Scapular Disorders: Types, Causes, and Treatment

Introduction:

The scapula is a triangular bone in the upper back. The muscles surrounding and supporting the bone are part of a complicated network. Together, these muscles enable individuals to move their arms. Therefore, the scapula's posture will change at rest and during motion if a medical condition or injury weakens or destabilizes these muscles. For example, one could experience considerable difficulty moving the arm, particularly while engaging in overhead tasks, due to a change in scapular placement or motion, which would weaken the shoulder. In addition, if the usual ball-and-socket alignment of the shoulder joint is altered, significant harm might result. Scapular dyskinesis is the word used by doctors to describe these changes. The primary form of treatment for scapular problems is physiotherapy, which aims to improve shoulder muscle strength and return the scapula to its normal position and range of motion.

What Are the Types of Scapular Disorders?

These are the most typical scapular disorders:

1. Scapula Winging:

When the muscles that maintain the scapula are too weak or paralyzed, the condition known as "winged scapula" (also known as scapula alata) results. Because of this, the scapula's medial or lateral margins extend from the back like wings. The primary causes of this illness are neurological and musculoskeletal. While seeing the patient from behind, scapula changes are typically visible. The shoulder blade's medial (inner) border will be more obvious than the opposite side. As the patient lifts their arm away from the body, this prominence will frequently become more obvious. This is frequently referred to as a "winged" scapula.

2. Scapula Fractures:

Rare shoulder girdle fractures, known as "scapula fractures," are brought on by high-energy trauma and linked to pulmonary damage, brain injury, and higher injury severity ratings. With a sling, treatment is often nonoperative.

3. Scapula Snapping:

An audible or palpable clicking of the scapula during movements of the complex shoulder joint is known as snapping scapula syndrome.

4. Interscapular Discomfort:

Their upper back often hurts between the shoulder blades. This ache is referred to the doctors as interscapular pain.

What Are the Causes of Scapular Disorders?

• The muscles regulating the scapula might be weak, out of balance, tense, or (rarely) detached.
• Damage to the nerves supplying the muscles.
• Accidents involving the shoulder joint or the bones that support the scapula.
• A variation from the normal range, or modification, in the scapula in its normal resting posture or moving usually when the arm moves.

What Are the Symptoms of Scapular Disorders?

• Weakness in the affected arm, the arm may feel "tired" or "dead" when individuals try to use it vigorously.
• Feeling fatigued with repetitive activities, especially overhead movements.
• Limited range of motion, raising the arm above shoulder height becomes difficult.
• With the shoulder, movement comes a snapping sound.
• A scapula that is visibly protruding or "winging."
• A forward-tilted or drooped posture on the afflicted side.

How Are Scapular Disorders Diagnosed?

The doctor will question the patient's symptoms, medical history, and general health. Next, the whole shoulder and scapula will be examined and searched for stiffness, weakness, or injuries. In most circumstances, the physical exam will involve the following:

• Visual Analysis: The doctor will examine the damaged scapula from behind and contrast it with the unaffected side. The doctor could ask people to raise and lower their arms three to five times, often holding modest weights in their hands, to check for scapular dyskinesis. This will often exhibit abnormal motion patterns and reveal any muscular weakness.

• Muscle Testing Is Done Manually: Next, the doctor will undertake strength tests of the shoulder and scapular muscles to evaluate whether muscular weakness contributes to the aberrant scapular motion.

• Corrective Movements: Particular tests entail remedial actions that will assist the doctor in understanding more about the situation. These tests include:

  • Scapular Assistance Test (SAT): In this exam, the doctor will provide light pressure on the scapula to guide it upward as they lift the arm. It is a sign that the muscles are not strong enough to lift the arm if the symptoms improve and the range of motion widens.

  • Test of Scapular Retraction (SRT): The doctor will evaluate overall arm strength by pressing down on the extended arm during this test. After that, they will physically retract the scapula and reassess the strength. Muscle strength will increase in scapular dyskinesis patients when the shoulder blade is retracted.

  • Imaging Tests: The diagnosis of scapular dyskinesis may not necessarily need imaging investigations. However, if the doctor suspects an injury to another region of the shoulder or a bone abnormality of the scapula (such as an osteochondroma), they may request an imaging examination, such as an X-ray, CT scan, or MRI scan.

How Are Scapular Disorders Treated?

• Scapular dyskinesis symptoms will nearly always go better with nonsurgical therapy.

• Nonsurgical treatment may include Nonsteroidal anti-inflammatory drugs (NSAIDs). For example, Ibuprofen and Naproxen are NSAIDs that can help reduce pain and swelling.

• The doctor or physical therapist will provide an exercise program targeting specific causes. Physical therapy usually focuses on enhancing the scapular stabilizing and movable muscle groups and stretching the restricted scapular motion-causing muscles.

• Employ ice massages or ice packs. The use of cold can decrease inflammation and alleviate discomfort. Cold therapy should be used for 15 to 20 minutes every two to three hours for inflammation and discomfort following an accident. Before engaging in stretching and strengthening exercises suggested by a physician, physical therapist, or sports trainer, heat may be used.

• However, if the shoulder joint injury is the root of the disorder, the doctor may conduct surgery to restore the damaged tissues.

• Rehabilitation will come next in order to have the scapula moving normally again.

Conclusion:

The upper back is located in the scapula, or shoulder blade. The posture of the scapula during rest or motion may change if an injury or illness makes these muscles weak or unbalanced. After addressing the underlying reasons for the dyskinesis and restoring normal scapular position and motion, the doctor could suggest a maintenance conditioning program that combines flexibility and strengthening. This is crucial if the profession or leisure hobbies require frequent or forceful shoulder and arm motions. One should perform these exercises three times each week or as the doctor directs.