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Background
The scapulothoracic articulation is not truly a joint. The scapula is almost entirely covered by muscle and glides over the chest wall without a cartilaginous or fibrous interface. Several bursae help facilitate smooth scapular gliding, some of which are variably present and thought to be adventitial. Patients with scapulothoracic dysfunction may present only with pain and/or mechanical symptoms including crepitus, snapping, or a clunk. Although scapulothoracic bursitis is most often implicated, several other pathologies may be causative or contributory.

Educational Goals / Teaching Points
This exhibit will review the musculoskeletal and neurovascular anatomy about the scapulothoracic articulation. The clinical presentation and common demographics will be described. The range of pathology as well as normal variations will be reviewed. Treatment options will be discussed with an emphasis on the role of imaging-guided injections. This exhibit is intended to benefit radiology trainees, practicing radiologists, and referring providers.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
The clinical features predisposing patients to develop scapulothoracic bursitis will be reviewed including repetitive stress, scapular dyskinesis, variant “normal” anatomy, skeletal dysplasia/exostosis, and post-traumatic / post-surgical changes. However, not all scapulothoracic dysfunction is solely due to a mechanical bursitis. A variety of tumors, both benign (elastofibroma dorsi, lipoma) and malignant (chondrosarcoma, Ewing sarcoma), may occur in this location. Infection is uncommon but should be considered. Vascular or venolymphatic malformations may be difficult to distinguish from a prominent vascular plexus. Recognizing the expected course of the dorsal scapular, spinal accessory, and long thoracic nerves as well as their adjacent arteries is important both for evaluating possible effects of a mass lesion and in pre-procedural planning. Magnetic resonance imaging is often the modality of choice. At our institution, ultrasound-guidance is preferred for real-time imaging-guidance for interventional procedures at the scapulothoracic articulation, but CT may also be employed.

Conclusion
Patients may present with a range of pathologies that may cause and/or contribute to clinical symptoms associated with scapulothoracic bursitis. Understanding the scapulothoracic anatomy is essential for accurate diagnosis and treatment recommendations as well as providing safe and effective imaging-guided intervention.