Scapulothoracic bursitis is a medical term describing a painful condition in the area of the shoulder blade. It is usually combined with crepitus and is thought to result from inflammation (bursitis) beneath the shoulder blade. Under normal conditions, the bursa allows the shoulder blade to “glide” over the chest wall.
This rare bursitis can arise after repeated overhead movements of the arm, causing changes in the biomechanics of the shoulder blade muscles, which, through fatigue, stop working in a coordinated way. As a result, friction between the shoulder blade and the chest wall increases, and the bursa between them becomes irritated and inflamed.
As mentioned, this is a rare finding, and so there is little evidence on the diagnosis and treatment of the condition.
Image: The shoulder blade comes into contact with the ribs (red circle), causing inflammation and bursitis.
Diagnosis
Patients often report grinding (“crunching”) sounds or noises on movement, accompanied by pain at the upper part of the shoulder blade. It occurs either in athletes during sport or in workers who have to repeat certain overhead movements.
The examination is done with the shoulder and trunk fully exposed, so that the examiner can see the whole shoulder girdle and shoulder blade. First, the symmetry of the shoulders is checked while standing, in case there is weakness of the shoulder blade muscles. The patient is then asked to raise and lower the arm so that the movement of the shoulder blade can be assessed and the painful spot located.
Image: Weakness of the shoulder blade muscles on the left causes asymmetry between the two sides.
Image: Normal movement of the shoulder blade allows the arm to move above the head as well.
Plain X-rays usually cannot show a bony abnormality of the shoulder blade irritating the bursa. A CT scan, however, can accurately show the shape of the shoulder blade.
Image: This X-ray shows the bursa in green between the ribs and the shoulder blade. An osteochondroma (black arrows) presses the bursa against the ribs.
Image: This CT scan shows the three-dimensional anatomy of the area. The red arrows show two rib fractures that have not healed (united) and cause irritation and inflammation of the bursa on movement.
Treatment – treatment options
Treatment should initially be conservative. The first priority is to relieve the patient with a corticosteroid injection into the bursa. The injection is not only therapeutic but also diagnostic.
Image: The injection is given into the bursa just beneath the shoulder blade.
In addition, a physiotherapy programme is recommended to strengthen and coordinate the shoulder blade muscles.
Anti-inflammatory medication can be given as an adjunct to relieve pain.
Surgery is reserved for patients who continue to suffer, with an impact on their quality of life. A prerequisite for surgery is a positive response and relief from the corticosteroid injection, at least temporarily. If the patient gets no relief at all from the injection, it is very likely that surgery will not be effective.
In cases of chronic pain, the bursa is removed arthroscopically. The patient lies face down (prone) and the arthroscopic instruments are inserted beneath the shoulder blade. In addition, a small piece of the shoulder blade is removed so that it does not painfully strike the ribs; this can be done arthroscopically or open, through a small incision.
Image: A small incision at the upper part of the shoulder blade allows part of the bone to be removed.
Image: This patient underwent open and arthroscopic surgery.
Rehabilitation
The patient usually leaves hospital on the day of surgery. A sling is worn for 4 weeks to allow the shoulder blade muscles to heal. Physiotherapy starts after one week and includes passive exercises. After 4 weeks the patient can return to daily activities, and after 3 to 4 months to sport.
Scapulothoracic bursitis
As mentioned, this is a rare finding, so there is little evidence on the diagnosis and treatment of the condition, and a very experienced orthopaedic surgeon is needed to diagnose scapulothoracic bursitis, and an even more experienced one to treat it surgically. Professor Salmas has extensive experience and knowledge in both the diagnosis and the surgical treatment of scapulothoracic bursitis. He has operated on many patients with scapulothoracic bursitis, including patients who come from other countries because they have struggled to get rid of their symptoms. Most patients with this condition see many doctors, usually without getting the right diagnosis and treatment, and often undergo the wrong shoulder operations because of a misdiagnosis.
The doctor will examine your case and recommend the right treatment.
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Patients with scapulothoracic bursitis (snapping scapula)
Scapulothoracic bursitis (snapping scapula) – arthroscopic bursectomy
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