Arthroscopic Scapulothoracic Bursectomy

What is Arthroscopic Scapulothoracic Bursectomy?

Arthroscopic scapulothoracic bursectomy is a minimally invasive surgical procedure employed for the treatment of persistent scapulothoracic bursitis, also known as snapping scapula syndrome, in which inflamed scapulothoracic bursa is removed with the aid of an arthroscope.

More than one-third of shoulder movement happens with the involvement of the scapula (shoulder blade) and thoracic rib cage. Bursitis is an inflammation of the fluid-filled sac called a bursa that protects and cushions your joints. Scapulothoracic bursitis is defined as inflammation of the scapulothoracic bursa, the bursa that sits between the scapula and the chest wall, secondary to injury or repetitive overuse owing to work or sports activities. The condition results in the shoulder area having a constant, dull ache, stiffness or tenderness, instability, swelling, a sensation of “snapping” or “grinding” when moving the arm, and increased pain with overhead activities.

The scapulothoracic bursa plays a significant role in the shoulder joint by enabling the shoulder blade to slide over the chest wall freely as the arm moves and provides smooth and pain-free motion of the scapula against the thoracic rib cage.

Anatomy of the Shoulder

The shoulder is a highly movable body joint that allows various movements of the arm. It is a ball and socket joint, where the head of the humerus (upper arm bone) articulates with the socket of the scapula (shoulder blade), which is called the glenoid. The two articulating surfaces of the bones are covered with cartilage, which prevents friction between the moving bones. The cartilage is lubricated by synovial fluid. Tendons and ligaments around the shoulder joint provide strength and stability to the joint.

Indications for Arthroscopic Scapulothoracic Bursectomy

The main indication for arthroscopic scapulothoracic bursectomy is failure of nonsurgical treatment modalities such as medications, physiotherapy, and RICE therapy to provide satisfactory relief for scapulothoracic bursitis. Some of the other causes of scapulothoracic bursitis that may indicate the need for arthroscopic scapulothoracic bursectomy include:

• Direct or indirect trauma
• Overuse syndromes
• Osseous abnormalities
• Muscle atrophy
• Glenohumeral joint dysfunction
• Idiopathic causes
• Overhead and repetitive shoulder movements

Preparation for Arthroscopic Scapulothoracic Bursectomy

Preoperative preparation for arthroscopic scapulothoracic bursectomy will involve the following steps:

• A thorough examination by your doctor to check for any medical issues that need to be addressed prior to surgery.
• Depending on your medical history, social history, and age, you may need to undergo tests such as blood work and imaging to help detect any abnormalities that could threaten the safety of the procedure.
• You will be asked if you have allergies to medications, anaesthesia, or latex.
• You should inform your doctor of any medications, vitamins, or supplements that you are taking.
• You should refrain from medications or supplements such as blood thinners, aspirin, or anti-inflammatory medicines for a week or two prior to surgery.
• You should refrain from alcohol or tobacco at least 24 hours prior to surgery.
• You should not consume any solids or liquids at least 8 hours prior to surgery.
• Arrange for someone to drive you home as you will not be able to drive yourself post surgery.
• A written consent will be obtained from you after the surgical procedure has been explained in detail.

Procedure for Arthroscopic Scapulothoracic Bursectomy

To qualify for the surgery, a patient should experience at least temporary relief from a cortisone shot as surgery will not be effective in a patient who does not receive any sort of relief from an injection.

The procedure for arthroscopic scapulothoracic bursectomy involves the following steps:

• General or local anaesthesia is administered to the patient.
• The patient lies face down on the table and the operative site is cleaned and marked with a sterile pen accordingly.
• The arm is adjusted in a “chicken wing” position as this increases the room between the scapula and the posterior chest wall and enhances arthroscopic visualisation.
• Your surgeon makes 2 to 3 small keyhole incisions along the scapula.
• An arthroscope, a slender tubular device attached with a light and a small video camera at the end is inserted through one of the incisions into the scapula.
• The video camera transmits the image of the inside of your shoulder joint onto a television monitor for your surgeon to view.
• Your surgeon then uses a shaver and cautery through the other tiny incisions to remove the inflamed bursal tissue as well as release any adhesions.
• After confirming adequate scapulothoracic debridement has been achieved, your surgeon removes the scope and the instruments.
• The tiny incisions are then closed and covered with a bandage.

Postoperative Care Instructions and Recovery

In general, postoperative care instructions and recovery after arthroscopic scapulothoracic bursectomy involves the following steps:

• You will be transferred to the recovery area to be monitored until you are awake from the anaesthesia.
• Your nurse will monitor your blood oxygen level and other vital signs as you recover.
• You may notice some pain, swelling, and discomfort in the shoulder area. Pain and anti-inflammatory medications are provided as needed.
• You may also apply ice packs on the shoulder area to help reduce swelling.
• Medications will also be prescribed as needed for symptoms associated with anaesthesia, such as vomiting and nausea.
• Antibiotics are prescribed for risk of infection associated with surgery.
• Keep your surgical site clean and dry. Instructions on surgical site care and bathing will be provided.
• Refrain from smoking as it can negatively affect the healing process.
• Eating a healthy diet rich in vitamin D is strongly advised to promote healing and a faster recovery.
• Refrain from strenuous activities, lifting heavy weights, and driving for the first 6 weeks. Gradual increase in activities over a period of time is recommended.
• An individualised physiotherapy protocol is designed to help strengthen your shoulder muscles and optimise shoulder function.
• You will be able to resume your normal activities in a couple of months; however, return to sports may take anywhere from 4 to 6 months.
• A periodic follow-up appointment will be scheduled to monitor your progress.

Risks and Complications of Arthroscopic Scapulothoracic Bursectomy

Arthroscopic scapulothoracic bursectomy is a relatively safe procedure; however, as with any surgery, there are risks and complications that could occur, such as:

• Bleeding
• Infection
• Damage to nerves or blood vessels
• Blood clots
• Anaesthetic complications
• Incomplete bursectomy
• Revision surgery