Abstract
Introduction
Snapping scapula symptoms occur due to disruption of the smooth gliding motion between scapula and thoracic cage. Patients present with pain in the scapulothoracic area aggravated by overhead and repetitive shoulder movements. It is often associated with audible and palpable crepitus, clicking, crunching, grating or snapping sensation. Open or arthroscopic scapulothoracic surgical treatment is an option when non-operative treatment modalities fail. The aim of our study was to assess the outcome of scapulothoracic arthroscopic treatment in patients with painful snapping scapula.
Methods
Eight patients underwent scapulothoracic arthroscopic treatment for painful snapping scapula. Pre-operatively, all these patients had a trial of conservative treatment modalities for at least 6 months, consisting of activity modification, analgesia and physiotherapy for restoration of normal scapulothoracic kinematics. All patients had a temporary pain relief following a local anaesthetic and steroid injection.
We graded the crepitus from 0 to 3 - 0 being no crepitus, 1 being palpable but not audible crepitus, 2 being soft audible crepitus and 3 being loud crepitus.
Operations were performed with the patients in either prone or semi-prone position. The arm was placed in the “chicken wing” position (arm in full internal rotation with the hand placed on the back), so that the scapula lifted up from the chest wall. Two portals along the medial border of scapula were used for arthroscopy and instrumentation. In two cases a superior portal was also used.
Outcome was assessed by pre and postoperative visual analogue score (VAS) and Oxford Shoulder Score. Pre and postoperative scores were compared using paired t-test. The significance level was set at P <. 05.
Results
Of the eight patients included in our study, two were male and six were female patients. Mean age at the time of surgery was 26 years (range 16–34 years). Based on the preoperative clinical and MRI/CT findings and intra-operative arthroscopic findings, five had scapulothoracic bursectomy and 3 had bursectomy and shaving of superomedial border of scapula. Mean follow up was 5 months (Range 2 to 7 months).
VAS score improved significantly from a mean of 9.4 preoperatively to 2.4 (P value .0002). There was also a significant improvement in Oxford Shoulder Score from a mean of 8.7 pre-operatively to 34.7 post operatively (P= .0001). Mean crepitus score significantly decreased from 2.6 to 0.3 (p <.0001). In six patients crepitus completely resolved. In two there was residual palpable crepitus but they had good pain relief. All eight patients were happy with the outcome of their surgery and will recommend this procedure to patients with similar symptoms.
Conclusion
Arthroscopic scapulothoracic treatment provides significant pain relief and functional improvement for painful snapping scapula symptoms not responding to non surgical treatment modalities.
