Scapulothoracic Arthroscopy: Indications, Review of Literature, and Report of 24 Patients (SS-16)

Abstract

•To evaluate the safety and efficacy of arthroscopy of the scapulothoracic joint with bursectomy and endoscopic resection of the superomedial corner of the scapula with a long term follow-up review. •The scapulothoracic syndrome, also known as the snapping scapula, is a relatively uncommon source of shoulder pain.•This was originally described by Boinet in 1867 and later by Milch (1933) and is generally described as a painful, tactile phenomenon at the superomedial corner of the scapula.•Morse described two categories of conditions that may contribute to snapping scapula. These include changes in the intervening soft tissues between the scapula and the chest wall (including muscle and bursa) and loss of congruity between the anterior scapular surface and the chest wall (Morse et al 1993). •Most patients report resolution of the symptoms with rest, anti-inflammatory medications, and physical therapy.•However, some patients do not improve, and several authors have sought surgical solutions to the problem.•Partial scapulectomy (open) (Morse et al 1993).•Arthroscopically (Harper et al 1999). •Retrospective clinical outcome study •24 patients unresponsive to conservative measures who underwent arthroscopic debridement of the scapulothoracic joint with endoscopic partial resection for treatment of snapping scapula by the senior author between 1993 and 2000.•13 men and 11 women, mean age of 40.2.•Chart review evaluated patients an average of 7.6 years post-operatively.•History of trauma in 11 patients.•Two patients were retired prior to the surgery, and four had Complex Regional Pain Syndrome prior to the surgery.•The patients were interviewed by telephone.•Detailed questionnaire which included the.•Visual Analog pain Score (VAS) (Scored 0-10; 10 indicating the worst possible pain).•ASES shoulder function index (SFI) (Scored 0-100; with 100 indicating excellent results). •The patient was positioned prone with the arm behind the patient.•The viewing portal should be established approximately three fingerbreadths medial to the scapula border just below the level of the scapular spine to avoid the dorsal scapular nerve and artery and accessory nerve.•A working portal is usually established at the midpoint between the scapular spine and the inferior angle of the scapula in a line parallel to the vertebral column and viewing portal. This position allows access to the superior, middle and inferior aspects of the scapula.•An incisor power shaver was used for resection of the underlying superomedial scapular bursal material. A burr or bone cutting device was then used for resection of the bony surface of the scapula at the superomedial aspect until a smooth surface was achieved at the scapulothoracic articulation. •Of the 24 patients, 4 were unavailable for follow up. Of the remaining 20 patients, 3 had bilateral procedures which were assessed as separate procedures for a total of 23 patients.•At final follow up the average VAS was 2.5 of 10 and the average SFI was 73.7 of 100.•16 of 20 could return to their previous work, and all 20 could participate in their previous activities.•22out of 23 patients were considered to have good or excellent results. Overall patient satisfaction with the procedure was high (22 of 23), and there were no complications.•All patients surveyed would recommend the procedure to another patient, and 95% would undergo the procedure again.•By subjective, patient reports, there was a statistically significant improvement in function and a decrease in pain (p<.0001, paired T test). Arthroscopy of the scapulothoracic joint with bursectomy and endoscopic resection of the superomedial scapula is a safe and effective treatment for snapping scapula.