2015 ISAKOS Biennial Congress ePoster #2107

Long-Term Results Following Scapulothoracic Bursectomy and Bone Resection in the Lateral Decubitus Position for Snapping Scapula Syndrome

Joe Kendal, BSc, Calgary UNITED KINGDOM
Neil Jain, BM, MRCS(Ed), FRCS(Tr&Orth), Manchester UNITED KINGDOM
William Regan, MD FRCSc, Vancouver, British Columbia CANADA
University of British Columbia, Vancouver, British Columbia, CANADA

FDA Status Not Applicable

Summary: The outcomes of scapulothoracic arthroscopic bursectomy for snapping scapula syndrome are unpredictable and unreliable in terms of being able to reliably tell the patient of a good long-term outcome from the surgery.

Abstract:

Introduction

Snapping scapula syndrome is a well-recognised condition causing posterior shoulder pain and disturbance in shoulder function. The mainstay of treatment is non-operative with many patients improving their symptoms with a continued course of physiotherapy. Surgery is indicated in patients with a mechanical cause such as and osteochondroma. For the cases that remain symptomatic in spite of conservative measures surgery may be indicated. Scapulothoracic bursectomy may be performed arthroscopically and may be considered with failure of conservative treatment. In the absence of bony abnormalities bone resection is not always performed. When reviewing the literature this procedure has been described with the patient lying prone and has yielded inconsistent and disappointing results. In our series we present long term follow-up of cases resistant to conservative treatment that underwent surgical intervention involving arthroscopic scapulothoracic bursectomy and bone resection with the patient in the lateral decubitus position.

Methods

Over a 9-year period 12 surgeries were performed in 12 patients. Each involved arthroscopic resection of the scapulothoracic bursa and bony resection of the supero-medial aspect of the scapula. Each patient had attempted at least 12 months non-operative treatment with all having physiotherapy and 38% having an unsuccessful injection of local anaesthetic and steroid. A single surgeon with significant experience of shoulder arthroscopy and shoulder pathology performed the surgery with the patient in the lateral decubitus position. A telephone questionnaire was performed recording an Oxford Shoulder score, SF-12 score and a general question about their general level of satisfaction with their outcome reviewed each patient.

Results

The review comprised 12 cases in 12 patients. The mean follow-up time was 5 years (range 2 to 9 years). The mean age of the patients was 34.6 years (range 23 to 57 years). The mean post-operative Oxford score was 29.8 (range 23 to 42) and the SF-12 score 30.4 (range 27 to 35). 1 patient (8.3%) required repeat surgical intervention with a revision procedure. Regarding subjective improvement, no patient described themselves as being perfect following their surgery with 42% describing some improvement and generally happy that they had the surgery. A further 16% of patients described some improvement and felt the surgery had been worthwhile. Noticeably 42% of the patients described no improvement following the procedure. We observed a trend of worse outcome with increased age although no trend was seen with time post surgery. When asked specifically, 92% of the patients commented upon weakness of internal rotation of the operated shoulder. No patient suffered a complication in terms of infection or injury to his or her dorsal scapular or spinal accessory nerves.

Conclusion

We report the outcomes of the surgery to be unpredictable and unreliable in terms of being able to reliably tell the patient of a good long-term outcome from the surgery. Internal rotation weakness should be expected and with a low long-term satisfaction rate we confirm that this should be a procedure of last resort with patient positioning for the operation having no beneficial effect.