Partial Scapulectomy Research Articles

Minimum 5-Year Clinical and Return-to-Sport Outcomes After Primary Arthroscopic Scapulothoracic Bursectomy and Partial Scapulectomy for Snapping Scapula Syndrome

Background: Snapping scapula syndrome (SSS) is a rare condition that is oftentimes debilitating. For patients whose symptoms are resistant to nonoperative treatment, arthroscopic surgery may offer relief. Because of the rarity of SSS, reports of clinical outcomes after arthroscopic SSS surgery are primarily limited to small case series and short-term follow-up studies. Purpose: To report minimum 5-year clinical and sport-specific outcomes after arthroscopic bursectomy and partial scapulectomy for SSS and to identify demographic and clinical factors at baseline associated with clinical outcomes at minimum 5-year follow-up. Study Design: Case series; Level of evidence, 4. Methods: Patients who underwent arthroscopic bursectomy and partial scapulectomy for SSS between October 2005 and February 2016 with a minimum of 5 years of postoperative follow-up were enrolled in this single-center study. Clinical outcome scores, including the 12-Item Short Form Health Survey (SF-12), American Shoulder and Elbow Surgeons (ASES) Shoulder Score, shortened version of the Disabilities of the Arm, Shoulder and Hand (QuickDASH) score, Single Assessment Numeric Evaluation (SANE), and visual analog scale (VAS) score for pain, were collected at a minimum 5-year follow-up. Additionally, it was determined which patients reached the minimal clinically important difference. Bivariate analysis was used to determine whether baseline demographic and clinical factors had any association with the outcome scores. Results: Of 81 patients eligible for inclusion in the study, follow-up was obtained for 66 patients (age 33.6 ± 13.3 years; 31 female). At a mean follow-up of 8.9 ± 2.5 years (range, 5.0-15.4 years), all of the outcome scores significantly improved compared with baseline. These included the ASES (from 56.7 ± 14.5 at baseline to 87.2 ± 13.9 at follow-up; P < .001), QuickDASH (from 38.7 ± 17.6 to 13.1 ± 14.6; P < .001), SANE (from 52.4 ± 21.2 to 82.7 ± 19.9; P < .001), SF-12 Physical Component Summary (from 39.7 ± 8.3 to 50.3 ± 8.2; P < .001), SF-12 Mental Component Summary (from 48.2 ± 11.7 to 52.0 ± 9.0; P = 0.014) and VAS pain (from 5.2 ± 2.1 to 1.4 ± 2.0; P < .001). The minimal clinically important difference in the ASES score was reached by 77.6% of the patients. Median postoperative satisfaction was 8 out of 10. It was found that 90.5% of the patients returned to sport, with 73.8% of the patients able to return to their preinjury level. At the time of final follow-up, 8 (12.1%) patients had undergone revision surgery for recurrent SSS symptoms. Older age at surgery (P = .044), lower preoperative SF-12 Mental Component Summary score (P = .008), lower preoperative ASES score (P = .019), and increased preoperative VAS pain score (P = .016) were significantly associated with not achieving a Patient Acceptable Symptom State on the ASES score. Conclusion: Patients undergoing arthroscopic bursectomy and partial scapulectomy for SSS experienced clinically significant improvements in functional scores, pain, and quality of life, which were sustained at a minimum of 5 years and a mean follow-up of 8.9 years postoperatively. Higher patient age, inferior mental health status, increased shoulder pain, and lower ASES scores at baseline were significantly associated with worse postoperative outcomes.

3D-printed glenoid implant reconstruction, after partial scapulectomy for malignant tumors: a case series

PurposeGlenoid tumors are extremely rare, and reconstruction remains very challenging. The aim of this study is to present the clinical and functional outcomes, of a new glenoid reconstruction method using 3-dimensional-printed implant.MethodsFour patients with primary glenoid tumors underwent reconstruction using 3-dimensional-printed glenoid implant linked with reverse shoulder arthroplasty. We retrospectively reviewed the clinical and functional outcome, using MSTS and DASH score, as well as complications’ rate.ResultsWide excision was achieved in all patients. No local recurrence or distant metastasis was diagnosed at the follow-up period. The mean MSTS score was 80.5%, and DASH score was 15.2%. According to Hendersons’ classification, there were no postoperative complications.ConclusionThe use of 3-dimensional-printed implants, can be a very reliable solution with satisfying clinical and functional outcomes for reconstruction, in patients with musculoskeletal malignancies of the glenoid.Level of evidence IV Treatment Study.

