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Escápula em ressalto

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Updated Oct 2026
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Esta página foi traduzida automaticamente e ainda não foi verificada por um médico. A versão em inglês é a versão oficial.

O que você está sentindo

A escápula em ressalto significa que você ouve ou sente um rangido, um estalo ou um ressalto vindo da sua escápula enquanto ela se move sobre a parede do tórax. Às vezes os médicos chamam isso de "síndrome da tábua de lavar roupa", porque o som pode parecer o de uma roda passando por uma tábua de lavar roupa. O barulho em si é comum. Cerca de um terço das pessoas sem nenhum sintoma tem algum rangido vindo da escápula. Sozinho, sem dor, ele não precisa de tratamento.

O que geralmente leva as pessoas a procurar atendimento é a dor. Ela fica ao redor ou embaixo da escápula, muitas vezes perto da borda interna, a mais próxima da coluna. Costuma piorar com atividades acima da cabeça, ao alcançar algo no alto ou do outro lado do corpo, e pode aparecer como queda no desempenho no esporte. A dor vem de uma bursa inflamada, a fina almofada cheia de líquido que permite que a escápula deslize suavemente sobre as costelas, ou do formato do próprio osso. A parede do tórax funciona como uma caixa de ressonância, por isso o barulho que você ouve é mais alto do que o movimento que o causa.

A dor pode dificultar as tarefas do dia a dia. Levantar uma panela pesada até uma prateleira alta, estender roupa no varal ou alcançar o cinto de segurança podem desencadeá-la. Algumas pessoas a percebem mais depois da atividade do que durante. Ela pode ser intensa o bastante para atrapalhar o sono ou impedir você de usar o braço normalmente.

Se os seus sintomas não estiverem melhorando, estiverem piorando ao longo de semanas, acordarem você à noite ou impedirem você de trabalhar ou de usar o braço, consulte o seu médico de família ou peça uma avaliação com especialista.

O que realmente está acontecendo

A sua escápula foi feita para deslizar. Ela fica apoiada na parede do tórax, separada dela por uma fina camada de tecido gorduroso e escorregadio que funciona como uma junta de vedação entre duas superfícies em movimento. Quatro articulações trabalham juntas para mover o seu ombro, e cerca de dois terços do movimento vêm da própria articulação esférica do ombro, enquanto o terço restante vem da escápula deslizando sobre as costelas. Quando esse deslizamento é suave, você nem o percebe.

O problema na escápula em ressalto é que algo perturba esse deslizamento. Às vezes é o formato do osso: a borda interna da escápula pode ser mais inclinada ou curvada em direção às costelas do que o habitual, de modo que fica mais perto da parede do tórax do que deveria. Às vezes é um pequeno caroço de osso a mais na escápula. Muitas vezes são os músculos ao redor da escápula trabalhando de forma desigual, de modo que ela não acompanha o movimento suavemente. Qualquer uma dessas causas pode fazer a escápula raspar ou enroscar em vez de deslizar.

O atrito irrita a almofada entre a escápula e as costelas. Essa almofada, chamada bursa, é uma bolsa fina cheia de líquido que funciona como um amortecedor entre o osso e os tecidos moles. Quando ela inflama, fica mais espessa e sensível, e essa é a dor que você sente embaixo ou ao redor da escápula. O atrito também pode causar um espessamento reativo do próprio tecido, a resposta do corpo ao atrito repetido.

Isso explica os sintomas descritos acima. O barulho vem das superfícies ásperas se movendo uma sobre a outra, e a parede do tórax o amplifica como uma caixa de ressonância. A dor vem da almofada inflamada, não do barulho em si. É por isso que os dois problemas são tratados de forma diferente, e por isso o tratamento se concentra em acalmar a inflamação e em reeducar os músculos que controlam a escápula.

O que podemos fazer a respeito

O Dr. Kieran Hirpara, cirurgião de membros superiores no Mater Private Hospital Rockhampton, começa sempre pelas opções menos invasivas adequadas ao seu caso. Em geral, os pacientes são encaminhados à nossa clínica pelo médico de família; caso um fisioterapeuta tenha sugerido que você nos procurasse, ainda assim será necessário um encaminhamento do seu médico de família para ter direito ao reembolso do Medicare. Na consulta na clínica, colhemos o histórico clínico, examinamos o seu ombro e solicitamos exames de imagem, se necessário, para descobrir o que está causando o barulho e a dor.

A maioria das pessoas melhora sem cirurgia, por isso o tratamento começa sem operação. O primeiro passo é um programa de fisioterapia para fortalecer os músculos que controlam a sua escápula, junto com o alongamento dos músculos que ficaram encurtados. Mudar as atividades que provocam os sintomas também ajuda. Dê a esse tratamento uma tentativa adequada de 3 a 6 meses antes de pensar em qualquer outra coisa.

Se a dor continuar, medicamentos podem ajudar a acalmar a inflamação. Os comprimidos anti-inflamatórios, do mesmo tipo que muitas pessoas tomam para dores musculares, fazem parte desta etapa. Também podemos oferecer uma injeção de corticoide e anestésico local, guiada por imagem, na bursa embaixo da sua escápula. Ela tem duas funções: acalma a almofada inflamada e confirma que é dali que vem a sua dor.

A cirurgia só é considerada quando a dor continua depois de vários meses desses tratamentos e eles não trouxeram melhora suficiente. A operação é uma cirurgia por vídeo (artroscópica), feita por pequenas incisões com uma câmera. Ela remove a bursa inflamada entre a sua escápula e as suas costelas. O canto superior interno da sua escápula só é aparado se, durante a operação, ele se mostrar proeminente. A dor da maioria das pessoas melhora bastante após a cirurgia, mas muitas vezes algum estalo continua. Conversaremos sobre o que a cirurgia pode significar para você e decidiremos juntos se ela é o passo certo.

O que esperar

A maioria das pessoas melhora sem cirurgia. O tratamento começa com fisioterapia para fortalecer os músculos que controlam a sua escápula, medicamentos anti-inflamatórios e mudança das atividades que provocam os sintomas. Dê a esse tratamento uma tentativa adequada de 3 a 6 meses. Muitas pessoas percebem que a dor diminui nesse período e nunca precisam de cirurgia.

