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Dey Hazra RO, Elrick BP, Ganokroj P, Nolte PC, Fossum BW, Brown JR, Hanson JA, Douglass BW, Dey Hazra ME, Provencher MT, Millett PJ. Anatomic safe zones for arthroscopic snapping scapula surgery: quantitative anatomy of the superomedial scapula and associated neurovascular structures and the effects of arm positioning on safety. J Shoulder Elbow Surg 2022; 31:e465-e472. [PMID: 35550433 DOI: 10.1016/j.jse.2022.03.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 03/23/2022] [Accepted: 03/27/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Neurovascular anatomy has not been previously quantified for the arthroscopic snapping scapula approach with the patient in the most frequent patient position ("chicken-wing" position). The purposes of this study were (1) to determine anatomic relationships of the superomedial scapula and neurovascular structures at risk during arthroscopic surgical treatment of snapping scapula syndrome (SSS), (2) to compare these measurements between the arm in the neutral position and the arm in the chicken-wing position, and (3) to establish safe zones for arthroscopic treatment of SSS. METHODS Eight fresh-frozen cadaveric hemi-torsos (mean age, 55.8 years; range, 52-66 years) were dissected to ascertain relevant anatomic structure locations including the (1) spinal accessory nerve, (2) dorsal scapular nerve, and (3) suprascapular nerve. A coordinate measuring device was used to collect data on the relationships of anatomic landmarks and at-risk structures during the surgical approach. RESULTS The dorsal scapular nerve was a mean of 24.4 mm medial to the superomedial scapula in the neutral position and 33.1 mm medial in the chicken-wing position (P < .001); the dorsal scapular nerve was 21.7 mm medial to the medial border of the scapular spine in the neutral position and 35.5 mm medial in the chicken-wing position (P < .001). The mean distance from the superomedial angle to the spinal accessory nerve intersection at the superior scapular border was 16.5 mm in the neutral position and 15.0 mm in the chicken-wing position (P = .031). The average distance from the superomedial angle to the closest point of the spinal accessory nerve was 11.6 mm and 10.4 mm in the neutral position and chicken-wing position, respectively (P = .039). CONCLUSION Neurologic structures around the scapula vary significantly between the neutral arm position and the chicken-wing position commonly used in the arthroscopic treatment of SSS. The chicken-wing position improves safe distances for the dorsal scapular nerve during medial-portal placement and should be considered as a primary position for arthroscopic management of SSS.
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Affiliation(s)
| | - Bryant P Elrick
- Steadman Philippon Research Institute, Vail, CO, USA; Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Phob Ganokroj
- Steadman Philippon Research Institute, Vail, CO, USA; Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | | | | | | | | | | | | | - Matthew T Provencher
- Steadman Philippon Research Institute, Vail, CO, USA; The Steadman Clinic, Vail, CO, USA
| | - Peter J Millett
- Steadman Philippon Research Institute, Vail, CO, USA; The Steadman Clinic, Vail, CO, USA.
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Osias W, Matcuk GR, Skalski MR, Patel DB, Schein AJ, Hatch GFR, White EA. Scapulothoracic pathology: review of anatomy, pathophysiology, imaging findings, and an approach to management. Skeletal Radiol 2018; 47:161-171. [PMID: 29075809 DOI: 10.1007/s00256-017-2791-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 09/27/2017] [Accepted: 10/05/2017] [Indexed: 02/02/2023]
Abstract
Symptomatic scapulothoracic disorders, including scapulothoracic crepitus and scapulothoracic bursitis are uncommon disorders involving the scapulothoracic articulation that have the potential to cause significant patient morbidity. Scapulothoracic crepitus is the presence of a grinding or popping sound with movement of the scapula that may or may not be symptomatic, while scapulothoracic bursitis refers to inflammation of bursa within the scapulothoracic articulation. Both entities may occur either concomitantly or independently. Nonetheless, the constellation of symptoms manifested by both entities has been referred to as the snapping scapula syndrome. Various causes of scapulothoracic crepitus include bursitis, variable scapular morphology, post-surgical or post-traumatic changes, osseous and soft tissue masses, scapular dyskinesis, and postural defects. Imaging is an important adjunct to the physical examination for accurate diagnosis and appropriate treatment management. Non-operative management such as physical therapy and local injection can be effective for symptoms secondary to scapular dyskinesis or benign, non-osseous lesions. Surgical treatment is utilized for osseous lesions, or if non-operative management for bursitis has failed. Open, arthroscopic, or combined methods have been performed with good clinical outcomes.
