Scapulothoracic bursectomy for snapping scapula syndrome.

Seventeen patients (9 women and 8 men) were prospectively evaluated to determine the results of open scapulothoracic bursectomy in the treatment of unremitting, painful scapular crepitus (snapping scapula syndrome). The mean duration of symptoms was 2 years (range, 4 months-6 years). Twelve related an injury history, and 5 had insidious onset of symptoms. Three had previous superomedial angle resections without relief. The mean age at surgery was 35 years (19-53 years), and follow-up averaged 2.5 years (2-6 years). The surgical approach reflected the rhomboid major from the medial scapula, giving access to the scapulothoracic bursa between the serratus anterior muscle and the rib cage. Only 4 cases required primary superomedial angle bone resection and one a revision resection. Mean outcome scores significantly improved preoperatively to postoperatively: American Shoulder and Elbow Surgeons score: from 48 to 91; Simple Shoulder Test: from 6.2 to 10.1; and Visual Analog Score for Pain: from 6.1 to 1.0 (P <.05). Return to work and sports averaged 3.5 months. Open scapulothoracic bursectomy allowed evaluation and treatment of all areas of potential pathology. Symptomatic crepitus was relieved, and pain relief and functional improvement were consistently achieved.