Snapping scapula syndrome causes painful crepitus with scapular motion, often without any bony abnormality on imaging. This prospective series evaluated open scapulothoracic bursectomy in 17 patients who failed conservative management. The study asks whether addressing the bursa rather than resecting bone reliably relieves symptoms.
When a patient has painful scapular crepitus that fails physiotherapy and injections, and imaging shows no osteochondroma, Luschka tubercle, or old fracture, think of the bursa, not the bone. This series reframes the pathology: the culprit is a thick fibrotic scapulothoracic bursa filling the space between the serratus anterior and the rib cage.
The clinical lesson is that isolated superomedial angle resection can miss this bursa and lead to recurrence, which is exactly what happened in the 3 revision patients here.
The surgical pearl worth memorizing: reflect the rhomboid major carefully to reach the bursa, protect the spinal accessory nerve on the undersurface of the trapezius, and resect bone only when the superomedial angle is genuinely prominent.
As a small prospective case series of 17 patients with no comparison group, the evidence is Level IV, so weight it as a technique validation rather than proof of superiority over arthroscopic approaches.
Snapping scapula syndrome causes painful crepitus with scapular motion, often without any bony abnormality on imaging. This prospective series evaluated open scapulothoracic bursectomy in 17 patients who failed conservative management. The study asks whether addressing the bursa rather than resecting bone reliably relieves symptoms.
When a patient has painful scapular crepitus that fails physiotherapy and injections, and imaging shows no osteochondroma, Luschka tubercle, or old fracture, think of the bursa, not the bone. This series reframes the pathology: the culprit is a thick fibrotic scapulothoracic bursa filling the space between the serratus anterior and the rib cage.
The clinical lesson is that isolated superomedial angle resection can miss this bursa and lead to recurrence, which is exactly what happened in the 3 revision patients here.
The surgical pearl worth memorizing: reflect the rhomboid major carefully to reach the bursa, protect the spinal accessory nerve on the undersurface of the trapezius, and resect bone only when the superomedial angle is genuinely prominent.
As a small prospective case series of 17 patients with no comparison group, the evidence is Level IV, so weight it as a technique validation rather than proof of superiority over arthroscopic approaches.