Combined Arthroscopic Scapulothoracic Bursectomy, Partial Scapulectomy, and Pectoralis Minor Release for the Treatment of Snapping Scapular Syndrome

Snapping scapula syndrome (SSS) is a source of pain and discomfort in patients. It is not uncommon for patients who present with SSS to have some degree of scapular dysfunction, especially with the tightness of the pectoralis minor (PM) muscle. In this Technical Note, we demonstrate our preferred technique for arthroscopic scapulothoracic bursectomy and partial scapulectomy with concomitant pectoralis minor release for the treatment of symptomatic SSS and PM tightness. In the treatment of these patients, PM release is beneficial because arthroscopic scapulothoracic bursectomy or partial scapulectomy alone may result in residual scapular dyskinesis.

What is the patient acceptance when only scapulectomy is possible in case of malignant tumor? A case series.

Scapulectomy is one of the surgical options in the case of malignant lesions in the scapula with an indication of surgical removal. Very few series in the literature have looked at postoperative quality of life and emotional acceptance, particularly in the case of scapulectomy without reconstruction. The objective is to assess the midterm results of scapulectomies in terms of function, quality of life, and acceptance for the patient. With a mean follow-up of 85 months (range 42 months-180 months), 11 scapulectomies for malignant tumors were performed with a mean age of 50 years: 5 partial scapulectomies, 4 total scapulectomies, and 2 subtotal scapulectomies. There were 6 chondrosarcomas, 2 high-grade osteosarcomas, 1 malignant peripheral nerve sheath tumor, and 1 low-grade atypical epithelioid sarcoma. The radio-clinical analysis was focused on functional results and mental health evaluation. The mean Musculoskeletal Tumor Society score of 11 scapulectomies was 20 ± 5 at 66% of normal, with the Disabilities of the Arm, Shoulder and Hand (DASH) score of 35 ± 26, and the Toronto Extremity Salvage Score of 76%. Patients had controlled pain (mean visual analog scale 1/10). Mobilities of the 11 scapulectomies were correct: average active anterior elevation of 89.5 ± 43 degrees, average abduction of 81 ± 42 degrees, average external rotation of 30 ± 25 degrees, and average internal rotation was at L5. Scapulectomy results in impaired physical and mental health compared with the general population (PCS-12=-9; MCS-12=-7). Partial scapulectomy, compared to total scapulectomy, gave better results: Musculoskeletal Tumor Society score (14±1 vs. 24±1 P=.0175), acceptance (45±9 vs. 92±16, P=.0184), mental health (MCS-12: 29±1 vs. 55±4, P=.0175), and Toronto Extremity Salvage Score (84±5 vs. 68±7, P=.0195). Partial and subtotal scapulectomies were better accepted (45±9 vs. 86±23, P=.0323) and tolerated (MCS-12: 29±1 vs. 52±6, P=.0099) by the patient compared to total scapulectomy. Total or partial scapulectomies without scapula reconstruction remain a disabling procedure performed with consequences on the physical and mental health of the patients. Partial or subtotal scapulectomy should be performed whenever possible because it seems to be associated with a better functional prognosis as well as less poor mental health and emotional acceptance of the patients, even though total scapulectomy may be necessary to obtain a complete curative tumor resection, which is the main goal.

Oncologic and functional outcomes of different reconstruction modalities after resection of chondrosarcoma of the scapula: a medium- to long-term follow-up study