Se a dor continuar depois de vários meses desses tratamentos, a cirurgia pode ser considerada. A cirurgia por vídeo remove a bursa inflamada entre a sua escápula e as suas costelas, e só apara o canto superior interno da escápula se ele se mostrar proeminente. A dor da maioria das pessoas melhora bastante após a cirurgia. Muitas vezes algum estalo continua, porque os tratamentos que ajudam a dor resolvem principalmente a dor, e não o barulho. O alívio completo de todos os sintomas não é o resultado habitual.

Sem tratamento, os sintomas podem persistir e ser intensos o bastante para atrapalhar o sono ou impedir você de usar o braço normalmente. A condição pode ser difícil de reconhecer e de tratar, por isso vale a pena obter um diagnóstico claro logo, em vez de esperar que ela melhore sozinha.

Se os seus sintomas não estiverem melhorando, estiverem piorando ao longo de semanas, acordarem você à noite ou impedirem você de trabalhar ou de usar o braço, consulte o seu médico de família ou peça uma avaliação com especialista.

Quando procurar ajuda médica

O barulho sozinho não é motivo de preocupação. Cerca de um terço das pessoas sem nenhum sintoma tem algum rangido vindo da escápula, e, sozinho, ele não precisa de tratamento. O que importa é a dor. Consulte o seu médico de família ou peça uma avaliação com especialista se tiver dor ao redor ou embaixo da escápula que não esteja melhorando, esteja piorando ao longo de semanas, acorde você à noite ou impeça você de trabalhar ou de usar o braço. Peça também uma avaliação se a dor for intensa o bastante para atrapalhar o sono, se o seu desempenho no esporte tiver caído ou se atividades acima da cabeça, como alcançar algo no alto ou do outro lado do corpo, provocarem a dor. A escápula em ressalto pode ser difícil de reconhecer, por isso vale a pena ter um diagnóstico claro logo.

Em maior profundidade

Advanced reading: the deeper science (optional)

Esta seção vai além do que você precisa para as suas próprias decisões de tratamento. Vale a pena ler mais sobre a escápula em ressalto porque o barulho e a dor são dois problemas diferentes, e os tratamentos que ajudam resolvem principalmente o segundo, e não o primeiro.

O barulho é comum; o problema é a dor

O rangido da escápula não é, por si só, sinal de doença. Uma revisão clássica sobre a condição cita um estudo antigo que encontrou crepitação escapular em 31% de 100 pessoas sem nenhum sintoma [1]. O que transforma o barulho numa condição é a dor, geralmente por uma bursa inflamada: a fina camada de tecido revestida de líquido que permite que a escápula deslize sobre as costelas.

O formato tem um papel. Num estudo de imagem, as pessoas com uma escápula que se curva para a frente ao longo da borda interna (um formato côncavo, com um "ângulo do corpo medial da escápula" positivo) tinham um risco 12 vezes maior de escápula em ressalto [2]. Essa medida acabou se mostrando menos útil do que parecia no início: um estudo posterior verificou que o mesmo ângulo varia bastante conforme a direção de onde é observado, por isso não é confiável o bastante para diagnosticar a condição sozinho [3]. Num modelo com cadáveres, a característica óssea mais importante foi o quanto a parte interna da escápula ficava projetada para a frente, em direção às costelas [4].

A maioria das pessoas melhora sem cirurgia

Numa série de 30 escápulas em 28 pacientes tratadas com um programa específico de fortalecimento muscular, 14 (50%) evoluíram bem só com os exercícios e 6 (21%) precisaram apenas de medicamentos anti-inflamatórios além deles, de modo que 71% alcançaram um resultado bom ou melhor, pela classificação do próprio estudo, sem cirurgia [5].

O acompanhamento mais longo vem da Finlândia. Doze pessoas que fizeram cirurgia aberta e 9 que foram tratadas sem cirurgia foram reavaliadas, em média, 22 anos depois. A dor ao esforço era baixa nos dois grupos: 0,8 em 10 após a cirurgia e 1,5 em 10 sem ela, uma diferença pequena demais para se ter certeza de que era real (p = 0,357) [6]. A dor melhorou rapidamente após a cirurgia em 7 de 12, mas, a longo prazo, os dois caminhos terminaram praticamente no mesmo lugar.

Uma injeção de anestésico local e corticoide na bursa tem duas funções: trata a inflamação e testa se a bursa é realmente a origem da dor. Num protocolo de atendimento do Reino Unido, 74 de 94 pacientes ainda tinham sintomas incômodos depois da fisioterapia e receberam uma injeção guiada por ultrassom; 55 tiveram uma boa resposta inicial, que se manteve em 17 [7]. Entre os 42 pacientes operados que foram acompanhados, os que tinham respondido bem à injeção melhoraram mais após a operação do que os que não tinham respondido [7]. Uma série americana maior, acompanhada por pelo menos cinco anos, não encontrou a mesma relação [8], por isso uma resposta fraca à injeção não descarta a cirurgia.

O que a cirurgia consegue, e o que não consegue

A maior série de longo prazo acompanhou 66 pessoas por 5 a 15 anos após a remoção da bursa por vídeo e o aparo do canto da escápula. A pontuação média do ombro subiu de 56,7 para 87,2 em 100, a dor caiu de 5,2 para 1,4 em 10, e 77,6% alcançaram uma melhora grande o bastante para ser percebida. Dos 42 que praticavam esporte, 38 (90,5%) voltaram a praticá-lo e 31 (73,8%) voltaram ao nível anterior ou perto dele. Oito (12,1%) precisaram de uma nova operação [8]. Outra série de 74 escápulas teve uma taxa semelhante de nova cirurgia (8 de 74) e verificou que pacientes mais velhos, pessoas com sintomas havia mais tempo e pessoas com pontuações mais baixas de bem-estar mental antes da cirurgia tendiam a evoluir menos bem [9].

