Scapulothoracic Bursitis and Snapping Scapula Syndrome

To produce smooth shoulder motion, the scapula must glide freely over the posterior thorax. Incongruence between the concave scapula and the convex thoracic wall, which can occur from anatomic predisposition, space-occupying skeletal lesions, fibrotic bursae, muscle imbalance, or a kyphotic posture, can produce painful crepitus and/or bursitis within the scapulothoracic articulation. While some patients are mildly symptomatic, others may complain of severe pain and poor shoulder function even with simple tasks.

The constellation of symptoms surrounding scapulothoracic crepitus or bursitis, commonly known as snapping scapula syndrome, can be classified according to the suspected cause. Excessive anterior angulation of the superomedial scapular angle or abnormal space-occupying lesions within the scapulothoracic space, such as elastofibromas, fibrotic bursae, or other osseous lesions, commonly result in mechanical crepitus. On the other hand, patients with scapular pain without mechanical symptoms are more likely to have symptomatic bursitis as a result of chronic overuse. However, this clear distinction is not commonly seen in clinical practice because mechanical crepitus can lead to symptomatic bursitis, and conversely, symptomatic bursitis can lead to mechanical crepitus. As a result, most patients have symptoms that may resemble both mechanical and nonmechanical origins.

Regardless of the etiology, current data support initial nonoperative management in patients with symptoms characteristic of scapulothoracic crepitus or bursitis. Surgical management is typically indicated after a trial of nonoperative treatment fails to result in symptomatic improvement. However, the thresh-old for early surgical intervention is lowered when an anatomic lesion capable of producing scapular snapping is identified on imaging studies because these patients are more likely to fail nonoperative treatment.

Scapulothoracic bursectomy with or without partial scapulectomy using an open, mini-open, or all-arthroscopic approach can result in considerable improvements in pain and function. However, several outcomes studies have shown that despite these improvements, many patients still suffer from continued pain and disability as evidenced by suboptimal clinical outcomes scores and marginal patient satisfaction ratings. Therefore, the purpose of this article is 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.

Full Article: Scapulothoracic Bursitis and Snapping Scapula Syndrome

Peter Millett, MD

Average rating:

39 reviews

Alexandra Thompson

Mar 23, 2024

by Alexandra Thompson on Peter Millett, MD

110%

Dr. Millett and his team did a SLAP tear repair and bicep tenodesis on my left shoulder. I use my arms as an artist, and love to swim in the ocean, surf, paddle, and telemark ski. So regaining full use of my shoulder and keeping my bicep attached was very important to me. Now, over two years later, my shoulder has the equivalent range of motion as my other arm and as before the injury, and no pain. After the first three months it felt so good and was so strong that - to my horror - I completely forgot my six-month follow-up.

Not only did Dr. Millett and his team make my arm as good as new, but having had the experience of such kindness and expertise throughout the process of surgery and recovery is like an added shoulder superpower.

Thank you Rita, Brooke, Jason, Sarah, Camille, Olivia, Dr. Millett and everyone! And see you soon when my husband comes in for his knee...

Jeff Chandler

Jan 31, 2022

by Jeff Chandler on Peter Millett, MD

Flawless procedure, Easy recovery

Dr. Millet's repaired my knee and tibia, following a botched operation by a different surgeon. That procedure was virtually pain free and I was weight bearing within a few days. That was 18 years ago and the knee is still strong. A few years after the knee incident, Dr Millet repaired my shoulder. My insurance company approved me for 3 months of disability following that surgery. I was off pain medication in 2 days and had 90% range of motion within a week. I withdrew my disability claim and returned to work within two weeks of surgery. I’m not a famous athlete—just a regular guy. Nonetheless, I was treated like an NFL at the Steadman clinic. Most notable was the time for recovery. Other surgeons perform their hour-long task in the OR and don’t involve themselves in the other functions. Peter and his team manages the entire process from diagnosis, anesthesia, nursing care, and therapy. He takes a holistic approach to patient care and doesn’t skip any steps.

Jenn West

Jul 2, 2021

by Jenn West on Peter Millett, MD

Saved My Life

I went to Dr. Millett after 7 knee surgeries (6 on my right and 1 on my left) and had seen 11 different surgeons who all refused to remove femur metal from my right leg. I am highly allergic to metal and the chronic pain was leaving me bedridden for 3.5wks out of a month. He personally wrote me back on my inquiry, listened to my concerns, scheduled my surgery within a week (due to insurance issues) and personally followed up with my recovery. The level of patient care from Dr. Millett and his ENTIRE team is above any care I have ever received in my 20 years of dealing with orthopedic surgeons. There are not enough words to describe the level of care, dedication and professionalism you receive from Dr. Millett and his staff.
My only disappointment is that I did not find him sooner!!!

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Scapulothoracic Bursitis and Snapping Scapula Syndrome

About the Author: Peter Millett, MD