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Scapula Resection

Removing part or all of the shoulder blade, while preserving as much shoulder function as possible.

The scapula, or shoulder blade, is the flat triangular bone that sits over the back of the ribcage and forms the socket side of the shoulder joint. Scapula resection, also called scapulectomy, is the surgical removal of part or all of that bone.

It is performed for a tumour of the scapula or for severe injury to it. Where only part of the bone is removed, the glenoid (the socket of the shoulder joint) is usually left intact, so that the shoulder joint itself is preserved. The aim throughout is to keep as much shoulder function as the underlying problem allows.

The procedure

How much of the scapula is removed depends on the extent of the disease or injury. A partial resection generally preserves the glenoid and therefore the shoulder joint. The operation is usually arthroscopic but can be performed open. About two hours of operating theatre time is typically booked.

Risks and complications

All surgery carries risk. The risks that are relevant to you are discussed with you in consultation before any decision about surgery is made.

General surgical risks

  • Bruising and haematoma. The amount of bruising varies from patient to patient and usually settles quickly. A haematoma, which is a collection of blood under the wound, occasionally needs to be drained in theatre.
  • Infection. Infection is possible, and is usually treated with antibiotics.
  • Deep vein thrombosis (DVT) and pulmonary embolism (PE). Blood clots can form in the veins of the leg and can travel to the lungs. These are serious conditions, but the risk of lasting harm is significantly reduced when they are recognised and treated promptly.
  • Anaesthetic risks. These are discussed with your anaesthetist before surgery. In Australia the risk of death from a general anaesthetic is around 1 in 100,000.
  • Wound problems. Superficial wound problems can occur, and most need a small intervention.

Risks specific to this procedure

  • Shoulder instability and dislocation. Removing part of the scapula alters the support around the shoulder joint, so the joint may become unstable or dislocate.
  • Limited range of motion. Some loss of shoulder movement is a recognised consequence of the operation.
  • Ongoing pain. Pain may continue after surgery.

Before surgery

There are a number of things to work through before your surgery. You will be given detailed written instructions covering all of this.

  • Confirm with your health fund that the hospital fee is covered.
  • Confirm your anaesthetist’s fees.
  • Register your details with the hospital.
  • Read, complete and return your paperwork to the rooms.
  • Plan your transport to and from hospital. You cannot drive yourself home.
  • Attend any pre-operative physiotherapy that has been recommended.
  • Complete any pre-operative pathology, such as blood tests, if it has been requested.
  • Wash the shoulder with benzoyl peroxide 5% wash, twice daily for two days, and then once more on the morning of surgery, five applications in total. This reduces the risk of infection with Cutibacterium acnes, a bacterium that lives in the skin.
  • Pack your hospital bag: your regular medications in their original packaging, a loose button-up shirt, nightwear and toiletries. Bring your CPAP machine if you have sleep apnoea.
  • If you take blood thinners, phone the rooms to confirm when to stop them.
  • If you take tablets for diabetes, phone your anaesthetist to confirm whether to stop them.
  • Confirm your admission details with the rooms one to two business days before surgery.

The day of surgery

  • Your admission details are confirmed one to two business days beforehand. Make a note of your admission time, which may be as early as 6am, and the time from which you must fast.
  • If you do not live in Brisbane, staying in the city the night before is usually recommended.
  • After the admissions process you wait in the surgical waiting area. Your anaesthetist will see you for a brief consultation before you go through to theatre.
  • Dr Cutbush will greet you in the anaesthetic bay and mark the operation site. You are then given the general anaesthetic.
  • The usual stay is one night. Discharge is generally around 10am, after Dr Cutbush has reviewed you.
  • You will be given a folder containing your post-operative pack: a letter describing what was found and what was done, together with your rehabilitation and aftercare information.
  • Arrange for someone to take you home.

Recovery and healing

Recovery varies a great deal with the extent of the resection. After a minor resection, a return to normal activities within about six weeks is typical. More complex surgery can take several months.

You will need time off work, help with some daily tasks, and a period in which you cannot drive.

Rehabilitation

Day one

The hospital physiotherapist will fit your sling and show you how to manage eating, showering and dressing. The goal from the outset is gentle function, and restoring both passive and active range of motion.

Because there is no surgical repair to protect in this operation, movement is safe. The sling is for comfort only and is generally discontinued within about a week. Light activities are fine within the limits of pain, but avoid repetitive or loaded work above chest height.

Pain management: ice, positioning, attention to posture, and prescribed medication. Postural and scapular positioning correction form part of the programme from day one.

Day one exercises

Active-assisted range of motion exercises start with no range limit, concentrating first on flexion and external rotation. They include:

  • Circular pendulums.
  • Supine flexion.
  • Forward lean on a bench.
  • Horizontal flexion.
  • Supine hand to head.
  • Internal rotation, hand to hip.

Follow-up

See a local physiotherapist at week two, to check active and passive range of motion and scapular mechanics. At week six you are reviewed by Dr Cutbush together with an Extend Rehabilitation physiotherapist.

Results after surgery

Results vary with the details of the surgery and with how much of the scapula had to be removed. Overall, most people experience improvement in pain and are left with adequate shoulder function, although some loss of range of motion can be common. How closely the rehabilitation programme is followed has a strong bearing on the outcome. Individual results vary.

Next steps

This page is general information about a surgical procedure and is not a recommendation that you have it. Whether surgery is appropriate for you can only be determined after assessment. All surgery carries risk; the risks relevant to you are discussed in consultation before any decision is made.

General information about a surgical procedure. It is not a recommendation that you have this operation, and it does not replace the advice Dr Cutbush gives you about your own shoulder. All surgery carries risk, and individual results vary.Read about the risks and what recovery involves.