A resolução completa é a exceção. Uma revisão sistemática de 203 ombros operados verificou que 42 (20,7%) ficaram completamente bons, 139 (68,5%) melhoraram mas ainda tinham alguns sintomas, e 22 (10,8%) tiveram um resultado ruim [10]. Uma revisão de 2026 com 464 pacientes chegou à mesma conclusão geral: tanto o tratamento não cirúrgico quanto o cirúrgico aliviam a dor, mas os sintomas mecânicos, o estalo e o rangido, muitas vezes não desaparecem completamente [11].

Vale a pena remover o osso?

Aparar o canto superior interno da escápula é a parte tradicional da operação, por isso é uma surpresa que isso possa acrescentar pouco. Um centro comparou 24 pessoas que tiveram apenas a bursa removida com 32 que também tiveram o canto aparado. As pontuações finais de dor (3,4 e 2,8 em 10, p = 0,351) e as pontuações do ombro (75,8 e 76,5, p = 0,895) foram iguais, e o estalo ainda estava presente em 58% e 59% [12]. A operação foi mais curta sem o trabalho no osso: 37,5 contra 61,2 minutos [12]. Os grupos foram acompanhados por períodos diferentes e não foram randomizados, por isso esta não é a palavra final, mas é por isso que a decisão de aparar o osso é tomada durante a operação, e não com antecedência.

Referências

[1] Kuhn JE, Plancher KD, Hawkins RJ. Symptomatic Scapulothoracic Crepitus and Bursitis. J Am Acad Orthop Surg. 1998;6(5):267-73. https://doi.org/10.5435/00124635-199809000-00001 [2] Spiegl UJ, Petri M, Smith SW, Ho CP, Millett PJ. Association between scapula bony morphology and snapping scapula syndrome. J Shoulder Elbow Surg. 2015;24(8):1289-95. https://doi.org/10.1016/j.jse.2014.12.034 [3] Percin B, Featherall J, Tashjian RZ, Chalmers PN, Joyce CD, Mortensen AJ, et al. The influence of scapular orientation on the medial scapula corpus angle in snapping scapula syndrome. JSES Int. 2025;9(1):70-8. https://doi.org/10.1016/j.jseint.2024.08.179 [4] Tahal DS, Katthagen JC, Marchetti DC, Mikula JD, Montgomery SR, Brady A, et al. A Cadaveric Model Evaluating the Influence of Bony Anatomy and the Effectiveness of Partial Scapulectomy on Decompression of the Scapulothoracic Space in Snapping Scapula Syndrome. Am J Sports Med. 2017;45(6):1276-82. https://doi.org/10.1177/0363546516687755 [5] Groh G, Simoni M, Allen T, Dwyer T, Heckman M, Rockwood C. Treatment of snapping scapula with a periscapular muscle strengthening program. J Shoulder Elbow Surg. 1996;5(2):S6. https://doi.org/10.1016/s1058-2746(96)80089-9 [6] Vastamäki M, Vastamäki H. Open Surgical Treatment for Snapping Scapula Provides Durable Pain Relief, but so Does Nonsurgical Treatment. Clin Orthop Relat Res. 2016;474(3):799-805. https://doi.org/10.1007/s11999-015-4614-1 [7] Tytherleigh-Strong G, Gill J, Griffiths E, Al-Hadithy N. Prognosis After Arthroscopic Superior Medial Scapuloplasty for Snapping Scapula Syndrome Improves After a Transient Beneficial Response With an Ultrasound-Guided Subscapular Cortisone Injection. Arthroscopy. 2020;36(12):2965-72. https://doi.org/10.1016/j.arthro.2020.07.024 [8] Rupp M, Geissbuhler AR, Rutledge JC, Amendola R, Hanson JA, Doan KC, et al. Minimum 5-Year Clinical and Return-to-Sport Outcomes After Primary Arthroscopic Scapulothoracic Bursectomy and Partial Scapulectomy for Snapping Scapula Syndrome. Am J Sports Med. 2024;52(6):1449-56. https://doi.org/10.1177/03635465241243072 [9] 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. 2016;33(4):726-32. https://doi.org/10.1016/j.arthro.2016.08.029 [10] Memon M, Kay J, Simunovic N, Ayeni OR. Arthroscopic management of snapping scapula syndrome improves pain and functional outcomes, although a high rate of residual symptoms has been reported. Knee Surg Sports Traumatol Arthrosc. 2017;26(1):221-39. https://doi.org/10.1007/s00167-017-4693-5 [11] Wallace K, Mitchell JK, Lauck BJ, Reed J, Conlon S, Kamath GV. Snapping Scapula Syndrome: A Systematic Review of Treatment Options and Outcomes. J Shoulder Elbow Surg. 2026. https://doi.org/10.1016/j.jse.2026.05.023 [12] Featherall J, Christensen GV, Mortensen AJ, Wheelwright JC, Chalmers PN, Tashjian RZ. Arthroscopic scapulothoracic bursectomy with and without superomedial angle scapuloplasty: a comparison of patient-reported outcomes. J Shoulder Elbow Surg. 2023;32(9):1945-52. https://doi.org/10.1016/j.jse.2023.03.020

Reviewed by AI synthesis (v2) — pending human review · 4 October 2026.

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Evidence & references

This is the clinical evidence summary written for health professionals. It is technical, and it lists the research this page was built from. You do not need to read it to understand your treatment or to make a decision about it.

Overview

  • Snapping scapula syndrome is caused by either osseous lesions or scapulothoracic bursitis [3].
  • The condition is also referred to as “washboard syndrome” and is attributed to bony and soft tissue abnormalities [9].
  • Snapping scapula represents the clinical expression of scapulothoracic impingement due to mechanical factors and/or muscle imbalance [7].
  • Osteochondroma of the scapula is a rare entity that may present with snapping scapula syndrome when it alters scapulothoracic mechanics [6].
  • Snapping scapula syndrome can be a debilitating disorder [2].
  • Diagnosis and management of snapping scapula syndrome remains challenging despite recent advances [1].
  • The condition can be difficult to recognize and treat [3].
  • Four-dimensional computed tomography scans facilitate preoperative planning by defining pathology and improving assessment of the amount and location of scapular bone and soft tissue causing symptoms [18].

