Arthroscopic management of snapping scapula syndrome improves pain and functional outcomes, although a high rate of residual symptoms has been reported
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PURPOSE: To investigate the use of arthroscopy in the management of patients with snapping scapula syndrome, including aetiology, surgical decision-making, outcomes, complications, effectiveness of arthroscopy, and quality of evidence of the existing literature. METHODS: Three databases (PubMed, Ovid [MEDLINE], and EMBASE) were searched independently and in duplicate to systematically screen the literature. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) checklist guided the reporting and data abstraction. Methodological quality of all included papers was assessed using the MINORS criteria. The results are presented in a narrative summary fashion using descriptive statistics including means, proportions, and ranges. RESULTS: Overall, 18 studies (5 case reports and 13 case series; all level IV evidence) were identified, including 201 patients (203 shoulders). The mean follow-up period was 32.7 months (range 1-154 months). Surgical decision-making for the use of arthroscopy was most commonly based on a failed trial of initial non-operative management in 17 studies (94%). Overall, 21% of cases achieved complete resolution of pre-operative symptoms, including pain, crepitus, and range of motion, while 68% of cases obtained some clinical improvement, but reported some residual symptoms (persistent crepitus [12%] and persistent scapulothoracic pain [4%]). Moreover, poor outcomes were reported 11% of cases and the most common complication was scapular oedema (6%). CONCLUSION: Arthroscopic management of snapping scapula syndrome yields improvement in pain, crepitus, and range of motion in a majority of patients; however, most patients experience residual symptoms. Further studies are needed to compare the outcomes of shoulder arthroscopy with other available treatment options for snapping scapula syndrome. Shoulder arthroscopy for snapping scapula can improve patients' symptoms; however, patients must be informed about the high likelihood of persistent symptoms post-operatively. LEVEL OF EVIDENCE: Systematic review of Level IV studies.