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Snapping scapula

51 citationsUpdated Oct 2026
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Overview

Snapping scapula syndrome is the clinical expression of scapulothoracic impingement resulting from mechanical factors and/or muscle imbalance [7]. The condition, also referred to as “washboard syndrome,” is attributed to bony and soft tissue abnormalities, specifically osseous lesions or scapulothoracic bursitis [9, 3]. While rare entities such as osteochondroma of the scapula may present with this syndrome by altering scapulothoracic mechanics [6], the disorder can be debilitating and remains difficult to recognize and treat [2, 3]. Despite recent advances, diagnosis and management continue to present challenges for clinicians [1]. Four-dimensional computed tomography scans facilitate preoperative planning by defining pathology and improving the assessment of the amount and location of scapular bone and soft tissue causing symptoms [18].

Treatment of patients with snapping scapula syndrome begins with nonoperative methods [5]. When nonoperative treatment fails, several surgical options exist [5]. Arthroscopic management is an effective treatment for both primary and revision cases, yielding significant improvements in pain, crepitus, range of motion, and function in a majority of patients [4, 17]. Arthroscopic scapulothoracic treatment provides significant pain relief and functional improvement for symptoms not responding to non-surgical modalities [8]. Specifically, arthroscopic scapuloplasty leads to significant improvement in pain and function in patients refractory to conservative treatment [15]. At a mean follow-up of 3.4 years, arthroscopic treatment resulted in significant improvement in pain and function with high patient satisfaction [14].

Although most patients experience residual symptoms following arthroscopic management [4], specific techniques offer robust outcomes. 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 conservative measures [19]. Arthroscopic resection of the medial superior hook formation in combination with partial bursectomy provided good results with significant gains in the WORC score in 90 % of patients troubled by painful snapping scapula for a long time and without relief by exercise-based rehabilitation [35]. In one case series, at the end of 1 year, all 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]. Individual patient outcomes have also demonstrated sustained relief; one patient remained asymptomatic with full range of motion and no further complaints of pain or snapping at twenty-six months postoperatively [12], while another reported that snapping and pain were completely gone and expressed satisfaction with the results at 2 years 6 months after the operation [13].

Anatomy & Pathophysiology

Etiology and Mechanism

Snapping scapula is the clinical expression of scapulothoracic impingement resulting from mechanical factors and/or muscle imbalance [7]. The condition is attributed to bony and soft tissue abnormalities [9]. Specific pathologies, such as osteochondroma of the scapula, may present with snapping scapula syndrome when they alter scapulothoracic mechanics [6]. Additionally, 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]. Biomechanically, 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].

Morphological variations are associated with the syndrome. 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]. During preoperative planning and the evaluation of scapulothoracic space decompression with partial scapulectomy, the anterior offset of the scapula appeared to be the most important bony parameter to consider [46].

Soft Tissue and Bursal Anatomy

The scapulothoracic articulation is one of the four articulations that work together to allow smooth shoulder function [64]. Normal shoulder motion is approximately two-thirds glenohumeral and one-third scapulothoracic [54]. The subscapular bursa lies between the subscapularis tendon and the neck of the scapula [55]. This bursa communicates with the joint cavity between the superior and middle glenohumeral ligaments [55]. In 28% of dissected specimens, the subscapular bursae merged with the subcoracoid bursae, forming a unique wide bursa in this region [55].

Diagnostic Imaging and Evaluation

Fluoroscopy provides a realtime method of evaluating and documenting abnormal osseous mechanics of the scapulothoracic bursal region [31]. Treatment of pain generated at the superomedial angle of the scapula depends on accurate diagnosis and most frequently relies on treatment of the primary cause of structural problems within the central shoulder [32]. Primary causes of structural problems leading to secondary peripheral periscapular overuse and muscle spasm include pathology of the acromioclavicular joint, glenohumeral joint, or supraspinatus outlet sliding mechanism [32].

Classification

Mauclaire: This system classifies scapulothoracic crepitus into three distinct types based on acoustic characteristics and pathologic significance. Froissement is defined as a gentle friction sound thought to be physiologic. Frottement presents as a louder sound with grating and is usually pathologic, suggesting a soft-tissue lesion or bursitis. Craquement is a loud snapping sound that is always pathologic, indicating an osseous lesion as the source of symptomatic scapulothoracic crepitus [26].

Other Considerations: Scapulothoracic crepitus is not necessarily a pathologic condition; Grünfeld reported finding scapular crepitus in 31% of 100 normal asymptomatic persons [26]. The condition is considered pathologic only if it is truly associated with pain, winging, or other disorders of the scapulothoracic articulation [26]. Snapping scapula is the clinical expression of scapulothoracic impingement due to mechanical factors and/or muscle imbalance [7], attributed to bony and soft tissue abnormalities [9]. Etiologies include rib fractures at the posterior angle [20] and scapulothoracic bursitis associated with ventral scapular osteochondromas, malunion of scapular or rib fractures, traumatic soft-tissue abnormalities, Sprengel’s deformity, developmental abnormalities of the scapular shape, or severe scoliosis with resulting deformity of the chest [48].

