Clinical Management of Scapulothoracic Bursitis and the Snapping Scapula

Abstract

Context:Symptomatic scapulothoracic bursitis and crepitus are disorders of the scapulothoracic articulation that are often poorly understood. They can be a source of persistent pain and dysfunction in the active overhead throwing athlete. It is important to distinguish between scapulothoracic bursitis and scapulothoracic crepitus. Scapulothoracic bursitis refers to inflammation of the bursae secondary to trauma or overuse owing to sports activities or work. Scapulothoracic crepitus is defined by a grinding, popping, or thumping sound or sensation secondary to abnormal scapulothoracic motion.Evidence Acquisition:This article presents the causes, diagnosis, and management of these shoulder conditions in a manner that is relevant to clinicians, athletic trainers, and physical therapists, and it reviews relevant studies to determine the consensus on nonoperative treatment, as well as open and arthroscopic surgical treatment.Results:The causes of scapulothoracic bursitis and crepitus include direct or indirect trauma, overuse syndromes, glenohumeral joint dysfunction, osseous abnormalities, muscle atrophy or fibrosis, and idiopathic causes. Scapulothoracic bursitis and crepitus remain primarily clinical diagnoses; however, imaging studies or local injections may also be helpful. The initial treatment of scapulothoracic bursitis and scapulothoracic crepitus should be nonoperative. Surgical treatment options include partial scapulectomy or resection of the superomedial angle of the scapula, open bursal resection, and arthroscopic bursectomy. Despite the lack of agreement among orthopaedic surgeons concerning which procedure is best for treating symptomatic scapulothoracic bursitis and crepitus, most reports have demonstrated good to excellent outcomes in a significantly high percentage of patients.Conclusion:Clearly, the best initial approach to these conditions is a nonoperative treatment plan that combines scapular strengthening, postural reeducation, and core strength endurance. The addition of local modalities, nonsteroidal anti- inflammatory drugs, and localized injections may also be helpful. If an appropriate trial of nonoperative management proves unsuccessful, surgical correction can produce good results.

Arthroscopic Scapulothoracic Decompression for Snapping Scapula Syndrome

“…Most patients respond to nonoperative treatment, including activity modification, nonsteroidal anti-inflammatory drugs, physical therapy, and injections of steroids and/ or local anesthetics. 4 For patients who do not respond to conservative measures, surgery is an effective option. 5 The arthroscopic anatomy of the space between the scapula and thoracic wall has been described, and the results of arthroscopic treatment of SSS have been published.…”

Scapulothoracic Anatomy and Snapping Scapula Syndrome

“…One review of 89 cases of scapulothoracic bursitis found that an anatomic abnormality was responsible for symptoms in 43% of the cases [30]. The Luschka Tubercle and excessive anterior angulation of the superior angle of the scapula are examples of skeletal abnormalities.…”

Dev bursite eşlik eden skapulada osteokondrom olgusunun manyetik rezonans görüntüleme bulguları

“…Skapular bursitler sıklıkla hareket ile artan ağrı şikayeti ile başvururlar ve skapulanın hareketi ile sesli ve palpabl krepitasyon olabilir 1 Bursitler genellikle altta yatan inflamatuar veya travmatik nedenlere bağlı olarak görülmektedir. Olgumuzda skapulada kitleye eşlik eden büyük boyutlu bursit olması ayırıcı tanıda malignite de düşünmemize neden oldu.…”