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Patients › Shoulder

Scapulothoracic bursectomy

Updated Oct 2026
Illustration: shoulder

Why this operation has been suggested

Dr Kieran Hirpara, an upper-limb surgeon at Mater Private Hospital Rockhampton, starts with the least invasive options that suit your condition. Patients are generally referred to our clinic by their GP; if a physiotherapist has suggested you see us, you will still need a referral from your GP in order to be eligible for the Medicare rebate. A clinic assessment, including your history, an examination and imaging where needed, establishes the diagnosis.

Snapping scapula syndrome happens when tissue in the space between your shoulder blade and your ribs becomes inflamed, or when a bony prominence on the blade catches as it moves. This is called a bursectomy: removal of an inflamed bursa, a thin cushion of tissue that normally helps the shoulder blade glide smoothly. We usually try non-operative care first, such as activity change, physiotherapy for the muscles around the shoulder blade, anti-inflammatory medicine, and an injection into the bursa, usually for 3 to 6 months. Surgery is considered when that has not given enough improvement.

The aim of this operation is pain relief. In published series, more than half of people still noticed some clicking or grating even when their pain had improved.

Before the operation

Before surgery is planned, you will have had scans such as X-rays, an ultrasound or an MRI. These show the space between your shoulder blade and your ribs and help plan your operation. Most people need no other tests. If you have other medical conditions, you may need blood tests or a review with the anaesthetist.

In the days before your operation, we will confirm the details with you. You will need to stop eating and drinking seven hours before your operation. We ask for seven hours rather than six so you can be brought forward if the theatre list runs early. Bring a list of your current medicines, as some may need to be paused. Arrange for someone to drive you home afterwards. Wear loose, comfortable clothing that is easy to change out of.

On the day

You arrive at the hospital's surgical admissions unit, where you are checked in and prepared for theatre. You will then meet the anaesthetist, the doctor who puts you to sleep and looks after you during the operation. This operation is done under general anaesthetic, so you will be fully asleep. At the end of the operation local anaesthetic is injected into the small wounds and the space under the shoulder blade to ease pain as you wake up. A separate nerve block is not usually needed for this operation. The anaesthetist will meet you beforehand and talk you through it.

You are then taken into the operating theatre, where the operation is performed. When it is finished, you wake up in the recovery area, where nurses monitor you while the anaesthetic wears off. Once you are stable, you either go to the ward or go home, depending on the procedure and your recovery.

What the operation involves

This operation is done through a few small cuts along the inner border of your shoulder blade, the side closest to your spine. You lie face down. Your surgeon works with a camera in the space between your shoulder blade and your ribs, not inside the shoulder joint itself.

Once the camera is in place, your surgeon removes the inflamed bursa, the thin cushion of tissue that has been causing pain as your shoulder blade moves. If the upper inner corner of your shoulder blade is found to be prominent, part of that corner is trimmed back as well. Whether this is needed is decided during the operation, based on what your surgeon sees.

The small cuts are closed with stitches. A dressing goes over the wounds, and local anaesthetic placed during the operation helps ease discomfort as you wake up.

After the operation

You will wake up in the recovery ward, where nurses keep a close eye on you as the anaesthetic wears off. Your arm rests in a simple sling for comfort; it comes off for exercises and washing. Pain relief is planned for you before you leave, and the local anaesthetic placed during the operation helps ease discomfort at first. You may notice swelling across the back and side of your chest from the fluid used during the operation; this is common and settles within hours to a day or two. Most patients stay one night in hospital after this operation, though some are able to go home the same day. We leave the dressing on for about 10 days; please do not take it off before then unless we tell you to. We change or remove it when we see you. Please have someone stay with you for the first 24 hours. You will be up and walking on the day of surgery, and most people manage light daily tasks within 1 to 4 weeks.

Recovery

For the first few days your shoulder and the area around your shoulder blade will feel sore and swollen. The swelling across your back and chest settles within hours to a day or two. Simple pain relief, as planned before you leave hospital, keeps you comfortable while this settles. Your arm rests in a sling for comfort; it comes off for exercises and washing.

You will start gentle movements early, guided by your physiotherapist. At first the exercises may feel awkward and the area around the small cuts may be tender. This eases as the swelling goes down. You can walk around the house from the day of surgery and manage light daily tasks as your comfort allows. You will need help at home for the first day or so, and someone should stay with you for the first 24 hours.

Once you are out of the sling, comfortable, and can turn the wheel and look over your shoulder without pain, you can usually drive again. Patients in a sling must not drive. Our page on driving after upper-limb surgery explains this in more detail. When your pain and strength have settled enough, you can return to desk work and light tasks, and later to heavier work, sport and the gym as your physiotherapist clears you.

Recovery varies from person to person. Your timeline may differ, and your surgeon and physiotherapist will guide you along the way.

What can go wrong

Most patients do well, but problems can occasionally happen. Your surgeon and the team monitor you closely to spot any issue early.

Because the operation works in the space between your shoulder blade and your ribs, the lung on that side sits close by. Very rarely, air can escape into the space around the lung. You would notice sudden breathlessness or sharp chest pain. Go to the emergency department if this happens.

The nerves and blood vessels running down your arm travel near the operation area. If one is affected, your fingers or hand may turn pale, cold, white, blue or dark, which can be a sign of a circulation problem. Go to the emergency department if you notice this. New numbness, or not being able to move the arm, hand or fingers, also needs review: call the clinic.