Clinical Presentation

Snapping scapula syndrome, also referred to as “washboard syndrome,” is a controversial condition attributed to bony and soft tissue abnormalities [9]. The condition is uncommon and likely underdiagnosed [42]. Scapulothoracic crepitus is not necessarily a pathologic condition, as scapular crepitus was found in 31% of 100 normal asymptomatic persons [26]. Symptomatic scapulothoracic crepitus is considered pathologic when associated with pain, winging, or other disorders of the scapulothoracic articulation [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]. These sounds are amplified by the air-filled thoracic cavity, which acts as a resonating chamber [26].

Scapulothoracic crepitus has been classified into three distinct types: * Froissement: A gentle friction sound, considered physiologic [26]. * Frottement: A louder sound with grating, usually pathologic [26]. * Craquement: A loud snapping sound, always pathologic [26].

Patients often present with decreased athletic performance and increased pain with overhead activities [42]. Snapping scapula can produce severe shoulder pain and dysfunction [24]. Crepitus can be reported 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 the syndrome include bony prominence at the superomedial scapular angle, imbalance of the periscapular muscles, and scapulothoracic bursitis [42].

Investigations

Plain radiography: Standardized plain films are almost always sufficient to garner the information needed for shoulder evaluation [38]. Proper radiographic technique is as important as proper surgical technique to achieve the desired outcome [38]. The first key view is the anteroposterior (AP) in the plane of the scapula, taken so that the x-ray beam passes through the glenohumeral joint [38]. The second key view is the axillary view, taken with the arm in the functional position of elevation in the plane of the scapula; this is referred to as the “truth view” because it demonstrates the glenohumeral relationships in the functional position of elevation [38]. At least two X-ray views should be obtained: an anteroposterior in the plane of the glenoid and an axillary projection with the arm in abduction [68]. Initially, all patients are usually asked to have AP and lateral plain radiographs of the shoulder related to their chief report [75]. The standard shoulder series should include orthogonal views, including a true AP view in the scapular plane, an AP view, an axillary view, and a scapular Y view [76]. The true AP view in the scapular plane visualizes the anterior greater tuberosity in profile [76]. The AP view visualizes the posterior aspect of the greater tuberosity and the lesser tuberosity in profile [76]. The axillary view is necessary in evaluation of glenohumeral joint instability and enables determination of the humeral head position in the glenoid fossa [76]. The scapular Y view provides visualization of the coracoacromial arch and can reveal coracoacromial spurs [76]. It is a reliable alternative for evaluation of glenohumeral subluxation and dislocation [76]. The scapular Y view can show scapular body abnormalities such as osteochondroma or fracture, and acromial shape [76].

MRI: Magnetic resonance imaging (MRI) is useful to identify osteonecrosis of the humeral head, or a bone tumour [68]. MRI can identify labral tears and rotator cuff tears, although the accuracy for these is enhanced by combining the scan with arthrography [68]. MRI is the modality of choice for evaluating the rotator cuff, biceps, and subacromial/subdeltoid bursa [75]. T1-weighted MRI can reveal Hill-Sachs lesions and is often used with magnetic resonance (MR) arthrograms to provide a more detailed picture of the joint surfaces [75]. T2-weighted MRI provides better visualization of full thickness rotator cuff tears [75]. MR arthrography is considered the benchmark for evaluation for labral tears and rarely is indicated for evaluation of rotator cuff pathology [75]. When MRI or MR arthrography is contraindicated, CT arthrography is indicated [75].

CT: Computed tomography (CT) is helpful for planning fracture surgery and shoulder joint replacement [68]. CT imaging is frequently used to evaluate fractures of the shoulder, to assess for bony lesions in recurrent instability cases, or for preoperative templating for shoulder arthritis [75]. CT with three-dimensional reconstructions is the advanced imaging study of choice for determining the extent of glenoid bone loss in the setting of shoulder instability [76]. CT scans have the disadvantage of being taken with the arm in the adducted position [38]. Four-dimensional computed tomography (4D CT) scans facilitate preoperative planning in snapping scapula syndrome [18]. 4D CT scan images defined pathology well in patients with snapping scapula syndrome [18]. 4D CT scans improved the assessment of the amount and location of the scapular bone and soft tissue causing symptoms [18].

