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Our daughter plays fast pitch ball on her high school team. She is the main pitcher but she's developed something they tell us is called snapping scapula. What's the best way to treat this problem?

Athletes involved in repetitive sports that include overhead throwing motions are more susceptible to snapping scapula than anyone else. Scapula refers to the shoulder blade. In this condition, pain and tenderness under and/or around the scapula is accompanied by grinding, snapping, crunching, or popping called crepitus. Crepitus can be felt by the affected person and often heard by others. When crepitus affects the scapula as it moves over the rib cage (thorax), it is referred to as scapulothoracic crepitus or snapping scapula. What can be done to fix the problem? Well, first an examination should be done to find out exactly what's going on. How is the scapula moving over the thorax? Are there obvious alterations in the normal movement patterns and biomechanics? What muscles are too tight, too loose, or weak? Are there any changes in the person's posture that might be contributing to the problem? Clinical testing of motion, mobility, and strength along with imaging studies and possibly electrodiagnostic tests help confirm the diagnosis. The examiner, whether an orthopedic surgeon, sports physician, or physical therapist, will also check to see if the symptoms are really coming from the cervical spine (neck). Once all the information has been collected, a program of nonoperative rehab is the first step. The physical therapist works with the patient to restore normal posture, scapular movement, strength, and endurance. It can take up to six months to create the form and function needed to a return to normal scapulothoracic and scapulohumeral motion. In some cases, the bursa is injected with a steroid to reduce swelling and irritation from the inflammatory process. When conservative (nonoperative) care doesn't solve the problem, then the surgeon gives some thought to operating. The inflamed bursae may be removed or alternately, a portion of the scapula may be cut out. Either one of these procedures takes pressure off the soft tissues that are getting pinched or rubbed against. In a young athlete like your daughter, it may only require a few changes in the way she pitches to correct the underlying cause. Once any postural or muscular problems are addressed, the snapping or other symptoms disappear. Most of the time, the athlete can continue playing while working through the rehab program, so they don't lose any time sitting on the bench.

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