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6 
Copyright © by Indiana State University                                                                                Clinical Practice in Athletic Training  
All rights reserved. ISSN Online 2577-8188                                                                              Volume 3 – Issue 1 – April 2020 
 

Unique Shoulder Arthroscopies: Snapping Scapula Syndrome and 
Scapular Nerve Entrapment  
Erica L. Taylor, MS, LAT, ATC, OTC; Spero Karas, MD 
Emory Sports Medicine, Atlanta, GA   
 

 
 
Full Citation 
Taylor E & Karas S. Unique shoulder arthroscopies: 
scapulothoracic bursectomy and spinoglenoid cyst 
excision. Clin Pract Athl Train. 2020;3(1):6-8. 
https://doi.org/10.31622/2020/0003.3.  
 
Presented at the 3rd Annual Athletic Trainers in the 
Physician Practice Society Meeting and Conference, 
Columbia South Carolina. February 28-29, 2020  
  

ABSTRACT 

Anatomy Review: The scapula provides the 
stable base for glenohumeral motion and 
provides origins and insertions for 17 muscles. 
The scapulothoracic (ST) joint lacks synovial lining 
and cartilaginous interface. The anterior scapula 
glides over the thoracic wall between several 
bursal and soft tissue planes.1,2 The 
suprascapular nerve emerges from the superior 
trunk of the brachial plexus (C5, C6) and travels 
across the posterior triangle of the the neck of 
the scapula trough the suprascapular and 
spinoglenoid notches. The suprascapular nerve 
innervates half of the rotator cuff musculature, 
the infraspinatus and supraspinatus. Snapping 
Scapula Syndrome (SSS) occurs when the ST 
articulation impinges on bony or soft tissue 
structures including a hooking or excessive 
angulation of the superomedial scapula or bursal 
inflammation.1,2,3,4 Patients experience pain with 
overhead activities accompanied by palpable 
and/or audible crepitus. Suprascapular Nerve 
Entrapment (SNE) can occur at the suprascapular 
notch, affecting both supraspinatus and 
infraspinatus muscles or at the spinoglenoid notch 
affecting only the infraspinatus muscle.5,6,7 
Extravasation of glenohumeral synovial fluid, due 
to a torn posterior labrum, can cause a ganglion 
cyst to appear secondarily.  A spinoglenoid cyst 

causes a patient to have atrophy of the 
infraspinatus, weakness with external rotation, 
and posterior shoulder pain or tenderness. 

Patient A: The patient was a 30-year-old 
female. Chief complaint of worsening left 
posteromedial scapular pain for 6 months with 
clicking, cracking, and popping of scapula. 
Recent treatment included 4 months of physical 
therapy and ST injection by outside MD. Injection 
provided significant relief and decreased 
crepitus. Physical exam revealed audible and 
palpable posterior crepitus with active and 
passive ROM, tenderness along posteromedial 
border of scapula. Due to success of previous 
injection and current worsening symptoms, she 
consented for diagnostic scapulothoracic 
arthroscopy.1,2,3,4 Positioned prone on Wilson 
frame, max internal rotation/”chicken wing” 
positioning of arm, surgeon stands opposite 
surgical side.3,4 Intra-operative findings included 
diffuse scapulothoracic bursitis and prominent 
superomedial scapular border that were 
addressed with a bursectomy and recession 
respectively. At 2 days post-op, she had no 
palpable/audible crepitus with 90° 
AROM/PROM and tenderness along scapula. 
Physical therapy focused on ROM and scapular 
stabilization. At 3 months post-op, she had no 
tenderness long medial scapular border and no 
recurrence of palpable or audible crepitus.  

Discussion Scapulothoracic 
Arthroscopy/Bursectomy: This procedure is 
indicated when there is pain at the superomedial 
border of the scapula with painful, audible 
and/or palpable crepitus that has responded 
well to injections but failed other conservative 
measures. Advantages include easy visualization 
of ST bursa and superomedial border of scapula 

https://doi.org/10.31622/2020/0003.3


Unique Shoulder Arthroscopies: Snapping Scapula Syndrome and Scapular Nerve Entrapment

7 
Copyright © by Indiana State University       Clinical Practice in Athletic Training 
All rights reserved. ISSN Online 2577-8188        Volume 3 – Issue 1 – April 2020  

with minimal tissue disturbance.1,2,3,4 Care should 
be taken to ensure superficial periosteal layer of 
superomedial scapula border remains intact. 
Although long term results are limited, patients 
have improved outcome scores are 2 years post-
op with primary and revision procedures.2 Injury 
to the chest well, thoracic cavity, and dorsal 
scapular nerve and/or artery is possible if 
portals are not made appropriately (<3m from 
medial border of scapula).3,4 

Patient B: The patient was a 39-year-old 
female. Chief complaint of worsening right 
shoulder pain and weakness for 1 year with 
insidious onset and failed conservative measures 
including physical therapy, NSAIDs, and activity 
modifications.  Physical exam revealed marked 
weakness with external rotation, infraspinatus 
fossa atrophy and positive special tests including 
Neers, Hawkins, and External Rotation Lag. MRI 
revealed posterior labral tear, spinolaminar 
labral cyst (2.7cm) extending into spinoglenoid 
notch, and edema within infraspinatus. Study was 
otherwise normal. Due to failed conservative 
treatment, the patient was consented for 
arthroscopic posterior Bankart repair and 
spinoglenoid cyst decompression.5,6,7 Cyst was 
decompressed with switching stick/shaver and 
posterior labral tear (10-6 o’clock) was repaired 
with Ultra Tape and 4 Micro-Raptor knotless 
anchors. Given physician’s standard Posterior 
Bankart rehabilitation protocol which included 4 
weeks in sling with abduction pillow. At 7 months 
post-operation, she has regained infraspinatus 
fossa bulk, significant strength on operative side 
yet continues to have decreased strength when 
comparted to uninvolved side. ROM is equal 
bilaterally.  

