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Functional Outcomes After Arthroscopic Scapulothoracic Bursectomy and Partial Superomedial Angle Scapulectomy.

Tashjian RZ, Granger EK, Barney JK, Partridge DR - Orthop J Sports Med (2013)

Bottom Line: SST scores improved significantly from a mean 7.7 ± 3.1 preoperatively to 10.3 ± 2.3 postoperatively (P = .03).VAS pain scores reduced significantly from 6.5 ± 2.2 preoperatively to 2.3 ± 2.4 postoperatively (P < .001).Even in patients at risk for poorer clinical outcomes, patient satisfaction and willingness to undergo the surgical procedure again was still high.

View Article: PubMed Central - PubMed

Affiliation: The University of Utah, Salt Lake City, Utah, USA.

ABSTRACT

Background: Arthroscopic scapulothoracic bursectomy with partial superomedial angle scapulectomy has been described as a treatment for persistent scapulothoracic bursitis with varying results.

Purpose: To evaluate patients after arthroscopic scapulothoracic bursectomy utilizing validated functional outcome instruments.

Study design: Case series.

Methods: Fifteen patients underwent arthroscopic scapulothoracic bursectomy and partial superomedial angle scapulectomy. Thirteen patients were available for review at a mean 27-month follow-up (range, 13-65 months). Patients were evaluated preoperatively with a history, physical examination evaluating medial scapula border tenderness and crepitus, pain visual analog scale (VAS) score, and the simple shoulder test (SST). Postoperatively, patients were evaluated with all preoperative questionnaires as well as a satisfaction survey and the American Shoulder and Elbow Surgeons (ASES) score.

Results: SST scores improved significantly from a mean 7.7 ± 3.1 preoperatively to 10.3 ± 2.3 postoperatively (P = .03). VAS pain scores reduced significantly from 6.5 ± 2.2 preoperatively to 2.3 ± 2.4 postoperatively (P < .001). Ninety-two percent (12/13) of patients were satisfied, and 92% (12/13) stated they would have the surgical procedure performed again. The mean ASES postoperative score was 80.1 (range, 38-100). The 2 clinical failures (ASES scores <50) had either a workers' compensation claim with persistent medial border tenderness or ongoing rotator cuff disease. Despite lower ASES scores, these patients were still satisfied with the procedure and would undergo it again.

Conclusion: Arthroscopic scapulothoracic bursectomy with partial superomedial angle scapulectomy provides significant improvements in pain and functional outcomes. Even in patients at risk for poorer clinical outcomes, patient satisfaction and willingness to undergo the surgical procedure again was still high.

No MeSH data available.


Related in: MedlinePlus

Undersurface of the scapula after partial superomedial angle scapulectomy removing a 2 cm × 2 cm × 3 cm triangle of superomedial scapular bone.
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fig4-2325967113505739: Undersurface of the scapula after partial superomedial angle scapulectomy removing a 2 cm × 2 cm × 3 cm triangle of superomedial scapular bone.

Mentions: All surgical procedures were performed prone with the arm placed in the “chicken wing” position (Figure 1). A 2-portal technique was utilized, with the first portal (inferior portal) created approximately 3 to 4 cm medial to the medial border of the scapula halfway between the scapula spine and the inferior angle in the superior/inferior direction (Figure 2). A 30° scope was utilized in all cases, starting in the inferior portal. A superior portal was created under spinal-needle localization at the level of the scapula spine 3 to 4 cm medial to the medial scapula border (Figure 2). A shaver and cautery were utilized in the superior portal to perform the scapulothoracic debridement, including removal of inflamed bursal tissue and release of adhesions. The superomedial angle was then outlined utilizing several spinal needles, and the underlying serratus anterior was released from this region of the scapula (Figure 3). Utilizing a 4.0-mm bur, a 2 cm × 2 cm × 3 cm triangle of the superomedial scapula corner was completely removed (Figure 4). The scope was then placed in the superior portal, and a shaver and cautery device were used to complete the bursectomy down to the inferior scapula angle. Postoperatively, patients were in a sling for comfort only and were allowed to use the shoulder as tolerated, with a lifting limitation of 10 pounds for 6 weeks. Formalized physical therapy was prescribed between postoperative weeks 2 and 6, including shoulder stretching and rotator cuff, deltoid, and scapula stabilizer strengthening exercises. At 6 weeks postoperative, patients were allowed to return to activities as tolerated.