The aim of the operation is to remove all of the inflamed tissue. Sometimes some is left behind, and the catching or grating feeling can continue. If your symptoms feel much the same after your recovery period, bring it up at your next review.

The same snapping feeling can also come back after a period of relief. Call the clinic if this happens, so we can assess whether further treatment would help.

Some people still notice clicking or grating after the operation, even when the pain has settled. This is common and does not always mean something has gone wrong. Mention it at your next review if it bothers you.

Some people continue to have symptoms after the operation, and scores measuring comfort and function can stay lower than expected. If your shoulder is not improving the way you hoped, raise it at your next review so we can look at what else might help.

The complications table on this page lists typical rates if you want the specifics.

When to call us

Call the clinic the same day if you have a fever, spreading redness around a wound, or fluid or pus leaking from it. Call us too if your pain keeps getting worse despite your pain medicines. Go to the emergency department if your calf becomes swollen or painful, or if you have shortness of breath or chest pain. These can be signs of a blood clot. Go to the emergency department as well if your fingers, hand or thumb turn pale, cold, white, blue or dark. Call the clinic if you notice new numbness, or cannot move your arm, hand or fingers. If you cannot reach us out of hours or on a weekend, go to your nearest emergency department.


Evidence & references

This is the clinical evidence summary written for health professionals. It is technical, and it lists the research this page was built from. You do not need to read it to understand your treatment or to make a decision about it.

Overview

  • Snapping scapula syndrome is caused by either osseous lesions or scapulothoracic bursitis [1].
  • Snapping scapula syndrome can be difficult to recognize and treat [1].
  • The best initial approach to scapulothoracic bursitis and crepitus is a nonoperative treatment plan that combines scapular strengthening, postural reeducation, and core strength endurance [6].
  • Nonoperative management is advised for 3 to 6 months before operative treatment [2].
  • Nonoperative management is as effective as surgical management in pain relief [2].
  • Open surgical treatment for snapping scapula provides durable pain relief [5].
  • Nonsurgical treatment for snapping scapula provides durable pain relief [5].
  • Surgically treated patients improved faster than nonsurgically treated patients [5].
  • It cannot be concluded that surgery is better than nonsurgical treatment for snapping scapula [5].
  • Arthroscopic scapulothoracic treatment provides good pain relief for scapulothoracic syndrome in patients who have failed to respond to nonoperative treatment modalities [3].
  • Arthroscopic scapulothoracic treatment provides functional improvement for scapulothoracic syndrome in patients who have failed to respond to nonoperative treatment modalities [3].
  • Arthroscopic bursoscopy and bursectomy is an effective surgical procedure in recalcitrant scapulothoracic bursitis with failed conservative management [4].
  • Extracorporeal shock wave therapy (ESWT) is a beneficial and trustable method of treatment for painful cases of scapulothoracic bursitis [7].

Anatomy & Pathophysiology

Scapulothoracic Articulation & Biomechanics

  • The scapula is separated from the chest wall by thin gliding fibro-fatty tissue, allowing its smooth excursion over the chest wall [12].
  • Normal shoulder motion is approximately two-thirds glenohumeral and one-third scapulothoracic [13].
  • The scapulothoracic articulation is one of four articulations that work together to allow smooth shoulder function [23].
  • The scapula is suspended by muscles alone and has shifted caudally from the cervical position in lower animals [20].
  • Broadening of the infraspinatus fossa has resulted in a change in the vector of muscle pull from the axillary border of the scapula to the glenoid fossa [20].
  • This adaptation allows the infraspinatus and teres minor muscles to be more effective in their roles as depressors and external rotators of the humeral head [20].
  • The scapula is anteverted on the chest wall approximately 30 degrees relative to the body [24].

Bony Anatomy

  • The scapula is triangular when viewed anteroposteriorly, with its base situated superiorly and its apex inferiorly [12].
  • The glenoid is connected with the flat body of the scapula by the scapular neck [12].
  • The hook-shaped coracoid process curves forwards from the superior surface of the scapular neck [12].
  • The scapular spine ends in a flattened bony process, the acromion, which curves forwards [12].
  • The highest concentration of bony mass in the scapula is located in the glenoid, the scapular neck (including the base of the coracoid process), and the lateral border of the scapular body [12].
  • The lateral pillar connects the inferior border of the glenoid with the inferior angle [12].
  • The spinal pillar arises from the central part of the glenoid and continues medially to become part of the base of the scapular spine [12].
  • The weakest bone in the scapula is located primarily in the central part of the biomechanical body, i.e., in the infraspinous fossa [12].
  • The weakest area of the circumference of the biomechanical body of the scapula is the spinomedial angle [12].
  • The glenoid is a convex structure of shallow depth shaped like an inverted pear [10].
  • The glenoid averages 5° of retroversion in relation to the axis of the scapular body [13].
  • The subchondral bone of the glenoid is relatively flat, and the articular concavity is augmented by cartilage and a circumferential labrum [13].
  • The acromion has three ossification centers: the metacromion (base), the mesoacromion (middle), and the preacromion (tip) [13].
  • Failure of fusion of the acromial ossification centers results in os acromiale [13].
  • The scapular spine is an osseous ridge that separates the supraspinatus and infraspinatus fossae [13].

