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Scapulothoracic Endoscopy for the Painful Snapping Scapula: Endoscopic Anatomy and Scapuloplasty Technique.

ABSTRACT: Chronic painful snapping scapula is characterized by inflammation and scarring of 1 or more bursae in the infraserratus space and is often refractory to conservative treatment. Surgical treatment involves excision of the bursae, as well as partial scapulectomy of the superomedial impinging region; both open and endoscopic approaches have been described with good results. Scapulothoracic endoscopy is technically difficult, and the potential complications can be serious. This report describes an endoscopic approach that can be performed with only 2 medial parascapular portals for visualization and instrumentation. The endoscopic anatomy of the infraserratus space is revisited, and 3 anatomic landmarks (serratus anterior, subspinous bursal curtain, and superomedial bony angle) are identified for safe dissection and intraoperative orientation. The surgical field is subdivided into 3 anatomic zones (superomedial space, subspinous space, and scapular bony angle), and the anatomic boundaries of these zones are demonstrated. The decompression procedure is subdivided into 4 stages (superomedial bursectomy, subspinous adhesiolysis, tuberoplasty, and scapuloplasty), and a measured resection technique for scapuloplasty is performed. The use of newer motorized rasps permits optimal bony resection, and additional portals are unnecessary. Overall, the step-by-step technique provides a methodical approach for safety, reproducibility, and optimization of the procedure.

SUBMITTER: Bhatia DN

PROVIDER: S-EPMC4722180 | biostudies-literature | 2015 Oct

REPOSITORIES: biostudies-literature

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Scapulothoracic Endoscopy for the Painful Snapping Scapula: Endoscopic Anatomy and Scapuloplasty Technique.

Bhatia Deepak N DN

Arthroscopy techniques 20151012 5

Chronic painful snapping scapula is characterized by inflammation and scarring of 1 or more bursae in the infraserratus space and is often refractory to conservative treatment. Surgical treatment involves excision of the bursae, as well as partial scapulectomy of the superomedial impinging region; both open and endoscopic approaches have been described with good results. Scapulothoracic endoscopy is technically difficult, and the potential complications can be serious. This report describes an e ...[more]

PMID: 26900553

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Project description:ContextSnapping scapula syndrome (SSS) is commonly misdiagnosed and underreported due to lack of awareness.ObjectiveThis scoping review aims to summarize the current evidence related to SSS diagnosis and treatment to aid clinicians in managing the condition more effectively.Data sourcesPubMed, Medline, and Embase databases were searched for studies related to the etiology, diagnosis, or treatment of SSS (database inception to March 2020).Study selectionDatabases were searched for available studies related to the etiology, diagnosis, or treatment of SSS.Study designA scoping review study design was selected to explore the breadth of knowledge in the literature regarding SSS diagnosis and treatment.Level of evidenceLevel 4.Data extractionPrimary outcomes abstraction included accuracy of diagnostic tests, functional outcomes, and pain relief associated with various nonoperative and operative treatment options for SSS.ResultsA total of 1442 references were screened and 40 met the inclusion criteria. Studies commonly reported SSS as a clinical diagnosis and relied heavily on a focused history and physical examination. The most common signs reported were medial scapular border tenderness, crepitus, and audible snapping. Three-dimensional computed tomography had high interrater reliability of 0.972, with a 100% success rate in identifying symptomatic incongruity of the scapular articular surface. Initial nonoperative treatment was reported as successful in most symptomatic patients, with improved visual analogue scale (VAS) scores (7.7 ± 0.5 pretreatment, to 2.4 ± 0.6). Persistently symptomatic patients underwent surgical intervention most commonly involving bursectomy, superomedial angle resection, or partial scapulectomy. High satisfaction rates of surgery were reported in VAS (6.9 ± 0.7 to 1.9 ± 0.9), American Shoulder and Elbow Surgeons scores (50.3 ± 12.2 to 80.6 ± 14.9), and mean simple shoulder test scores (5.6 ± 1.0 to 10.2 ± 1.1).ConclusionFocused history and physical examination is the most crucial initial step in the diagnostic process, with supplemental imaging used to assess for structural etiologies when nonoperative management fails. Nonoperative management is as effective as surgical management in pain relief and is advised for 3 to 6 months before operative treatment.

Project description:Background and Objectives: Anatomical post-surgical alterations of the upper gastrointestinal (GI) tract have always been challenging for performing diagnostic and therapeutic endoscopy, especially when biliopancreatic diseases are involved. Esophagectomy, gastrectomy with various reconstructions and pancreaticoduodenectomy are among the most common surgeries causing upper GI tract alterations. Technological improvements and new methods have increased the endoscopic success rate in these patients, and the literature has been rapidly increasing over the past few years. The aim of this systematic review is to identify evidence on the available biliopancreatic endoscopic techniques performed in the altered post-surgical anatomy of upper GI tract. Materials and Methods: We performed a systematic search of PubMed, MEDLINE, Cochrane Library, and SCOPUS databases. Study-level variables extracted were the last name of the first author, publication year, study design, number of patients, type of post-surgical anatomical alteration, endoscopic technique, success rate and endoscopic-related adverse events. Results: Our primary search identified 221 titles, which was expanded with studies after the citation search. The final full-text review process identified 52 articles (31 retrospective studies, 8 prospective studies and 13 case reports). We found several different techniques developed over the years for biliopancreatic diseases in altered anatomy, in order to perform both endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP). They included enteroscopy-assisted ERCP (double and single balloon enteroscopy-ERCP, spiral enteroscopy-ERCP) laparoscopic assisted ERCP, EUS-Directed transgastric ERCP, EUS-directed transgastric intervention, gastric access temporary for endoscopy, and percutaneous assisted trans prosthetic endoscopic therapy. The success rate was high (most of the techniques showed a success rate over 90%) and a low rate of adverse events were reported. Conclusions: We suggest the considerationof the novel techniques when approaching patients with altered anatomy who require biliopancreatic endoscopy, focusing on the surgery type, success rate and adverse events reported in the literature.

Dataset Information

Scapulothoracic Endoscopy for the Painful Snapping Scapula: Endoscopic Anatomy and Scapuloplasty Technique.

Publications

Scapulothoracic Endoscopy for the Painful Snapping Scapula: Endoscopic Anatomy and Scapuloplasty Technique.

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