ObjectivesTo evaluate the oncologic and functional results of scapular reconstruction after partial or total scapulectomy for chondrosarcoma.Materials and methodsTwenty-one patients with chondrosarcoma who underwent partial or total scapulectomy between January 2005 and July 2019 were reviewed retrospectively.ResultsAt a mean follow-up of 62.6 months (range, 13–123 months), four patients developed local recurrence, and three developed distant metastases, one of which developed both recurrence and metastasis. The overall survival rate of patients at 5 years was 84.6%, the disease-free survival rate was 69.3%, and the complication rate was 19% (4/21). The 1993 American Musculoskeletal Tumor Society (MSTS93) scores of patients in the partial scapulectomy group, total scapulectomy + humeral suspension group and prosthetic reconstruction group were 26.50 ± 1.38, 19.00 ± 2.58, and 21.38 ± 2.62, respectively. There was a statistically significant difference between the partial scapulectomy group and the total scapulectomy + humeral suspension or prosthetic reconstruction group ( P = 0.006 and 0.0336, respectively). The range of motion of the shoulder joint for forward flexion was 80.83° ± 11.14°, 51.25° ± 21.36°, and 52.50° ± 11.02°, respectively. The p-values for the comparison between the partial scapulectomy group and the total scapulectomy + humeral suspension or prosthetic reconstruction group were 0.0493 and 0.0174, respectively. And the range of motion of abduction was 75.00° ± 10.49°, 32.50° ± 11.90°, 41.88° ± 11.63°, respectively. Patients in the partial scapulectomy group had significantly better postoperative shoulder abduction function than the total scapulectomy + humeral suspension or prosthetic reconstruction group (P = 0.0035 and 0.0304, respectively). There was no significant difference in MSTS93 scores and flexion and abduction function of the shoulder joint in the upper extremity after total scapulectomy with humeral suspension or prosthetic reconstruction (P > 0.05).ConclusionsSurgical treatment of chondrosarcoma of the scapula can achieve a satisfactory prognosis and shoulder function. Total scapulectomy followed by prosthetic reconstruction or humeral suspension are both feasible treatments.

Arthroscopic Treatment of Snapping Scapula Syndrome With Scapulothoracic Bursectomy and Partial Scapulectomy

Snapping scapula syndrome (SSS) is a painful and debilitating condition that occurs as a result of disruption of normal scapulothoracic articulation and inflammation of numerous soft tissue and bursal structures that function to facilitate scapulothoracic motion. Historically, when nonoperative management of SSS failed, patients progressed to open surgical management. However, as arthroscopic techniques have evolved, the condition has been increasingly treated arthroscopically because of the minimally invasive nature, periscapular muscle-preserving approach with decreased risk to surrounding neurovascular structures, better intraoperative visualization, and quicker patient recovery and rehabilitation. The objective of this Technical Note is to describe our arthroscopic approach for the management of SSS using two portals to complete a scapulothoracic bursectomy and partial scapulectomy of the superomedial scapula. Level of Evidence: Level I: shoulder

Diagnosis and Treatment of Snapping Scapula Syndrome: A Scoping Review.

Context:Snapping scapula syndrome (SSS) is commonly misdiagnosed and underreported due to lack of awareness.Objective:This scoping review aims to summarize the current evidence related to SSS diagnosis and treatment to aid clinicians in managing the condition more effectively.Data Sources:PubMed, Medline, and Embase databases were searched for studies related to the etiology, diagnosis, or treatment of SSS (database inception to March 2020).Study Selection:Databases were searched for available studies related to the etiology, diagnosis, or treatment of SSS.Study Design:A scoping review study design was selected to explore the breadth of knowledge in the literature regarding SSS diagnosis and treatment.Level of Evidence:Level 4.Data Extraction:Primary outcomes abstraction included accuracy of diagnostic tests, functional outcomes, and pain relief associated with various nonoperative and operative treatment options for SSS.Results:A total of 1442 references were screened and 40 met the inclusion criteria. Studies commonly reported SSS as a clinical diagnosis and relied heavily on a focused history and physical examination. The most common signs reported were medial scapular border tenderness, crepitus, and audible snapping. Three-dimensional computed tomography had high interrater reliability of 0.972, with a 100% success rate in identifying symptomatic incongruity of the scapular articular surface. Initial nonoperative treatment was reported as successful in most symptomatic patients, with improved visual analogue scale (VAS) scores (7.7 ± 0.5 pretreatment, to 2.4 ± 0.6). Persistently symptomatic patients underwent surgical intervention most commonly involving bursectomy, superomedial angle resection, or partial scapulectomy. High satisfaction rates of surgery were reported in VAS (6.9 ± 0.7 to 1.9 ± 0.9), American Shoulder and Elbow Surgeons scores (50.3 ± 12.2 to 80.6 ± 14.9), and mean simple shoulder test scores (5.6 ± 1.0 to 10.2 ± 1.1).Conclusion:Focused history and physical examination is the most crucial initial step in the diagnostic process, with supplemental imaging used to assess for structural etiologies when nonoperative management fails. Nonoperative management is as effective as surgical management in pain relief and is advised for 3 to 6 months before operative treatment.

