Arthroscopic treatment for snapping scapula: a prospective case series
Tóm tắt
Painful snapping scapula can be a disabling condition. The object of this prospective study was to assess the efficiency of arthroscopic bone resection of the medial superior corner of scapula, in patients suffering from continuously painful snapping scapula. Twenty patients with painful snapping scapula underwent arthroscopic scapulothoracic bursectomi and resection of the hook formation at the medial superior margin of the scapular. Preoperatively, all patients reported temporary relief via a local anesthetic injection and had completed a 3-month rehabilitation program. The Western Ontario Rotator Cuff index (WORC) was used for the assessment of pain and function levels both pre- and postoperatively. Twenty patients (13 women and 7 men) were included. The mean follow-up was 2.9 years (range 2–5 years). The mean age was 40 years (range 19–68 years). The mean duration of symptoms was 4 years (range 4 months–20 years). Seven previously had arthroscopic operations in the affected shoulder with acromioplasty, with or without acromioclavicular joint resection. The median preoperative WORC score was 35.0 (range 18–74) and significantly increased to 86.4 (range 33–100) postoperatively. Out of 20 patients, 18 improved and 19 indicated that they would undergo the surgery again. In this study, it was found that, among patients troubled by painful snapping scapula and without relief by exercise-based rehabilitation, arthroscopic resection of the medial superior hook formation in combination with partial bursectomy provides a serious gain in respect to the WORC score and is believed to be an effective treatment in most cases. One patient had a serious complication.
Tài liệu tham khảo
Grunfeld G (1927) Beitrag zur Genese des Skapularkrachens und der Skapulargerausche. Arch Orthop J Unfall Chir 24:610–615
Millett PJ, Warner JJP (2006) Management of recalcitrant scapulothoracic bursitis : endoscopic scapulothoracic bursectomy and scapuloplasty. Tech Should Elb Surg 7:200–205
Oizumi N, Suenaga N, Minami A (2004) Snapping scapula caused by abnormal angulation of the superior angle of the scapula. J Should Elb Surg 13:115–118
Riet RPV, Bell SN, Fa FAO (2006) Scapulothoracic arthroscopy. Tech Should Elb Surg 7:143–146
Kibler WB, McMullen J (2003) Scapular dyskinesis and its relation to shoulder pain. J Am Acad Orthop Surg 11:142–151
Manske RC, Reiman MP, Stovak ML (2004) Nonoperative and operative management of snapping scapula. Am J Sports Med 32:1554–1565
Kibler WB, Sciascia AD, Uhl TL, Tambay N, Cunningham T (2008) Electromyographic analysis of specific exercises for scapular control in early phases of shoulder rehabilitation. Am J Sports Med 36:1789–1798
Kuhn JE, Plancher KD, Hawkins RJ (1998) Symptomatic scapulothoracic crepitus and bursitis. J Am Acad Orthop Surg 6:267–273
Kuhne M, Boniquit N, Ghodadra N, Romeo AA, Provencher MT (2009) The snapping scapula: diagnosis and treatment. Arthroscopy 25:1298–1311
Lazar MA, Kwon YW, Rokito AS (2009) Snapping scapula syndrome. J Bone Joint Surg Am 91:2251–2262
Ruland LJ, Ruland CM, Matthews LS (1995) Scapulothoracic anatomy for the arthroscopist. Arthroscopy 11:52–56
Milch H (1961) Snapping scapula. Clin Orthop 20:139–150
Fukunaga S, Futani H, Yoshiya S (2007) Endoscopically assisted resection of a scapular osteochondroma causing snapping scapula syndrome. World J Surg Oncol 5:37
Kibler WB (2010) Snapping scapula. Arthroscopy 26:299–300 (author reply 301)
Provencher MT, Kuhne M, Romeo AA, Ghodadra N, Boniquit N (2010) Author’ s reply. YJARS Elsevier Inc. 26:301
Pavlik A, Ang K, Coghlan J, Bell S (2003) Arthroscopic treatment of painful snapping of the scapula by using a new superior portal. Arthroscopy 19:608–612
Lehtinen JT, Macy JC, Cassinelli E, Warner JJP (2004) The painful scapulothoracic articulation. Clin Orthop Relat Res 423:99–105
Pearse EO, Bruguera J, Massoud SN, Sforza G, Copeland SA, Levy O (2006) Arthroscopic management of the painful snapping scapula. Arthroscopy 22:755–761
Carlson HL, Haig AJ, Stewart DC (1997) Snapping scapula syndrome: three case reports and an analysis of the literature. Arch Phys Med Rehabil 78:506–511
Harper GD, McIlroy S, Bayley JI, Calvert PT (1999) Arthroscopic partial resection of the scapula for snapping scapula: a new technique. J Should Elb Surg 8:53–57
Lesprit E, Hued JCL, Moinard M, Schaeverbeke T, Chauveaux D (2001) Case reports Snapping scapula syndrome : conservative and surgical treatment. Eur J Orthop Surg Traumatol 11:51–54
Lien S-B, Shen P-H, Lee C-H, Lin L-C (2008) The effect of endoscopic bursectomy with mini-open partial scapulectomy on snapping scapula syndrome. J Surg Res 150:236–242
Nicholson GP, Duckworth MA (2002) Scapulothoracic bursectomy for snapping scapula syndrome. J Should Elb Surg 11:80–85
Ermiş MN, Aykut US, Durakbaşa MO, Ozel MS, Bozkuş FS, Karakaş ES (2012) Snapping scapula syndrome caused by subscapular osteochondroma. Eklem Hastalik Cerrahisi 23(1):40–43
Kirkley A, Alvarez C, Griffin S (2003) The development and evaluation of a disease-specific quality-of-life questionnaire for disorders of the rotator cuff: The Western Ontario Rotator Cuff Index. Clin J Sport Med 13:84–92
Chan B-K, Chakrabarti AJ, Bell SN (2002) An alternative portal for scapulothoracic arthroscopy. J Should Elb Surg 11:235–238
Bell SN, van Riet RP (2008) Safe zone for arthroscopic resection of the superomedial scapular border in the treatment of snapping scapula syndrome. J Should Elb Surg 17:647–649
Aggarwal A, Wahee P, Aggarwal AK, Kaur H, Sahni D (2012) Anatomical considerations for safe scapular resection in snapping scapula syndrome. Surg Radiol Anat SRA 34:43–47
Mozes G, Bickels J, Ovadia D, Dekel S (1999) The use of three-dimensional computed tomography in evaluating snapping scapula syndrome. Orthopedics 22:1029–1033