Scapular Disorders -Types, Causes, Symptoms, Home Remedies

SCAPULAR DISORDERS

The scapula (also known as shoulder blade) is a triangular shaped bone situated in the upper back. The bone is encircled and supported by a complex system of muscles. These muscles work in tandem to help you move your arm. If an injury or a medical condition weakens or alters the balance of these muscles, the position of the scapula, both at rest and at motion, will also be altered.

As a result of an alteration in scapular positioning or motion, you may find it extremely difficult to move your arm, especially when performing overhead activities, thereby weakening your shoulder. An alteration can cause serious damage if the normal ball-and-socket alignment of your shoulder joint is not maintained. The medical term for these alternations is scapular dyskinesis.

Physiotherapy is the general treatment for scapular disorders, focussing on strengthening the muscles in the shoulder and restoring the proper position and motion of the scapula.

TYPES OF SCAPULAR DISORDERS

Following are the commonly found scapular disorders:
• Winging scapula
• Scapula fractures
• Snapping scapula
• Interscapular pain
• Sprengel’s shoulder/Undescended scapula

MAJOR CAUSES OF SCAPULAR DISORDERS

• Weakness, imbalance, tightness, or detachment of the muscles that control the scapula
• Injuries to the nerves that supply the muscles
• Injuries to the bones that support the scapula or injuries within the shoulder joint

SYMPTOMS OF SCAPULAR DISORDERS

• Pain with or without tenderness around the scapular region, particularly on the top and medial border
• Weakness in the affected arm, the arm may feel “tired” or “dead” when you try to use the it in a vigorous way
• Feeling fatigue with repetitive activities, especially overhead movements
• Limited range of motion, raising the arm above the shoulder height becomes difficult
• A “crunching” or “snapping” sound with shoulder movement
• Noticeable protrusion or “winging” of the scapula
• A drooped or forward tilted posture on the affected side

HOME REMEDIES

Following are some of the simple home remedies with which symptoms of scapular disorders may improve.

Restoring good posture – As you go about doing your day-to-day activities, make sure you are standing and sitting properly. To do this, pull your shoulder blades back together, and bend your elbows down and back as if you are trying to put them in your back pockets.

Proper exercise routine – If you do regular exercise programme make sure you have a balanced upper body strength sessions. It is ideal to include stretching exercises for your front shoulder muscles and for shoulder joint rotation.

Heat therapy – Soaking in a hot bath tub or using a heating pad may help relax tight shoulder muscles.

If your symptoms linger even after the above-mentioned home remedies, it is time to consult your doctor. He/She can help identify the exact cause of your scapular disorder and can chalk out a treatment plan accordingly.

PHYSICAL EXAMINATION

Your doctor will discuss about your overall health, past medical history and ask about the symptoms you have. Following that he/she will conduct a thorough physical examination, looking for injury, pain, weakness or tightness. In general, doctor’s physical exam includes the following sessions:

Visual observation – Your doctor will have a closer look at the infected shoulder from behind, comparing it to the noninvolved shoulder. In order to check if a severe scapular disorder is present you may be asked to move your arms up and down three to five times. This is to reveal any weakness in the muscles and check the disorder pattern.

Manual muscle testing – This involves strength testing of the shoulder and scapular muscles to check if muscle weakening is the reason behind abnormal scapular motion.

IMAGING STUDIES

Imaging studies are not always a standard procedure to arrive at a diagnosis of scapular disorders. However, your doctor may order one, such as an x-ray, computerised tomography (CT) or magnetic resonance imaging (MR), if there is suspicion of a bony abnormality of the scapula or the injury extends to the other part of the shoulder.

NON-SURGICAL TREATMENTS

Generally symptoms of scapular disorders improve with non-surgical treatments which may include:

• Nonsteroidal anti-inflammatory drugs: NSAIDs, such as ibuprofen and naproxen, can help relieve pain and swelling

• Physiotherapy – Your doctor or physiotherapist may set an exercise programme for you that targets the exact cause of the disorder. The objective of the physiotherapy is to strengthen and stabilise the shoulder muscles and stretch the muscles that restrict range of motion

SURGICAL PROCEDURE

If the muscle weakness is out of weakness and tightness, surgery may not be required. However, if the scapular disorder is due to a severe injury to the shoulder, your doctor may resort to performing a surgical procedure to repair and reconstruct injured tissues. Normal scapular motion can be regained through proper rehabilitation after the surgery.

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Q and As Scapular Disorders

What is a scapular retraction test?

The scapular retraction test is done to identify patients with any weakness in their supraspinatus muscle, which is a muscle of the shoulder blade due to scapular dyskinesis. In this test, the scapula is stabilized in a retracted position, and the strength of the supraspinatus muscle is tested.

The neutral retracted scapular position improves the strength of the supraspinatus, allowing it to produce maximum force capacity compared to excessive protracted or retracted scapular positions.

This is also a strengthening movement for the scapular (shoulder blade) and the back of the shoulder. If there is pain with the shoulder joint in the back or a restriction in the front of the shoulder, this is an excellent exercise for improved posture and upper back strength.

2.How long does it take for scapula muscles to heal?

Moderate sprains or strains of the scapular muscles may take as long as six to eight weeks before day-to-day shoulder activities can be resumed. Severe muscle strains or sprains may feel better within four to six weeks, but they need three to five months of rehabilitation before full shoulder activity is resumed.

In cases of scapular winging caused by damage to the serratus anterior nerve sometimes heal on their own within two years. Doctors usually recommend light physical therapy or a brace for several months early during the recovery.

3.How should you sleep with scapular pain?

It is important that a comfortable sleeping position is used otherwise it worsens the scapular pain. Adjusting the sleeping position to the opposite side or to the back or the stomach may help take pressure off an aching shoulder. A pillow can be utilized. Most people change positions in their sleep. So a pillow can be placed in such a way that it will prevent rolling onto the affected shoulder.

One should keep a regular sleep schedule and turn off any TVs, computers, phones, or other screens shortly before bed. It is advised to avoid caffeine, nicotine, and alcohol in the evening. This aids in falling asleep at a suitable hour.

4.Are scapular disorders common among office workers?

There is a statistically higher prevalence of scapular disorders among office workers with neck and scapular complaints. Scapular disorders are associated with abnormal posture and muscle.

Prolonged sitting with abnormal posture, coupled with non-ergonomic chairs elevates the scapular and backache in office workers. It is advised to take periodic breaks to stretch and get some activity. These steps help avoid muscle stiffness and soreness.

5.When is surgery required for a scapular injury?

In cases where nonsurgical treatment options are not providing any relief, doctors may recommend surgery. In addition, scapular injuries caused by trauma are more likely to need surgery. Like scapular winging due to damage to the spinal accessory nerve usually requires surgery. The most common surgical treatments are nerve and muscle transfers. These surgeries involve taking all or part of a nerve or muscle and moving it to another part of the body.