The Painful Scapulothoracic Articulation

Lehtinen, Janne; Macy, J.C.; Cassinelli, Ezequiel H.; Warner, Jon J.P.

doi:10.1097/01.blo.0000128647.38363.8e

Cited by 59 publications

(88 citation statements)

References 17 publications

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“…Although many patients can be treated nonsurgically, some remain so severely symptomatic that they wish to undergo surgery; these patients can be treated with resection of the medial upper corner of the scapula, among numerous other possible surgical approaches [1,12,14,18]. Although there have been numerous studies regarding surgical treatment of a painful snapping scapula [2,6,7,10,11,13,15,20], to our knowledge, there are none that have evaluated patients at long term. We found that at a minimum of 16 years followup, patients treated surgically report little pain, some crepitus (although it usually is painless), and a consistent ability to return to work.…”

Section: Discussionmentioning

confidence: 99%

“…Several studies showed good short-term outcomes after superomedial angle resection [9,10,20]. However, to our knowledge, no long-term outcome reports exist that describe results with or without this surgery.…”

Section: Introductionmentioning

confidence: 93%

“…The condition usually is managed nonsurgically [8], but when symptoms persist, some are treated with surgery [3,4,8,11,13,21,22,24]. Various open surgical [10,15,16,24] or arthroscopic [2,7,9,12,14,19,20] treatments have been described, from a simple [24,25] to a more-substantial resection of almost the entire supraspinatus fossa [8] with associated bursectomy [12] or bursectomy alone [18,20].…”

Section: Introductionmentioning

confidence: 99%

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

Vastamäki

2016

Clinical Orthopaedics &Amp; Related Research

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 93%

Section: Introductionmentioning

confidence: 99%

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

Vastamäki

2016

Clinical Orthopaedics &Amp; Related Research

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“…The amount of bony resection is controversial, and the resection amount ranges between 1 and 7 cm. 12,13 Bell and colleagues [14][15][16] have described a safe zone for arthroscopic resection of the superomedial scapular border and have suggested an alternative superior portal (Bell portal) for bony resection. However, Aggarwal et al 17 have suggested that the suprascapular nerve may be vulnerable in 14% of resections, and Blønd and Rechter 18 have described 1 long thoracic nerve lesion that probably occurred because of trauma from a shaver blade in the superior Bell portal.…”

Section: Discussionmentioning

confidence: 99%

Scapulothoracic Endoscopy for the Painful Snapping Scapula: Endoscopic Anatomy and Scapuloplasty Technique

Bhatia

2015

Arthroscopy Techniques

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Chronic painful snapping scapula is characterized by inflammation and scarring of 1 or more bursae in the infraserratus space and is often refractory to conservative treatment. Surgical treatment involves excision of the bursae, as well as partial scapulectomy of the superomedial impinging region; both open and endoscopic approaches have been described with good results. Scapulothoracic endoscopy is technically difficult, and the potential complications can be serious. This report describes an endoscopic approach that can be performed with only 2 medial parascapular portals for visualization and instrumentation. The endoscopic anatomy of the infraserratus space is revisited, and 3 anatomic landmarks (serratus anterior, subspinous bursal curtain, and superomedial bony angle) are identified for safe dissection and intraoperative orientation. The surgical field is subdivided into 3 anatomic zones (superomedial space, subspinous space, and scapular bony angle), and the anatomic boundaries of these zones are demonstrated. The decompression procedure is subdivided into 4 stages (superomedial bursectomy, subspinous adhesiolysis, tuberoplasty, and scapuloplasty), and a measured resection technique for scapuloplasty is performed. The use of newer motorized rasps permits optimal bony resection, and additional portals are unnecessary. Overall, the step-by-step technique provides a methodical approach for safety, reproducibility, and optimization of the procedure.T he painful snapping scapula is a chronic disabling disorder of the scapulothoracic articulation and is characterized by painful crepitus and scapular dyskinesia. Structural and postural abnormalities predispose to development of adhesions and bursitis in the subspinous and superomedial infraserratus regions of the scapula. Structural bony abnormalities described in the literature include the Luschka tubercle and aberrant muscle attachments; in addition, an association between bony scapular morphology and snapping scapula has been suggested. 1-3 Failure of conservative treatment and the presence of an identifiable structural causative lesion are indications for surgical decompression. 4 Endoscopic-assisted and all-endoscopic scapulothoracic bursectomy with or without partial scapular resection has been described and is successful in approximately two-thirds of patients. [5][6][7] However, scapulothoracic endoscopy is technically difficult, and this is attributable to lack of a potentially distensible space, as well as the paucity of intraoperative anatomic landmarks for endoscopic orientation. Moreover, the proximity to the chest wall, apical pleura, and several neurovascular structures makes endoscopic exploration challenging. 8,9 The purpose of this report is to describe a step-by-step technique for safe scapulothoracic endoscopy using standard anatomic landmarks to guide dissection. The technique involves 2 portals for access to 2 scapulothoracic spaces (superomedial and subspinous), and the decompression procedure is subdivided into 4 stages (superom...

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“…In Milch's case series, he concluded, ''simple removal of portions of the scapula will result in prompt and permanent cure'' [4]. With that admonition, it is not surprising that superomedial corner resections gained popularity for patients with persistent symptoms, and Vastamäki and colleagues quoted several papers [3,5] demonstrating good short-term results.…”

mentioning

confidence: 99%

CORR Insights®: Open Surgical Treatment for Snapping Scapula Provides Durable Pain Relief, but so Does Nonsurgical Treatment

Warme

2016

Clinical Orthopaedics &Amp; Related Research

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The Painful Scapulothoracic Articulation

Cited by 59 publications

References 17 publications

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

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

Scapulothoracic Endoscopy for the Painful Snapping Scapula: Endoscopic Anatomy and Scapuloplasty Technique

CORR Insights®: Open Surgical Treatment for Snapping Scapula Provides Durable Pain Relief, but so Does Nonsurgical Treatment

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