Technique and Outcomes of Arthroscopic Scapulothoracic Bursectomy and Partial Scapulectomy

Authors:

Peter J Millett, Trevor R Gaskill, Marilee P Horan, Olivier A van der Meijden

Abstract:

The scapulothoracic articulation is a critical component of normal shoulder function. The convex chest wall and concave anterior scapula typically form a congruent articulation that is able to glide smoothly on the interposed muscular and bursal layers. Though uncommon, abnormalities within this articulation can result in pain or mechanical symptoms. These disorders range from mildly symptomatic, intermittent bursitis to recalcitrant crepitus that may result in considerable pain and disability in some circumstances.

Disorders of the scapulothoracic articulation can be characterized based on etiology. When no mechanical symptoms are present, the pain is likely due to an overuse syndrome resulting in symptomatic bursitis. This is frequently seen in young active patients and overhead athletes. By contrast, the presence of mechanical symptoms may indicate the presence of ab- normal bony or soft-tissue morphology within the scapulothoracic articulation. Repeated impingement of these structural irregularities often results in concomitant inflammation, bursitis, and scapular snapping.

Literature supports initial nonoperative management regardless of the etiology of the scapulothoracic pain. It is recognized, however, that bursitis occurring in the absence of an anatomic lesion responds more favorably to nonoperative management than when an anatomic lesion can be identified. When symptoms do not respond to nonsurgical measures or in the presence of structural abnormalities, surgical intervention is often necessary. Open techniques have historically resulted in substantial symptomatic relief. However, release of muscular insertions from the scapula can result in considerable morbidity and may slow rehabilitation.

Recently, arthroscopic techniques have been developed to minimize surgical morbidity, improve cosmesis, and accelerate rehabilitation. An understanding of the arthroscopic anatomy is critical to avoid the numerous neurovascular structures in this area, yet it is unfamiliar to many surgeons. There are also few clinical reports available to gauge the efficacy of an arthroscopic technique. The purpose of this study was to present the surgical outcomes of a large consecutive series of patients with scapulothoracic bursitis and describe an arthroscopic approach to scapulothoracic bursectomy and partial scapulectomy. It was our hypothesis that arthroscopic scapulothoracic bursectomy and partial scapulectomy would result in improved subjective shoulder outcome scores at a minimum of 2 years’ follow-up.

For the complete study: Technique and Outcomes of Arthroscopic Scapulothoracic Bursectomy and Partial Scapulectomy

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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Technique and Outcomes of Arthroscopic Scapulothoracic Bursectomy and Partial Scapulectomy

Authors:

Abstract:

About the Author: Peter Millett, MD