Arthroscopic Treatment of Snapping Scapula Syndrome: Outcomes at Minimum of 2 Years

Snapping scapula syndrome (SSS), or scapulothoracic bursitis, is a rare cause of shoulder pain and dysfunction. The scapula plays an important role in the function of the shoulder girdle and upper extremity by providing a stable base for glenohumeral motion.

Unlike most other joints in the body, however, the scapulothoracic joint is inherently incongruent and lacks features such as a synovial lining or cartilaginous inter- face at its articulation. Instead, the anterior scapula glides over the convex thoracic wall with several bursal and soft-tissue planes interposed between the bony surfaces.1 Because the only scapular attachments to the axial skeleton are through the acromioclavicular and sternoclavicular joints, the scapula is stabilized through dynamic control of the periscapular musculature. Any alterations in the normal anatomy or kinematics of the scapula, chest wall, or surrounding tissues can therefore result in pathologic irritation of the subscapular bursa or fibrosis of the bursa, leading to crepitus or snapping of the scapulothoracic joint. Recent literature has suggested that patients with anterior angulation of the medial scapula in the axial plane are at greater risk of having SSS.2 However, it remains unclear if the bony morphology of the scapula affects the patients’ functional outcome. As with other musculoskeletal disorders, it has been postulated that there is also a psychological profile or tendency that is associated with this disorder.

Initial nonoperative treatment is successful in most patients and should include physical therapy, anti-inflammatory medications, and activity modification. Corticosteroid injections can also be used as both a diagnostic and therapeutic modality. For patients who do not respond well to extensive conservative management, surgical intervention may be considered. Since the first description of arthroscopic bursectomy with partial scapulectomy for SSS in 1999 by Harper there have been limited outcome studies. These have reported good to excellent clinical outcomes, although prior data are limited to case reports or small case series.8 More recently, arthroscopic approaches have been developed, allowing for symptomatic bursal debridement and bony resection through a minimally invasive approach. Although technically challenging, arthroscopy offers additional ad- vantages of preservation of muscular attachments, improved cosmetic appearance, and faster recovery times.

Although our knowledge of SSS and associated surgical techniques continues to evolve, there is limited information in the current literature regarding patient- reported outcomes after arthroscopic treatment. The purpose of this study was to investigate clinical outcomes after primary and revision arthroscopic treatment for SSS and identify predictive factors associated with outcomes.

Arthroscopic Treatment of Snapping Scapula Syndrome: Outcomes at Minimum of 2 Years

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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Arthroscopic Treatment of Snapping Scapula Syndrome: Outcomes at Minimum of 2 Years

About the Author: Peter Millett, MD