Functional Outcomes After Arthroscopic Scapulothoracic Bursectomy and Partial Superomedial Angle Scapulectomy.

Tashjian RZ, Granger EK, Barney JK, Partridge DR - Orthop J Sports Med (2013)

Undersurface of the scapula after partial superomedial angle scapulectomy removing a 2 cm × 2 cm × 3 cm triangle of superomedial scapular bone.
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4555498&req=5

fig4-2325967113505739: Undersurface of the scapula after partial superomedial angle scapulectomy removing a 2 cm × 2 cm × 3 cm triangle of superomedial scapular bone.
Mentions: All surgical procedures were performed prone with the arm placed in the “chicken wing” position (Figure 1). A 2-portal technique was utilized, with the first portal (inferior portal) created approximately 3 to 4 cm medial to the medial border of the scapula halfway between the scapula spine and the inferior angle in the superior/inferior direction (Figure 2). A 30° scope was utilized in all cases, starting in the inferior portal. A superior portal was created under spinal-needle localization at the level of the scapula spine 3 to 4 cm medial to the medial scapula border (Figure 2). A shaver and cautery were utilized in the superior portal to perform the scapulothoracic debridement, including removal of inflamed bursal tissue and release of adhesions. The superomedial angle was then outlined utilizing several spinal needles, and the underlying serratus anterior was released from this region of the scapula (Figure 3). Utilizing a 4.0-mm bur, a 2 cm × 2 cm × 3 cm triangle of the superomedial scapula corner was completely removed (Figure 4). The scope was then placed in the superior portal, and a shaver and cautery device were used to complete the bursectomy down to the inferior scapula angle. Postoperatively, patients were in a sling for comfort only and were allowed to use the shoulder as tolerated, with a lifting limitation of 10 pounds for 6 weeks. Formalized physical therapy was prescribed between postoperative weeks 2 and 6, including shoulder stretching and rotator cuff, deltoid, and scapula stabilizer strengthening exercises. At 6 weeks postoperative, patients were allowed to return to activities as tolerated.

Bottom Line: SST scores improved significantly from a mean 7.7 ± 3.1 preoperatively to 10.3 ± 2.3 postoperatively (P = .03).VAS pain scores reduced significantly from 6.5 ± 2.2 preoperatively to 2.3 ± 2.4 postoperatively (P < .001).Even in patients at risk for poorer clinical outcomes, patient satisfaction and willingness to undergo the surgical procedure again was still high.

View Article: PubMed Central - PubMed

Affiliation: The University of Utah, Salt Lake City, Utah, USA.

ABSTRACT

Background: Arthroscopic scapulothoracic bursectomy with partial superomedial angle scapulectomy has been described as a treatment for persistent scapulothoracic bursitis with varying results.

Purpose: To evaluate patients after arthroscopic scapulothoracic bursectomy utilizing validated functional outcome instruments.

Study design: Case series.

Methods: Fifteen patients underwent arthroscopic scapulothoracic bursectomy and partial superomedial angle scapulectomy. Thirteen patients were available for review at a mean 27-month follow-up (range, 13-65 months). Patients were evaluated preoperatively with a history, physical examination evaluating medial scapula border tenderness and crepitus, pain visual analog scale (VAS) score, and the simple shoulder test (SST). Postoperatively, patients were evaluated with all preoperative questionnaires as well as a satisfaction survey and the American Shoulder and Elbow Surgeons (ASES) score.

Results: SST scores improved significantly from a mean 7.7 ± 3.1 preoperatively to 10.3 ± 2.3 postoperatively (P = .03). VAS pain scores reduced significantly from 6.5 ± 2.2 preoperatively to 2.3 ± 2.4 postoperatively (P < .001). Ninety-two percent (12/13) of patients were satisfied, and 92% (12/13) stated they would have the surgical procedure performed again. The mean ASES postoperative score was 80.1 (range, 38-100). The 2 clinical failures (ASES scores <50) had either a workers' compensation claim with persistent medial border tenderness or ongoing rotator cuff disease. Despite lower ASES scores, these patients were still satisfied with the procedure and would undergo it again.

Conclusion: Arthroscopic scapulothoracic bursectomy with partial superomedial angle scapulectomy provides significant improvements in pain and functional outcomes. Even in patients at risk for poorer clinical outcomes, patient satisfaction and willingness to undergo the surgical procedure again was still high.

No MeSH data available.


Related in: MedlinePlus