Snapping Scapula Syndrome

Snapping scapula syndrome (SSS) is a rare diagnosis but one that can cause severe morbidity. A typical presentation is that of chronic periscapular pain with or without mechanical crepitus. Most commonly, young, active patients who perform repetitive overhead activities are affected. Causes of SSS include chronic overuse, predisposing scapular or thoracic anatomical variants, muscle abnormalities, and bony or soft tissue masses. Computed tomography (CT) and magnetic resonance imaging (MRI) have been shown to be the most useful techniques to diagnose this pathology and guide management. Nonoperative management consists of scapular stabilization, postural exercises, and injections and is considered to be first-line treatment for patients with symptoms of this disorder. If these measures fail, open or endoscopic surgery is indicated. The threshold for surgical intervention may be lower for patients with a primary anatomic variant as a contributor for their symptoms. Irrespective of whether surgery is open or endoscopic, a comprehensive knowledge of the neuroanatomic structures surrounding the scapula is crucial to avoid iatrogenic injury. Postoperative outcomes in the literature thus far have been promising both for operative and nonoperative management approaches; however, these reports are limited by the low prevalence of the condition and resulting small patient cohorts. Higher levels of evidence are necessary to determine the best treatment strategies definitively.