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Scapulothoracic Bursitis
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Contents
Other Names
- Subscapular Bursitis
- Scapulothoracic Crepitus
- Snapping Scapula Syndrome
- Scapulocostal Syndrome
- Washboard Syndrome
Background
- This page refers to bursopathies of the Scapulothoracic Joint which is most commonly referred to as scapulothoracic bursitis
Pathophysiology
Etiology
- Carlson et al[1]
- Skeletal abnormalities (43%)
- Idiopathic (30%)
- History of first rib resection (15%)
- Muscle or bursal changes (10%)
- Mccluskey et al: trauma reported in 6 of 9 cases including MVC, fall on outsretched extremity[2]
- Overuse injuries including overhead sports (swimming, throwing, raquet sports)
- Sisto et al: seen in MLB pitchers due to flawed throwing mechanics[3]
- Bony abnormalities
- Muscle pathology
- Includes fibrotic muscle, atrophy, edema and anomalous muscle insertions[6]
- Other soft tissue pathology
- Syphilis or tuberculosis lesions
- Elastofibroma Dorsi
- Structural abnormalities
- Primarily spinal including scoliosis and kyphosis[7]
Pathoanatomy
- Scapulothoracic Joint
- Scapulothoracic muscles (coordinate scapulothoracic motion)
- Scapulohumeral muscles: provide power to the Humerus
- Rotator Cuff (also regulate activities of the Glenohumeral Joint)
- Coracobrachialis
- Deltoid
- Teres Major
- Bursa
- Infraserratus bursa: between Serratus Anterior and chest wall
- Supraserratus bursa: between Subscapularis and serratus anterior
- Minor bursa inconsistently found at
- Superomedial angle of scapula
- Inferior angle of the scapula
- Trapezoid bursa
Risk Factors
- Sports
- Pitching
- Swimming
- Football
- Gymnastics
- Weight training
- Occupations (which?)
- Scoliosis
- Kyphosis
Differential Diagnosis
- Fractures
- Proximal Humerus Fracture
- Humeral Shaft Fracture
- Clavicle Fracture
- Scapula Fracture
- First Rib Fracture (traumatic or atraumatic)
- Dislocations & Separations
- Arthropathies
- Muscle & Tendon Injuries
- Rotator Cuff
- Bursopathies
- Ligament Injuries
- Neuropathies
- Other
- Pediatrics
- Coracoid Avulsion Fracture
- Humeral Head Epiphysiolysis (Little League Shoulder)
Clinical Features
- General: Physical Exam Shoulder
- History
- May endorse a history of overhead or overuse sports
- Often complain of pain with activity
- May report crepitus or crackling with movement of the scapula
- Physical
- Crepitus may be reproducible with range of motion of the scapula
- Tenderness if present is most common at medial border of scapula[8]
- Inspection may reveal scapular winging which suggests a space occupying lesion
- Scapular dyskinesis
Evaluation
- Radiographs
- Standard Radiographs Shoulder
- Often normal, useful to exclude osseus etiologies
- CT
- Useful if physician suspects bony etiology with normal radiographs
- One study used 3-dimensional CT reconstruction of scapula and chest wall found bony abnormalities in 26/26 patients[9]
- MRI
- Useful to evaluate for soft tissue lesions
- Corticosteroid Injection
- Injection of corticosteroid and/or local anesthetic can be used to help confirm diagnosis
- This should be performed with ultrasound or fluoroscopy
- EMG/NCS
- Should be considered if any muscle weakness or atrophy
Classification
- N/A
Management
Nonoperative
- First line therapy in most cases
- Most beneficial if etiology is one of the following
- Soft tissue disorder
- Altered posture
- Scapular dyskinesia
- Scapular winging
- Treatment
- Rest
- Medications including NSAIDS, Acetaminophen
- Activity modification
- Physical Therapy
- Emphasis on periscapular muscles, rotator cuff and posture
- Consider Iontophoresis[10], topical Ethyl Chloride[11]
- Corticosteroid Injection under ultrasound guidance
- Other considerations
- Figure of 8 Splint may help with posture
Operative
- Indications
- Refractory to non-operative management
- Mass or aggressive lesion
- Technique
- Bursectomy
- Resection of osseous lesion
- Resection of scapular border
Rehab and Return to Play
Rehabilitation
- Emphasis on:
- Posture
- Strength
- Endurance
- Addressing postural dysfunction particularly important in patients with kyphsosis, scoliosis or scapular protraction
Return to Play
- Needs to be updated
Complications
- Neurovascular injury
- Pneumothorax
See Also
- Internal
- External
- Sports Medicine Review Shoulder Pain: https://www.sportsmedreview.com/by-joint/shoulder/
References
- ↑ Carlson HL, Haig AJ, Stewart DC. Snapping scapula syndrome: three case reports and an analysis of the literature. Arch Phys Med Rehabil. 1997;78:506-511
- ↑ McCluskey GM, Bigliani LU. Partial scapulectomy for disabling scapulothoracic snapping. Orthop Trans. 1990;14:252-253
- ↑ Sisto DJ, Jobe FW. The operative treatment of scapulothoracic bursitis in professional pitchers. Am J Sports Med. 1986;14:192-194
- ↑ Parsons TA. The snapping scapula and subscapular exostoses. J Bone Joint Surg Br. 1973;55:345-349
- ↑ Steindler A. Traumatic Deformities and Disabilities of the Upper Extremity. Springfield, IL: Charles C Thomas; 1946:112-118
- ↑ Weeks LE. Scapular winging due to serratus anterior avulsion fracture. Orthop Trans. 1993;17:184
- ↑ Pavlick A, Ang K, Coghlan J, Bell S. Arthroscopic treatment of painful snapping of the scapula by using a new superior portal. Arthroscopy. 2003;19:608-612
- ↑ Rose DI, Novak EJ. The painful shoulder: the scapulocostal syndrome in shoulder pain. J Kans Med Soc. 1966;67:112-114
- ↑ Mozes G, Bickels J, Ovadia D, Dekel S. The use of three-dimensional computed tomography in evaluating snapping scapula syndrome. Orthopedics. 1999;22:1029-1033
- ↑ Ciullo JV, Jones E. Subscapular bursitis: conservative and endoscopic treatment of “snapping scapula” or “washboard syndrome.” Orthop Trans. 1992-1993;16:740
- ↑ Percy EC, Birbrager D, Pitt MJ. Snapping scapula: a review of the literature and presentation of 14 patients. Can J Surg. 1988;31:248-250
Created by:
John Kiel on 25 February 2020 18:16:16
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Last edited:
1 October 2022 19:10:50
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