Prolotherapy for Shoulder Injury – Snapping Scapula Syndrome

Snapping Scapula Syndrome, also known as Scapulocostal Syndrome or Scapulothoracic Syndrome, is characterized by a grating, grinding, popping or snapping sensation of the scapula onto the back side of the ribs or thoracic area of the spine. The condition can be quite painful and is extremely irritating to the patient suffering with it. The normal treatments of NSAIDs, cortisone shots, trigger point injections, physiotherapy, chiropractic care, and surgery often lead to suboptimal results. In our experience, the best chance at cure for the condition is when a patient receives Prolotherapy using the Hackett-Hemwall technique like we do here at Caring Medical.

Traditional medicine’s approach to the causes of snapping scapula syndrome: Traditional medical doctors typically diagnose the cause of snapping scapula as weakness of the serratus anterior muscle. This can cause a winging of the scapula which then can cause snapping. This is typically due to a long thoracic nerve injury which generally improves over time. Try this out: Hold out your hands in front of you with the elbows extended. Have a friend check your shoulders in back of you for a winging of your scapula(e), If no winging is present, then this is not the problem.

The typical physical therapy approach to snapping scapula syndrome, scapulocostal syndrome or scapulothoracic syndrome is to strengthen the serratus anterior muscle and/or put the patient through a scapular stabilization exercise program. While this is helpful (even in conjunction with Prolotherapy) it is rarely curative alone. In our experience, patients frequently require Prolotherapy to be fully cured of this condition.

Caring Medical’s answer to the cause of snapping scapula syndrome: We ask you, “What realistically could cause the scapula to start rubbing against a rib?” Is it likely going to come from an injury to the scapula? We feel that this is quite doubtful yet, almost 100% of the traditional medical treatments are performed to the scapula or the muscles that attach to the scapula. Doctors inject cortisone shots into and around the scapula. Patient get trigger point injections or massage therapy to break up “scar tissue.”  While this approach gives some temporary relief, it is rarely curative, as we end up seeing these patients after they have tried these traditional treatments.  Remember, this condition can be quite painful and is extremely irritating.  Trust me, when people spend a lot of money on therapies that are helpful but not curative (when they thought they were going to be cured) this is also quite irritating! It is our opinion that the best alternative treatment for snapping scapula syndrome is Prolotherapy.

Based on treating many painful shoulders at Caring Medical over the years, the most likely cause of the majority of snapping scapula syndrome, scapulocostal syndrome, and scapulothoracic syndrome is a slipping rib. A rib that is too mobile will surely rub on the under side of the scapula. When the patient receives chiropractic or osteopathic manipulation, the shoulder feels better for awhile, but again the snapping returns. The snapping returns because the ligaments that attach the ribs to the vertebrae (costovertebral ligaments) remain injured. Prolotherapy treatments to these ligaments that are causing the snapping scapula syndrome can cure the condition.

How are rib-vertebrae ligaments injured?  Have you ever coughed hard and felt something “go out?” This is especially common when you are sick with a cold or flu.  Anything that increases intrathoracic pressure like a cough or valsalva maneuver (yes, like during a bowel movement) can cause those ligaments to stretch or tear. Obviously, any trauma to the side of the body or onto/into a rib can also cause injury. We have also seen it caused by open heart surgery or lung surgeries. Any surgery that involve cracking open a rib or the chest can stretch those ligaments. What about pregnancy? If snapping scapula syndrome occurred after pregnancy, then most likely it started as a rib that was too mobile and began rubbing beneath the scapula. During pregnancy, the body produces a lot of the hormone relaxin, which is the hormone that causes ligaments to become lax or stretch so the baby can be delivered vaginally. During the last part of the labor, the mother must do a lot of pushing which can also cause injury to the rib-vertebrae junction. What about sports? Anyone who has experienced receiving a hockey stick or elbow into their sides or their ribs can end up with snapping scapula syndrome. Prolotherapy works very well to correct all of these causes of snapping scapula syndrome.

If you or someone you love has been diagnosed with snapping scapula syndrome, scapulocostal syndrome or scapulothoracic syndrome consider Prolotherapy to the entire shoulder area.

We use Prolotherapy to stimulate the body to repair painful areas. Specifically it involves injections into ligament/bone interfaces to stimulate ligaments to repair.  Ligaments are bands of collagen that provide stability to joints like the rib-vertebrae junction. Prolotherapy to the costovertebral junctions can cure snapping scapula syndrome. A patient in our office is typically seen every four weeks for three to six visits to achieve a full cure.

Ross A. Hauser, M.D
Dr. Hauser the Medical Director of the comprehensive Prolotherapy, PRP, and Bone Marrow Prolotherapy clinic, Caring Medical & Rehabilitation Services in Oak Park, Illinois treating shoulder injuries and other chronic joint pain related injuries. Dr. Hauser is one of the leading experts in the treatment of chronic pain and sports injuries with Prolotherapy.