Bilateral snapping skapula sendromunun artroskopik tedavisi: Olgu sunumu ve literatürün incelenmesi

Yıl 2015, , 91 - 96, 19.03.2015

Sven Freche Franziska Juch Thomas Nusselt Karl-Stefan Delank Alexander Hagel

https://doi.org/10.3944/AOTT.2015.3241

Öz

Snapping skapula sendromu, omuz cerrahisinde ender görülen bir durumdur. Klinik olarak, omuz hareketi sırasında omuz ağrısı ve yüksek krepitus olarak kendini gösterir. Bunun dışında, glenohu¬meral bursit ilave bir ağrıya yol açabilir. Snapping skapula sendromu, skapulanın superomedial bölü¬münde artan açılanmanın bursit ile birleşmesi sonucu ortaya çıkar. Subskapular osteokondrom ya da kaburga kırıklarının kaynamaması gibi sık görülen nedenler ise değerlendirme dışı bırakılmıştır. Bu çalışmamızda, sol omuzunu hareket ettirdiğinde sürekli omuz ağrısı ile birlikte rahatsız edici derecede krepitusu olan 24 yaşındaki bir kadın hasta sunuyoruz. Hastanın radyolojik muayeneleri ile her iki ta¬rafta skapulanın superomedialinde açılanma ve MRG ile sol omuzdaki bursit teyit edildi. Hastanın sol skapuladaki yerleşik kemik oluşumu minimal invaziv artroskopik düzeltme ve bursektomi ile başarılı bir şekilde tedavi edildi. Hastanın her iki omuzu için, ayrıca, belli ağrı azaltıcı fizyoterapi egzersizleri uygulandı. Altı ay sonraki takip muayenesinde hastanın her iki omuzunu krepitus olmaksızın ağrısız bir şekilde hareket ettirebildiği görüldü. 

Anahtar Kelimeler

Çatırdama; omuz; snapping skapula sendromu; superomedial skapula.

Arthroscopic treatment of bilateral snapping scapula syndrome: a case report and review of the literature

Öz

Snapping scapula syndrome represents a rare entity in shoulder surgery. Clinically, it presents as shoulder pain and loud crepitus during shoulder movement. Moreover, glenohumeral bursitis can cause additional pain. Snapping scapula syndrome is caused by an increased angulation of the superomedial part of the scapula combined with bursitis. Other common causes such as subscapular osteochondroma or rib fracture non-unions were excluded. We report a 24-year-old female patient with persisting shoulder pain and disturbing crepitus during movement of the left shoulder. Radiographic examination revealed increased angulation of the superomedial scapula on both sides and MRI, bursitis of the left shoulder. The patient was successfully treated with minimally invasive arthroscopic trimming of the prominent osseous formation at the left scapula combined with bursectomy. Additionally, specific pain-adapted physiotherapeutic exercises of both shoulders were performed. The patient had a painfree shoulder movement without crepitus on both sides at the 6th month follow-up.

