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Scapulothoracic Bursitis

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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
    • Most commonly osteochondroma which can arise from ribs or scapula[4]
    • Can lead to "pseudo-winging" due to lesion mechanically forcing scapula away from chest wall
    • Luschka's tubercle has been implicated[5]
    • Malunion of rib fractures, scapula fractures are known causes
  • Muscle pathology
    • Includes fibrotic muscle, atrophy, edema and anomalous muscle insertions[6]
  • Other soft tissue pathology
  • Structural abnormalities
    • Primarily spinal including scoliosis and kyphosis[7]

Pathoanatomy


Risk Factors

  • Sports
    • Pitching
    • Swimming
    • Football
    • Gymnastics
    • Weight training
  • Occupations (which?)
  • Scoliosis
  • Kyphosis

Differential Diagnosis


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
  • 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

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


See Also


References


  1. 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
  2. McCluskey GM, Bigliani LU. Partial scapulectomy for disabling scapulothoracic snapping. Orthop Trans. 1990;14:252-253
  3. Sisto DJ, Jobe FW. The operative treatment of scapulothoracic bursitis in professional pitchers. Am J Sports Med. 1986;14:192-194
  4. Parsons TA. The snapping scapula and subscapular exostoses. J Bone Joint Surg Br. 1973;55:345-349
  5. Steindler A. Traumatic Deformities and Disabilities of the Upper Extremity. Springfield, IL: Charles C Thomas; 1946:112-118
  6. Weeks LE. Scapular winging due to serratus anterior avulsion fracture. Orthop Trans. 1993;17:184
  7. 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
  8. Rose DI, Novak EJ. The painful shoulder: the scapulocostal syndrome in shoulder pain. J Kans Med Soc. 1966;67:112-114
  9. 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
  10. Ciullo JV, Jones E. Subscapular bursitis: conservative and endoscopic treatment of “snapping scapula” or “washboard syndrome.” Orthop Trans. 1992-1993;16:740
  11. 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
Authors:
Last edited:
13 November 2020 14:02:38
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