Rehabilitation of periscapular malignant soft-tissue tumors after partial scapulectomy, wide resection and split-thickness skin grafting: A case report

Abstract Background: Wide resection of malignant bone and soft-tissue tumors of the extremities may impair the functions of the affected limbs. Partial scaplectomy affects shoulder movements, resulting in disabilities

Malignant tumors of the shoulder girdle: Surgical and functional outcomes.

Large resection and reconstruction of the malignant tumors of the shoulder girdle are used to provide maximum protection of the soft tissues with sufficient surgical margin. However, these have their own difficulties. The goals of this study were to review demographic data of 187 patients diagnosed with the malignant tumors located around shoulder between 2001 and 2016 in our clinic, to evaluate the functional outcomes and surgical outcomes, and to classify the resection methods according to new classification systems. There were 187 patients (108 male and 79 female) and the mean age at surgery was 47.9 (range 2-87). Fifty-one of these patients underwent biopsy only: 8 partial/total claviculectomy, 10 partial/total scapulectomy, 80 proximal humeral resection, 5 total humeral resection, 6 shoulder girdle resection, and 13 amputations. Eighty-six had prosthetic implants, five had fibula transpositions, and one had a massive homologous bone graft. Seventy-one of the 136 patients were followed for an average of 40.3 months. When the bone resections were evaluated, the best results were obtained while the rotator cuff function is preserved in glenoid preserving partial scapulectomy, partial/total claviculectomy, and proximal humerus intercalary resection. In total, scapulectomy and proximal/total humeral resection operations' results were moderate because of partial or total injury of the abductor mechanism. As a result, malignant tumors of the shoulder girdle and soft tissue can be treated with limb-sparing surgery procedures. Reconstructive procedures and reconstructive methods such as prosthetic replacement, auto-allograft, and soft tissue reconstructions should be specified in each case. These resection and reconstruction methods are reliable and applicable procedures for local tumor control, pain control, and functional outcomes. More rarely, amputation/disarticulation can be performed.

Fractures of the scapula

Although scapular fractures only occur infrequently, the anatomical location of the scapula means that it is critical for thoracic limb function, therefore appropriate treatment is essential in maintaining limb function. The scapula has a substantial protective soft tissue envelope and considerable trauma is required to fracture it; consequently a high proportion of patients suffer concurrent injuries that may take precedence for management on initial presentation. Scapular fractures are generally classified as stable extra-articular, unstable extra-articular and intra-articular, with surgical treatment being advised for the latter two categories. Cases for which conservative management is appropriate carry an excellent prognosis, as healing generally occurs quickly and shoulder function is often restored even in cases of malunion. Open reduction and internal fixation is employed for some scapular body and spine fractures, fractures of the acromion, most fractures of the scapular neck, fractures of the supraglenoid tuberosity and fractures of the glenoid. The prognosis following scapular body fracture repair is generally excellent, the prognosis for scapular neck fractures is good to excellent, while the prognosis for articular fractures may be poorer, with the majority of dogs regaining function but with a persistent lameness associated. Salvage options are rarely required following scapular fracture, but include shoulder arthrodesis, excision arthroplasty and partial scapulectomy.

A Cadaveric Model Evaluating the Influence of Bony Anatomy and the Effectiveness of Partial Scapulectomy on Decompression of the Scapulothoracic Space in Snapping Scapula Syndrome

