Caring Medical - Where the world comes for ProlotherapySnapping Scapula Syndrome | Prolotherapy non-surgical options

Snapping Scapula Syndrome

Ross Hauser, MD

Diagnosing Snapping Scapula Syndrome

Snapping Scapula Syndrome, also known as “Washboard syndrome,” Scapulocostal Syndrome or Scapulothoracic Syndrome, is characterized by a grating, grinding, popping or snapping sensation of the scapula onto the back side of the ribs or thoracic area of the spine.

The condition can be quite painful and is extremely irritating to the patient suffering with it. The traditional treatments using nonsteroidal anti-inflammatories, cortisone shots, trigger point injections, physiotherapy, chiropractic care, and surgery often lead to suboptimal results.

In our experience, the best chance at cure for the condition is when a patient addresses the underlying instability in the scapulothoracic area, which allows the scapula and ribs to move normally, without the abnormal wear and tear. At our office, we have treated many cases of scapulocostal syndrome using Comprehensive dextrose Prolotherapy.

Diagnosing snapping scapula syndrome

The diagnosis of snapping scapula is controversial because Snapping scapula syndrome is considered a rare condition. It is basically a problem of the normal interplay and movement between the anterior (or front) of the scapula and the posterior (or back of the) chest wall.

How you get snapping scapula syndrome can be the result of many factors is multifactorial, and contributing factors include scapular dyskinesis also referred to as SICK scapula syndrome where wear and tear from overuse weaken the supportive tissue that hold the scapula in place. Shoulder bursitis and and tears in the periscapular muscles.

Doctors in Italy recently published their findings that snapping scapula syndrome was underestimated for long time and often associated only with specific osseous (soft tissue/bone) abnormalities. Their research suggested that symptomatic bursitis may be the cause of snapping scapula syndrome.1

Snapping Scapula Syndrome can also be caused by weakness of the serratus anterior muscle. This can cause a winging of the scapula which then can cause snapping. This is typically due to a long thoracic nerve injury which generally improves over time.

Arthroscopic Treatment of Snapping Scapula Syndrome

Doctors from the Steadman Philippon Research Institute provide an assessment of Arthroscopic Treatment of Snapping Scapula Syndrome in the medical journal Arthroscopy.

They looked at patients who underwent arthroscopic treatment for Snapping Scapula Syndrome after extensive nonoperative treatments failed. Nonoperative treatments include mainly physical therapy and anti-inflammatory medication, Prolotherapy techniques were NOT among the nonoperative treatments offered.

  • Seventy-four Snapping Scapulas who underwent arthroscopic surgery were examined in follow up:
    • Eight scapulae failed initial surgical management (10.9%) because of recurrent pain and underwent revision surgery at an average within one year of the first surgery
    • Of the remaining 66, average patient satisfaction rating post surgery was 7 of 10.

Greater age, lower preoperative psychological score, and longer duration of symptoms before surgery correlated with lower postoperative outcome scores.2

Prolotherapy treatment of snapping scapula syndrome

The typical physical therapy approach to snapping scapula syndrome, scapulocostal syndrome or scapulothoracic syndrome is to strengthen the serratus anterior muscle and/or put the patient through a scapular stabilization exercise program. While this is helpful (even in conjunction with Prolotherapy) it is rarely curative alone. In our experience, patients frequently require Prolotherapy to be fully cured of this condition.

We ask you, “What realistically could cause the scapula to start rubbing against a rib?” Is it likely going to come from an injury to the scapula? We feel that this is quite doubtful yet, almost 100% of the traditional medical treatments are performed to the scapula or the muscles that attach to the scapula. Doctors inject cortisone shots into and around the scapula. Patient get trigger point injections or massage therapy to break up “scar tissue.”

While this approach gives some temporary relief, it is rarely curative, as we end up seeing these patients after they have tried these traditional treatments.

Based on treating many painful shoulders at Caring Medical over the years, the most likely cause of the majority of snapping scapula syndrome, scapulocostal syndrome, and scapulothoracic syndrome is a slipping rib. Please see our article on Slipping Rib Syndrome.

A rib that is too mobile will surely rub on the under side of the scapula. When the patient receives chiropractic or osteopathic manipulation, the shoulder feels better for awhile, but again the snapping returns. The snapping returns because the ligaments that attach the ribs to the vertebrae (costovertebral ligaments) remain injured. Prolotherapy treatments to these ligaments that are causing the snapping scapula syndrome can cure the condition.

In our published research in the Journal of Prolotherapy, we relayed a case study of a 31 year-old-female patient in our article: Treatment of Joint Hypermobility Syndrome, Including Ehlers-Danlos Syndrome, with Hackett-Hemwall Prolotherapy.

The patients came in at the suggestion of her osteopathic doctor because of the diminishing benefits manipulation was having on her pain.

The patient stated that she “has always had loose joints” and for most of her adult life has needed either chiropractic or osteopathic care to function. Her significant pain started 10 years earlier while on the rowing team at college. Her primary pain was located in the left T1-T4 (thoracic spine) area and left shoulder. A previous MRI of the thoracic area was read as normal. She had tried acupuncture, electrical stimulation, physical therapy, and various medications and manual therapies without lasting relief.

On physical examination, she had noticeable ligament laxity in multiple thoracic/rib junctions (costovertebral) and her left shoulder easily dislocated.

At the initial visit, dextrose Prolotherapy was given to her left thoracic facets and costovertebral junctions. When seen one month later, she felt 40% better and another Prolotherapy treatment was given to the same area. She was not seen again for several months and felt her thoracic pain didn’t need treatment anymore but she wanted to start treatment for her left shoulder instability.

The patient did not return for one year because of resolution of her thoracic and shoulder pain with the previous Prolotherapy treatments. Her return visit surrounded hip pain.

Have you been diagnosed with snapping scapula syndrome, scapulocostal syndrome or scapulothoracic syndrome? Please consider Prolotherapy.

Are you a candidate for our non-surgical treatments? Ask our specialists:

Get Help and Information

1 Merolla G, Cerciello S, Paladini P, Porcellini G. Snapping scapula syndrome: current concepts review in conservative and surgical treatment. Muscles, Ligaments and Tendons Journal. 2013;3(2):80-90. doi:10.11138/mltj/2013.3.2.080.  [Pubmed] [Google Scholar]

2 Menge TJ, Horan MP, Tahal DS, Mitchell JJ, Katthagen JC, Millett PJ. Arthroscopic treatment of snapping scapula syndrome: outcomes at minimum of 2 years. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2017 Apr 30;33(4):726-32. [Pubmed] [Google Scholar]


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