Most orthopedic surgeons, and even many shoulder experts, are a little intimidated by the evaluation and management of patients with conditions affecting the scapula, periscapular muscles, and scapulothoracic joint. Explanations for this include relative unfamiliarity with the anatomy, function, physical examination, and diagnostic categories related to the scapula, and the fact that surgical procedures around the scapula are not performed commonly. Dysfunction of the scapulothoracic joint may play a major role in patients with diverse shoulder conditions such as disorders of the clavicle and the acromioclavicular joint, shoulder instability, and rotator cuff disease. Additionally, the scapulothoracic joint and periscapular muscles may be affected by disorders such as traumatic muscle avulsions, injuries to various nerves, fractures of the scapula and the glenoid cavity, bursitis, osteochondromas, and congenital abnormalities. Finally, some patients present with pain and dysfunction secondary to poor control of the periscapular muscles in the absence of specific structural pathology.
A 1-Year Cost Analysis of Spinal Surgical Procedures in Spain: Neurosurgeons Versus Orthopedic Surgeons