Working Diagnosis:
Snapping scapula syndrome due to a left scapular enchondroma

Treatment:
Activity modifications, NSAIDs, scapulothoracic stabilization exercises, and intermittent monitoring. She had three ultrasound-guided scapulothoracic bursa injections over a period of 6 months, which provided 100% relief for 1 week after each injection.

Outcome:
After discussion with an orthopedic oncologist, the patient decided to continue with conservative management. She continues to play Division 1 collegiate softball with some pain, which is tolerable. She has returned to full activities.

Author's Comments:
A medial scapular enchondroma is an atypical cause of snapping scapula syndrome. Enchondromas account for approximately 10% of all benign osseous tumors. The most common locations are hands, feet, distal femur, proximal humerus, then tibia. Enchondromas are rare in the scapula, pelvis and ribs; enchondromas in these rare areas should warrant further evaluation for chondrosarcoma.

Editor's Comments:
Snapping scapula syndrome typically manifests as pain located to the superomedial angle and inferior pole of the scapula with overhead motions or repetitive use of the shoulder, often including crepitus. Pain/crepitus may be increased by compression of the superior angle of the scapula against the chest wall during arm abduction, and relieved with cross arm abduction. Scapulothoracic bursitis, scapular dyskinesis from muscle imbalances, or space occupying lesions (especially if asymetry is present) are all possible causes. Conservative management should be sought first and includes correction of muscle length-strength imbalances, postural education, and corticosteroid injections to the bursa. Rarely, surgical correction is pursued.

References:
https://radiopaedia.org/articles/enchondroma
http://orthoinfo.aaos.org/topic.cfm?topic=a00085
http://emedicine.medscape.com/article/389224-overview
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3711706/

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