There are many causes of upper back pain, but one problem that often escapes detection is a bursitis problem under the scapula or shoulder blade. Many times this is a source of chronic and episodic flare-up pain that can be disabling from work or sport. The condition may become acute with trauma or an event that aggravates the problem.
Understanding the Problem
The shoulder blade is a triangle shaped bone that is suspended over the rib cage on the back. It only attaches to the skeleton by the acromioclavicular joint of the shoulder. The muscles of the back that attach to the scapula are what holds it in place. The rotator cuff muscles originate from this bone. It is vital in the movement of the upper extremity and the scapula moves with shoulder activity. There are 17 muscles that attach to each scapula. When there are problems with movement of the scapula, pain can ensue.
What are Bursa and What Do They Do?
The bursa are small sacks filled with a slippery fluid that literally greases the movement of tendons or muscles to prevent friction. They vary in size and location. They form in areas of friction and stress to allow freedom of motion without pain. Scapular bursa have been implicated in the cause of upper back pain. The bursa can become acutely inflamed from trauma or gradually become painful from repetition or posture. This has been called scapulocostal bursitis or it has been referred to as, the “snapping scapula syndrome”.
What are the Symptoms of Scapulocostal Bursitis?
Pain is not only in the upper to mid back area, but there are other regions and complaints that can make the diagnosis of this condition problematic. The following are some of the classic complaints:
- Shoulder Pain
- Upper Back Pain when Arising In The Morning
- Burning and Ache in the Scapula Area
- Posterior Arm Pain that does not radiate Below the Elbow
- Anterior Shoulder Pain
- Neck Stiffness
- There are No Neurological Signs
- “Clicking and Popping” noises in the Shoulder
- Sharp Pain on palpation over the Scapulocostal Bursa
- “Winging” of the Scapula
What are the causes of Scapulocostal Bursitis?
There are many potential problems or activities that cause this painful condition. Activities that can contribute to this bursitis:
- Poor Posture – Slumping and Rounded Shoulders
- Prolonged Computer Use
- Not using a headset at work if your job requires a great deal of telephone work
- Doing repetitive activities above shoulder height
- Rotator Cuff Injury
- Direct Trauma to the Scapula
- Sport
- Myofascial trigger points of the shoulder and upper thoracic (mid back) spine
- Arthritis
- Thoracic Outlet
- Plus many more problems and conditions have been implicated
Scapulocostal bursitis is often confused with other medical conditions such as a pinched nerve in the neck. The history and examination process should give the doctor a good foundation to help determine the cause of your upper back pain. One major defining finding with scapulocostal bursitis versus a pinched nerve, is that there are no sensory changes when performing neurological testing of the upper extremity.
How does Chiropractic Care help Scapulocostal Bursitis?
Treatment will be directed to the spine for care of any biomechanical problems that are found. Support adhesive elastic strapping or regular sport tape may be used at the beginning of treatment to reduce movement and put compression over the bursa area to help ease the acute pain. Ice treatment to the area in the acute stages is helpful with pain relief. The use of ultrasound to the bursa area and electrical muscle stimulation (EMS)) to the supporting muscles of the scapula. Mobilization of the scapula may be performed to aid in improving scapular movement. Posture corrections at work, home or other activities of daily living will be discussed. Specific exercises to help maintain motion and add strength to the area will be recommended. Caution is needed as a return of symptoms can be triggered by events that stress or injure the area. Self-care is necessary to help prevent recurrences of this painful problem.
The doctors at Coon Rapids Chiropractic Office have had success in the care and treatment of this condition.