Ultrasound-guided subscapular local anesthetic and cortisone injection before arthroscopic superior medial scapuloplasty can improve outcomes for patients with snapping scapular syndrome, new research shows.
Subscapular Cortisone Injection Can Improve Scapuloplasty Outcomes
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Secondary#arthroscopicsuperiormedialscapuloplasty#snappingscapulasyndrome#subscapularcortisoneinjection
In the study, “Prognosis After Arthroscopic Superior Medial Scapuloplasty for Snapping Scapula Syndrome Improves After a Transient Beneficial Response With an Ultrasound-Guided Subscapular Cortisone Injection,” published in the December 2020 issue of the journal Arthroscopy, the authors evaluated 47 patients who underwent arthroscopic superior medial scapuloplasty for snapping scapula syndrome between January 2009 and December 2016.
All of the patients had failed a structured physical therapy program and had either a good response or no to minimal response to the preoperative cortisone injection. Thirty-one of the patients had a good response to the injection and 11 patients had no to little response.
Before the surgery and at the final follow-up about two years later the researchers used QuickDASH, Constant and Visual Analog Scale (VAS) scores to assess pain and functionality.
According to the data collected, there was a significant improvement after surgery in the mean QuickDASH score (from 39 to 20; p < .001) (minimal clinically important difference [MCID] 15.91), Constant score (from 57 to 87; p < .001) (MCID 10.4), and VAS (from 6 to 2; p < .001) (MCID 3).
While both groups saw improvements in scores, the good response group had markedly better scores than the no to minimal response group. (p < .05).
The study authors wrote, “The results of this study suggest that arthroscopic scapuloplasty can lead to a significant improvement in pain and function in all patients with a clinical diagnosis of snapping scapula syndrome refractory to conservative treatment. Patients who gained a good transient response to a preoperative ultrasound-guided subscapular cortisone injection obtained a significantly better recovery than those who did not. A preoperative ultrasound-guided subscapular cortisone injection appeared to be of prognostic value.”
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This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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