Soft Tissue & Bursae

  • The subscapular bursa lies between the subscapularis tendon and the neck of the scapula [14].
  • The subscapular bursa communicates with the joint cavity between the superior and middle glenohumeral ligaments [14].
  • The subscapular bursa protects the tendon of the subscapularis at the point where it passes under the base of the coracoid process and over the neck of the scapula [14].
  • The subscapular bursa is linked to the coracoid process by a suspensory ligament [14].
  • In 28% of specimens dissected by Colas and colleagues, the subscapular bursae merged with the subcoracoid bursae, forming a unique wide bursa in this region [14].
  • The subscapular bursa often houses loose bodies in the shoulder [14].
  • The subscapular bursa is a region in which synovitis of the shoulder may be most intense [14].
  • Small fringes, or villi, can project into the joint cavity from the subscapular bursa [14].
  • The rotator cuff is a sheet of conjoined tendons closely applied over the shoulder capsule and inserting mainly into the greater tuberosity of the humerus [18].
  • The subscapularis is inserted into the lesser tuberosity [18].
  • The coracoacromial arch is formed by the acromion process posterosuperiorly, the coracoid process anteriorly, and the coracoacromial ligament joining them [18].
  • The subacromial bursa separates the rotator cuff tendons from the coracoacromial arch, allowing them to glide [18].

Pathophysiology

Investigations

Imaging Principles and General Approach

  • The purpose of shoulder imaging is to help establish the diagnosis, determine the severity of the pathoanatomy, assist in surgical planning, and enable the surgeon to illustrate the condition of the shoulder to the patient [8].
  • Unless a specific research protocol is in place, the temptation to “overimage” should be resisted, obtaining only the scans or reconstructions that are necessary for the care of the patient [8].
  • Standardized plain films are almost always sufficient to garner the information needed for shoulder evaluation [8].
  • Proper radiographic technique is as important as proper surgical technique to achieve the desired outcome [8].
  • The shoulder is a three-dimensional structure that cannot be represented by a single planar view [30].
  • Critical relationships, such as the degree of centering of the humeral head, change with the position of the arm [30].
  • Shoulder pathology may be found in a large number of different bones and soft tissues [30].
  • Overlying and superimposed structures as well as metallic implants may complicate imaging the structures of interest [30].
  • Surgeons need to develop a judicious approach to imaging that yields the information necessary to treat the patient while avoiding the tendency to "over-image" [30].

Plain Radiography

  • At least two X-ray views should be obtained for shoulder evaluation: an anteroposterior in the plane of the glenoid and an axillary projection with the arm in abduction to show the relationship of the humeral head to the glenoid [27].
  • The first key view is the anteroposterior (AP) in the plane of the scapula taken so that the x-ray beam passes through the glenohumeral joint [8].
  • The AP view in the plane of the scapula shows the superoinferior position of the humeral head relative to the glenoid, the presence of osteophytes on the humeral head and glenoid, narrowing of the joint space, and the degree of medial displacement of the humerus in relation to the lateral acromial line [8].
  • The AP view in the plane of the scapula also shows the quality of the humeral and glenoid bone, the presence of loose bodies, and whether there is humeral head collapse or deformity [8].
  • The second key view is the axillary view taken with the arm in the functional position of elevation in the plane of the scapula and oriented so that both the spinoglenoid notch and the scapular neck are visible [8].
  • The axillary view shows a different perspective of the humeral anatomy, the amount of glenoid bone, the shape of the glenoid, its version in relation to the plane of the scapula, and the relationship of the humeral head to the glenoid fossa [8].
  • The standardized axillary view is referred to as the “truth view” because it demonstrates the glenohumeral relationships in the functional position of elevation [8].
  • CT scans have the disadvantage of being taken with the arm in the adducted position, whereas the axillary truth view is taken with the arm in elevation [8].
  • When taken properly, standardized anteroposterior and axillary views indicate the thickness of the cartilage space between the humerus and the glenoid, relative positions of the humeral head and the glenoid, presence of osteophytes, degree of osteopenia, and extent of bony deformity and erosion [8].
  • Joint space narrowing is most evident on the axillary truth view as opposed to images made with the arm at the side [8].
  • The axillary truth view can show posterior subluxation or “functional decentering” that is not evident in images taken with the arm at the side [8].
  • The degree of posterior subluxation can be measured as the position of the center of the humeral head in relation to the plane of the scapula, the position of the center of the humeral head in relation to the glenoid face, or the point of contact of the humeral articular surface on the glenoid articular surface [8].
  • The point of contact of the humeral articular surface on the glenoid articular surface reflects the degree of centering of the net humeral joint reaction force on the glenoid [8].
  • Malcentering of the joint reaction force leads to posterior instability, posterior glenoid wear, and “rocking horse” loosening of prosthetic glenoid components [8].
  • The standard shoulder series should include orthogonal views of the shoulder, including a true AP view in the scapular plane, an AP view, an axillary view, and a scapular Y view [35].
  • The true AP view in the scapular plane visualizes the anterior greater tuberosity in profile and can reveal proximal humeral migration [35].
  • The AP view with the arm in internal rotation visualizes the posterior aspect of the greater tuberosity and the lesser tuberosity in profile [35].
  • The axillary view is necessary for evaluation of glenohumeral joint instability and enables determination of the humeral head position in the glenoid fossa [35].
  • The axillary view may detect occult, locked posterior shoulder dislocation in a patient who exhibits a lack of passive external rotation [35].
  • The axillary view is helpful in evaluation of glenoid morphology in glenohumeral osteoarthritis and provides good visualization of the coracoid process, acromion, and distal clavicle [35].
  • The scapular Y view provides visualization of the coracoacromial arch and can reveal coracoacromial spurs [35].
  • The scapular Y view is a reliable alternative for evaluation of glenohumeral subluxation and dislocation [35].
  • The scapular Y view can show scapular body abnormalities, such as osteochondroma or fracture, and acromial shape [35].
  • The acromiohumeral distance is normally 7 to 14 mm [35].
  • The width of the glenohumeral joint space should be symmetric superiorly and inferiorly [35].
  • The coracoclavicular distance is normally 1.1 to 1.3 cm [35].
  • Neer classified acromial morphology as type I (flat), type II (curved), and type III (hooked) [35].
  • Type III acromial morphology has been shown to have a correlation with the presence of rotator cuff disease, although no direct causal relationship has been demonstrated [35].
  • The Neer classification of acromial morphology has shown relatively poor interobserver reliability [35].
  • Arthritis, calcific tendinitis, and osteolysis of the distal clavicle can be observed on plain radiograph [34].

