Abstract
Objectives:
The mainstay of operative treatment of scapulothoracic bursitis is arthroscopic debridement of the scapulothoracic joint. Historically, this surgery has included bony debridement of the superior medial angle of the scapula as this is thought to decrease friction and crepitus at this location. However, there is significant variation in this technique across surgeons. Recently there is a trend towards more limited, soft-tissue-only scapulothoracic debridement. There is some data to suggest that limited soft tissue debridement provides sufficient resolution of symptoms in this patient population. However, these data comprise small numbers of patients and optimal surgical technique is not yet definitively established. The objectives of this study were to 1) obtain mid-term patient reported outcomes of arthroscopic scapulothoracic debridement, and 2) compare outcomes between soft-tissue-only and bony resection procedures. The authors hypothesized that bony resection would provide superior pain relief and function.
Methods:
All cases of scapulothoracic debridement completed at a single academic institution from 2007 through 2020 were reviewed. Prior to 2013, all cases were conducted using superior medial angle bony resection (historical control). After 2013 nearly all cases utilized a soft-tissue-only debridement technique (intervention group). Patient demographics, preoperative functional scores, preoperative visual analog scale (VAS) pain, and response to corticosteroid injection data were abstracted from the electronic medical record via retrospective review. Patients were surveyed to capture American Shoulder and Elbow Surgeons (ASES) score, Simple Shoulder Test(SST), VAS pain, and SANE scores, as well as qualitative discussion of shoulder function. Comparisons in clinical characteristics and patient reported outcomes were made across the bone resection and soft-tissue-only debridement groups. Student’s t-test was used for continuous variable comparisons. Fisher’s exact test was used for categorical variable comparisons. All analysis was conducted in R Statistical Software.
Results:
Twenty-nine patients underwent scapulothoracic soft-tissue-only debridement and 38 patients underwent arthroscopic superior medial angle bony resection. Distributions of demographic variables were similar across both groups including age, sex, laterality, tobacco use, Worker’s Compensation, anxiety, and depression. Mean follow-up in the soft tissue only group was 3.97± 2.89 years while follow-up in the bony debridement group was 8.11± 2.78 years (P <0.001). VAS pain scores (3.14 ± 1.77 vs. 2.69 ± 2.12 (P = 0.429)), ASES scores (78.06 ± 13.90 vs. 77.24 ± 22.06 (P = 0.881)), and SST scores (9.24 ± 1.79 vs. 9.72 ± 2.60 (P=0.464)) were similar between the soft-tissue-only and bony debridement groups, respectively. Rates of subsequent shoulder surgery were also similar between groups, 23.8% in the soft-tissue-only debridement group and 20.7% in the bony debridement group (P = 1.000). In the multivariable model, neither age, BMI, good response to injection, nor follow-up duration were found to be significant predictors of ASES scores. The bone resection group demonstrated a slight trend towards increased patient satisfaction with the surgery (75.9% versus 57.1% (P = 0.274))
Conclusions:
This study demonstrates that both soft-tissue-only debridement and bony resection of the superior medial angle of the scapula achieve similar functional and pain outcomes in patients with scapulothoracic bursitis. The overall majority of patients are satisfied with the outcome of this surgery, however, the rate of satisfaction may be slightly higher in the bone resection group. Interestingly, good response to injection, constituting greater than minimal relief was not predictive of ASES score at final follow-up. This analysis may be limited, however, given that very few patients who underwent surgery did not have a good response to injection therapy.
In conclusion, both arthroscopic soft-tissue-only debridement and arthroscopic superior medial angle bony resection are both effective and acceptable treatments for scapulothoracic bursitis with similar outcomes in regards to shoulder function, pain, reoperation, and patient satisfaction.
Patient Demographics and Clinical Variables
Outcomes at Final Follow-up