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Affiliation(s)
- Walter Osias
- Department of Radiology, Keck School of Medicine, University of Southern California, 1500 San Pablo Street, Second Floor Imaging, Los Angeles, CA, 90033, USA
| | - George R Matcuk
- Department of Radiology, Keck School of Medicine, University of Southern California, 1500 San Pablo Street, Second Floor Imaging, Los Angeles, CA, 90033, USA
| | - Matthew R Skalski
- Department of Radiology, Keck School of Medicine, University of Southern California, 1500 San Pablo Street, Second Floor Imaging, Los Angeles, CA, 90033, USA
| | - Dakshesh B Patel
- Department of Radiology, Keck School of Medicine, University of Southern California, 1500 San Pablo Street, Second Floor Imaging, Los Angeles, CA, 90033, USA
| | - Aaron J Schein
- Department of Radiology, Keck School of Medicine, University of Southern California, 1500 San Pablo Street, Second Floor Imaging, Los Angeles, CA, 90033, USA
| | - George F Rick Hatch
- Department of Orthopedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Eric A White
- Department of Radiology, Keck School of Medicine, University of Southern California, 1500 San Pablo Street, Second Floor Imaging, Los Angeles, CA, 90033, USA.
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Clarke DO, Crichlow A, Christmas M, Vaughan K, Mullings S, Neil I, Whyte N. The unusual osteochondroma: A case of snapping scapula syndrome and review of the literature. Orthop Traumatol Surg Res 2017; 103:1295-1298. [PMID: 28965995 DOI: 10.1016/j.otsr.2017.01.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Revised: 01/03/2017] [Accepted: 01/13/2017] [Indexed: 02/02/2023]
Abstract
Snapping scapula syndrome is a rare condition characterized by crepitus of the scapula on motion of the ipsilateral upper extremity. It may be quite painful and disabling. The majority of cases are due to bursal and muscular disorders. Snapping scapula syndrome secondary to an underlying osteochondroma is an even more infrequent phenomenon. The case presented highlights the unusual post pubertal growth of an osteochondroma of the scapula that progressed to develop a snapping scapular syndrome. Review of the literature revealed less than fifty reported cases of this phenomenon secondary to an underlying osteochondroma.
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Affiliation(s)
- D O Clarke
- Department of Orthopaedic Surgery, The University Hospital of the West Indies, Mona Campus, Kingston 7, Jamaica.
| | - A Crichlow
- Department of Orthopaedic Surgery, The University Hospital of the West Indies, Mona Campus, Kingston 7, Jamaica
| | - M Christmas
- Department of Orthopaedic Surgery, The University Hospital of the West Indies, Mona Campus, Kingston 7, Jamaica
| | - K Vaughan
- Department of Orthopaedic Surgery, The University Hospital of the West Indies, Mona Campus, Kingston 7, Jamaica
| | - S Mullings
- Department of Orthopaedic Surgery, The University Hospital of the West Indies, Mona Campus, Kingston 7, Jamaica
| | - I Neil
- Department of Orthopaedic Surgery, The University Hospital of the West Indies, Mona Campus, Kingston 7, Jamaica
| | - N Whyte
- Department of Orthopaedic Surgery, The University Hospital of the West Indies, Mona Campus, Kingston 7, Jamaica
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Abstract
OBJECTIVE Extracorporeal shockwave therapy (ESWT) has been used successfully in treatment of musculoskeletal disorders. Our objective was to assess the effectiveness of low versus middle-energy ESWT on snapping scapula bursitis. METHODS Thirty-five patients, divided into two groups, group (L), received low-energy ESWT, group (M) received middle-energy ESWT. Groups were evaluated at 1,3,6 and 12 months using the Visual Analogue Scale (VAS), the Constant-Murley scoring (CMS) and the Roles and Maudsley criteria. RESULTS In groups (L) and (M), VAS average values after 1,3,6 months and one year were (43±5.17, 38±4.33, 28±4.18 and 19±3.39) and (37±4.85, 26±4.74, 21±4.45 and 7±3.42) respectively. At six and twelve months, statistical difference was detected, P (0.034, 0.026) respectively. After one year of completing the treatment, the average values of CMS were (83.5±6.44 and 91±5.33) respectively, P=0.046. Roles and Maudsley criteria demonstrated that, patients in group (L), 6 (35%) excellent, 5 (29%) good, 4 (24%) acceptable and 2 (12%) had poor results. Whereas, patients in group (M), 11 (61%) excellent, 3 (17%) good, 3 (17%) acceptable and 1 (5%) had poor results. CONCLUSION Although low-energy ESWT showed good early-term results, but middle-energy ESWT protocol demonstrated better early-term, Mid-term, and late-term results.
