Scapulothoracic bursitis

Radiopaedia • CC-by-nc-sa 3.0 • de

Scapulothoracic bursitis (rare plural: scapulothoracic bursitides) is defined by inflammation of the scapulothoracic bursae.

Terminology

The constellation of symptoms arising from scapulothoracic bursitis is commonly referred to as snapping scapula syndrome. If this occurs in the context of mechanical symptoms, it is called scapulothoracic crepitus. The distinction is often clinically difficult, as symptomatic bursitis can manifest as mechanical crepitus, and vice versa .

Clinical presentation

Patients typically present with pain (at the superomedial angle or inferior scapular pole) during overhead activity, or repetitive shoulder movement . This may be accompanied by audible or palpable crepitus with scapular movement or localized swelling.

Pathology

Bursitis generally occurs as a result of acute trauma, or in chronic overuse (especially if there is underlying anatomic predisposition). Most cases result from abnormal scapular kinematics, leading to chronic inflammation .

Radiographic features

Plain radiograph

Useful in identifying osseous lesions (most commonly osteochondromas) or skeletal abnormality.

Standard shoulder series (AP and lateral) and an axillary view recommended.

CT

Not routinely indicated unless skeletal lesion or joint incongruity demonstrated. Utility in further characterizing bony morphology and potential surgical planning.

MRI 

Signal characteristics include

  • T1: homogenous isointense lesion, between serratus anterior muscle and the chest wall
  • T2: high signal intensity
  • T1 + contrast (Gd): moderate peripheral enhancement

Treatment and prognosis

Treatment is generally conservative in the absence of suspected malignancy, significant skeletal abnormality or a space-occupying lesion; NSAIDs, rehabilitation and physiotherapy, postural training and activity modification. Refractory cases may warrant local therapeutic injections or surgery (i.e. bursectomy or osseous resection) .

Differential diagnosis