Grinding shoulder blade

What it is

The shoulder blade glides over the curved back of the ribcage on a layer of muscle and two bursae. Snapping scapula syndrome is grinding, clunking or snapping during that movement, and it ranges from a harmless noise to a genuinely painful problem.

It becomes painful when the space between the blade and the ribs is compromised - by a thickened, inflamed bursa, by wasting of the muscle that should cushion the blade, or by a bony prominence on the underside of the scapula or the rib. The distinction between noise and pain is what determines whether anything needs doing.

What it feels like

• Grinding, crunching or snapping felt and often heard behind the shoulder blade
• Worst raising and lowering the arm, and reaching overhead
• Aching under and around the inner edge of the shoulder blade
• Sometimes a distinct clunk at one point in the movement
• Often no pain at all, in which case it needs nothing

What causes it

Most people have more than one of these at once, and they feed each other. Read the list looking for the two or three that sound like your week rather than for the one true answer — the ones that describe you are the ones worth acting on.

Bursal thickening and inflammation

The bursae between the scapula and the ribcage can thicken and become inflamed with repeated movement, reducing the smooth gliding and producing both the noise and the pain.

Muscle atrophy

Serratus anterior and subscapularis cushion the blade against the ribs. When they waste, the blade sits closer to the ribcage and grinds rather than glides.

Scapular dyskinesis

A blade that does not move in the right pattern rubs where it should glide. Poor scapular control is both a cause and a consequence of the problem.

A bony prominence

An osteochondroma, a healed rib fracture or an unusually angled upper corner of the scapula can create a genuine mechanical obstruction. This version is more likely to need surgical treatment.

Thoracic kyphosis

A more rounded upper back changes the curvature the blade has to travel over, and it is associated with more grinding.

Repetitive overhead activity

Overhead sport and overhead work move the blade through its full range many times a day, which is what irritates the bursae.

Weak lower trapezius and serratus

Without these the blade winges slightly and sits at a poor angle, which changes where and how it contacts the ribcage.

A previous rib or scapular fracture

Healed with any deformity, it changes the surface the blade travels over and can produce mechanical grinding years later.

Being thin

Less soft tissue between the blade and the ribs means more contact. It is a genuine anatomical factor rather than a moral one.

Who tends to get it

• Overhead athletes - swimmers, throwers, volleyball players
• Anyone doing repetitive overhead work
• People with a rounded upper back or poor scapular control
• Thinner individuals, in whom there is less cushioning
• Anyone with a previous rib or scapular fracture

What makes it worse, and what settles it

The qFIT routine for this

Ready-made routineShoulder Relief & Overhead Range

qFIT already has this one built. It runs massage first, then stretching, then strength — the order that works on a body that is already sore — and every activity in it carries the reason it is there.

The button below opens your Checklist with this routine already selected, so instead of your whole list you land on just its Categories, Targets and Exercises, each with its checkbox, ready to tick as you work through them.

Have more than one problem? Tick yours under My Problems on My Profile and your Checklist's Routine list gains Recommended for my problems — every routine for the problems you picked, merged into one. Your picks stay private; that filter is the only thing they feed.

Get it checked if…

Painless crepitus needs no treatment; a hard bony clunk with pain may need imaging for an osteochondroma

And whatever the body part: chest pain or unusual breathlessness on exertion; a fever alongside the pain; unexplained weight loss; pain that is constant and unrelated to how you move; new numbness, weakness or loss of bladder or bowel control; or one calf that is swollen, warm and painful. Any of those, stop and get assessed.

How it usually goes

Painless grinding needs no treatment and often persists indefinitely without causing a problem. Painful cases improve with scapular strengthening and posture work over eight to twelve weeks in the majority. Where a bony prominence is the cause, surgery is effective and is worth considering if conservative treatment fails. Grinding that appeared after a fracture, or that comes with a palpable lump, is worth imaging.

Prevalence basis: Shoulder clinic series

Others the same routine covers

These share the Shoulder Relief & Overhead Range routine, so the work is the same. If one of them also sounds like you, that is a reason to expect more from it, not less.

This is general information, not a diagnosis, and it cannot examine you. If it matches you, use it to ask better questions of a clinician rather than to replace one.