Scapulothoracic crepitus and bursitis of the scapulothoracic articulation are uncommon and poorly understood disorders. Painless crepitus may be physiological, whereas the opposite, a clinically significant bursitis, may occur without crepitus or sound. Scapular noises attributed to crepitus arise from anatomical changes of the soft tissues in the articulation or from bony incongruity. Physical examination may find tenderness over the superomedial border, pseudowinging, sometimes a mild fullness can be palpated with or without audible crepitus. Initial treatment is nonoperative with rest, nonsteroidal anti-inflammatory drugs, activity modification, and shoulder rehabilitation. Nonoperative treatment is quite effective for bursitis secondary to overuse; but surgery, open or arthroscopic, may be warranted if the structural lesions are causing painful crepitus.