This review examines symptomatic scapulothoracic crepitus and bursitis, two related but distinct disorders of the articulation between the scapula and posterior chest wall. It covers the bursal anatomy, causes of crepitus, and a treatment algorithm from conservative care to partial scapulectomy and bursectomy.
When a patient reports painful scapular grinding, your first job is to separate physiologic noise from true pathology. Crepitus alone means little. Pain, winging, or a palpable mass is what makes it symptomatic.
Use the sound to guide your workup. A loud snap (craquement) points to a bony lesion, most often an osteochondroma, so get tangential scapular radiographs and consider CT. A softer grating (frottement) suggests soft-tissue bursitis that will usually respond to conservative care.
Start nonoperatively for nearly everyone except clear bone lesions: posture correction, serratus anterior and subscapularis strengthening, NSAIDs, and cautious injections. Remember pneumothorax risk with any injection near the chest wall.
For the surgical anatomy, the key pearl is that superomedial resection endangers the dorsal scapular artery and suprascapular nerve as you carry the cut laterally.
This review examines symptomatic scapulothoracic crepitus and bursitis, two related but distinct disorders of the articulation between the scapula and posterior chest wall. It covers the bursal anatomy, causes of crepitus, and a treatment algorithm from conservative care to partial scapulectomy and bursectomy.
When a patient reports painful scapular grinding, your first job is to separate physiologic noise from true pathology. Crepitus alone means little. Pain, winging, or a palpable mass is what makes it symptomatic.
Use the sound to guide your workup. A loud snap (craquement) points to a bony lesion, most often an osteochondroma, so get tangential scapular radiographs and consider CT. A softer grating (frottement) suggests soft-tissue bursitis that will usually respond to conservative care.
Start nonoperatively for nearly everyone except clear bone lesions: posture correction, serratus anterior and subscapularis strengthening, NSAIDs, and cautious injections. Remember pneumothorax risk with any injection near the chest wall.
For the surgical anatomy, the key pearl is that superomedial resection endangers the dorsal scapular artery and suprascapular nerve as you carry the cut laterally.