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Affiliation(s)
- Nihat Acar
- Nihat Acar, Department of Orthopaedics and Traumatology, Catalca Ilyas Cokay Hospital, Catalca, Istanbul, Turkey
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Morita W, Nozaki T, Tasaki A. MRI for the diagnosis of scapular dyskinesis: a report of two cases. Skeletal Radiol 2017; 46:249-252. [PMID: 27832291 DOI: 10.1007/s00256-016-2528-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 10/03/2016] [Accepted: 10/30/2016] [Indexed: 02/02/2023]
Abstract
Scapular dyskinesis describes the altered position of the scapula and/or abnormal movements of the scapulothoracic joint. It is caused by bony anatomical variations, bursitis, tumors, and muscular pathological conditions including loss of innervation and fibrosis. Scapular dyskinesis is just as often subclinical as it is symptomatic, and as the periscapular anatomical changes may not result in patient symptoms, a precise diagnosis of the etiology and pathophysiology has been a challenge. Scapular bony prominence is a common etiology of scapular dyskinesis, but does not always result in morbidity. We report a case of a 39-year-old man in whom an extensive MRI with fluid-sensitive imaging sequences covering the whole of the scapula was beneficial in diagnosing the inflammation adjacent to the bony deformity, which confirmed the etiology of scapular dyskinesis. Furthermore, in a 41-year old man without any anatomical variances, a similar MRI showed inflammation at the subscapular fossa that suggested altered scapular kinematics. An arthroscopic debridement of the lesion improved the symptoms. MRI in conjunction with plain radiographs, CT and physical examination enabled a precise diagnosis of the etiology. Fluid-sensitive MR images are important in defining the presence of inflammation, and are beneficial in determining the pathological significance of findings through other diagnostic measures.
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Affiliation(s)
- Wataru Morita
- Department of Orthopaedic Surgery, St Luke's International Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo, 104-8560, Japan.
| | - Taiki Nozaki
- Department of Radiology, St. Luke's International Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo, 104-8560, Japan
| | - Atsushi Tasaki
- Department of Orthopaedic Surgery, St Luke's International Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo, 104-8560, Japan
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Zaidenberg EE, Rossi LA, Bongiovanni SL, Tanoira I, Maignon G, Ranalletta M. Snapping scapular syndrome secondary to rib intramedullary fixation device. Int J Surg Case Rep 2015; 17:158-60. [PMID: 26629853 DOI: 10.1016/j.ijscr.2015.11.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Revised: 11/12/2015] [Accepted: 11/12/2015] [Indexed: 11/22/2022] Open
Abstract
Intramedullary rib fixation has become popular. Snapping scapula syndrome is a cause of persistent pain around the scapulothoracic joint. We present a case of snapping scapula secondary to migration of a intramedullary rib splint into the scapulothoracic joint.
Background Scapulo-thoracic joint disorders, including bursitis and crepitus, are commonly misdiagnosed problems and can be a source of persistent pain and dysfunction Presentation of the case This article describes an unusual case of a snapping scapula syndrome secondary to a migration through the lateral cortex of a rib splint intramedullary fixation device into the scapulothoracic joint. Discussion Recently, the operative fixation of multiple ribs fractures with intramedullary fixation devices has become popular. Despite the good outcomes with new rib splint designs, concern remains about the potential complications related to potential loss of fracture reduction with migration of the wire resulting in pain or additional injury to the surrounding tissues. Conclusion Surgeons should pay attention to any protrusion of intramedullary rib implants, especially in the evaluation of routine X-rays following surgical treatment. We should be aware of the possibility of this rare cause of snapping scapula syndrome to avoid delayed diagnosis and consider removing the implant will resolve the pain.
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Sivananda P, Rao BK, Kumar PV, Ram GS. Osteochondroma of the ventral scapula causing scapular static winging and secondary rib erosion. J Clin Diagn Res 2014; 8:LD03-5. [PMID: 24995200 DOI: 10.7860/jcdr/2014/8129.4335] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Accepted: 02/16/2014] [Indexed: 11/24/2022]
Abstract
An osteochondroma is a benign tumour of bone, which is located mainly in the metaphysis of long bones. It does not commonly occur in the scapula. On the ventral surface of the scapula, it can produce various manifestations due to mass effect. We are reporting a rare presentation of an osteochondroma at superomedial angle of ventral aspect of the scapula in a 31-year-old female. She initially presented with a painful shoulder and radiating pain in the arm. The scapular mass produced pseudo winging of the scapula and erosion of the ribs on the same side. The patient was successfully managed by open excision, using a parascapular approach. The patient had no evidence of recurrence at one year's follow-up and is currently able to carry on her day to day activities without any discomfort.
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Affiliation(s)
- P Sivananda
- Associate Professor, Department of Orthopaedics, King George Hospital , Visakhapatnam, Andhra Pradesh, India
| | - B Kailash Rao
- Former Professor, Department of Orthopaedics, King George Hospital , Visakhapatnam, Andhra Pradesh, India
| | - P Varun Kumar
- Resident, Department of Orthopaedics, King George Hospital , Visakhapatnam, Andhra Pradesh, India
| | - G Santhosh Ram
- Resident, Department of Orthopaedics, King George Hospital , Visakhapatnam, Andhra Pradesh, India
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