Ultrasound: Ultrasound is a simple and accurate test for identifying rotator cuff tears and calcific tendinitis [68]. Ultrasound can be useful in guiding injections or barbotage [68]. Ultrasonography is a low-cost alternative to MRI and arthrography for evaluating both skeletal and soft-tissue structures of the shoulder [75]. Ultrasonography can provide immediate, real-time visualization of the rotator cuff, biceps tendon, and calcific deposits [75]. Ultrasonography can be used to measure the subacromial space and detect atrophy of rotator cuff muscles [75]. Ultrasonography can evaluate impingement in various positions and motions due to real-time imaging [75]. Ultrasonography is highly operator dependent and is not as useful for evaluating labral tears or rotator cuff tears that are very small or larger than 3 cm [75].

Fluoroscopy: Fluoroscopy provides a real-time method of evaluating and documenting abnormal osseous mechanics of the scapulothoracic bursal region [31].

Aspiration: Imaging-guided injections provide an alternative means of diagnosis in cases where direct imaging is usually not successful [48]. The scapulothoracic bursa is located between the serratus anterior and the chest wall [48]. Cadaveric studies indicate that loose areolar tissue may be present in the scapulothoracic space instead of a well-delineated bursa [48]. Cross-sectional imaging was not part of the patient workup in a study population of 20 patients with scapulothoracic bursitis [48].

Arthroscopy: Arthroscopy is useful for diagnosing and treating subacromial impingement, intra-articular lesions, detachment of the glenoid labrum and rotator cuff tears [68].

Other Considerations: The purpose of imaging of the shoulder is to help establish the diagnosis, determine the severity of the pathoanatomy, assist in surgical planning, and enable the surgeon to illustrate the condition of the shoulder to the patient [38]. Unless a specific research protocol is in place, the temptation to “overimage” should be resisted, obtaining only the scans or reconstructions that are necessary for the care of the patient [38]. Scapular crepitus was found in 31% of 100 normal asymptomatic persons [26]. 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]. A mass composed of alternating strands of fatty and fibrous tissue is pathognomonic for elastofibroma dorsi if it is located at the inferior pole of the scapula [36]. Arthrography involves injection of contrast agent in conjunction with either an MRI or CT scan, enhancing imaging of the joint to enable better identification of normal structures and pathology involving the joint surfaces [75]. Planes translated above the reference plane showed consistent differences but still high variability in the influence of scapular orientation on the medial scapula corpus angle, warranting further investigation [22].

Treatment

Non-Operative

Nonsurgical management is the first-line treatment for snapping scapula syndrome and is curative in most cases [29]. Initial therapy includes physical therapy focused on scapular muscle strengthening, nonsteroidal anti-inflammatory medications (NSAIDs), and analgesia [29, 42]. Strengthening weak periscapular muscle groups, combined with simultaneous stretching of contracted muscles and training of antagonistic muscle groups, yields good clinical results [42]. Additional nonsurgical options include local corticosteroid injections, local anesthetic injections, and extracorporeal shockwave therapy [40, 42]. Nonoperative management should be initiated for 3 to 6 months before considering surgical intervention [40]. Surgery is generally recommended only after 6 months of nonsurgical treatment without improvement [42]. Long-term outcomes for nonsurgical treatment are favorable; at a minimum of 16 years follow-up, results were not distinguishable from the surgically treated group [24].

Operative

Indications: Surgical management is indicated for patients who fail conservative therapy, specifically after 6 months of nonsurgical treatment with no improvement [42]. It is also considered after 3 to 6 months of nonoperative management including analgesia, physiotherapy, injections, or shockwave therapy [40].

Surgical Approach / Technique: Operative options include partial scapulectomy and bursectomy, performed via open or arthroscopic approaches [81]. Most authors recommend partial scapulectomy or resection of the superomedial angle of the scapula in patients with scapular crepitus and pain caused by bony incongruity [81]. Arthroscopic bursectomy and partial scapulectomy is a reasonable option for patients failing conservative management, though it is technically demanding and requires an in-depth understanding of the complex anatomy of the scapulothoracic region [23]. Arthroscopic access to the scapulothoracic space is simple and reproducible, with bursal tissue clearance optimizing visualization [25]. Operative time is shorter without scapuloplasty [30].

Outcomes: Arthroscopic management yields improvement in pain, crepitus, and range of motion in a majority of patients; however, most patients experience residual symptoms [4]. 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]. At a minimum of 16 years follow-up, patients treated surgically report little pain, some crepitus (although it usually is painless), and a consistent ability to return to work [24]. In one case, the patient remained asymptomatic with full range of motion and no further complaints of pain or snapping at twenty-six months postoperatively [12].

Complications

Other Considerations: Snapping scapula syndrome is difficult to recognize and treat [3]. Arthroscopic management of snapping scapula syndrome results in most patients experiencing residual symptoms [4]. Arthroscopic bursectomy and partial scapulectomy is technically demanding and requires an in-depth understanding of the complex anatomy of the scapulothoracic region [23].

