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Scapulothoracic Arthroscopy

What is Scapulothoracic Arthroscopy?

Scapulothoracic arthroscopy is a minimally invasive surgical procedure for the treatment of shoulder conditions such as snapping scapula syndrome, bursitis, loose bodies, and benign tumors that have failed to respond to conservative treatment measures. The procedure involves small incisions and the placement of an arthroscope, a small flexible tube with a light and tiny camera at its end, and thin surgical instruments into the scapulothoracic joint to evaluate and treat the condition.

Anatomy of the Shoulder

The shoulder is a highly movable body joint that allows various movements of the arm. It is a ball and socket joint, where the head of the humerus (upper arm bone) articulates or connects with the socket of the scapula (shoulder blade), called the glenoid. The two articulating bone surfaces are covered with cartilage, which prevents friction during movement. The cartilage is lubricated by synovial fluid. Tendons and ligaments around the shoulder joint provide strength and stability to the joint. The scapulothoracic joint is located where the scapula joins the rib cage (thorax).

Indications for Scapulothoracic Arthroscopy

The most common indication for scapulothoracic arthroscopy is a shoulder condition called scapulothoracic bursitis, also known as snapping scapula syndrome. The condition is characterized by inflammation of the scapulothoracic bursa - a closed, fluid-filled sac - that sits between the scapula and the chest wall. The inflammation is due to injury or repetitive overuse from work or sports activities. The scapulothoracic bursa plays a significant role in the shoulder joint by enabling the shoulder blade to slide over the chest wall freely as the arm moves, providing smooth and pain-free motion. Scapulothoracic bursitis is experienced as the following:

  • A constant dull ache, stiffness, or tenderness in the shoulder area.
  • A feeling of instability or swelling.
  • A sensation of snapping or grinding when moving the arm.
  • Increased pain when performing overhead activities.

Your surgeon may recommend scapulothoracic arthroscopy for:

  • Bursectomy (bursa removal) due to scapulothoracic bursitis
  • Removal of loose bodies (free-floating pieces of debris in the joint)
  • Removal of an osteochondroma (benign tumor)
  • Bursectomy and partial superomedial scapulectomy due to snapping scapula syndrome

Preparation for Scapulothoracic Arthroscopy

Preoperative preparation for scapulothoracic arthroscopy involves the following steps:

  • A thorough examination is performed by your doctor to check for any medical issues that need to be addressed prior to surgery.
  • Depending on your medical history, social history, and age, you may need to undergo tests such as blood work and imaging to help detect any abnormalities that could compromise the safety of the procedure.
  • You will be asked if you have allergies to medications, anesthesia, or latex.
  • You should inform your doctor of any medications, vitamins, or supplements that you are taking, or any conditions you have such as heart or lung disease.
  • You may be asked to stop taking blood-thinners, anti-inflammatories, or vitamins/herbal supplements for a week or two.
  • You should refrain from alcohol and tobacco at least a few days prior to surgery and several weeks after surgery.
  • You should not consume any solids or liquids at least 8 hours prior to surgery.
  • Arrange for someone to drive you home as you will not be alert enough to drive yourself after surgery.
  • Informed consent will be obtained from you after the surgery has been explained in detail.

Procedure for Scapulothoracic Arthroscopy

In general, the procedure for scapulothoracic arthroscopy will involve the following steps:

  • You will be administered general or local anesthesia by your anesthesiologist.
  • You will lie face down on the operating table and the operative site will be cleaned and marked with a sterile pen accordingly.
  • The arm is adjusted in a “chicken wing” position, as this increases the space between the scapula and the posterior chest wall, enhancing arthroscopic visualization.
  • Your surgeon makes 2 to 3 small keyhole incisions along the scapula.
  • An arthroscope, a slender tubular device with a light and a small camera at its end, is inserted through one of the incisions into the scapula.
  • The camera transmits the image of the inside of your scapulothoracic joint onto a monitor for your surgeon to view.
  • Your surgeon then uses miniature surgical instruments to carry out the required repair such as the removal of inflamed bursal tissue, bony protrusions, tumors or loose bodies, as well as the release of any adhesions present.
  • After adequate scapulothoracic repair has been achieved, your surgeon removes the scope and the instruments.
  • The tiny incisions are then closed with stitches or small sterile bandage strips.

Postoperative Care and Recovery

In general, postoperative care instructions and recovery after scapulothoracic arthroscopy involves the following steps:

  • You will be transferred to the recovery area where your nurse will closely observe you for any allergic/anesthetic reactions and monitor your vital signs as you recover.
  • Following the surgery, your arm will be placed in a shoulder sling for 2 to 4 weeks to rest the shoulder and promote healing.
  • You may notice some pain, swelling, and discomfort in the shoulder area. Pain and anti-inflammatory medications are provided as needed to address these.
  • You may also apply ice packs on the shoulder area to help reduce swelling and pain.
  • Antibiotics are prescribed for the risk of surgery-related infection.
  • Keep the surgical site clean and dry. Instructions on surgical site care and bathing will be provided.
  • Refrain from smoking, as it can hinder the healing process.
  • Refrain from strenuous activities, lifting heavy weights, and driving for the first 6 weeks. A gradual increase in activities is recommended.
  • An individualized physical therapy regimen is designed to help strengthen your shoulder muscles and optimize shoulder function.
  • You will be able to resume your normal activities in a couple of months; however, a return to sports may take 4 to 6 months.
  • A periodic follow-up appointment will be scheduled to monitor your progress.

Risks and Complications

Scapulothoracic arthroscopy is a relatively safe surgery; however, as with any surgery, the following risks and complications may occur:

  • Bleeding
  • Infection
  • Damage to nerves or blood vessels
  • Blood clots
  • Anesthetic/allergic reactions
  • Inadequate bursectomy or bony resection
  • Persistence of pain and other symptoms
  • The need for revision surgery
  • ABOS
  • Columbia University
  • University of Pennsylvania
  • Mayo Clinic