Arthroscopic scapuloplasty addresses snapping scapula syndrome by removing the inflamed bursa, irregular bone, or soft-tissue masses at the scapulothoracic articulation that produce painful crepitus during shoulder motion. The procedure is reserved for patients whose snapping is painful and has not improved with non-surgical care.
What Is Arthroscopic Scapuloplasty?
The scapulothoracic articulation is the gliding space between the deep surface of the scapula and the chest wall, cushioned by three bursae. The scapula slides and rotates against the chest wall during shoulder motion. When this gliding space becomes irritated by overuse, bony irregularities, or soft-tissue masses, painful crepitus develops.
Arthroscopic scapuloplasty involves arthroscopic exploration of the scapulothoracic space, removal of inflamed bursa (scapulothoracic bursectomy), and resection of any irregular bone or masses on the undersurface of the scapula. The procedure is performed through small portals along the medial border of the scapula.
Who Is a Candidate?
Candidates for arthroscopic scapuloplasty typically have:
- Symptomatic snapping scapula syndrome with painful crepitus
- Failure of non-surgical treatment (activity modification, physical therapy, scapulothoracic bursa injection)
- Identifiable bursitis, osteochondroma, or soft-tissue mass on imaging
- Functional limitation from scapular pain
- Realistic expectations about the procedure’s effects on snapping versus pain
Painless snapping is common and does not require surgery. Snapping driven primarily by scapular dyskinesis without an anatomic cause may not benefit from surgery.
How the Procedure Is Performed
The procedure is performed under general anesthesia. The patient is positioned to expose the medial border of the scapula. Two or three portals are placed along the medial scapular border, taking care to avoid neurovascular structures (dorsal scapular nerve and artery).
The arthroscope is introduced into the scapulothoracic space. The bursa is identified and inflamed tissue is removed. Any irregular bone on the undersurface of the scapula is resected with a burr. Soft-tissue masses (such as osteochondromas) are excised when present.
Recovery and Rehabilitation
Recovery is relatively quick:
- Sling for one to two weeks for comfort
- Active motion begins early
- Progressive strengthening at two to four weeks, with attention to scapular stabilizers
- Return to most activity at six to eight weeks
A targeted physical therapy program after surgery addresses any underlying scapular dyskinesis that contributed to symptoms.
Risks and Outcomes
Risks include nerve injury (dorsal scapular nerve), persistent crepitus (the snapping may not fully resolve), persistent pain, and pneumothorax (rare but possible during portal placement near the chest wall). Outcomes are good when the underlying anatomic cause is correctly identified and addressed.
Why Dr. Chudik for Arthroscopic Scapuloplasty
Dr. Chudik treats the full range of shoulder pathology, including the less common scapulothoracic conditions. His evaluation distinguishes anatomic causes of snapping (bursitis, bone irregularities, osteochondromas) from mechanical causes (scapular dyskinesis), which drives whether surgery or rehabilitation is the appropriate treatment. When surgery is indicated, his arthroscopic experience minimizes the soft-tissue disruption of older open techniques.