Treatment

  • Treatment of patients with snapping scapula syndrome begins with nonoperative methods [5].
  • When nonoperative treatment fails, several surgical options exist [5].
  • Arthroscopic management of snapping scapula syndrome yields improvement in pain, crepitus, and range of motion in a majority of patients [4].
  • Most patients experience residual symptoms following arthroscopic management [4].
  • Arthroscopic scapulothoracic treatment provides significant pain relief and functional improvement for painful snapping scapula symptoms not responding to non-surgical treatment modalities [8].
  • Arthroscopic treatment for snapping scapula syndrome resulted in significant improvement in pain and function with high patient satisfaction at a mean follow-up of 3.4 years [14].
  • Arthroscopic scapuloplasty leads to significant improvement in pain and function in patients with snapping scapula syndrome refractory to conservative treatment [15].
  • Arthroscopic surgery is an effective treatment for snapping scapula syndrome in both primary and revision cases, showing significant improvements in all postoperative outcome scores at a mean of 3.4 years [17].
  • Arthroscopic resection of the superomedial corner of the scapula is a useful technique in patients whose pain and clicking can be clinically localized and who have failed to respond to conservative measures [19].
  • Arthroscopic resection of the medial superior hook formation in combination with partial bursectomy provided good results with significant gains with respect to the WORC score in 90 % of the patients troubled by painful snapping scapula for a long time and without relief by exercise-based rehabilitation [35].
  • At the end of 1 year, all patients in a case series had a constant score above 90 and were completely relieved of snapping around the scapula having full pain-free movements at the shoulder and scapulothoracic joints [11].
  • A patient remained asymptomatic with full range of motion and no further complaints of pain or snapping at twenty-six months postoperatively [12].
  • At 2 years 6 months after the operation, snapping and pain were completely gone and the patient was satisfied with the results [13].

Anatomy & Pathophysiology

Etiology and Mechanism

  • Snapping scapula is the clinical expression of scapulothoracic impingement due to mechanical factors and/or muscle imbalance [7].
  • The condition is attributed to bony and soft tissue abnormalities [9].
  • Osteochondroma of the scapula may present with snapping scapula syndrome when it alters scapulothoracic mechanics [6].
  • Subscapular elastofibroma is a reactive pseudotumor resulting from mechanical friction of the scapula on the chest wall [86].

Bony Anatomy and Morphology

  • The scapula is separated from the chest wall by thin gliding fibro-fatty tissue, allowing its smooth excursion over the chest wall [53].
  • Anterior angulation of the medial scapula in the axial plane was associated with snapping scapula syndrome [34].
  • Patients with a concave-shaped scapula and a positive medial scapula corpus angle may be at risk for snapping scapula syndrome [47].
  • The anterior offset of the scapula appeared to be the most important bony parameter to consider during preoperative planning and the evaluation of scapulothoracic space decompression with partial scapulectomy [46].
  • The weakest area of the circumference of the biomechanical body of the scapula is the connection of the scapular spine and the medial border of the scapula, known as the spinomedial angle [53].
  • The superior angle and the adjacent part of the supraspinous fossa form an appendage that serves as a surface of insertion or origin of muscles but does not transmit compressive forces from the glenoid [53].

Soft Tissue and Neurovascular Anatomy

  • Neurologic structures around the scapula vary significantly between the neutral arm position and the chicken-wing position commonly used in the arthroscopic treatment of snapping scapula syndrome [85].
  • The scapula is attached to the axial skeleton by the clavicle, specifically by the acromioclavicular and sternoclavicular joints [53].
  • The scapula serves for attachment of a number of muscles originating from the axial skeleton that control its motion [53].

Classification

  • Mauclaire classified scapulothoracic crepitus into three types: froissement (a gentle friction sound thought to be physiologic), frottement (a louder sound with grating, which is usually pathologic), and craquement (a loud snapping sound, which is always pathologic) [26].
  • Frottement may suggest a soft-tissue lesion or bursitis, while craquement may suggest an osseous lesion as the source of symptomatic scapulothoracic crepitus [26].
  • The snapping scapula syndrome is caused by either osseous lesions or scapulothoracic bursitis [3].
  • Snapping scapula is the clinical expression of the scapulothoracic impingement due to mechanical factors and/or muscle imbalance [7].
  • The snapping scapula, also called “washboard syndrome,” is a controversial condition attributed to bony and soft tissue abnormalities [9].
  • Rib fractures at the posterior angle could cause snapping scapula syndrome [20].

Clinical Presentation

  • Snapping scapula syndrome is an uncommon condition that is likely underdiagnosed [42].
  • The condition can produce severe shoulder pain and dysfunction [24].
  • Patients often present with decreased athletic performance and increased pain with overhead activities [42].
  • Crepitus is a reported symptom in patients with snapping scapula syndrome [42].
  • High clinical suspicion is necessary in patients presenting with medial scapular border tenderness, palpable crepitus, and audible snapping [40].
  • Potential factors causing snapping scapula syndrome include bony prominence at the superomedial scapular angle, imbalance of the periscapular muscles, and scapulothoracic bursitis [42].
  • Scapulothoracic crepitus is not necessarily a pathologic condition, as it was found in 31% of 100 normal asymptomatic persons [26].
  • Scapulothoracic crepitus is considered pathologic if it is associated with pain, winging, or other disorders of the scapulothoracic articulation [26].
  • The condition has been referred to by various names, including snapping scapula, washboard syndrome, scapulothoracic syndrome, rolling scapula, grating scapula, and scapulocostal syndrome [26].
  • Mauclaire classified scapulothoracic crepitus into three types: froissement (gentle friction sound), frottement (louder sound with grating), and craquement (loud snapping sound) [26].
  • Scapular noises arise from anatomic changes in the tissue interposed between the scapula and the chest wall and/or an incongruent scapulothoracic articulation [26].
  • The air-filled thoracic cavity acts as a resonating chamber that amplifies scapulothoracic crepitus [26].
  • A mass composed of alternating strands of fatty and fibrous tissue located at the inferior pole of the scapula is pathognomonic for elastofibroma dorsi [36].
  • Scapular osteochondroma is a rarely reported cause of scapular pseudo-winging and should be considered in the differential diagnosis when winging and a mass are present [43].
  • The differential diagnosis for causes of snapping scapula includes idiopathic causes, scapulothoracic bursitis, osteochondromas, and elastofibromas [42].
  • Four-dimensional computed tomography scans facilitate preoperative planning by defining pathology and assessing the amount and location of scapular bone and soft tissue causing symptoms [18].
  • Plain radiographs and CT scans provide detailed information about osseous abnormalities in snapping scapula syndrome [42].
  • MRI characterizes bursal and other soft-tissue pathologies in snapping scapula syndrome [42].