Computed Tomography (CT)

  • CT scans may offer a few degrees of increased precision in the measurement of glenoid version [8].
  • There is no conviction that increased precision in glenoid version measurement via CT improves the quality of the surgery or the clinical outcome [8].
  • There is information that can be gathered from properly taken plain films that cannot be obtained from CT scans [8].
  • Three-dimensional reconstructions can reveal fine details of the shoulder anatomy, but this additional information rarely changes the planning or conduct of the arthroplasty [8].
  • CT imaging is frequently used to evaluate fractures of the shoulder, to assess for bony lesions in recurrent instability cases, or for preoperative templating for shoulder arthritis [34].
  • CT with three-dimensional reconstructions is the advanced imaging study of choice for determining the extent of glenoid bone loss in the setting of shoulder instability [35].
  • CT is helpful for planning fracture surgery and shoulder joint replacement [27].

Magnetic Resonance Imaging (MRI)

  • MRI is useful to identify osteonecrosis of the humeral head, or a bone tumour [27].
  • MRI can identify labral tears and rotator cuff tears, although the accuracy for these is enhanced by combining the scan with arthrography [27].
  • MRI is the modality of choice for evaluating the rotator cuff, biceps, and subacromial/subdeltoid bursa [34].
  • T1-weighted MRI can reveal Hill-Sachs lesions and is often used with magnetic resonance (MR) arthrograms to provide a more detailed picture of the joint surfaces [34].
  • T2-weighted MRI provides better visualization of full thickness rotator cuff tears [34].
  • Traditional magnetic resonance imaging (MRI) is a diagnostic tool to complement both physical examination and standard radiographs in the management of patients with anterior shoulder instability [32].
  • MRI is utilized for evaluation of soft tissues, which can be performed with high contrast and spatial resolution [32].
  • MR accuracy in identifying labral and rotator cuff tears in the literature ranges from 70% to 100% [32].
  • The acquired multi-planar imaging allows for the detailed evaluation of the glenoid, labrum, joint capsule, and rotator cuff in different planes [32].
  • Abduction and external rotation (ABER) of the arm is an alternative position utilized to increase the sensitivity and specificity for detecting anteroinferior labroligamentous injury [32].
  • Limited range of motion or pain may prohibit patients from performing the ABER provocative maneuver [32].
  • Full routine MRI or MRA examination had similar accuracy as the ABER sequence in evaluating the anteroinferior labral–ligamentous complex [32].
  • The sensitivity of MRA with the ABER position for detecting anteroinferior labral lesions was significantly higher than that of the MRA in neutral position [32].
  • MRA with the ABER position is more effective in identifying Perthes lesions than MRA in neutral position [32].
  • MRAs can demonstrate a patulous capsule on the coronal, sagittal, and axial imaging in patients with multidirectional instability [32].
  • MRAs can be helpful in evaluating lesions of the rotator interval and other associated findings that may affect the eventual surgical plan [32].
  • The presence of glenoid dysplasia, increased capsular cross-sectional area, and increased glenoid retroversion have all been found to be associated with increased posterior labral tears and symptomatic instability [32].
  • Glenoid retroversion was significantly increased in patients with symptomatic posterior labral tears [32].
  • There was no significant association between instability and increased humeral head subluxation in patients with symptomatic posterior labral tears [32].
  • The diagnosis of multidirectional instability is a clinical one, and the need for expensive and/or invasive imaging should be weighed against the information that will be gained from these studies [32].

