Scapulothoracic Bursitis - Causes, Symptoms, Diagnosis, and Treatment

Introduction:

Scapulothoracic bursitis is a disorder of scapulothoracic articulation. It causes persistent pain and dysfunction in overhead-throwing athletes. It is the inflammation of the bursae (small fluid-filled sacs that reduce friction between moving parts of the joints) secondary to trauma or overuse. Whereas scapulothoracic crepitus refers to a popping, grinding, or thumping sound due to abnormal scapulothoracic movements. Also called snapping scapula syndrome.

What Is the Anatomy of Scapulothoracic Bursae?

The scapula is a thin triangle-shaped bone that serves as an attachment for extrinsic and intrinsic muscles that provide stability to the glenohumeral and scapulothoracic joints. In addition, it provides a stable base of support for the humerus. The scapula is attached to the axial skeleton through the clavicle (collar bone), and it is the essential link for coordinated upper extremity activity. Bursae are small fluid-filled sacs that reduce friction between moving parts of the joints and allow for smooth and gliding movements. Scapulothoracic joints have two minor and four major bursae. The bursae are found over the triangular surface at the spine of the scapula.

What Are the Causes of Scapulothoracic Bursitis?

1. Abnormalities in bone and muscles.

2. Trauma.

3. Overuse due to sports and other activities.

4. Anatomic deformity.

5. Soft tissue pathology.

6. Idiopathic.

7. Postural dysfunction.

What Are the Symptoms?

1. Shoulder pain of sudden or gradual onset.

2. Pain is dull, mild, or sharp.

3. Shoulder stiffness.

4. The range of motion is painful.

5. Night pain while lying on the affected side.

6. Sharp pain with overhead shoulder movements.

What Are the Types of Scapulothoracic Bursitis?

• Chronic: Repeated acute injury results in chronic scapulothoracic bursitis. Initially, the person will not have any symptoms. However, over time the inflammation causes muscle weakness and causes pain. Some people will get accustomed to the symptoms they experience.

• Acute: Acute scapulothoracic bursitis results from an accident or injury. Pain on touching or moving the shoulder.

• Infectious: In rare cases, staphylococcus infections cause scapulothoracic bursitis. The shoulder will be purple or red and warm to the touch. The person will experience fever and sharp pain in the shoulder.

What Are the Risk Factors of Scapulothoracic Bursitis?

1. Professionals like painters, carpenters, and builders do repetitive work.

2. Athletes who play football, softball, or lacrosse.

3. Arthritis (inflammation of the joints).

4. Diabetes.

5. Kidney disease.

6. Thyroid disorder.

How to Diagnose?

Physical Examination:

1. Scapulothoracic bursitis is diagnosed most often clinically.

2. Clinical evaluation begins with a thorough history and physical examination.

3. Individuals with scapulothoracic bursitis will complain of pain with increased activity and audible and palpable crepitus (crackling sound) with the range of motion.

4. The crepitus associated with bursitis is less intense in nature.

5. Some individuals will not have pain.

6. In severe bursitis, individuals will have pain even at rest.

7. Sometimes scapulothoracic bursitis is bilateral (both sides).

8. On inspection, the scapula may reveal fullness or winging, which suggests a space-occupying lesion in the scapulothoracic space.

9. Visual inspection reveals alteration in the normal position or motion of the scapulothoracic joint.

10. The normal ratio of glenohumeral and scapulothoracic rotation is 2:1 throughout the full range of elevation.

11. Defective patterns usually have decreased glenohumeral and increased scapulothoracic movements, which leads to clinically apparent protrusion at the lateral border of the axilla.

12. Additionally, the individual's posture may reveal moderate to severe forward head position and rounded shoulders suggestive of scapular symptoms.

13. Neuromuscular examination of scapulothoracic bursitis individuals remains normal whereas assessment of muscle strength remains critical.

14. Basic manual muscle testing should focus on the strength of the scapular muscles.

15. A loss of muscle tone or alteration in scapulothoracic rhythm may lead to increased friction resulting in snapping.

16. The physician will then do the trapezius muscle tightness test.

17. On palpation, there is localized tenderness on the injured area and crepitus (crackling sound) while doing full range of motion.

18. Injection of local anesthetic and Corticosteroids may also help in diagnosing scapulothoracic bursitis.

Other Investigations: X-rays, computed tomography, and magnetic resonance imaging are also helpful in identifying anatomic pathology.

What Is the Treatment Plan?

Non-operative Management:

1. Non-operative management should be the first line of treatment for scapulothoracic bursitis.

2. Non-operative treatment seems beneficial in soft tissue disorder, altered posture, scapular dyskinesis (deviation of the scapula from normal position), and scapular winging.

3. Initial treatment includes rest, systemic anti-inflammatory drugs, activity modification, and shoulder rehabilitation.

4. The planned rehabilitation program is mandatory and should focus on posture, endurance, and strength.

5. For individuals with aggravating factors such as scapular protraction, postural exercises help to strengthen the upper thoracic muscles and prevent sloping of the shoulders.

6. In addition, a figure eight harness may be a useful tool to attain normal posture.

7. Rehabilitation exercises should focus on strengthening the periscapular muscles and stretching their antagonist counterparts.

8. Endurance exercises should consist of low-intensity exercises with high volume.

9. In order to stimulate the true function of a scapular stabilizer during sporting or repetitive work activities, fifteen to twenty repetitions with lighter loads should be performed.

10. A carefully designed rehabilitation exercise should be continued for three to six months or until the goal is met.

11. The rehabilitation exercise should progress from isotonic and isometric strengthening to eccentric strengthening of the muscles.

12. Failure to treat the individual properly will lead to poor results.

13. Other modes of non-operative methods are heat application, massage, ultrasound, and iontophoresis (transdermal drug delivery through the skin).

Operative Management:

1. The decision and timing of operative management should be individualized for each person.

2. Operative options include partial splitting of the scapula and open or arthroscopic splitting of the bursae.

3. Resection of the partial scapula is recommended for individuals with pain and crepitus (crackling sound).

4. The complications associated with open or arthroscopic splitting of bursae include postoperative hematoma (blood clot under the skin), nerve injury, and recurrence of bursitis.

5. Most individuals return to work or sports within four months after thoracic posture, scapular control, and strength are obtained through rehabilitation.

Conclusion:

Scapulothoracic bursitis can be diagnosed clinically, and imaging studies are helpful in confirmatory diagnosis. The best initial approach to treat this condition is a non-operative treatment plan that combines scapular strengthening, postural reeducation, and core strength endurance. In addition, Nonsteroidal anti-inflammatory drugs and local injections are also helpful. If the non-surgical treatment proves unsuccessful, then surgical correction can be done.