CORR Insights(®): Open Surgical Treatment for Snapping Scapula Provides Durable Pain Relief, but so Does Nonsurgical Treatment.

V astamaki and colleagues are to be congratulated for their long-term followup study on the treatment of snapping scapula that demonstrates clinical equipoise at 16 years between open superomedial corner resection and observation. Is this condition analogous to the natural history of intervertebral disk herniations, which seem to end up in a similar spot in 10 years, with or without discectomy? [2] Perhaps we need to reflect on what in fact is—and is not—known about this clinical entity. In the classic article by Henry Milch, snapping scapula syndrome was described as ‘‘a tactile-acoustic phenomenon’’ likened to ‘‘the muffled sound of a stick being drawn across a picket fence’’ [4]. Encountering a patient with this condition in the clinic is intimidating, as the snapping is often loud and the scapular dyskinesis can be dramatic. It follows that there must be a straightforward and easily treatable cause for this aberration. In Milch’s case series, he concluded, ‘‘simple removal of portions of the scapula will result in prompt and permanent cure’’ [4]. With that admonition, it is not surprising that superomedial corner resections gained popularity for patients with persistent symptoms, and Vastamaki and colleagues quoted several papers [3, 5] demonstrating good short-term results. As is often the case with relatively rare conditions, any given orthopaedist is unlikely to have a wealth of experience managing patients with these findings, and most of the evidence we have derives from small case series. Given that the precise origin of the snapping is often unknown, ‘‘specific treatments that are effective for some patients may not be effective for others’’ and that ‘‘many patients experience continued shoulder disability even after surgical intervention’’ [7]. Surgeons have not had uniformly good results with this procedure, so careful patient selection is paramount to obtaining a good result. For example, resection of the superomedial corner would be unlikely to help a baseball pitcher who is predisposed to develop bursitis at the inferior angle [6]. This CORR Insights is a commentary on the article ‘‘Open Surgical Treatment for Snapping Scapula Provides Durable Pain Relief, but so Does Nonsurgical Treatment’’ by Vastamaki and colleagues available at: DOI: 10.1007/s11999-015-4614-1. The author certifies that he, or any member of his immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/ licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request. The opinions expressed are those of the writers, and do not reflect the opinion or policy of CORR or The Association of Bone and Joint Surgeons. This CORR Insights comment refers to the article available at DOI: 10.1007/s11999-0154614-1. W. J. Warme MD (&) Department of Orthopaedic Surgery, University of Washington, 4245 Roosevelt Way NE, Seattle, WA 981956500, USA e-mail: warmewj@u.washington.edu CORR Insights Published online: 25 November 2015 The Association of Bone and Joint Surgeons1 2015