Anahtar Kelimeler

Cracking, shoulder, snapping scapula syndrome, superomedial scapula

Kaynakça

• Boinet W. [Case presentation]. Bulletin de la Société Im- périalé de Chirurgie de Paris 1867;8:458.
• Takahara K, Uchiyama S, Nakagawa H, Kamimura M, Ohashi M, Miyasaka T. Snapping scapula syndrome due to malunion of rib fractures: a case report. J Shoulder El- bow Surg 2004;13:95-8.
• Kuhne M, Boniquit N, Ghodadra N, Romeo AA, Provencher MT. The snapping scapula: diagnosis and treatment. Arthroscopy 2009;25:1298-311.
• Liu YL, Cui GQ, Ao YF, Yang YP, Zheng ZZ. A new cause of snapping scapula and its arthroscopic treatment. Chin Med J (Engl) 2012;125:4149-51.
• Kuhn JE, Plancher KD, Hawkins RJ. Symptomatic scapu- lothoracic crepitus and bursitis. J Am Acad Orthop Surg 1998;6:267-73.
• Boyle MJ, Misur P, Youn SM, Ball CM. The superome- dial bare area of the costal scapula surface: a possible cause of snapping scapula syndrome. Surg Radiol Anat 2013;35:95-8.
• Milch H, Burmann MS. Snapping scapula and humerus varus. Arch Surg 1933;26:510.
• Sauser G. Tuberculum hemi-articulare scapulae. [Ar- ticle in German] Zeitschr F, Anat U. Entwicklungsgesch 1936;106:80-2.
• Milch H. Partial scapulectomy for snapping of the scapu- la. J Bone Joint Surg Am 1950;32:561-6.
• Carlson HL, Haig AJ, Stewart DC. Snapping scapula syn- drome: three case reports and an analysis of the literature. Arch Phys Med Rehabil 1997;78:506-11.
• Strizak AM, Cowen MH. The snapping scapula syn- drome. A case report. J Bone Joint Surg Am 1982;64:941- 2.
• Lazar MA, Kwon YW, Rokito AS. Snapping scapula syn- drome. J Bone Joint Surg Am 2009;91:2251-62.
• Edelson JG. Variations in the anatomy of the scapula with reference to the snapping scapula. Clin Orthop Relat Res 1996;322:111-5.
• Oizumi N, Suenaga N, Minami A. Snapping scapula caused by abnormal angulation of the superior angle of the scapula. J Shoulder Elbow Surg 2004;13:115-8.
• Aggarwal A, Wahee P, Harjeet, Aggarwal AK, Sahni D. Variable osseous anatomy of costal surface of scapula and its implications in relation to snapping scapula syndrome. Surg Radiol Anat 2011;33:135-40.
• Samilson RL, Morris JM, Thompson RW. Tumors of the scapula. J Bone Joint Surg Am 1967;49:202.
• Nielsen T, Sneppen O, Myhre-Jensen O, Daugaard S, Nİrbaek J. Subscapular elastofibroma: a reactive pseudo- tumor. J Shoulder Elbow Surg 1996;5:209-13.
• Okada K, Terada K, Sashi R, Hoshi N. Large bursa for- mation associated with osteochondroma of the scapula: a case report and review of the literature. Jpn J Clin Oncol 1999;29:356-60.
• Majó J, Gracia I, Doncel A, Valera M, Nşñez A, Guix M. Elastofibroma dorsi as a cause of shoulder pain or snap- ping scapula. Clin Orthop Relat Res 2001;388:200-4.
• Marcos J, Rodríguez Russo P, Lima S, Rodríguez EL. Elas- tofibroma dorsi: an unusual case of a subscapular nodular mass. J Clin Rheumatol 2004;10:21-4.
• Daigeler A, Vogt PM, Busch K, Pennekamp W, Weyhe D, Lehnhardt M, et al. Elastofibroma dorsi--differential diagnosis in chest wall tumours. World J Surg Oncol 2007;5:15.
• Cinar BM, Akpinar S, Derincek A, Beyaz S, Uysal M. Elastofibroma dorsi: an unusual cause of shoulder pain. Acta Orthop Traumatol Turc 2009;43:431-5. [Article in Turkish]
• Aalderink K, Wolf B. Scapular osteochondroma treated with arthroscopic excision using prone positioning. Am J Orthop (Belle Mead NJ) 2010;39:E11-4.
• Parratt MT, Donaldson JR, Flanagan AM, Saifuddin A, Pollock RC, Skinner JA, et al. Elastofibroma dorsi: man- agement, outcome and review of the literature. J Bone Joint Surg Br 2010;92:262-6.
• Vela P, Andrés Collado M, Agulló Antón A, Cerezal Garrido J, Hoz J. Clinical Images: osteochondroma lead- ing to snapping scapula syndrome. Arthritis Rheum 2010;62:1838.
• Ermiş MN, Aykut US, Durakbaşa MO, Ozel MS, Bozkuş FS, Karakaş ES. Snapping scapula syndrome caused by subscapular osteochondroma. Eklem Hastalik Cerrahisi 2012;23:40-3.
• Kwon OS, Kelly JI. Delayed presentation of osteochon- droma on the ventral surface of the scapula. Int J Shoulder Surg 2012;6:61-3.
• Pérez D, Cano JR, Caballero J, López L. Minimally-inva- sive resection of a scapular osteochondroma. Interact Car- diovasc Thorac Surg 2011;13:468-70.
• Frost NL, Parada SA, Manoso MW, Arrington E, Ben- fanti P. Scapular osteochondromas treated with surgical excision. Orthopedics 2010;33:804.
• Wood VE, Verska JM. The snapping scapula in asso- ciation with the thoracic outlet syndrome. Arch Surg 1989;124:1335-7.
• Manske RC, Reiman MP, Stovak ML. Nonoperative and operative management of snapping scapula. Am J Sports Med 2004;32:1554-65.
• Parsons TA. The snapping scapula and subscapular exos- toses. J Bone Joint Surg Br 1973;55:345-9.
• Mozes G, Bickels J, Ovadia D, Dekel S. The use of three- dimensional computed tomography in evaluating snap- ping scapula syndrome. Orthopedics 1999;22:1029-33.
• Sans N, Jarlaud T, Sarrouy P, Giobbini K, Bellumore Y, Railhac JJ. Snapping scapula: the value of 3D imaging. [Article in French] J Radiol 1999;80:379-81. [Abstract]
• de Haart M, van der Linden ES, de Vet HC, Arens H, Snoep G. The value of computed tomography in the diag- nosis of grating scapula. Skeletal Radiol 1994;23:357-9.
• Morse BJ, Ebraheim NA, Jackson WT. Partial scapu- lectomy for snapping scapula syndrome. Orthop Rev 1993;22:1141-4.
• Lien SB, Shen PH, Lee CH, Lin LC. The effect of endo- scopic bursectomy with mini-open partial scapulectomy on snapping scapula syndrome. J Surg Res 2008;150:236- 42.
• Nicholson GP, Duckworth MA. Scapulothoracic bursec- tomy for snapping scapula syndrome. J Shoulder Elbow Surg 2002;11:80-5.
• Pearse EO, Bruguera J, Massoud SN, Sforza G, Copeland SA, Levy O. Arthroscopic management of the painful snapping scapula. Arthroscopy 2006;22:755-61.
• Bell SN, van Riet RP. Safe zone for arthroscopic resec- tion of the superomedial scapular border in the treatment of snapping scapula syndrome. J Shoulder Elbow Surg 2008;17:647-9.
• Yamamoto T, Nishida K, Mizuno K. Snapping scapula: Formation of an erosive, subscapular bursal cyst after par- tial scapulectomy. J Shoulder Elbow Surg 1993;2:317-20.
• Higuchi T, Ogose A, Hotta T, Okamoto K, Kamura T, Sasai K, et al. Clinical and imaging features of distended scapulothoracic bursitis: spontaneously regressed pseudo- tumoral lesion. J Comput Assist Tomogr 2004;28:223-8.
• Percy EC, Birbrager D, Pitt MJ. Snapping scapula: a re- view of the literature and presentation of 14 patients. Can J Surg 1988;31:248-50.
• Elser F, Millett PJ, Lorenz S, Südkamp NP, Braun S. Di- agnosis and treatment of snapping scapula. [Article in German] Arthroskopie 2010;23:259-64.