Investigations

  • Symptomatic scapulothoracic crepitus is considered pathologic when associated with pain, winging, or other disorders of the scapulothoracic articulation [26].
  • Scapulothoracic crepitus is attributed to anatomic changes in the tissue interposed between the scapula and the chest wall or an incongruent scapulothoracic articulation [26].
  • The air-filled thoracic cavity acts as a resonating chamber that amplifies scapulothoracic crepitus noises [26].
  • Frottement (a louder sound with grating) usually suggests a soft-tissue lesion or bursitis, while craquement (a loud snapping sound) always suggests an osseous lesion [26].
  • Four-dimensional computed tomography (4D CT) scans define pathology well and improve the assessment of the amount and location of scapular bone and soft tissue causing symptoms in snapping scapula syndrome [18].
  • Fluoroscopy provides a real-time method for evaluating and documenting abnormal osseous mechanics of the scapulothoracic bursal region [31].
  • Anterior angulation of the medial scapula in the axial plane is associated with snapping scapula syndrome [34].
  • The anterior offset of the scapula is the most important bony parameter to consider during preoperative planning and evaluation of scapulothoracic space decompression with partial scapulectomy [46].
  • Imaging-guided injections provide an alternative means of diagnosis in cases where direct imaging is usually not successful [48].
  • Rib fractures at the posterior angle can cause snapping scapula syndrome [20].

Treatment

Non-Operative Management

  • In most cases, nonoperative treatment is curative and includes physical therapy for scapular muscle strengthening and nonsteroidal anti-inflammatory medications [29].
  • Nonsurgical management remains the first treatment option, with surgery recommended after 6 months of nonsurgical treatment with no improvement [42].
  • Nonoperative management of snapping scapula syndrome in the form of analgesia, physiotherapy, local corticosteroid injection, and/or extracorporeal shockwave therapy should be initiated for 3 to 6 months before considering surgical management [40].
  • Strengthening weak periscapular muscle groups combined with simultaneous stretching of contracted muscles and training of antagonistic muscle groups can yield good clinical results [42].
  • Physical therapy, injections with local anesthetics and/or steroids, and NSAIDs can be useful in nonsurgical management [42].
  • Patients treated nonsurgically achieved results that were not distinguishable from the surgically treated group in a small series with a minimum of 16 years follow-up [24].
  • At a minimum of 16 years follow-up, patients treated nonsurgically reported little pain, some crepitus (usually painless), and a consistent ability to return to work [24].

Operative Management

  • When nonoperative treatment fails, several surgical options exist for snapping scapula syndrome [5].
  • Most patients experience residual symptoms after arthroscopic management of snapping scapula syndrome [4].
  • For patients who fail conservative management, arthroscopic bursectomy and partial scapulectomy is a reasonable option [23].
  • Arthroscopic bursectomy and partial scapulectomy is technically demanding and requires an in-depth understanding of the complex anatomy of the scapulothoracic region [23].
  • Improvement in functional outcomes and pain relief are reliably achieved after surgical treatment of snapping scapula syndrome [28].
  • Poorer outcomes can be seen in workers' compensation patients as well as those with residual symptomatic shoulder pathology following surgical treatment [28].
  • Operative time is shorter without scapuloplasty when performing arthroscopic scapulothoracic bursectomy [30].
  • Open surgical treatment for snapping scapula provides durable pain relief [24].
  • Patients treated surgically for snapping scapula report little pain, some crepitus (usually painless), and a consistent ability to return to work at a minimum of 16 years follow-up [24].
  • At the end of 1 year, all patients in a case series of arthroscopic management for recalcitrant scapulothoracic bursitis had a constant score above 90 and were completely relieved of snapping around the scapula [11].
  • Patients in a case series of arthroscopic management for recalcitrant scapulothoracic bursitis had full pain-free movements at the shoulder and scapulothoracic joints at 1 year [11].
  • A patient with snapping scapula syndrome remained asymptomatic with full range of motion and no further complaints of pain or snapping at twenty-six months postoperatively [12].
  • Snapping and pain were completely gone and the patient was satisfied with the results at 2 years 6 months after operation for abnormal angulation of the superior angle of the scapula [13].
  • Arthroscopic access to the scapulothoracic space is simple and reproducible, with bursal tissue clearance optimizing visualization [25].
  • Arthroscopic treatment of snapping scapula follows 8 key steps to ensure a safe and effective procedure [10].
  • A technique for arthroscopic management of snapping scapula syndrome includes scapulothoracic bursectomy and superomedial partial scapulectomy, which has been refined over nearly two decades of experience [16].
  • Most authors have recommended partial scapulectomy or resection of the superomedial angle of the scapula in patients with scapular crepitus and pain caused by bony incongruity [81].
  • The decision for and timing of operative management should be individualized for each patient [81].
  • Operative options include partial scapulectomy and open versus arthroscopic bursectomy [81].

Complications

  • Arthroscopic management of snapping scapula syndrome results in most patients experiencing residual symptoms [4].
  • Snapping scapula syndrome is difficult to recognize and treat [3].

Recovery

Non-Operative

  • Nonoperative treatment for snapping scapula syndrome includes physical therapy for scapular muscle strengthening and nonsteroidal anti-inflammatory medications [29].
  • In most cases, nonoperative treatment is curative [29].