Background: Snapping scapula syndrome (SSS) is caused by bony and/or soft tissue impingement in the scapulothoracic articulation. Surgical resection of the superomedial angle (SMA) plus bursectomy can provide relief in most cases; however, the amount needed to achieve adequate scapulothoracic space decompression (SSD) is unknown. Purpose: The aim of this study was to evaluate the effectiveness of partial scapulectomy and the influence of bony anatomy on SSD. It was hypothesized that the anterior offset and costomedial angle would correlate with the amount of bony resection needed to achieve adequate SSD. Study Design: Controlled laboratory study. Methods: Twenty pairs (n = 40) of shoulder specimens (mean age, 58 years [range, 41-64 years]; 10 male and 10 female specimens) were included. The scapula shape, medial scapula corpus angle (MSCA), anterior offset, and costomedial angle were obtained from computed tomography scans. Specimens were dissected, and each bare bony scapula was rigidly mounted. Points were collected using a 3-dimensional measuring arm. An SMA point and theoretical resection points (incremental 1-cm points up to 3 cm) proceeding laterally and medially were collected. The scapular plane was interpolated using points from the posterior scapular body. The horizontal distances of the anterior offset and each resection point to the scapular plane were calculated. The difference between the native anterior offset and the offset after resection represented the SSD. Adequate SSD was set at 5 mm. One-way analyses of variance and Pearson correlations were used with statistical significance set at P < .05. Results: The maximum SSD with 3-cm resection was significantly correlated with the anterior offset (R = 0.83, P < .001) as well as the costomedial angle (R = −0.43, P = .006) but not the MSCA (R = −0.11, P = .495) or scapula shape (F2,37 = 0.39, P = .681). For the 5 scapulae with an anterior offset of less than 20 mm, a 5-mm SSD was not achieved. For 18 of 30 (60%) scapulae with an anterior offset between 20 mm and 35 mm, 3-cm resection provided at least a 5-mm SSD. For the 5 scapulae with an anterior offset of greater than 35 mm, 2-cm resection resulted in at least a 5-mm SSD in all cases. Conclusion: The anterior offset of the scapula appeared to be the most important bony parameter to consider during preoperative planning and the evaluation of SSD with partial scapulectomy. Clinical Relevance: The results of this study may help surgeons with preoperative planning of surgical decompression of the scapulothoracic space for patients with symptomatic SSS.

Thoracoplasty in the Management of Chronic Empyema: Experience of a Sub Saharan African Country

Introduction: The current main indication of thoracoplasty is empyema following or not lung resection, when the other surgical methods such as thoracic drainage, pleurostomy and/or pulmonary decortication have failed or are not useful. The authors report the role of thoracoplasty in the management of chronic empyema. Method: Between 2004 and 2015, eight male patients underwent thoracoplasty, in the Department of Thoracic Surgery at the University Hospital of Fann, Dakar, Senegal. The mean age was 40 years old. In all cases, the first step of the treatment was thoracic drainage with Heimlich valve in an ambulatory patient, associated with antibiotic according to the result of bacterial culture. In three patients, thoracostomy was indicated to control local infection before thoracoplasty. Results: Indications for thoracoplasty were refractory post resectionnal lung empyema in 6 cases and chronic primary apical empyema in 2 cases. Bronchopleural fistula was found in 5 patients. We performed three superior partial thoracoplasty, and five enlarged thoracoplasty. A myoplasty, using latissimus dorsi to fill the empyema space, was associated with thoracoplasty in five cases. Bronchopleural fistula cure consisted of a direct X form suture in two cases and of intercostal muscle apposition on the fistula in others ones. Partial scapulectomy, by resection of the inferior third part of the scapula was done in three patients. After a mean follow up of one year, no patient presented with persistence or recurrence of empyema. Then we concluded that they were healed. Conclusion: Thoracoplasty is an efficient procedure for the management of chronic empyema. So it is necessary for each team to established define criteria that will allow a patient to undergo thoracoplasty in order to do not use it for any desperate case of refractory chronic empyema.

