Abstract
Purpose
To evaluate the prognostic value of an ultrasound-guided subscapular local anesthetic
and cortisone injection in a consecutive series of patients who underwent an arthroscopic
superior medial scapuloplasty for snapping scapula syndrome (SSS) and had been refractory
to conservative treatment.
Methods
We undertook an arthroscopic superior medial scapuloplasty on patients with a clinical
diagnosis of SSS who had failed a structured physiotherapy program and had either
gained a good response or no to minimal response to preoperative ultrasound-guided
subscapular local anesthetic and cortisone injection. The patients were assessed preoperatively
and at final follow-up with the QuickDASH and Constant scores, and their pain was
assessed with a visual analog scale (VAS).
Results
Between January 2009 and December 2016, 47 patients were included in the study, with
a minimal follow-up of 2 years. There were 29 female and 18 male patients, and the
mean age at the time of surgery was 27.4 years (range 15 to 61). Forty-two patients
were available at final follow-up. There were 31 patients in the good response group
and 11 patients in the no to minimal response group. For all patients, the mean time
to follow-up was 41.8 months (range 24 to 108). There was a significant improvement
after surgery in the mean QuickDASH score (from 39 to 20, P < .001) (minimal clinically important difference [MCID] 15.91) , Constant score (from
57 to 87, P < .001) (MCID 10.4), and VAS (from 6 to 2, P < .001) (MCID 3). For the good response group, there was a significant improvement
after surgery in the mean QuickDASH score (from 38 to 18, P < .001) (MCID 15.91), the Constant score (from 57 to 89) (MCID 10.4), and the VAS
(from 6 to 2, P < .001) (MCID 3). For the no to minimal response group, there was a significant improvement
after surgery in the mean QuickDASH score (from 42 to 24, P < .01) (MCID 15.91), the Constant score (from 58 to 80, P < .002) (MCID 10.4), and the VAS (from 6 to 2, P < .01) (MCID 3). The difference in postoperative improvement of the QuickDASH and
Constant scores between the good response and the no to minimal response groups was
statistically significant (P < .05).
Conclusion
The results of this study suggest that arthroscopic scapuloplasty can lead to a significant
improvement in pain and function in all patients with a clinical diagnosis of snapping
scapula syndrome refractory to conservative treatment. Patients who gained a good
transient response to a preoperative ultrasound-guided subscapular cortisone injection
obtained a significantly better recovery than those who did not. A preoperative ultrasound-guided
subscapular cortisone injection appeared to be of prognostic value.
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References
- Beitrag zur Genese des Skapularkrachens und der Skapuloargeraushe.Arch Orthop J Unfall Chir. 1927; 24: 610-615
- Arthroscopic treatment of snapping scapula syndrome: Outcomes at minimum of 2 years.Arthroscopy. 2017; 33: 726-732
- The snapping scapula: Diagnosis and treatment.Arthroscopy. 2009; 25: 1298-1311
- Snapping scapula.Arthroscopy. 2010; 26: 299-300
- Nonoperative and operative management of snapping scapula.Am J Sports Med. 2004; 32: 1554-1565
- Arthroscopic mangement of scapulothoracic disorders.in: Miller M.D.C.B. Textbook of Arthroscopy. 3rd ed. Saunders, Philidelphia2004: 277-287
- Symptomatic scapulothoracic crepitus and bursitis.J Am Acad Orthop Surg. 1998; 6: 267-273
- Snapping scapula syndrome: Three case reports and an analysis of the literature.Arch Phys Med Rehabil. 1997; 78: 506-511
- The use of three-dimensional computed tomography in evaluating snapping scapula syndrome.Orthopedics. 1999; 22: 1029-1033
- Arthroscopic management of snapping scapula syndrome improves pain and functional outcomes, although a high rate of residual symptoms has been reported.Knee Surg Sports Traumatol Arthrosc. 2018; 26: 221-239
- Arthroscopic partial resection of the scapula for snapping scapula: A new technique.J Shoulder Elbow Surg. 1999; 8: 53-57