Arthrography

  • Arthrography involves injection of contrast agent in conjunction with either an MRI or CT scan, enhancing imaging of the joint to enable better identification of normal structures and pathology involving the joint surfaces [34].
  • MR arthrography is considered the benchmark for evaluation for labral tears and rarely is indicated for evaluation of rotator cuff pathology [34].
  • When MRI or MR arthrography is contraindicated, such as in patients with a pacemaker or vascular clips, CT arthrography is indicated [34].
  • Magnetic resonance (MR) arthrography refers to MRI of a joint that has been injected with an intra-articular contrast agent such as diluted gadolinium or saline solution [32].
  • The contrast material is injected prior to MRI by fluoroscopic or ultrasound guidance under strict aseptic technique [32].
  • By distending the joint capsule, the cartilage, ligaments, and labrum are outlined with contrast, increasing the sensitivity for detecting tears and other lesions [32].
  • In the acute dislocation setting, a joint effusion with distension of the joint may outline structures similarly, making the arthrogram unnecessary [32].
  • MR arthrography has proven utility by increasing both sensitivity and specificity in detecting injuries to the capsulolabral–ligamentous complex as compared to traditional MRI [32].
  • In a meta-analysis of 6 studies including 4,667 shoulders, MRA had greater diagnostic test accuracy for the detection of glenoid labral lesions than MRI [32].
  • MRA sensitivity for glenoid labral lesions was 88% and specificity was 93% [32].
  • MRI sensitivity for glenoid labral lesions was 76% and specificity was 87% [32].

Ultrasonography

  • Ultrasonography is a simple and accurate test for identifying rotator cuff tears and calcific tendinitis [27].
  • Ultrasonography can be useful in guiding injections or barbotage, such as aspirating calcific deposits in the rotator cuff [27].
  • Ultrasonography is a low-cost alternative to MRI and arthrography for evaluating both skeletal and soft-tissue structures of the shoulder [34].
  • Ultrasonography can provide immediate, real-time visualization of the rotator cuff, biceps tendon, and calcific deposits [34].
  • Ultrasonography can be used to measure the subacromial space and detect atrophy of rotator cuff muscles [34].
  • As a result of providing images in real-time, ultrasonography can evaluate impingement in various positions and motions [34].
  • Ultrasonography is highly operator dependent [34].
  • Ultrasonography is not as useful for evaluating labral tears or rotator cuff tears that are very small or larger than 3 cm [34].
  • The most commonly performed joint examination using ultrasonography is the shoulder examination [25].
  • Accuracy of shoulder ultrasonography depends on the skill of the scanner operator and an awareness of pitfalls that are encountered [25].

Treatment

Non-Operative

  • Extracorporeal shock wave therapy (ESWT) is a beneficial and trustable method of treatment that can be strongly recommended in painful cases of scapulothoracic bursitis [7].
  • Patients treated nonsurgically for snapping scapula did so well, although surgically treated patients improved faster [5].

Operative

  • Arthroscopic scapulothoracic treatment provides good pain relief and functional improvement for scapulothoracic syndrome in patients who have failed to respond to nonoperative treatment modalities [3].

Complications

  • The snapping scapula syndrome can be difficult to recognize and treat [1].

Recovery

Non-Operative Management

  • Patients treated nonsurgically did so well [5].

Operative Management

Comparative Outcomes

Key Evidence

  • [L5] The snapping scapula syndrome is caused by either osseous lesions or scapulothoracic bursitis and can be difficult to recognize and treat. [1] (10.1155/2013/635628)
  • [L4] Nonoperative management is as effective as surgical management in pain relief and is advised for 3 to 6 months before operative treatment. [2] (10.1177/19417381211029211)
  • [L4] Based on the results, the study concludes that arthroscopic scapulothoracic treatment provides good pain relief and functional improvement for scapulothoracic syndrome in patients who have failed to respond to nonoperative treatment modalities. [3] (10.2174/1874325001711010785)
  • [L4] Arthroscopic bursoscopy and bursectomy is an effective surgical procedure in recalcitrant scapulothoracic bursitis with failed conservative management. [4] (10.13107/jocr.2025.v15.i02.5290)
  • [L3] Since the decision to treat these patients surgically was somewhat subjective, and since patients treated nonsurgically did so well (although the surgically treated patients improved faster), we cannot conclude that surgery is better than nonsurgical treatment. [5] (10.1007/s11999-015-4614-1)
  • [L5] The best initial approach to scapulothoracic bursitis and crepitus is a nonoperative treatment plan that combines scapular strengthening, postural reeducation, and core strength endurance. [6] (10.1177/1941738109338359)
  • [L1] We believe that ESWT is a beneficial and trustable method of treatment and can be strongly recommended in painful cases of scapulothoracic bursitis. [7] (10.1177/2309499016684723)

References

[1] Scapulothoracic Anatomy and Snapping Scapula Syndrome. Anatomy Research International. 2013. DOI: 10.1155/2013/635628

[2] Diagnosis and Treatment of Snapping Scapula Syndrome: A Scoping Review. Sports Health: A Multidisciplinary Approach. 2021. DOI: 10.1177/19417381211029211

[3] Outcome of Scapulothoracic Arthroscopy for Painful Snapping Scapula. The Open Orthopaedics Journal. 2017. DOI: 10.2174/1874325001711010785

[4] Arthroscopic Management of Snapping Scapular Syndrome due to Recalcitrant Scapulothoracic Bursitis – A Case Series. Journal of Orthopaedic Case Reports. 2025. DOI: 10.13107/jocr.2025.v15.i02.5290

[5] Open Surgical Treatment for Snapping Scapula Provides Durable Pain Relief, but so Does Nonsurgical Treatment. Clinical Orthopaedics & Related Research. 2016. DOI: 10.1007/s11999-015-4614-1

[6] Clinical Management of Scapulothoracic Bursitis and the Snapping Scapula. Sports Health: A Multidisciplinary Approach. 2010. DOI: 10.1177/1941738109338359

[7] The effectiveness of extracorporeal shock wave therapy in snapping scapula. Journal of Orthopaedic Surgery. 2017. DOI: 10.1177/2309499016684723

[8] Rockwood And Matsen S The Shoulder. Arthroscopic Management of Prearthritic and Arthritic Conditions of the Shoulder and the Postarthroplasty Shoulder > SUMMARY.