Discussion Scapulothoracic 
Arthroscopy/Bursectomy: Spinoglenoid notch 
cysts can be treated in several ways including 
physical therapy and/or NSAIDs, needle 
aspiration, labral repair, and cyst 
excision/decompression +/- labral repair.5 
When treated operatively, patients can be 

positioned in beach chair or lateral decubitus. 
The cyst can be viewed/decompressed in the 
subacromial or intra-articular spaces.5,6,7 In this 
case, the patient was in lateral decubitus and the 
cyst was decompressed intra-articularly. 
Literature shows no recurrence of surgical 
decompressed cysts at 6 months post-op (n=21) 
versus 45% recurrence with needle aspiration 
(n=11).5,6 

Correspondence 
Erica Taylor, 10310 The Grove Blvd. Baton Rouge, LA, 
70810.  
Email: etaylor225@gmail.com  

REFERENCES 

1. Menge TJ, Horan MP, Tahal DS, Mitchell JJ,
Katthagen JC, Millett PJ. Arthroscopic
treatment of snapping scapula syndrome:
Outcomes at minimum of
2 Years. Arthroscopy. 2017;33(4):726–732.
https://doi.org/10.1016/j.arthro.2016.08.0
29.

2. Tahal DS, Katthagen C, Marchetti DC. A
cadaveric model evaluating the influence of
bony anatomy and the effectiveness of
partial scapulectomy on decompression of
the scapulothoracic space in snapping
scapula syndrome. AM J Sports Med.
2017;45(6) 1276-1282.
https://doi.org10.1177/03635465166877
55.

3. Saper M, Kaisk C, Dietzel D. Arthroscopic
scapulothoracic decompression for snapping
scapula syndrome. Arthrosc Tech.
2015;4(6):e631-636.
https://doi.org/10.1016/j.eats.2015.07.00
2.

4. Karas, Spero. Arthroscopic Resection of the
Superior Medial Border of the Scapula.
VuMedi.com.
www.vumedi.com/video/arthroscopic-
resection-of-the-superior-medial-border-of-
the-scapula/.

5. Piatt B, Hawkins R, Frit, R, Ho C, Wolf E,
Schickendantz M. Clinical evaluation and

mailto:etaylor225@gmail.com
https://doi.org/10.1016/j.arthro.2016.08.029
https://doi.org/10.1016/j.arthro.2016.08.029
https://doi.org10.1177/0363546516687755
https://doi.org10.1177/0363546516687755
https://doi.org/10.1016/j.eats.2015.07.002
https://doi.org/10.1016/j.eats.2015.07.002
http://www.vumedi.com/video/arthroscopic-resection-of-the-superior-medial-border-of-the-scapula/
http://www.vumedi.com/video/arthroscopic-resection-of-the-superior-medial-border-of-the-scapula/
http://www.vumedi.com/video/arthroscopic-resection-of-the-superior-medial-border-of-the-scapula/


Unique Shoulder Arthroscopies: Snapping Scapula Syndrome and Scapular Nerve Entrapment 
 

 

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Copyright © by Indiana State University                                                                                Clinical Practice in Athletic Training  
All rights reserved. ISSN Online 2577-8188                                                                              Volume 3 – Issue 1 – April 2020  

treatment of spinoglenoid notch ganglion 
cysts. J Shoulder Elbow Surg. 
2002;11(6):600-604. 
https://doi.org/10.1067/mse.2002.127094 

6. Kim SJ, Choi YR, Jung M, Park JY, Chun YM. 
Outcomes of arthroscopic decompression of 
spinoglenoid cysts through a subacromial 
approach. Arthroscopy. 2017;33(1):62-67. 
https://doi.org/10.1016/j.arthro.2016.05.0
34.    

7. Ghodadra N, Nho S, Verma, N, Reiff S, 
Piasecki D, Provencher M, Romeo A. 
Arthroscopic decompression of the 
suprascapular nerve at the spinoglenoid 
notch and suprascapular notch through the 
subacromial space. Arthroscopy. 
2009;25(4):439-445. 
https://doi.org/10.1016/j.arthro.2008.10.0
24.    

 

https://doi.org/10.1067/mse.2002.127094
https://doi.org/10.1016/j.arthro.2016.05.034
https://doi.org/10.1016/j.arthro.2016.05.034
https://doi.org/10.1016/j.arthro.2008.10.024
https://doi.org/10.1016/j.arthro.2008.10.024