Two-Year Outcomes following Arthroscopic Treatment for Snapping Scapula Syndrome

Objectives:Snapping scapula syndrome is a rare cause of shoulder pain that can result in significant dysfunction. The purpose of this study was to report clinical outcomes following arthroscopic treatment for snapping scapula syndrome, as well as identify associated risk factors that affect outcomes.Methods:One-hundred patients underwent arthroscopic treatment for snapping scapula syndrome from October 2005 to October 2013. This was an IRB-approved retrospective outcomes study with prospectively collected data. Patients were excluded if they had prior scapula or rib surgeries, or concomitant sternoclavicular or glenohumeral reconstructive procedures. Patients included in this study failed non-operative modalities for mechanical symptoms of snapping scapula and reported symptomatic relief from a local anesthetic injection prior to surgery. Preoperative and postoperative pain and functioning levels were assessed with the American Shoulder and Elbow Surgeons (ASES), QuickDASH (Disabilities of the Arm, Shoulder and Hand), and general health SF-12 including both physical (PCS) and mental (MCS) components. Patient satisfaction was recorded on a 10-point visual analog scale (VAS).Results:There were 86 scapulae in 79 patients that met inclusion criteria. Mean age at time of surgery was 33 years old (range 12-65). A partial scapulectomy and bursectomy was performed in 79 scapulae, with 7 having bursectomy alone. Mean duration from onset of symptoms to surgery was 3.8 years (range 90 days-16.6 years). One patient died in the follow-up period from unrelated causes, and 6 patients refused to participate. Of the remaining 72 scapula, 8/72 (11%) failed and underwent a revision procedure at a mean of 309 days (SD+283 days). Of those that met inclusion criteria and did not require revision surgery, 86% (55/64) returned surveys with a mean follow-up of 3.4 years (range 2-7 years). There was a significant improvement following surgery in SF-12 PCS (p<0.001), SF-12 MCS (p=0.043), ASES (p<0.001), and QuickDASH (p=0.001) scores. Overall, median patient satisfaction was 7 out of 10 (range 1 to 10). Increasing age correlated with decreased postoperative SF-12 PCS (r= -.372;p=0.007), ASES (r= .279;p=0.043), and QuickDASH (r=.350;p=0.011) scores, while gender was not found to be associated with outcomes. A lower preoperative SF-12 MCS score was found to correlate with lower postoperative ASES scores (r=.395;p=0.011), while longer duration of symptoms prior to surgery also correlated with lower postoperative ASES (rho=-.296; p=0.027) and QuickDASH (rho=.315;p=0.019) scores.Conclusion:Arthroscopic surgery is an effective treatment for individuals that have failed conservative management for snapping scapula syndrome, demonstrating significant improvements in all postoperative outcome scores at a mean of 3.4 years. Lower preoperative mental status score, greater age, and longer duration of symptoms prior to surgery were associated with poorer outcomes.

Arthroscopic Partial Scapulectomy for the Treatment of Snapping Scapula

Arthroscopic Partial Scapulectomy for the Treatment of Snapping Scapula

Arthroscopic Scapulothoracic Decompression for Snapping Scapula Syndrome

Snapping scapula syndrome at the superomedial corner of the scapula can lead to significant shoulder dysfunction. Bursectomy with or without partial scapulectomy is currently the most beneficial primary method of treatment in patients in whom nonoperative therapy fails. Arthroscopic access to the scapulothoracic space is simple and reproducible with the technique described in this report. The bursal tissue can be cleared, optimizing visualization of the scapulothoracic space and the anatomic structures. Arthroscopic decompression of the scapulothoracic bursa and resection of the superomedial corner of the scapula are highlighted in a video example.

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

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.

Outcomes After Arthroscopic Scapulothoracic Bursectomy and Partial Superomedial Angle Scapulectomy

Arthroscopic scapulothoracic bursectomy with partial superomedial angle scapulectomy has been described as a surgical treatment for persistent scapulothoracic bursitis with varying results. The purpose of this study was to evaluate patients after arthroscopic scapulothoracic bursectomy and partial scapulectomy utilizing validated functional outcome instruments. 15 patients underwent arthroscopic scapulothoracic bursectomy and partial superomedial angle scapulectomy. 13 of 15 were available for review at an average of 27 months follow-up (range, 13 to 65 months). Patients were evaluated preoperatively and postoperatively with a history, physical exam evaluating medial scapula border tenderness and crepitus, a visual analog scale pain (VAS pain) scale and the Simple Shoulder Test (SST). Postoperatively patients were also evaluated with a yes/no question on satisfaction and the American Shoulder and Elbow Surgeons (ASES) score. SST and VAS pain scores improved by 2.6 (p=0.03) and 4.3 (p<0.001) points. 92% (12 of 13) of patients were satisfied and 92% (12 of 13) stated they would have the surgical procedure performed again. The average ASES postoperative score was 80.1 (range, 38 to 100). The two clinical failures (ASES scores under 50) had either a Workers Compensation claim with persistent medial border tenderness or ongoing rotator cuff disease. The single unsatisfied patient had persistent medial border tenderness and crepitus. Arthroscopic scapulothoracic bursectomy with partial superomedial angle scapulectomy is a reasonable treatment option for scapulothoracic bursitis. Improvements in pain and functional outcome scores are predictable. Poorer outcomes may be observed in patients with ongoing Workers Compensation claims or with concurrent syptomatic shoulder pathology besides scapulothoracic bursitis. Even with poorer scores, patients are often satisfied and would undergo the procedure again.