Recovery

Other Considerations: Most patients experience residual symptoms following arthroscopic management of snapping scapula syndrome [4]. In one reported case, a patient had not suffered recurrent pain in the left shoulder one year after excision [90].

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)
  • [L5] Planes translated above the reference plane showed consistent differences but still high variability, warranting further investigation. [22] (10.1016/j.jseint.2024.08.179)
  • [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)
  • [L4] Treatment of the pain generated at the superomedial angle of the scapula depends on accurate diagnosis and most frequently relies on treatment of the primary cause of structural problems within the central shoulder (A/C joint, glenohumeral joint or supraspinatus outlet sliding mechanism pathology) which leads to secondary peripheral periscapular overuse and muscle spasm. [32] (10.1016/s1058-2746(96)80320-x)
  • [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)
  • [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] The results of this study provide a large safe zone that can maximize the amount of bone that can be resected confidently from the superomedial corner of the scapula. [88] (10.1016/j.jse.2007.12.007)
  • [L5] A year after excision, the patient has not suffered recurrent pain in the left shoulder. [90] (10.1016/1058-2746(93)90078-u)

See Also

References

[1] Snapping Scapula Syndrome: Diagnosis and Management. Journal of the American Academy of Orthopaedic Surgeons. 2013. DOI: 10.5435/jaaos-21-04-214

[2] Technique and Outcomes of Arthroscopic Scapulothoracic Bursectomy and Partial Scapulectomy. Arthroscopy. 2012. DOI: 10.1016/j.arthro.2012.05.889

[3] Scapulothoracic Anatomy and Snapping Scapula Syndrome. Anatomy Research International. 2013. DOI: 10.1155/2013/635628

[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

[5] Nonoperative and Operative Management of Snapping Scapula. The American Journal of Sports Medicine. 2004. DOI: 10.1177/0363546504268790

[6] The unusual osteochondroma: A case of snapping scapula syndrome and review of the literature. Orthopaedics & Traumatology: Surgery & Research. 2017. DOI: 10.1016/j.otsr.2017.01.019

[7] Surgical management of snapping scapula. Journal of Shoulder and Elbow Surgery. 1996. DOI: 10.1016/s1058-2746(96)80466-6

[8] Outcome of Scapulothoracic Arthroscopy for Painful Snapping Scapula. The Open Orthopaedics Journal. 2017. DOI: 10.2174/1874325001711010785

[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

[22] The influence of scapular orientation on the medial scapula corpus angle in snapping scapula syndrome. JSES International. 2025. DOI: 10.1016/j.jseint.2024.08.179

[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

[32] Management of pain at the superomedial angle of the scapula. Journal of Shoulder and Elbow Surgery. 1996. DOI: 10.1016/s1058-2746(96)80320-x

[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

[38] Rockwood And Matsen S The Shoulder. Arthroscopic Management of Prearthritic and Arthritic Conditions of the Shoulder and the Postarthroplasty Shoulder > Radiographic Evaluation.

[40] Diagnosis and Treatment of Snapping Scapula Syndrome: A Scoping Review. Sports Health: A Multidisciplinary Approach. 2021. DOI: 10.1177/19417381211029211

[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

[48] Fluoroscopically Guided Scapulothoracic Injections. American Journal of Roentgenology. 2003. DOI: 10.2214/ajr.181.5.1811232

[53] Rockwood And Green S Fractures In Adults. 29: Principles of Nonunion and Bone Defect Treatment > Applied Anatomy Related to Scapular Fractures.

[54] Aaos Comprehensive Orthopaedic Review 3. Anatomy of the Shoulder, Arm, and Elbow > I. Shoulder.

[55] Rockwood And Matsen S The Shoulder. Developmental Anatomy of the Shoulder and Anatomy of the Glenohumeral Joint > Bursae.

[64] Campbell S Operative Orthopaedics 4 Volume Set. ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION WITH BONE-PATELLAR TENDON-BONE GRAFT > SHOULDER INJURIES > ANATOMY AND BIOMECHANICS.

[68] Apley And Solomon S Concise System Of Orthopaedics And Trauma. INVESTIGATION.

[75] Orthopaedic Knowledge Update 13 Ebook Without Multimedia. Shoulder Anatomy and Biomechanics, Clinical Evaluation, Imaging > Clinical Evaluation > Imaging.

[76] Aaos Comprehensive Orthopaedic Review 3. Imaging of the Shoulder and Elbow > I. Shoulder.

[81] Clinical Management of Scapulothoracic Bursitis and the Snapping Scapula. Sports Health: A Multidisciplinary Approach. 2010. DOI: 10.1177/1941738109338359

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

[88] Safe zone for arthroscopic resection of the superomedial scapular border in the treatment of snapping scapula syndrome. Journal of Shoulder and Elbow Surgery. 2008. DOI: 10.1016/j.jse.2007.12.007

[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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