Scapulothoracic Arthroscopy & Lysis of Adhesions

 

What Is Scapular Crepitus?

The scapula, or shoulder blade, glides over the chest wall (rib cage) as your arm moves. Normally this movement is smooth and silent.

Scapular crepitus (sometimes called “snapping scapula syndrome”) occurs when movement becomes:

• Noisy (popping, grinding, clicking, snapping)
• Painful
• Catching or restricted

This may result from:

• Inflammation of the tissue between the shoulder blade and ribs
• Adhesions or scar tissue
• Bony changes such as exostosis (“bone spurs”) from previous fracture
• Muscle imbalance or abnormal shoulder mechanics

Patients may notice:

• Grinding or snapping when reaching overhead
• Audible “popping” and “clicking” with motion of the scapula
• A sensation of rubbing or friction under the scapula

Initial (Non-Surgical) Treatment

Before considering surgery, most patients try extensive:

• Physical therapy targeted and strengthening the muscles around the shoulder blade
• Anti-inflammatory medications
• Postural training and exercises
• Activity modification

Many patients improve with these treatments. However, when symptoms persist despite months of appropriate care, surgery may be recommended.

What Is Scapulothoracic Arthroscopy?

Scapulothoracic arthroscopy is a minimally invasive shoulder surgery performed through small incisions along the side of the shoulder blade.

Using a tiny camera and instruments, Dr. Huff:

1. Examines the space between the scapula and rib cage
2. Removes inflamed tissue (bursectomy)
3. Releases abnormal scar tissue (lysis of adhesions)
4. Shaves or smooths small bony irregularities if present (debridement)

This creates more room for smooth movement between the shoulder blade and the chest wall, reducing friction and pain.

Who Is a Good Candidate?

You may be recommended for this procedure if:

• You have persistent scapular pain or grinding lasting12+ months
• Physical therapy and injections have not relieved symptoms
• Imaging (MRI, CT, or ultrasound) suggests:
  • Scar tissue
  • Bursal inflammation
  • Bony prominence or irregularities
• Symptoms limit daily function, work, exercise, or sports

Benefits of Surgery

Most patients experience:

• Reduction or elimination of grinding or snapping
• Decrease in pain
• Better shoulder motion
• Improved comfort with overhead activity

Risks and Complications

Although uncommon, possible risks include:

• Infection
• Persistent pain or symptoms

What to Expect After Surgery

Recovery & Rehabilitation

Phase 1: Immediate Post-op (0–2 Weeks After Surgery)

Goals:

• Allow arthroscopic portal sites to heal

What to Expect:

• You may briefly wear a sling for comfort, but it isnot required for long-term immobilization. We recommend early motion to prevent recurrence of scar.
• Pain, swelling, and soreness are normal.

Therapy Focus:

• Gentle arm motion is allowed immediately.
• Avoid heavy lifting, pushing, pulling, or repetitive overhead motion.
• Ice and anti-inflammatories are used to help minimize pain and facilitate early movement

Phase 2: Early Rehabilitation (Weeks 2–6 After Surgery)

Goals:

• Re-establishing smooth scapulothoracic motion
• Preventing scar formation

Therapy Focus:

• Stretching the soft tissues around the scapula
• No heavy lifting, pushing, or pulling

Phase 3: Strengthening Phase (Weeks 6–12 After Surgery)

Goals:

• Normalize shoulder function
• Return to full sport and activities

Therapy focus:

• Strengthening the rotator cuff
• Strengthening scapular stabilizers (rhomboids, serratus anterior, lower trapezius)
• Core and shoulder blade endurance training

Many patients begin noticing meaningful reduction in snapping and pain during this stage.

 

 

I hope this provides some useful information regarding the procedure and recovery. Please never hesitate to schedule a consultation with Dr. Huff if you think you may benefit from this procedure.

Best,

Scott Huff, MD