Osias Walter, Matcuk George R, Skalski Matthew R, Patel Dakshesh B, Schein Aaron J, Hatch George F Rick, White Eric A
Department of Radiology, Keck School of Medicine, University of Southern California, 1500 San Pablo Street, Second Floor Imaging, Los Angeles, CA, 90033, USA.
Department of Orthopedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
Skeletal Radiol. 2018 Feb;47(2):161-171. doi: 10.1007/s00256-017-2791-6. Epub 2017 Oct 26.
Symptomatic scapulothoracic disorders, including scapulothoracic crepitus and scapulothoracic bursitis are uncommon disorders involving the scapulothoracic articulation that have the potential to cause significant patient morbidity. Scapulothoracic crepitus is the presence of a grinding or popping sound with movement of the scapula that may or may not be symptomatic, while scapulothoracic bursitis refers to inflammation of bursa within the scapulothoracic articulation. Both entities may occur either concomitantly or independently. Nonetheless, the constellation of symptoms manifested by both entities has been referred to as the snapping scapula syndrome. Various causes of scapulothoracic crepitus include bursitis, variable scapular morphology, post-surgical or post-traumatic changes, osseous and soft tissue masses, scapular dyskinesis, and postural defects. Imaging is an important adjunct to the physical examination for accurate diagnosis and appropriate treatment management. Non-operative management such as physical therapy and local injection can be effective for symptoms secondary to scapular dyskinesis or benign, non-osseous lesions. Surgical treatment is utilized for osseous lesions, or if non-operative management for bursitis has failed. Open, arthroscopic, or combined methods have been performed with good clinical outcomes.
有症状的肩胛胸壁关节疾病，包括肩胛胸壁关节弹响和肩胛胸壁滑囊炎，是涉及肩胛胸壁关节的罕见疾病，有可能导致患者出现严重的发病情况。肩胛胸壁关节弹响是指肩胛骨活动时出现摩擦音或弹响声，可能有症状，也可能没有症状，而肩胛胸壁滑囊炎是指肩胛胸壁关节内滑囊的炎症。这两种情况可能同时发生，也可能单独出现。尽管如此，这两种情况所表现出的一系列症状被称为弹响肩胛综合征。肩胛胸壁关节弹响的各种原因包括滑囊炎、肩胛骨形态各异、手术或创伤后改变、骨和软组织肿块、肩胛骨运动障碍以及姿势缺陷。影像学检查是体格检查的重要辅助手段，有助于准确诊断和进行适当的治疗管理。非手术治疗，如物理治疗和局部注射，对于肩胛骨运动障碍或良性非骨性病变引起的症状可能有效。手术治疗适用于骨性病变，或滑囊炎的非手术治疗失败时。已采用开放手术、关节镜手术或联合手术方法，临床效果良好。
