Scapulothoracic anatomy for the arthroscopist

Ruland, L; Ruland, Charles M.; Matthews, Leslie S.

doi:10.1016/0749-8063(95)90088-8

Cited by 75 publications

(73 citation statements)

References 4 publications

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“…[11][12][13] Medial portal entry into the scapulothoracic space should be more than 3 cm from the medial border of the scapula and inferior to the level of the scapular spine to avoid these structures. 6,7,10,[14][15][16] The suprascapular nerve arises from the upper trunk of the brachial plexus and travels with the suprascapular artery to enter the suprascapular notch just medial to the base of the coracoid. 10,14 These structures are at risk with portal placement superior to the scapular spine with the instrumentation oriented toward the coracoid process.…”

Section: Discussionmentioning

confidence: 99%

“…6,7,10,[14][15][16] The suprascapular nerve arises from the upper trunk of the brachial plexus and travels with the suprascapular artery to enter the suprascapular notch just medial to the base of the coracoid. 10,14 These structures are at risk with portal placement superior to the scapular spine with the instrumentation oriented toward the coracoid process. They can also be injured if the bony resection is taken too far laterally.…”

Section: Discussionmentioning

confidence: 99%

“…6,14 Furthermore, when the surgeon is creating the viewing and working portals, blunt trocars must be used and inserted parallel to the ventral surface of the scapula to avoid a perpendicular orientation and overpenetration into the pulmonary thoracic cavity or axillary neurovascular structures. 10,14,15,17 When both the working and viewing portals are placed inferior to the spine and medial to the medial border of the scapula, their proximity and the depth of penetration required through the rhomboid muscles makes the superomedial corner difficult to access. 10 The superior Bell portal described by Chan et al 10 is located at the junction of the medial and middle thirds from a line connecting the superior angle of the scapula medially and the outer aspect of the acromion laterally.…”

Section: Discussionmentioning

confidence: 99%

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Arthroscopic Scapulothoracic Decompression for Snapping Scapula Syndrome

Saper

Kasik

Dietzel

2015

Arthroscopy Techniques

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Snapping scapula syndrome at the superomedial corner of the scapula can lead to significant shoulder dysfunction. Bursectomy with or without partial scapulectomy is currently the most beneficial primary method of treatment in patients in whom nonoperative therapy fails. Arthroscopic access to the scapulothoracic space is simple and reproducible with the technique described in this report. The bursal tissue can be cleared, optimizing visualization of the scapulothoracic space and the anatomic structures. Arthroscopic decompression of the scapulothoracic bursa and resection of the superomedial corner of the scapula are highlighted in a video example.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Arthroscopic Scapulothoracic Decompression for Snapping Scapula Syndrome

Saper

Kasik

Dietzel

2015

Arthroscopy Techniques

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“…Moreover, the proximity to the chest wall, apical pleura, and several neurovascular structures makes endoscopic exploration challenging. 8,9 The purpose of this report is to describe a step-by-step technique for safe scapulothoracic endoscopy using standard anatomic landmarks to guide dissection. The technique involves 2 portals for access to 2 scapulothoracic spaces (superomedial and subspinous), and the decompression procedure is subdivided into 4 stages (superomedial bursectomy, subspinous adhesiolysis, tuberoplasty, and scapuloplasty).…”

mentioning

confidence: 99%

“…8,9 The inferior scapular portal is placed 4 mm below the scapular spine and 2 to 3 cm medial to the medial scapular border. The arthroscope sheath with a blunt obturator is angled slightly inferiorly and perpendicular to the medial scapular border and is passed into the infraserratus subspinous space.…”

mentioning

confidence: 99%

Scapulothoracic Endoscopy for the Painful Snapping Scapula: Endoscopic Anatomy and Scapuloplasty Technique

Bhatia

2015

Arthroscopy Techniques

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Chronic painful snapping scapula is characterized by inflammation and scarring of 1 or more bursae in the infraserratus space and is often refractory to conservative treatment. Surgical treatment involves excision of the bursae, as well as partial scapulectomy of the superomedial impinging region; both open and endoscopic approaches have been described with good results. Scapulothoracic endoscopy is technically difficult, and the potential complications can be serious. This report describes an endoscopic approach that can be performed with only 2 medial parascapular portals for visualization and instrumentation. The endoscopic anatomy of the infraserratus space is revisited, and 3 anatomic landmarks (serratus anterior, subspinous bursal curtain, and superomedial bony angle) are identified for safe dissection and intraoperative orientation. The surgical field is subdivided into 3 anatomic zones (superomedial space, subspinous space, and scapular bony angle), and the anatomic boundaries of these zones are demonstrated. The decompression procedure is subdivided into 4 stages (superomedial bursectomy, subspinous adhesiolysis, tuberoplasty, and scapuloplasty), and a measured resection technique for scapuloplasty is performed. The use of newer motorized rasps permits optimal bony resection, and additional portals are unnecessary. Overall, the step-by-step technique provides a methodical approach for safety, reproducibility, and optimization of the procedure.T he painful snapping scapula is a chronic disabling disorder of the scapulothoracic articulation and is characterized by painful crepitus and scapular dyskinesia. Structural and postural abnormalities predispose to development of adhesions and bursitis in the subspinous and superomedial infraserratus regions of the scapula. Structural bony abnormalities described in the literature include the Luschka tubercle and aberrant muscle attachments; in addition, an association between bony scapular morphology and snapping scapula has been suggested. 1-3 Failure of conservative treatment and the presence of an identifiable structural causative lesion are indications for surgical decompression. 4 Endoscopic-assisted and all-endoscopic scapulothoracic bursectomy with or without partial scapular resection has been described and is successful in approximately two-thirds of patients. [5][6][7] However, scapulothoracic endoscopy is technically difficult, and this is attributable to lack of a potentially distensible space, as well as the paucity of intraoperative anatomic landmarks for endoscopic orientation. Moreover, the proximity to the chest wall, apical pleura, and several neurovascular structures makes endoscopic exploration challenging. 8,9 The purpose of this report is to describe a step-by-step technique for safe scapulothoracic endoscopy using standard anatomic landmarks to guide dissection. The technique involves 2 portals for access to 2 scapulothoracic spaces (superomedial and subspinous), and the decompression procedure is subdivided into 4 stages (superom...

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Scapulothoracic Endoscopy: Anatomic, Clinical, and Surgical Perspectives

Matthews¹,

Yurkofsky²

2001

Advanced Arthroscopy

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Scapulothoracic anatomy for the arthroscopist

Cited by 75 publications

References 4 publications

Arthroscopic Scapulothoracic Decompression for Snapping Scapula Syndrome

Arthroscopic Scapulothoracic Decompression for Snapping Scapula Syndrome

Scapulothoracic Endoscopy for the Painful Snapping Scapula: Endoscopic Anatomy and Scapuloplasty Technique

Scapulothoracic Endoscopy: Anatomic, Clinical, and Surgical Perspectives

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