- Arthroscopic management of painful and stiff scapulothoracic articulation.Arthroscopy. 2003; 19: E28
- Scapulothoraic disorders.in: Anders J.W.K. The Athlete’s Shoulder. Churchill Livingstone, New York1994: 305-316
- The outcome of scapulothoracic fusion for painful winging of the scapula in dystrophic and non-dystrophic conditions.J Bone Joint Surg Br. 2012; 94: 1253-1259
- Arthroscopic treatment for snapping scapula: A prospective case series.Eur J Orthop Surg Traumatol. 2014; 24: 159-164
- Arthroscopic treatment of painful snapping of the scapula by using a new superior portal.Arthroscopy. 2003; 19: 608-612
- Scapulothoracic arthroscopy for symptomatic snapping scapula: A prospective cohort study with two-year mean follow-up.Musculoskelet Surg. 2014; 98: 41-47
- Functional outcomes after arthroscopic scapulothoracic bursectomy and partial superomedial angle scapulectomy.Orthop J Sports Med. 2013; 1 (2325967113505739)
- Technique and outcomes of arthroscopic scapulothoracic bursectomy and partial scapulectomy.Arthroscopy. 2012; 28: 1776-1783
- Arthroscopic management of the painful snapping scapula.Arthroscopy. 2006; 22: 755-761
- Association between scapula bony morphology and snapping scapula syndrome.J Shoulder Elbow Surg. 2015; 24: 1289-1295
- A clinical method of functional assessment of the shoulder.Clin Orthop Relat Res. 1987; : 160-164
- The Disabilities of the Arm, Shoulder and Hand (DASH) outcome questionnaire: Longitudinal construct validity and measuring self-rated health change after surgery.BMC Musculoskelet Disord. 2003; 4: 11
- Minimal clinically important difference of the Disabilities of the Arm, Shoulder and Hand outcome measure (DASH) and its shortened version (QuickDASH).J Orthop Sports Phys Ther. 2014; 44: 30-39
- Investigating minimal clinically important difference for Constant score in patients undergoing rotator cuff surgery.J Shoulder Elbow Surg. 2013; 22: 1650-1655
- Clinically important change in the visual analog scale after adequate pain control.Acad Emerg Med. 2003; 10: 1128-1130
- The scaphoid scapula: A frequent anomaly in development of hereditary, clinical and anatomical significance.Med Rec. 1910; 78: 861-873
- Variations in the anatomy of the scapula with reference to the snapping scapula.Clin Orthop Relat Res. 1996; : 111-115
- The superomedial bare area of the costal scapula surface: A possible cause of snapping scapula syndrome.Surg Radiol Anat. 2013; 35: 95-98
- Bony structures related to snapping scapula: Correlation to gender, side and age.Surg Radiol Anat. 2014; 36: 3-9
- An alternative portal for scapulothoracic arthroscopy.J Shoulder Elbow Surg. 2002; 11: 235-238
- Scapulothoracic bursitis and snapping scapula syndrome: A critical review of current evidence.Am J Sports Med. 2015; 43: 236-245
Article info
Publication history
Published online: September 01, 2020
Accepted:
July 15,
2020
Received:
December 8,
2019
See commentary on page 2973Footnotes
The authors report that they have no conflicts of interest in the authorship and publication of this article. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
Identification
Copyright
Crown Copyright © 2020 Published by Elsevier on behalf of the Arthroscopy Association of North America. All rights reserved.
ScienceDirect
Access this article on ScienceDirectLinked Article
- Editorial Commentary: Snapping Scapula Syndrome: Predictors of Outcomes After Arthroscopic TreatmentArthroscopyVol. 36Issue 12
- PreviewSnapping scapula syndrome and scapulothoracic bursitis are rare, often painful or functionally limiting conditions that can present owing to underlying anatomic abnormalities or can be idiopathic in nature. When there are no underlying structural abnormalities, diagnosis can be challenging and frequently patients will present with chronic pain having received multiple diagnostic and treatment modalities with no success. Injections into the scapulothoracic bursa, in conjunction with physical therapy, have been shown to be effective for the patient with snapping scapula syndrome and/or scapulothoracic bursitis, when recognized.
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