Open Surgical Treatment for Snapping Scapula Provides Durable Pain Relief, but so Does Nonsurgical Treatment

Abstract

Background Resection of the medial upper corner of the scapula is one option for treating patients with a painful chronic snapping scapula. However, the degree to which this procedure results in sustained relief of pain during long-term followup, and whether surgical treatment offers any compelling advantages over nonsurgical approaches at long-term followup, are not known. Questions/purposes We asked: (1) At long-term followup after surgical treatment of a painful snapping scapula, did patients' pain decrease? (2) Did scapulocostal crepitation improve? (3) Did patients return to work? Methods Between 1971 and 1992, 15 patients underwent surgery by one surgeon for persistent ([ 1 year) and severely painful crepitus around the superomedial scapula that did not respond to nonsurgical approaches. The procedure consisted of an open resection of the superomedial corner of the scapula and release of the levator scapulae muscle. Patients treated surgically were compared with a group of nine patients treated nonsurgically between 1975 and 1997; their treatments included temporary physiotherapy, massage, and NSAIDs. In general, the patients treated nonsurgically presented with less pain. However, during much of this study period, objective pain and functional scales were not in common use, and so baseline scores were not available. Of the 15 patients treated surgically, nine participated in a clinical and questionnaire survey at a mean of 22 years (range, 16-35 years), and 12 participated in a questionnaire survey a mean 27 years after surgery (range, 23-43 years). Of the nine patients treated nonsurgically, seven participated in a clinical followup and questionnaire survey at a mean followup of 16 years (range, 10-25 years), and all nine completed a questionnaire survey at a mean of 22 years (range, 17-33 years). Patient age at onset of symptoms was a mean of 27 years. The clinical followup and questionnaires focused on pain, crepitation, and work status.

Diagnosis and Treatment of Snapping Scapula Syndrome: A Scoping Review

“…Nonoperative treatment of SSS can be as effective as surgical options for the majority of patients and underlying etiologies. 24 , 50 In this review, 4 studies (2 CSI and 2 ESWT therapy) found improved VAS scores from a mean of 7.7 ± 0.5 pretreatment to 2.4 ± 0.6 at the latest follow-up, which is comparable to the the 5 operative management studies reporting VAS improvement postoperatively, from a mean of 6.9 ± 0.7 to a mean of 1.9 ± 0.9. 1 , 2 , 7 , 8 , 13 , 23 , 35 , 41 , 47 Notably, this improvement in VAS is greater than the MCID of 3 for both groups.…”

“…Finally, 1 study (24 patients, level 3 evidence) compared open superomedial scapular resection to nonoperative management for milder SSS presentations. 50 The authors concluded no significant difference between operative and nonoperative SSS management outcome in their series, with the operative group presenting with more pain at baseline. Because of the nonrandomized nature of this study and difference in symptom severity of the 2 groups preoperatively, it was cautioned that the study could not definitively conclude that nonoperative management is superior.…”

“…Because of the nonrandomized nature of this study and difference in symptom severity of the 2 groups preoperatively, it was cautioned that the study could not definitively conclude that nonoperative management is superior. 50 …”

“…13,23,[25][26][27]35,41,47 Identification of the underlying etiology for SSS is paramount as anatomic variations in scapular morphology can predispose to SSS, and nonoperative treatment may not be effective in these cases. 50 In 13 cases examined by Lesprit et al, 22 nonoperative treatment was 50% (5 of 10) effective in alleviating idiopathic SSS symptoms. On the other hand, when a skeletal abnormality was identified and treated, surgical treatment with superior angle or osteochondroma resection was reported to have good results in 7 of 8 patients.…”

“…Because of the nonrandomized nature of this study and difference in symptom severity of the 2 groups preoperatively, it was cautioned that the study could not definitively conclude that nonoperative management is superior. 50 DISCUSSION SSS continues to be an underrecognized source of shoulder morbidity. This scoping review summarizes the best available literature on the diagnosis and management of SSS and provides a treatment algorithm for patients with this condition (Figure 2).…”