Technique and Outcomes of Arthroscopic Scapulothoracic Bursectomy and Partial Scapulectomy

Arthroscopic Scapulothoracic Decompression for Snapping Scapula Syndrome

“…The obvious advantage of arthroscopic decompression is the less invasive nature of the procedure compared with traditional open techniques that involve more muscle stripping and dissection of muscular attachments. 6 Earlier postoperative rehabilitation and return to full function, faster recovery rates, better cosmetic appearance, and shorter hospital stays have also been reported. [6][7][8][9]15,16,19,20 The morbidity of scapulothoracic access is minimal.…”

“…There was a reduction in pain in all cases, and all patients reported that the procedure was worthwhile. Millett et al 6 reported a retrospective study of 23 shoulders, of which 21 underwent both arthroscopic bursectomy and scapuloplasty whereas the remaining 2 underwent bursectomy alone. At a mean follow-up of 2.5 years, the median American Shoulder and Elbow Surgeons score showed measurable improvement from 53 points preoperatively to 73 points postoperatively.…”

“…[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.…”

“…They can also be injured if the bony resection is taken too far laterally. 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.…”

“…5 The arthroscopic anatomy of the space between the scapula and thoracic wall has been described, and the results of arthroscopic treatment of SSS have been published. [6][7][8][9] The purpose of this report is to describe, in detail, access to the scapulothoracic space and basic principles for arthroscopic decompression of the superomedial scapula.…”