[10] Rockwood And Matsen S The Shoulder. Shoulder and Elbow Specialty Clinic Workers’ Survey > ANATOMY.

[12] Rockwood And Green S Fractures In Adults. 29: Principles of Nonunion and Bone Defect Treatment > Applied Anatomy Related to Scapular Fractures.

[13] Aaos Comprehensive Orthopaedic Review 3. Anatomy of the Shoulder, Arm, and Elbow > I. Shoulder.

[14] Rockwood And Matsen S The Shoulder. Developmental Anatomy of the Shoulder and Anatomy of the Glenohumeral Joint > Bursae.

[18] Apley And Solomon S Concise System Of Orthopaedics And Trauma. DISORDERS OF THE ROTATOR CUFF.

[20] Rockwood And Matsen S The Shoulder. Developmental Anatomy of the Shoulder and Anatomy of the Glenohumeral Joint > Development of Individual Regions.

[23] Campbell S Operative Orthopaedics 4 Volume Set. ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION WITH BONE-PATELLAR TENDON-BONE GRAFT > SHOULDER INJURIES > ANATOMY AND BIOMECHANICS.

[24] Miller S Review Of Orthopaedics. Genetics of musculoskeletal conditions and abnormalities are summarized in Table 1.27 > UPPER EXTREMITY > SHOULDER.

[25] Orthopaedic Knowledge Update Sports Medicine 6. Diagnostic Ultrasonography and Ultrasonography-­Guided Procedures > Annotated References.

[27] Apley And Solomon S Concise System Of Orthopaedics And Trauma. INVESTIGATION.

[30] Rockwood And Matsen S The Shoulder. Developmental Anatomy of the Shoulder and Anatomy of the Glenohumeral Joint > SENIOR EDITOR COMMENTARY.

[32] Rockwood And Green S Fractures In Adults. 29: Principles of Nonunion and Bone Defect Treatment > Magnetic Resonance Imaging and Arthrography.

[34] Orthopaedic Knowledge Update 13 Ebook Without Multimedia. Shoulder Anatomy and Biomechanics, Clinical Evaluation, Imaging > Clinical Evaluation > Imaging.

[35] Aaos Comprehensive Orthopaedic Review 3. Imaging of the Shoulder and Elbow > I. Shoulder.

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Using Creative Commons Public Licenses

Creative Commons public licenses provide a standard set of terms and conditions that creators and other rights holders may use to share original works of authorship and other material subject to copyright and certain other rights specified in the public license below. The following considerations are for informational purposes only, are not exhaustive, and do not form part of our licenses.

Considerations for licensors: Our public licenses are intended for use by those authorized to give the public permission to use material in ways otherwise restricted by copyright and certain other rights. Our licenses are irrevocable. Licensors should read and understand the terms and conditions of the license they choose before applying it. Licensors should also secure all rights necessary before applying our licenses so that the public can reuse the material as expected. Licensors should clearly mark any material not subject to the license. This includes other CC- licensed material, or material used under an exception or limitation to copyright. More considerations for licensors: wiki.creativecommons.org/Considerations_for_licensors

Considerations for the public: By using one of our public licenses, a licensor grants the public permission to use the licensed material under specified terms and conditions. If the licensor's permission is not necessary for any reason--for example, because of any applicable exception or limitation to copyright--then that use is not regulated by the license. Our licenses grant only permissions under copyright and certain other rights that a licensor has authority to grant. Use of the licensed material may still be restricted for other reasons, including because others have copyright or other rights in the material. A licensor may make special requests, such as asking that all changes be marked or described. Although not required by our licenses, you are encouraged to respect those requests where reasonable. More considerations for the public: wiki.creativecommons.org/Considerations_for_licensees


Creative Commons Attribution-NonCommercial 4.0 International Public License

By exercising the Licensed Rights (defined below), You accept and agree to be bound by the terms and conditions of this Creative Commons Attribution-NonCommercial 4.0 International Public License ("Public License"). To the extent this Public License may be interpreted as a contract, You are granted the Licensed Rights in consideration of Your acceptance of these terms and conditions, and the Licensor grants You such rights in consideration of benefits the Licensor receives from making the Licensed Material available under these terms and conditions.