Operative Outcomes

  • Improvement in functional outcomes and pain relief are reliably achieved after surgical treatment [28].
  • Poorer outcomes can be seen in workers' compensation patients as well as those with residual symptomatic shoulder pathology [28].
  • At the end of 1 year, all the patients had a constant score above 90 and were completely relieved of snapping around the scapula having full pain-free movements at the shoulder and scapulothoracic joints [11].
  • The patient remained asymptomatic with full range of motion and no further complaints of pain or snapping at twenty-six months postoperatively [12].
  • A year after excision, the patient has not suffered recurrent pain in the left shoulder [90].

Surgical Technique and Planning

  • Operative time is shorter without scapuloplasty [30].
  • The 4D CT scan images defined pathology well in patients with snapping scapula syndrome and improved assessment of the amount and location of the scapular bone and soft tissue causing symptoms [18].

Key Evidence

  • [L5] Diagnosis and management of snapping scapula syndrome remains challenging despite recent advances. [1] (10.5435/jaaos-21-04-214)
  • [L4] Snapping scapula syndrome can be a debilitating disorder. [2] (10.1016/j.arthro.2012.05.889)
  • [L5] The snapping scapula syndrome is caused by either osseous lesions or scapulothoracic bursitis and can be difficult to recognize and treat. [3] (10.1155/2013/635628)
  • [L1] Arthroscopic management of snapping scapula syndrome yields improvement in pain, crepitus, and range of motion in a majority of patients; however, most patients experience residual symptoms. [4] (10.1007/s00167-017-4693-5)
  • [L5] Treatment of patients with snapping scapula syndrome begins with nonoperative methods; when nonoperative treatment fails, several surgical options exist. [5] (10.1177/0363546504268790)
  • [Case_report] Osteochondroma of the scapula is a rare entity that may present with snapping scapula syndrome when it alters scapulothoracic mechanics. [6] (10.1016/j.otsr.2017.01.019)
  • [L4] Snapping scapula is the clinical expression of the scapulothoracic impingement due to mechanical factors and/or muscle imbalance. [7] (10.1016/s1058-2746(96)80466-6)
  • [L4] Arthroscopic scapulothoracic treatment provides significant pain relief and functional improvement for painful snapping scapula symptoms not responding to non-surgical treatment modalities. [8] (10.2174/1874325001711010785)
  • [L5] The snapping scapula, also called “washboard syndrome” is a controversial condition attributed to bony and soft tissue abnormalities. [9] (10.11138/mltj/2013.3.2.080)
  • [L5] Arthroscopic treatment of snapping scapula follows 8 key steps to ensure a safe and effective procedure. [10] (10.1016/j.eats.2025.103671)
  • [L4] At the end of 1 year, all the patients had a constant score above 90 and were completely relieved of snapping around the scapula having full pain-free movements at the shoulder and scapulothoracic joints. [11] (10.13107/jocr.2025.v15.i02.5290)
  • [Case_report] The patient remained asymptomatic with full range of motion and no further complaints of pain or snapping at twenty-six months postoperatively. [12] (10.2106/00004623-198264060-00020)
  • [L5] At 2 years 6 months after the operation, snapping and pain were completely gone and the patient was satisfied with the results. [13] (10.1016/s1058-2746(03)00178-2)
  • [L3] Arthroscopic treatment for snapping scapula syndrome resulted in significant improvement in pain and function with high patient satisfaction at a mean follow-up of 3.4 years. [14] (10.1177/2325967116s00097)
  • [L3] Arthroscopic scapuloplasty leads to significant improvement in pain and function in patients with snapping scapula syndrome refractory to conservative treatment. [15] (10.1016/j.arthro.2020.07.024)
  • [L5] This Technical Note presents a technique for arthroscopic management of snapping scapula syndrome that includes scapulothoracic bursectomy and superomedial partial scapulectomy, which has been refined over nearly two decades of experience. [16] (10.1016/j.eats.2022.02.028)
  • [L5] The editorial commentary notes that the referenced study by Menge et al. concludes that arthroscopic surgery is an effective treatment for snapping scapula syndrome in both primary and revision cases, showing significant improvements in all postoperative outcome scores at a mean of 3.4 years. [17] (10.1016/j.arthro.2016.11.017)
  • [L5] The 4D CT scan images defined pathology well in patients with snapping scapula syndrome and improved assessment of the amount and location of the scapular bone and soft tissue causing symptoms. [18] (10.1016/j.jse.2014.09.020)
  • [L4] Arthroscopic resection of the superomedial corner of the scapula is a useful technique in patients whose pain and clicking can be clinically localized and who have failed to respond to conservative measures. [19] (10.1016/s1058-2746(99)90056-3)
  • [L5] It should be noted that rib fractures at the posterior angle could cause snapping scapula syndrome. [20] (10.1016/s1058-2746(03)00055-7)
  • [Paper] For those patients who fail conservative management, arthroscopic bursectomy and partial scapulectomy is a reasonable option, but is technically demanding and requires an in-depth understanding of the complex anatomy of the scapulothoracic region. [23] (10.1016/j.csm.2014.06.003)
  • [L3] [24] (10.1007/s11999-015-4614-1)
  • [Paper] Arthroscopic access to the scapulothoracic space is simple and reproducible, with bursal tissue clearance optimizing visualization. [25] (10.1016/j.eats.2015.07.002)
  • [L4] [26] (10.5435/00124635-199809000-00001)
  • [L4] Improvement in functional outcomes and pain relief are reliably achieved after surgical treatment, although poorer outcomes can be seen in workers' compensation patients as well as those with residual symptomatic shoulder pathology. [28] (10.1177/2325967113505739)
  • [L5] In most cases, nonoperative treatment is curative and includes physical therapy for scapular muscle strengthening and nonsteroidal anti-inflammatory medications. [29] (10.1016/j.arthro.2008.12.022)
  • [L3] Operative time is shorter without scapuloplasty. [30] (10.1016/j.jse.2023.03.020)
  • [L5] Fluoroscopy provides a realtime method of evaluating and documenting abnormal osseous mechanics of the scapulothoracic bursal region. [31] (10.1007/s11420-007-9047-2)
  • [L3] Anterior angulation of the medial scapula in the axial plane was associated with SSS. [34] (10.1016/j.jse.2014.12.034)
  • [L4] In this study, it was found that arthroscopic resection of the medial superior hook formation in combination with partial bursectomy provided good results with significant gains with respect to the WORC score in 90 % of the patients troubled by painful snapping scapula for a long time and without relief by exercise-based rehabilitation. [35] (10.1007/s00590-012-1154-1)
  • [L4] A mass composed of alternating strands of fatty and fibrous tissue is pathognomonic if it is located at the inferior pole of the scapula. [36] (10.1016/j.jbspin.2004.04.006)
  • [L4] [40] (10.1177/19417381211029211)
  • [Case_report] Scapular osteochondroma is a rarely reported cause of scapular pseudo-winging, and should be considered in the differential diagnosis when winging and a mass are present. [43] (10.1007/s11552-014-9659-1)
  • [L5] The anterior offset of the scapula appeared to be the most important bony parameter to consider during preoperative planning and the evaluation of scapulothoracic space decompression with partial scapulectomy. [46] (10.1177/0363546516687755)
  • [L3] Those patients with a concave-shaped scapula and a positive MSCA may be at risk for SSS. [47] (10.1177/2325967114s00063)
  • [L4] [48] (10.2214/ajr.181.5.1811232)
  • [L5] [81] (10.1177/1941738109338359)
  • [L5] Neurologic structures around the scapula vary significantly between the neutral arm position and the chicken-wing position commonly used in the arthroscopic treatment of SSS. [85] (10.1016/j.jse.2022.03.029)
  • [L4] Subscapular elastofibroma is a reactive pseudotumor resulting from mechanical friction of the scapula on the chest wall. [86] (10.1016/s1058-2746(05)80008-4)
  • [L5] A year after excision, the patient has not suffered recurrent pain in the left shoulder. [90] (10.1016/1058-2746(93)90078-u)