Interscapulothoracic resection of tumours of shoulder with a note on reconstruction.

We retrospectively reviewed the outcomes of 33 consecutive patients who had undergone an extra-articular, total or partial scapulectomy for a malignant tumour of the shoulder girdle between 1 July 2001 and 30 September 2013. Of these, 26 had tumours which originated in the scapula or the adjacent soft tissue and underwent a classic Tikhoff-Linberg procedure, while seven with tumours arising from the proximal humerus were treated with a modified Tikhoff-Linberg operation. We used a Ligament Advanced Reinforcement System for soft-tissue reconstruction in nine patients, but not in the other 24. The mean Musculoskeletal Tumor Society score (MSTS) was 17.6 (95% confidence interval (CI) 15.9 to 19.4); 17.6 (95% CI 15.5 to 19.6) after the classic Tikhoff-Linberg procedure and 18.1 (95% CI 13.8 to 22.3) after the modified Tikhoff-Linberg procedure. Patients who had undergone a LARS soft-tissue reconstruction had a mean score of 18.6 (95% (CI) 13.9 to 22.4) compared with 17.2 (95% CI 15.5 to 19.0) for those who did not. The Tikhoff-Linberg procedure is a useful method for wide resection of a malignant tumour of the shoulder girdle which helps to preserve hand and elbow function. The method of soft-tissue reconstruction has no effect on functional outcome.

Scapulothoracic Bursitis and Snapping Scapula Syndrome

Background: Symptomatic scapulothoracic disorders, such as painful scapular crepitus and/or bursitis, are uncommon; however, they can produce significant pain and disability in many patients. Purpose: To review the current knowledge pertaining to snapping scapula syndrome and to identify areas of further research that may be helpful to improve clinical outcomes and patient satisfaction. Study Design: Systematic review. Methods: We performed a preliminary search of the PubMed and Embase databases using the search terms “snapping scapula,” “scapulothoracic bursitis,” “partial scapulectomy,” and “superomedial angle resection” in September 2013. All nonreview articles related to the topic of snapping scapula syndrome were included. Results: The search identified a total of 167 unique articles, 81 of which were relevant to the topic of snapping scapula syndrome. There were 36 case series of fewer than 10 patients, 16 technique papers, 11 imaging studies, 9 anatomic studies, and 9 level IV outcomes studies. The level of evidence obtained from this literature search was inadequate to perform a formal systematic review or meta-analysis. Therefore, a critical review of current evidence is presented. Conclusion: Snapping scapula syndrome, a likely underdiagnosed condition, can produce significant shoulder dysfunction in many patients. Because the precise origin is typically unknown, specific treatments that are effective for some patients may not be effective for others. Nevertheless, bursectomy with or without partial scapulectomy is currently the most effective primary method of treatment in patients who fail nonoperative therapy. However, many patients experience continued shoulder disability even after surgical intervention. Future studies should focus on identifying the modifiable factors associated with poor outcomes after operative and nonoperative management for snapping scapula syndrome in an effort to improve clinical outcomes and patient satisfaction.

猫ワクチン関連肉腫に対して根治的切除手術を行った7例

Feline vaccine-associated sarcoma(FVAS)is a locally aggressive tumor with high rates of local recurrence after incomplete excision. Radical tumor excision with 5 cm lateral margins and 2 fascial planes deep to the tumor was performed in 7 cats(median: 11 years old)with FVAS. Three cats had preoperative radiation treatment(RT), and three cats had local recurrence after previous surgeries. The surgical margins were 5-8 cm from the palpable edges of the tumor, and the suture line in the recurrent cases, or from the RT range. Osteotomy of spinous processes(six cases), partial scapulectomy(two cases), and front limb amputation(one case)were also performed. Complete excision as determined by histologic examination of surgical margins was achieved in five cats, and in the remaining two cats, it was suggestive that the deep surgical margins were not adequate. One cat died of nontumor-related causes within 10 days of surgery. Median survival time of the other six cats was 15. 5 months(3-52 months), and five of them had no evidence of local tumor recurrence at the time of death. Radical excision appeared to be a valuable method of attaining improved outcome with a longer survival time without local recurrence in the treatment of FVAS.