SCAPULOTHORACIC DECOMPRESSION
The Goal
Dr. Kevin Wall provides specialized, fellowship-trained surgical treatment for Scapulothoracic Bursitis (Snapping Scapula Syndrome/ Scapulothoracic Crepitus) to restore smooth motion and relieve pain for patients in Richmond, VA, and the surrounding Central Virginia communities. The scapulothoracic articulation is unique because it is not a true joint, but a sliding interface where the shoulder blade glides over the rib cage, cushioned by a bursal sac of fluid, and muscle. When this gliding mechanism fails—due to a bony bump (like a hooked scapular piece of bone) or chronic inflammation (bursitis)—patients experience a painful, audible grinding or "clunking" sensation. The goal of this procedure is to mechanically clear the space, removing the inflammed bursa and friction points to allow the scapula to glide silently and painlessly once again.
This page is designed to educate you specifically about this procedure. Additional information that generally applies to most of Dr. Wall’s surgeries can be found on these pages:
The Procedure
This procedure is minimally invasive and highly effective for patients who have failed physical therapy and injections.
The Technique
Arthroscopic Approach: Dr. Wall performs the surgery using 2-3 small portal incisions. A camera is inserted into the space between the shoulder blade and the ribs.
Bursectomy: The chronically inflamed, thickened bursa tissue (which is often the source of the "grinding" noise) is removed to reduce friction.
Scapuloplasty / Ostectomy of the Superomedial Angle: In many patients, the top inner corner of the scapula is curved or "hooked," digging into the ribs. Dr. Wall uses a specialized burr to shave down this bony prominence, reshaping it into a smooth, flat surface.
Safety First: Dr. Wall utilizes a careful technique to protect the dorsal scapular nerve and preserve the attachments of the levator scapulae and rhomboid muscles, avoiding the complication of muscle detachment that can occur with older, open techniques.
Additional Procedures
Dorsal Scapular Neurolysis: Since the dorsal scapular nerve is often irritated with scapulothoracic bursitis and it lives in the same space, a dorsal scapular nerve release is frequently performed during the same surgery.
Post-Op Protocol
Because this is a "clean-up" procedure (debridement) rather than a structural repair, the recovery focus is on immediate mobilization to prevent new scar tissue from forming.
Immediate Motion (Phase 1):
Sling: A sling is provided strictly for comfort for the first 1–3 days. You are encouraged to stop using it as soon as the anesthesia wears off.
"Early & Often": The most critical part of recovery is moving the shoulder blade immediately. Patients are instructed to perform "scapular clocks" (rolling the shoulder) right away to ensure the raw bone surfaces heal smoothly without sticking together.
Physical Therapy:
Formal therapy begins within the first week.
Strengthening: Once the pain of surgery subsides (typically 2–3 weeks), progressive strengthening of the periscapular muscles begins.
Return to Activity: Most patients return to desk work within a few days and full sports/heavy lifting by 4–6 weeks.
When to Seek Care
You should schedule a consultation if:
You hear and feel a loud, painful "crunch" or "pop" under your shoulder blade every time you lift your arm.
You have pain at the top inner corner of your shoulder blade that radiates up your neck.
You have tried cortisone injections into the bursa, but the relief was only temporary.