References

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[4] Arthroscopic management of snapping scapula syndrome improves pain and functional outcomes, although a high rate of residual symptoms has been reported. Knee Surgery, Sports Traumatology, Arthroscopy. 2017. DOI: 10.1007/s00167-017-4693-5

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[9] Snapping scapula syndrome: current concepts review in conservative and surgical treatment. Muscles, Ligaments and Tendons Journal. 2013. DOI: 10.11138/mltj/2013.3.2.080

[10] Full‐House Arthroscopic Treatment of Snapping Scapula Syndrome: Bursectomy, Levator Scapulae Release, and Partial Scapulectomy. Arthroscopy Techniques. 2025. DOI: 10.1016/j.eats.2025.103671

[11] Arthroscopic Management of Snapping Scapular Syndrome due to Recalcitrant Scapulothoracic Bursitis – A Case Series. Journal of Orthopaedic Case Reports. 2025. DOI: 10.13107/jocr.2025.v15.i02.5290

[12] The snapping scapula syndrome. A case report.. The Journal of Bone & Joint Surgery. 1982. DOI: 10.2106/00004623-198264060-00020

[13] Snapping scapula caused by abnormal angulation of the superior angle of the scapula. Journal of Shoulder and Elbow Surgery. 2004. DOI: 10.1016/s1058-2746(03)00178-2

[14] Two-Year Outcomes following Arthroscopic Treatment for Snapping Scapula Syndrome. Orthopaedic Journal of Sports Medicine. 2016. DOI: 10.1177/2325967116s00097

[15] Prognosis After Arthroscopic Superior Medial Scapuloplasty for Snapping Scapula Syndrome Improves After a Transient Beneficial Response With an Ultrasound‐Guided Subscapular Cortisone Injection. Arthroscopy. 2020. DOI: 10.1016/j.arthro.2020.07.024

[16] Arthroscopic Treatment of Snapping Scapula Syndrome With Scapulothoracic Bursectomy and Partial Scapulectomy. Arthroscopy Techniques. 2022. DOI: 10.1016/j.eats.2022.02.028

[17] Editorial Commentary: Arthroscopy of the Scapulothoracic Joint for Treatment of Snapping Scapula Syndrome—Minimum 2‐Year Results in a Large Series, a Long‐Awaited Publication. Arthroscopy. 2017. DOI: 10.1016/j.arthro.2016.11.017

[18] Four-dimensional computed tomography scans facilitate preoperative planning in snapping scapula syndrome. Journal of Shoulder and Elbow Surgery. 2015. DOI: 10.1016/j.jse.2014.09.020

[19] Arthroscopic partial resection of the scapula for snapping scapula: A new technique. Journal of Shoulder and Elbow Surgery. 1999. DOI: 10.1016/s1058-2746(99)90056-3

[20] Snapping scapula syndrome due to malunion of rib fractures: a case report. Journal of Shoulder and Elbow Surgery. 2004. DOI: 10.1016/s1058-2746(03)00055-7

[23] Snapping Scapula Syndrome in the Military. Clinics in Sports Medicine. 2014. DOI: 10.1016/j.csm.2014.06.003

[24] Open Surgical Treatment for Snapping Scapula Provides Durable Pain Relief, but so Does Nonsurgical Treatment. Clinical Orthopaedics & Related Research. 2016. DOI: 10.1007/s11999-015-4614-1

[25] Arthroscopic Scapulothoracic Decompression for Snapping Scapula Syndrome. Arthroscopy Techniques. 2015. DOI: 10.1016/j.eats.2015.07.002

[26] Symptomatic Scapulothoracic Crepitus and Bursitis. Journal of the American Academy of Orthopaedic Surgeons. 1998. DOI: 10.5435/00124635-199809000-00001

[28] Functional Outcomes After Arthroscopic Scapulothoracic Bursectomy and Partial Superomedial Angle Scapulectomy. Orthopaedic Journal of Sports Medicine. 2013. DOI: 10.1177/2325967113505739

[29] The Snapping Scapula: Diagnosis and Treatment. Arthroscopy. 2009. DOI: 10.1016/j.arthro.2008.12.022

[30] Arthroscopic scapulothoracic bursectomy with and without superomedial angle scapuloplasty: a comparison of patient-reported outcomes. Journal of Shoulder and Elbow Surgery. 2023. DOI: 10.1016/j.jse.2023.03.020

[31] Imaging-Guided Treatment of Scapulothoracic Bursitis. HSS Journal®: The Musculoskeletal Journal of Hospital for Special Surgery. 2007. DOI: 10.1007/s11420-007-9047-2

[34] Association between scapula bony morphology and snapping scapula syndrome. Journal of Shoulder and Elbow Surgery. 2015. DOI: 10.1016/j.jse.2014.12.034

[35] Arthroscopic treatment for snapping scapula: a prospective case series. European Journal of Orthopaedic Surgery & Traumatology. 2013. DOI: 10.1007/s00590-012-1154-1

[36] Imaging study findings in elastofibroma dorsi. Joint Bone Spine. 2004. DOI: 10.1016/j.jbspin.2004.04.006

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[42] Chapter 5 Adhesive Capsulitis, Cartilage Lesions, Nerve Compression Disorders, and Snapping Scapula. 2019.

