping or Popping Sensations: Audible or palpable sensations (snapping scapula syndrome) during shoulder movement.
  • Weakness in Shoulder Movements: Reduced strength, particularly during lifting or overhead activities.
  • Limited Range of Motion: Difficulty in fully rotating or elevating the arm.
  • Muscle Imbalance or Atrophy: Visible changes in the muscle size or function around the shoulder blade.

Causes and Risk Factors for Scapulothoracic Disorders

Scapulothoracic disorders can result from:

  • Muscle Imbalance: Weakness or tightness in muscles supporting the scapula, such as the serratus anterior, rhomboids, and trapezius, leading to poor scapular positioning.
  • Poor Posture: Rounded shoulders or slouched posture increases stress on the scapulothoracic region.
  • Overuse or Repetitive Strain: Repeated overhead activities in sports or work can strain the scapulothoracic joint.
  • Trauma: Direct injuries, fractures, or previous shoulder injuries can disrupt scapular motion.
  • Nerve Injury: Injury to nerves controlling scapular muscles, such as the long thoracic nerve, can lead to scapular winging.

Understanding these risk factors can aid in managing and preventing scapulothoracic disorders.

Types of Scapulothoracic Disorders

There are various types of scapulothoracic disorders, including:

  1. Snapping Scapula Syndrome: Characterised by a snapping or popping sensation due to irregular scapula motion or contact with the rib cage.
  2. Scapular Dyskinesis: Abnormal movement or positioning of the scapula, often due to muscle imbalance or weakness.
  3. Scapular Winging: A condition where the scapula protrudes from the back due to nerve or muscle dysfunction, usually involving the serratus anterior or trapezius muscles.
  4. Scapulothoracic Bursitis: Inflammation of the bursae located between the scapula and thoracic wall, leading to pain and swelling.

Each condition has unique characteristics and requires specific management approaches.

Diagnosis of Scapulothoracic Disorders

Dr Ben McGrath uses a comprehensive approach to diagnose scapulothoracic disorders:

  • Medical History and Physical Examination: Assessing symptoms, posture, scapular movement, and specific strength tests.
  • Imaging Tests:
    • X-rays or MRI: These may reveal abnormalities in the scapula or surrounding tissues, such as bursitis or bone spurs.
    • Ultrasound: Used to assess soft tissue issues, such as bursitis or muscle tears.
    • Electromyography (EMG): To evaluate muscle activity and identify potential nerve involvement.

Accurate diagnosis is essential for developing an effective treatment plan.

Non-Surgical Treatments for Scapulothoracic Disorders

Non-surgical management is often effective in treating scapulothoracic disorders:

  • Physiotherapy: A targeted exercise program to improve scapular control, strengthen supporting muscles, and enhance range of motion.
  • Posture Correction and Training: Exercises and techniques to correct poor posture, which can reduce stress on the scapulothoracic region.
  • Manual Therapy: Mobilisation techniques and soft tissue release to alleviate pain and restore scapular motion.
  • Activity Modification: Avoiding movements that exacerbate symptoms, such as repetitive overhead lifting.
  • Medications: NSAIDs may help manage pain and inflammation. Always consult a healthcare provider before starting any medication.

These treatments aim to alleviate symptoms and support recovery through improved scapular function.

Surgical Treatments for Scapulothoracic Disorders

Surgery may be recommended for severe cases or when non-surgical treatments are ineffective:

  • Scapulothoracic Bursectomy: Surgical removal of inflamed bursa to alleviate pain, often performed arthroscopically.
  • Scapular Muscle Repair or Release: Repairing damaged muscles or releasing tight tissue that restricts scapular movement.
  • Bone Resection (Partial Scapulectomy): Removal of a small portion of the scapula to reduce friction with the rib cage, typically in cases of snapping scapula syndrome.
  • Nerve Decompression or Repair: If nerve compression is causing scapular winging, decompression or nerve repair may be necessary.

Dr McGrath evaluates each patient’s condition and discusses appropriate surgical options if non-surgical management has not been successful. Post-operative rehabilitation is essential for optimal recovery.

When to See Dr Ben McGrath for Shoulder Pain or Dysfunction

If you experience persistent shoulder or upper back pain, audible or palpable snapping sensations, or limited shoulder movement, a consultation with Dr McGrath can provide an accurate diagnosis and effective treatment options to restore comfort and mobility.

FAQs About Scapulothoracic Disorders

Many cases improve with physiotherapy, posture correction, and activity modification. Surgery is typically reserved for severe or persistent cases.

Recovery times vary depending on the procedure, but most patients regain function within 3–6 months with proper rehabilitation.

Good posture, regular strength training, and avoiding repetitive strain on the shoulder can help reduce the risk of scapulothoracic disorders.

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