Snapping Scapula Syndrome in the Setting of Elastofibroma Dorsi: A Case Report

A 54-year-old woman presented with a 15-year history of progressively worsening left snapping scapula syndrome (SSS) in the setting of ipsilateral elastofibroma dorsi. Her pain was refractory to multiple conservative measures. She was successfully treated with focal ultrasound-guided corticosteroid injection to the superomedial border of the scapula. There was demonstrable improvement in findings between pre- and post-procedural MRI examinations. Despite the underlying cause of SSS, trials of nonoperative treatment techniques are warranted before considering surgical options. Focal ultrasound-guided corticosteroid injection, in conjunction with physiotherapy, is one such example.

Diagnosis and Treatment of Snapping Scapula Syndrome: A Scoping Review

Context: Snapping scapula syndrome (SSS) is commonly misdiagnosed and underreported due to lack of awareness. Objective: This scoping review aims to summarize the current evidence related to SSS diagnosis and treatment to aid clinicians in managing the condition more effectively. Data Sources: PubMed, Medline, and Embase databases were searched for studies related to the etiology, diagnosis, or treatment of SSS (database inception to March 2020). Study Selection: Databases were searched for available studies related to the etiology, diagnosis, or treatment of SSS. Study Design: A scoping review study design was selected to explore the breadth of knowledge in the literature regarding SSS diagnosis and treatment. Level of Evidence: Level 4. Data Extraction: Primary outcomes abstraction included accuracy of diagnostic tests, functional outcomes, and pain relief associated with various nonoperative and operative treatment options for SSS. Results: A total of 1442 references were screened and 40 met the inclusion criteria. Studies commonly reported SSS as a clinical diagnosis and relied heavily on a focused history and physical examination. The most common signs reported were medial scapular border tenderness, crepitus, and audible snapping. Three-dimensional computed tomography had high interrater reliability of 0.972, with a 100% success rate in identifying symptomatic incongruity of the scapular articular surface. Initial nonoperative treatment was reported as successful in most symptomatic patients, with improved visual analogue scale (VAS) scores (7.7 ± 0.5 pretreatment, to 2.4 ± 0.6). Persistently symptomatic patients underwent surgical intervention most commonly involving bursectomy, superomedial angle resection, or partial scapulectomy. High satisfaction rates of surgery were reported in VAS (6.9 ± 0.7 to 1.9 ± 0.9), American Shoulder and Elbow Surgeons scores (50.3 ± 12.2 to 80.6 ± 14.9), and mean simple shoulder test scores (5.6 ± 1.0 to 10.2 ± 1.1). Conclusion: Focused history and physical examination is the most crucial initial step in the diagnostic process, with supplemental imaging used to assess for structural etiologies when nonoperative management fails. Nonoperative management is as effective as surgical management in pain relief and is advised for 3 to 6 months before operative treatment.