Section 1 -- Definitions.

a. Adapted Material means material subject to Copyright and Similar Rights that is derived from or based upon the Licensed Material and in which the Licensed Material is translated, altered, arranged, transformed, or otherwise modified in a manner requiring permission under the Copyright and Similar Rights held by the Licensor. For purposes of this Public License, where the Licensed Material is a musical work, performance, or sound recording, Adapted Material is always produced where the Licensed Material is synched in timed relation with a moving image.

b. Adapter's License means the license You apply to Your Copyright and Similar Rights in Your contributions to Adapted Material in accordance with the terms and conditions of this Public License.

c. Copyright and Similar Rights means copyright and/or similar rights closely related to copyright including, without limitation, performance, broadcast, sound recording, and Sui Generis Database Rights, without regard to how the rights are labeled or categorized. For purposes of this Public License, the rights specified in Section 2(b)(1)-(2) are not Copyright and Similar Rights.

d. Effective Technological Measures means those measures that, in the absence of proper authority, may not be circumvented under laws fulfilling obligations under Article 11 of the WIPO Copyright Treaty adopted on December 20, 1996, and/or similar international agreements.

e. Exceptions and Limitations means fair use, fair dealing, and/or any other exception or limitation to Copyright and Similar Rights that applies to Your use of the Licensed Material.

f. Licensed Material means the artistic or literary work, database, or other material to which the Licensor applied this Public License.

g. Licensed Rights means the rights granted to You subject to the terms and conditions of this Public License, which are limited to all Copyright and Similar Rights that apply to Your use of the Licensed Material and that the Licensor has authority to license.

h. Licensor means the individual(s) or entity(ies) granting rights under this Public License.

i. NonCommercial means not primarily intended for or directed towards commercial advantage or monetary compensation. For purposes of this Public License, the exchange of the Licensed Material for other material subject to Copyright and Similar Rights by digital file-sharing or similar means is NonCommercial provided there is no payment of monetary compensation in connection with the exchange.

j. Share means to provide material to the public by any means or process that requires permission under the Licensed Rights, such as reproduction, public display, public performance, distribution, dissemination, communication, or importation, and to make material available to the public including in ways that members of the public may access the material from a place and at a time individually chosen by them.

k. Sui Generis Database Rights means rights other than copyright resulting from Directive 96/9/EC of the European Parliament and of the Council of 11 March 1996 on the legal protection of databases, as amended and/or succeeded, as well as other essentially equivalent rights anywhere in the world.

l. You means the individual or entity exercising the Licensed Rights under this Public License. Your has a corresponding meaning.

Section 2 -- Scope.

a. License grant.

1. Subject to the terms and conditions of this Public License, the Licensor hereby grants You a worldwide, royalty-free, non-sublicensable, non-exclusive, irrevocable license to exercise the Licensed Rights in the Licensed Material to:

a. reproduce and Share the Licensed Material, in whole or in part, for NonCommercial purposes only; and

b. produce, reproduce, and Share Adapted Material for NonCommercial purposes only.

2. Exceptions and Limitations. For the avoidance of doubt, where Exceptions and Limitations apply to Your use, this Public License does not apply, and You do not need to comply with its terms and conditions.

3. Term. The term of this Public License is specified in Section 6(a).

4. Media and formats; technical modifications allowed. The Licensor authorizes You to exercise the Licensed Rights in all media and formats whether now known or hereafter created, and to make technical modifications necessary to do so. The Licensor waives and/or agrees not to assert any right or authority to forbid You from making technical modifications necessary to exercise the Licensed Rights, including technical modifications necessary to circumvent Effective Technological Measures. For purposes of this Public License, simply making modifications authorized by this Section 2(a) (4) never produces Adapted Material.

5. Downstream recipients.

a. Offer from the Licensor -- Licensed Material. Every recipient of the Licensed Material automatically receives an offer from the Licensor to exercise the Licensed Rights under the terms and conditions of this Public License.

b. No downstream restrictions. You may not offer or impose any additional or different terms or conditions on, or apply any Effective Technological Measures to, the Licensed Material if doing so restricts exercise of the Licensed Rights by any recipient of the Licensed Material.

6. No endorsement. Nothing in this Public License constitutes or may be construed as permission to assert or imply that You are, or that Your use of the Licensed Material is, connected with, or sponsored, endorsed, or granted official status by, the Licensor or others designated to receive attribution as provided in Section 3(a)(1)(A)(i).

b. Other rights.

1. Moral rights, such as the right of integrity, are not licensed under this Public License, nor are publicity, privacy, and/or other similar personality rights; however, to the extent possible, the Licensor waives and/or agrees not to assert any such rights held by the Licensor to the limited extent necessary to allow You to exercise the Licensed Rights, but not otherwise.

2. Patent and trademark rights are not licensed under this Public License.

3. To the extent possible, the Licensor waives any right to collect royalties from You for the exercise of the Licensed Rights, whether directly or through a collecting society under any voluntary or waivable statutory or compulsory licensing scheme. In all other cases the Licensor expressly reserves any right to collect such royalties, including when the Licensed Material is used other than for NonCommercial purposes.

Section 3 -- License Conditions.

Your exercise of the Licensed Rights is expressly made subject to the following conditions.

a. Attribution.

1. If You Share the Licensed Material (including in modified form), You must:

a. retain the following if it is supplied by the Licensor with the Licensed Material:

i. identification of the creator(s) of the Licensed Material and any others designated to receive attribution, in any reasonable manner requested by the Licensor (including by pseudonym if designated);

ii. a copyright notice;

iii. a notice that refers to this Public License;

iv. a notice that refers to the disclaimer of warranties;

v. a URI or hyperlink to the Licensed Material to the extent reasonably practicable;

b. indicate if You modified the Licensed Material and retain an indication of any previous modifications; and

c. indicate the Licensed Material is licensed under this Public License, and include the text of, or the URI or hyperlink to, this Public License.

