Definition
Disruption of the normal smooth motion of the scapulothoracic joint
- posterior scapula pain with overhead motion
Etiology
1. Bony abnormalities
- osteochondromas
- prominence of the superior medial border of the scapula / Luschka tubercle
2. Soft tissue abnormalities
- bursitis / scar tissue
- muscular weakness
3. Masses
- elastofibroma
- osteosarcome
4. Kyphosis / scoliosis
5. Scapular winging - neurological issues
Anatomy
Scapulothoracic joint
- non cartilaginous
- scapula glides on the muscles of the posterior thoracic wall
- infraserratus, subserratus, and trapezoid bursa
Clinical
Posterior scapula pain with overhead activities
Medial scapula tenderness
Snapping / popping with scapula movement
- examine from the back as patient abducts arm
- see or feel snapping / crepitis
Pain relief with diagnosis local anesthetic + cortisone injections
3D CT
Exclude scapula mass / osteochondroma
Anatomic scapular variations i.e prominent medial scapula border - Luschka tubercle
MRI
Exclude masses / space occupying lesions
Bursitis
Nonoperative management
Physiotherapy
Periscapular strengthening
Local anesthetic + cortisone injections
Chang et al Arch Phys Med 2009
- 22 cases scapulothoracic bursitis treated with cortisone injections
- 3 months of pain relief
Shock wave therapy
- RCT of 43 patients with scapulothoracic bursitis
- cortisone injection v ECSW
- better pain relief with ECSW at 3 and 6 months
Operative management
Options
Excision of masses i.e osteochondroma, elastofibromas
Scapulothoracic arthroscopy - bursectomy and partial scapulectomy
Pectoralis minor release
Scapulothoracic arthroscopy
Technique
Vumedi scapulothoracic arthroscopy and partial scapulectomy video
Vumedi scapulothoracic arthroscopy and partial scapulectomy video 2
Vumedi scapulothoracic arthroscopy and bursectomy video
Patient prone
- arm maximally internally rotated to elevate medial scapula from thoracic wall
- chicken wing position
- 2 portals medial to medial border of scapula
- spinal accessory / dorsal scapula nerve at risk medially
- transverse cervical artery superiorly
- suprascapular nerve and artery laterally
- bursectomy and release of adhesions between scapula and chest wall
- resection of the superior-medial border of scapula
- resect 2 x 2 cm scapula
Results
- 74 patients undergoing arthroscopy for snapping scapula
- 11% failure rate
- mean age 33
- 66 patients with minimum 5 years follow up
- 90% return to sport
- 74% at preinjury level
- 12% revision surgery
Pectoralis minor release
Indication
Scapula protraction
Tight pectoralis minor
Failure nonoperative management
Technique
Arthroscopy techniques arthroscopic pectoralis minor release PDF
Results
- 6 patients undergo mini-open pectoralis minor release
- reduction in scapula protraction
- good result in all patients