Arthroscopic Management of Scapulothoracic Bursitis: Clinical Outcomes and Assessment of Novel Bony Parameters on Magnetic Resonance Imaging

Abstract

Background: Scapulothoracic bursitis is a significant clinical condition that limits day-to-day function. Arthroscopic scapular debridement and resection have provided satisfactory outcomes; however, techniques, approaches, and recommendations remain varied. Novel bony parameters have also gained increasing interest owing to their value in preoperative planning.

Purpose: To assess midterm clinical outcomes after the arthroscopic management of scapulothoracic bursitis and to identify and measure novel bony parameters on preoperative magnetic resonance imaging.

Study design: Case series; Level of evidence, 4.

Methods: A total of 8 patients underwent arthroscopic scapular debridement and bursectomy; 5 of the 8 patients underwent additional medial scapulectomy. There were 5 male (62.5%) and 3 female (37.5%) patients with a mean age of 30.1 ± 12.3 years (range, 19-58 years). Inclusion criteria for surgery were patients with symptomatic scapulothoracic bursitis for whom extensive nonoperative modalities had been utilized for at least 6 months but failed. Outcome measures included the Oxford Shoulder Score (OSS), University of California Los Angeles (UCLA) shoulder rating scale, Constant Shoulder Score (CSS), and visual analog scale (VAS) for pain. The bony parameters included scapular shape, anterior offset, costomedial angle, and medial scapular corpus angle (MSCA).

Results: The follow-up duration was at least 2 years for all patients (mean follow-up, 25.0 ± 4.1 months [range, 24-35 months]). The majority of patients had a concave-shaped scapula (62.5%). The mean anterior offset was 24.3 ± 3.4 mm, and the mean costomedial angle was 132.3° ± 9.6°. Half the patients had a positive MSCA, while the other half had a negative MSCA. A statistically significant improvement was observed in the OSS, UCLA, CSS, and VAS scores from preoperatively to 2-year follow-up (P < .001 for all). No complications were observed.

Conclusion: Arthroscopic scapular debridement and resection provided satisfactory midterm clinical outcomes for the treatment of scapulothoracic bursitis.

Keywords: anterior offset; costomedial angle; scapulectomy; scapulothoracic bursitis; superomedial angle resection.

Figure 1.

Sagittal magnetic resonance imaging showing the assessment of the anterior offset, measured as the horizontal distance from a line drawn along the plane of the scapula (vertical white line) to the superomedial angle of the scapula. In this example, the offset was 2.7 cm.

Figure 2.

(A) Reference schematic showing the assessment of the costomedial angle, defined as the angle between the superior and inferior scapular wings along the medial border of the scapula. (B) The costomedial angle of 130.6° as measured on a sagittal cut of the scapula on magnetic resonance imaging.

Figure 3.

Axial magnetic resonance imaging showing a (A) straight-shaped scapula and (B) concave-shaped scapula.

Figure 4.

Axial magnetic resonance imaging of the scapular region demonstrating a negative medial scapular corpus angle (posterior scapular angulation away from the thorax; yellow line).

Figure 5.

Preoperative and 2-year postoperative functional outcome scores. The y-axis denotes outcome measure values. Black lines represent the raw data of individual patients, while red lines and asterisks represent mean values. CSS, Constant Shoulder Score; OSS, Oxford Shoulder Score; UCLA, University of California Los Angeles; VAS, visual analog scale.