synonyms: scapulothoracic bursitis, snapping scapula, scapulothoracic crepitus, washboard syndrome,
Scapulothoracic Bursitis ICD-9
- 726.10 (Disorders of bursae and tendons in shoulder; unspecified)
- 726.19 (Other affections of shoulder region, not elsewhere classified; scapulohumeral fibrositis)
Scapulothoracic Bursitis Etiology / Epidemiology / Natural History
- A tactile sound is created by anomalous tissue between the thoracic wall and the scapula.
- May be caused by abnormal scapular motion, hooked shaped prominence of the superomedial angle of the scapula (Luschka tubercle), osteochondroma, sketetal exostosis, rib fracture malunion, chondrosarcoma, muscle atrophy related to denervation, sports overuse(swimming, pitching, weight lifting, gymnastics, football), prior surgery (first rib resection, subserratus breast implant placement).
Scapulothoracic Bursitis Anatomy
- Scapular motion and function is maintained purely by dynamic muscular control
- Normal resting position: scapula sits approximately 2 inches laterally from the spine on the posterior thorax between the 2nd through 7th ribs or transverse processes.
- Generally lies 30° to 40° in the frontal plane and tipped anteriorly approximately 10° to 20° from vertical.
- Scapulothoracic pseudojoint consists of three layers: superficial, intermediate and deep.
- Inferior angle bursa is located between the inferior angle of the scapula and the latissimus dorsi. (Williams GR, CORR 1999;359:237).
- Trapezial bursa is located between the trapzius and the superomedial angle of the scapula. (Williams GR, CORR 1999;359:237).
- Scapulothoracic (supraserratus) bursa is located between the serratus anterior and the thoracic cage; averages 9 x 7.4 cm. (Williams GR, CORR 1999;359:237).
- Subscapular (infraserratus) bursa is located between the serratus anterior and subscapularis muscles; averages 5.3 x 5.3cm. (Williams GR, CORR 1999;359:237).
- See also Shoulder Anatomy.
Scapulothoracic Bursitis Clinical Evaluation
- Pain and grinding at the inferior angle of the scapula. Generally occurs during the late cocking and acceleration phases of throwing in the throwing athlete.
Scapulothoracic Bursitis Xray / Diagnositc Tests
Scapulothoracic Bursitis Classification / Treatment
- Conservative therapy: rest, shoulder exercises, antiinflammatory medications, and cortisone injections.
- Surgical: Excision of the thickened bursa; only indicated after failure of conservative treatment. (Sisto DJ, AJSM 1986;14:192).
Scapulothoracic Bursitis Associated Injuries / Differential Diagnosis
- SICK syndrome (Burkhart SS, Arthroscopy, 2003;19:641).
Scapulothoracic Bursitis Complications
- Nerve or vascular injury
- Incomplete releif of pain
- Incomplete return of funtion
- Medical and anesthesia risks including heart attack, stroke and death
Scapulothoracic Bursitis Follow-up Care
Scapulothoracic Bursitis Review References