Snapping scapula syndrome: a systematic review of treatment options and outcomes

Snapping scapula syndrome (SSS), or scapulothoracic bursitis, is an under-recognized disorder characterized by painful, audible, or palpable crepitus between the scapula and thoracic wall. While nonoperative management is the standard first-line treatment, surgical intervention is often considered for refractory cases.

Evaluate the literature regarding treatment modalities, compare patient-reported outcome measures (PROMs), and assess complication and recurrence rates for both nonoperative and operative management of SSS.

The search was conducted from inception of 6 databases. Inclusion criteria were peer-reviewed clinical studies with Level IV evidence or higher of human subjects treated for SSS. Study quality was assessed using the Methodological Index for Non-Randomized Studies (MINORS) and Risk of Bias 2 tools. Extracted data included demographics, surgical techniques, PROMs, complication, and reoperation rates. Descriptive statistics and forest plots were utilized.

Twenty-one studies (464 patients) were included: 2 Level I RCTs, 2 Level III cohort studies, and 17 Level IV case series. Nonoperative treatment (3 studies, 62 procedures) showed significant pain relief at 3-6 months, with mean visual analog scale improvements ranging from 3.7 to 6.0; however, symptoms often persisted. Operative treatments (18 studies, 408 procedures) included arthroscopic (15), mini-open (1), and open (2) approaches. Operative management resulted in improvements across all PROMs. There was a reported cumulative 22% postoperative complication rate with 83% being postoperative pain and persistent crepitus which led to reoperation rates ranging between 8.3% to 14.3%.

Both nonoperative and operative treatments for SSS provide meaningful pain relief, though complete resolution of mechanical symptoms is often unachieved. Operative intervention leads to durable improvements in functional outcomes for patients who fail conservative management. However, the literature is limited by low-level evidence and high heterogeneity in surgical techniques and outcome measures, necessitating future prospective, standardized studies to optimize patient selection and treatment protocols.