Arthroscopic Superomedial Angle Resection | Snapping Scapula Syndrome Treatment

This case study shoulder surgeon Dr. Peter Millett demonstrates a technique for arthroscopic bursectomy and superior medial angle resection in a young patient with recalcitrant scapula thoracic bursitis and snapping scapula syndrome that failed a course of conservative treatment.

The scapula thoracic articulation is unique in that it does not rely upon congruent articular surfaces or synovial fluids to produce a fluid shoulder motion. Rather, normal scapular motion depends on the presence and function of saradious anterior and the subscapular muscles in addition to the super spunadious and the infraspuradious bursa.

There are numerous causes of potential causes of snapping scapula syndrome. Patients report debilitating pain most often around the superior medial scapular angle with shoulder elevation. Surgical treatment may be recommended for patients with lesions within the scapular thoracic space, or in those who have failed at least 3 months of conservative treatment.

Arthroscopic superomedial angle resection requires a through understanding of scapula thoracic anatomy to avoid neurovascular injury. Before beginning arthroscopy, the patient is placed prone in the chick wing position. The arthroscopic portals are established. Inflamed bursal tissue beneath the superior medial angle is debrided until the underlying bone is skeletonized. Remaining bursal tissue is removed to provide accurate visualization prior to bony resection. Resection is there performed.

Following post-operative rehabilitation, most patients demonstrate painless use of the operative extremity in the absence of mechanical crepitus. Therefore, arthroscopic superomedial angle resection is a viable treatment option for select patients with snapping scapula syndrome.