2. You may satisfy the conditions in Section 3(a)(1) in any reasonable manner based on the medium, means, and context in which You Share the Licensed Material. For example, it may be reasonable to satisfy the conditions by providing a URI or hyperlink to a resource that includes the required information.

3. If requested by the Licensor, You must remove any of the information required by Section 3(a)(1)(A) to the extent reasonably practicable.

4. If You Share Adapted Material You produce, the Adapter's License You apply must not prevent recipients of the Adapted Material from complying with this Public License.

Section 4 -- Sui Generis Database Rights.

Where the Licensed Rights include Sui Generis Database Rights that apply to Your use of the Licensed Material:

a. for the avoidance of doubt, Section 2(a)(1) grants You the right to extract, reuse, reproduce, and Share all or a substantial portion of the contents of the database for NonCommercial purposes only;

b. if You include all or a substantial portion of the database contents in a database in which You have Sui Generis Database Rights, then the database in which You have Sui Generis Database Rights (but not its individual contents) is Adapted Material; and

c. You must comply with the conditions in Section 3(a) if You Share all or a substantial portion of the contents of the database.

For the avoidance of doubt, this Section 4 supplements and does not replace Your obligations under this Public License where the Licensed Rights include other Copyright and Similar Rights.

Section 5 -- Disclaimer of Warranties and Limitation of Liability.

a. UNLESS OTHERWISE SEPARATELY UNDERTAKEN BY THE LICENSOR, TO THE EXTENT POSSIBLE, THE LICENSOR OFFERS THE LICENSED MATERIAL AS-IS AND AS-AVAILABLE, AND MAKES NO REPRESENTATIONS OR WARRANTIES OF ANY KIND CONCERNING THE LICENSED MATERIAL, WHETHER EXPRESS, IMPLIED, STATUTORY, OR OTHER. THIS INCLUDES, WITHOUT LIMITATION, WARRANTIES OF TITLE, MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, NON-INFRINGEMENT, ABSENCE OF LATENT OR OTHER DEFECTS, ACCURACY, OR THE PRESENCE OR ABSENCE OF ERRORS, WHETHER OR NOT KNOWN OR DISCOVERABLE. WHERE DISCLAIMERS OF WARRANTIES ARE NOT ALLOWED IN FULL OR IN PART, THIS DISCLAIMER MAY NOT APPLY TO YOU.

b. TO THE EXTENT POSSIBLE, IN NO EVENT WILL THE LICENSOR BE LIABLE TO YOU ON ANY LEGAL THEORY (INCLUDING, WITHOUT LIMITATION, NEGLIGENCE) OR OTHERWISE FOR ANY DIRECT, SPECIAL, INDIRECT, INCIDENTAL, CONSEQUENTIAL, PUNITIVE, EXEMPLARY, OR OTHER LOSSES, COSTS, EXPENSES, OR DAMAGES ARISING OUT OF THIS PUBLIC LICENSE OR USE OF THE LICENSED MATERIAL, EVEN IF THE LICENSOR HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH LOSSES, COSTS, EXPENSES, OR DAMAGES. WHERE A LIMITATION OF LIABILITY IS NOT ALLOWED IN FULL OR IN PART, THIS LIMITATION MAY NOT APPLY TO YOU.

c. The disclaimer of warranties and limitation of liability provided above shall be interpreted in a manner that, to the extent possible, most closely approximates an absolute disclaimer and waiver of all liability.

Section 6 -- Term and Termination.

a. This Public License applies for the term of the Copyright and Similar Rights licensed here. However, if You fail to comply with this Public License, then Your rights under this Public License terminate automatically.

b. Where Your right to use the Licensed Material has terminated under Section 6(a), it reinstates:

1. automatically as of the date the violation is cured, provided it is cured within 30 days of Your discovery of the violation; or

2. upon express reinstatement by the Licensor.

For the avoidance of doubt, this Section 6(b) does not affect any right the Licensor may have to seek remedies for Your violations of this Public License.

c. For the avoidance of doubt, the Licensor may also offer the Licensed Material under separate terms or conditions or stop distributing the Licensed Material at any time; however, doing so will not terminate this Public License.

d. Sections 1, 5, 6, 7, and 8 survive termination of this Public License.

Section 7 -- Other Terms and Conditions.

a. The Licensor shall not be bound by any additional or different terms or conditions communicated by You unless expressly agreed.

b. Any arrangements, understandings, or agreements regarding the Licensed Material not stated herein are separate from and independent of the terms and conditions of this Public License.

Section 8 -- Interpretation.

a. For the avoidance of doubt, this Public License does not, and shall not be interpreted to, reduce, limit, restrict, or impose conditions on any use of the Licensed Material that could lawfully be made without permission under this Public License.

b. To the extent possible, if any provision of this Public License is deemed unenforceable, it shall be automatically reformed to the minimum extent necessary to make it enforceable. If the provision cannot be reformed, it shall be severed from this Public License without affecting the enforceability of the remaining terms and conditions.

c. No term or condition of this Public License will be waived and no failure to comply consented to unless expressly agreed to by the Licensor.

d. Nothing in this Public License constitutes or may be interpreted as a limitation upon, or waiver of, any privileges and immunities that apply to the Licensor or You, including from the legal processes of any jurisdiction or authority.


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