[43] Pseudo-Winging of the Scapula Caused by Scapular Osteochondroma: Review of Literature and Case Report. HAND. 2014. DOI: 10.1007/s11552-014-9659-1

[46] A Cadaveric Model Evaluating the Influence of Bony Anatomy and the Effectiveness of Partial Scapulectomy on Decompression of the Scapulothoracic Space in Snapping Scapula Syndrome. The American Journal of Sports Medicine. 2017. DOI: 10.1177/0363546516687755

[47] Significant Association Between Snapping Scapula Syndrome and Anterior Angulation of the Superomedial Scapular Angle. Orthopaedic Journal of Sports Medicine. 2014. DOI: 10.1177/2325967114s00063

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[86] Subscapular elastofibroma: A reactive pseudotumor. Journal of Shoulder and Elbow Surgery. 1996. DOI: 10.1016/s1058-2746(05)80008-4

[90] Snapping scapula: Formation of an erosive, subscapular bursal cyst after partial scapulectomy. Journal of Shoulder and Elbow Surgery. 1993. DOI: 10.1016/1058-2746(93)90078-u

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c. You must comply with the conditions in Section 3(a) if You Share all or a substantial portion of the contents of the database.

For the avoidance of doubt, this Section 4 supplements and does not replace Your obligations under this Public License where the Licensed Rights include other Copyright and Similar Rights.

Section 5 -- Disclaimer of Warranties and Limitation of Liability.

a. UNLESS OTHERWISE SEPARATELY UNDERTAKEN BY THE LICENSOR, TO THE EXTENT POSSIBLE, THE LICENSOR OFFERS THE LICENSED MATERIAL AS-IS AND AS-AVAILABLE, AND MAKES NO REPRESENTATIONS OR WARRANTIES OF ANY KIND CONCERNING THE LICENSED MATERIAL, WHETHER EXPRESS, IMPLIED, STATUTORY, OR OTHER. THIS INCLUDES, WITHOUT LIMITATION, WARRANTIES OF TITLE, MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, NON-INFRINGEMENT, ABSENCE OF LATENT OR OTHER DEFECTS, ACCURACY, OR THE PRESENCE OR ABSENCE OF ERRORS, WHETHER OR NOT KNOWN OR DISCOVERABLE. WHERE DISCLAIMERS OF WARRANTIES ARE NOT ALLOWED IN FULL OR IN PART, THIS DISCLAIMER MAY NOT APPLY TO YOU.

b. TO THE EXTENT POSSIBLE, IN NO EVENT WILL THE LICENSOR BE LIABLE TO YOU ON ANY LEGAL THEORY (INCLUDING, WITHOUT LIMITATION, NEGLIGENCE) OR OTHERWISE FOR ANY DIRECT, SPECIAL, INDIRECT, INCIDENTAL, CONSEQUENTIAL, PUNITIVE, EXEMPLARY, OR OTHER LOSSES, COSTS, EXPENSES, OR DAMAGES ARISING OUT OF THIS PUBLIC LICENSE OR USE OF THE LICENSED MATERIAL, EVEN IF THE LICENSOR HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH LOSSES, COSTS, EXPENSES, OR DAMAGES. WHERE A LIMITATION OF LIABILITY IS NOT ALLOWED IN FULL OR IN PART, THIS LIMITATION MAY NOT APPLY TO YOU.

c. The disclaimer of warranties and limitation of liability provided above shall be interpreted in a manner that, to the extent possible, most closely approximates an absolute disclaimer and waiver of all liability.

Section 6 -- Term and Termination.

a. This Public License applies for the term of the Copyright and Similar Rights licensed here. However, if You fail to comply with this Public License, then Your rights under this Public License terminate automatically.

b. Where Your right to use the Licensed Material has terminated under Section 6(a), it reinstates:

1. automatically as of the date the violation is cured, provided it is cured within 30 days of Your discovery of the violation; or

2. upon express reinstatement by the Licensor.

For the avoidance of doubt, this Section 6(b) does not affect any right the Licensor may have to seek remedies for Your violations of this Public License.

c. For the avoidance of doubt, the Licensor may also offer the Licensed Material under separate terms or conditions or stop distributing the Licensed Material at any time; however, doing so will not terminate this Public License.

d. Sections 1, 5, 6, 7, and 8 survive termination of this Public License.

Section 7 -- Other Terms and Conditions.

a. The Licensor shall not be bound by any additional or different terms or conditions communicated by You unless expressly agreed.

b. Any arrangements, understandings, or agreements regarding the Licensed Material not stated herein are separate from and independent of the terms and conditions of this Public License.

Section 8 -- Interpretation.

a. For the avoidance of doubt, this Public License does not, and shall not be interpreted to, reduce, limit, restrict, or impose conditions on any use of the Licensed Material that could lawfully be made without permission under this Public License.

b. To the extent possible, if any provision of this Public License is deemed unenforceable, it shall be automatically reformed to the minimum extent necessary to make it enforceable. If the provision cannot be reformed, it shall be severed from this Public License without affecting the enforceability of the remaining terms and conditions.

c. No term or condition of this Public License will be waived and no failure to comply consented to unless expressly agreed to by the Licensor.

d. Nothing in this Public License constitutes or may be interpreted as a limitation upon, or waiver of, any privileges and immunities that apply to the Licensor or You, including from the legal processes of any jurisdiction or authority.

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