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Anatomical considerations for safe scapular resection in snapping scapula syndrome

Surgical and Radiologic Anatomy volume 34, pages 43–47 (2012)Cite this article

Abstract

Background

The resection of the superomedial angle of the scapula in snapping scapula syndrome is associated with potential risk of injury to the suprascapular nerve. The aim of the present study was to determine the distance of site of resection on the upper border of the scapula from the suprascapular notch during arthroscopic resection of the superomedial angle using standard superior Bell’s and medial portals at the middle of medial border.

Materials and methods

The study was conducted on 92 intact dry adult scapulae of unknown sex. The junction of the medial two-thirds and the lateral one-third of an imaginary line joining the superomedial angle and the lateral margin of the acromion was marked as superior Bell’s portal. The middle of the medial border was considered as the arthroscopic resection target. The site of resection on the upper border was found out with the help of these two points and other relevant measurements were also taken.

Results

The distance between the suprascapular notch and the lateral edge of resection on the upper border of the scapula was more than 10 mm in 85.9% cases and less than 10 mm in 14.1%. A statistically significant positive correlation was found between this distance and the distance between the superior angle and acromion angle of the scapula.

Conclusion

Our study suggests that during arthroscopic resection using superior Bell’s portal and medial portal, suprascapular notch hence the suprascapular nerve would have safe margin of more than 10 mm from the resection site on upper border in 85.9% cases and would be vulnerable to injury in 14% cases. The procedure would be safer in patients with a wider scapula.

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References

  1. Aggarwal A, Wahee P, Harjeet, Aggarwal AK, Sahni D (2011) Variable osseous anatomy of costal surface of scapula and its implications in relation to snapping scapula syndrome. Surg Radiol Anat 33:135–140

  2. Bell SN, Van Riet RP (2008) Safe zone for arthroscopic resection of the superomedial scapular border in the treatment of snapping scapular syndrome. J Shoulder Elbow Surg 17:647–649

    PubMed  Article  Google Scholar 

  3. Chan BK, Chakrabarti AJ, Bell SN (2002) An alternative portal for scapulothoracic arthroscopy. J Shoulder Elbow Surg 11:235–238

    PubMed  Article  Google Scholar 

  4. Ciullo JV (1992) Subscapular bursitis. Treatment of “snapping scapula” or “washboard syndrome”. Arthroscopy 8:412–413

    Google Scholar 

  5. Harper GD, Mcllroy S, Bayley JIL, Calvert PT (1999) Arthroscopic partial resection of the scapula for snapping scapula: a new technique. J Shoulder Elbow Surg 8:53–57

    PubMed  Article  CAS  Google Scholar 

  6. Lehtinen JT, Macy JC, Cassinelli E, Warner JJP (2004) The painful scapulothoracic articulation: surgical management. Clin Orthop 423:99–105

    PubMed  Article  Google Scholar 

  7. Lehtinen JT, Tingart MJ, Apreleva M, Warner JP (2005) Quantitative morphology of the scapula: normal variations of the superomedial scapular angle and superior and inferior pole thickness. Orthopedics 28(5):481–486

    PubMed  Google Scholar 

  8. Milch H, Burman MS (1933) Snapping scapula and humerus varus: report of six cases. Arch Surg 26:570–588

    Article  Google Scholar 

  9. Oizumi N, Suenaga N, Minami A (2004) Snapping scapula caused by abnormal angulation of the superior angle of the scapula. J Shoulder Elbow Surg 13:115–118

    PubMed  Article  Google Scholar 

  10. Pavlik A, Ang K, Coghlan J, Bells S (2003) Arthroscopic treatment of painful snapping of scapula by using a new superior portal. Arthroscopy 19(6):608–612

    PubMed  Article  Google Scholar 

  11. Van Riet RP, Bell SN (2006) Scapulothoracic arthroscopy. Tech Shoulder Elbow Surg 7:143–146

    Article  Google Scholar 

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Conflict of interest

The authors declare that they have no conflict of interest.

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Affiliations

  1. Department of Anatomy, Post Graduate Institute of Medical Education and Research, # 123-C Type V Sector 24-A, Chandigarh, 160023, India

    Anjali Aggarwal, Pratima Wahee, Harjeet Kaur & Daisy Sahni

  2. Department of Orthopaedic Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India

    Aditya K. Aggarwal

Authors
  1. Anjali Aggarwal
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  2. Pratima Wahee
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  3. Aditya K. Aggarwal
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  4. Harjeet Kaur
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  5. Daisy Sahni
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Correspondence to Anjali Aggarwal.

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Aggarwal, A., Wahee, P., Aggarwal, A.K. et al. Anatomical considerations for safe scapular resection in snapping scapula syndrome. Surg Radiol Anat 34, 43–47 (2012). https://doi.org/10.1007/s00276-011-0835-5

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  • DOI: https://doi.org/10.1007/s00276-011-0835-5

Keywords

  • Suprascapular nerve
  • Suprascapular notch
  • Superomedial angle
  • Arthroscopy