Q: Everytime I life my arm up overhead, I get a loud snapping sound and instant pain. It feels like it's coming from my shoulder blade. This is becoming a major problem in my life because I am a lacrosse player on a college scholarship. What can I do to stop this from happening?

A: You may have a problem that involves the scapula (shoulder blade). Without a properly functioning scapula, smooth and coordinated motion and function of the arm is compromised. Problems affecting the scapula that can disrupt the motion and rhythm of arm movement include bursitis, snapping scapula, and tumors (benign or malignant) of the bone or nearby soft tissues.

Snapping scapula syndrome is the most common problem among this group of scapular disorders. As the name suggests, when the arm moves, some portion of the scapula drags against the rib cage causing a snapping sound and sensation. Pain is often (though not always) a main feature associated with this problem. Patients present with a range of severity from mildly irritating to extreme disability. The people affected most often are usually young athletes who (like yourself) are involved in activities requiring repetitive overhead motion.

An understanding of the knowledge we have about this problem is important because surgery doesn't always "fix" the problem. That's why conservative care is recommended first. This approach may include medications and change in activity type/level to reduce inflammation. If these measures don't help, then one to three steroid injections may be tried.

Physiotherapy to address posture and weakness or imbalance in muscle function is a key feature of the nonoperative approach to snapping scapula syndrome. Patients are advised to be patient as the rehabilitation process can take up to six months to be effective. Only when there are tumors or "masses" should surgery be considered sooner. When six months (or more) of conservative care fails to change the clinical picture, then surgery to remove a portion of the bone and/or inflamed bursae may be advised.

The first step is really to get a proper diagnosis. See your student health care provider and describe your symptoms. With a thorough history and physical examination, your health care provider will be able to determine whether imaging studies are needed and order them.

Sometimes a plain X-ray is all that is needed. They may reveal bone spurs or other bony masses. When appropriate, CT scans or MRI may be requested. A final diagnosis may require arthroscopic examination but this is not typically needed. Treatment will depend on the underlying cause of the problem. In most cases, the first step is physiotherapy. The physiotherapist will help you correct any alignment or postural problems contributing to the symptoms. Stretching and strengthening may be important as well. Expect a recovery time between six weeks and six months.

Reference: Trevor Gaskill, MD, and Peter J. Millett, MD, MSc. Snapping Scapula Syndrome: Diagnosis and Management. In Journal of the American Academy of Orthopaedic Surgeons. April 2013. Vol. 21. No. 4. Pp. 214-224.

The Cambridge Physiotherapy provides services for physiotherapy in Cambridge, Galt, and Preston.