Congenital high scapula (Sprengel's deformity): Four cases

We report a series of four cases of congenital high scapula (or Sprengel's deformity) diagnosed and followed in our establishment. The main feature of this very rare congenital malformation of the pectoral girdle is an abnormally high, more or less dysmorphic scapula. A congenitally high scapula is often discovered in young children, when consequences for aesthetics, and sometimes functional difficulties, are brought to light. When surgical treatment is envisaged, imaging is recommended to diagnose a supernumerary structure, ossified (an omovertebral bone) or not (a fibrous and/or cartilaginous connection), extending from the scapula to the cervical spine. This needs to be resected. A CT scan is essential for detecting an omovertebral bone and the vertebral bone abnormalities that are often associated with it. MRI and ultrasound are very useful for assessing any fibrous and/or cartilaginous components. An ultrasound examination has the undeniable advantage of being quick and easy in these young children.     

Congenital elevation of the scapula

A literature review allowed classification of seven cases of Sprengel's deformity based on that described by Rigault et al. This classification into three types as a function of degree of elevation defines each case within the context of associated malformations, and appropriate therapy. Surgery is indicated, employing Woodward's type of operation, for patients with functional and esthetic deficits, particularly in Rigault's type II deformity.     

Vertical scapular osteotomy in congenital high scapula

PurposeChildren with congenital high scapula (CHS) have a cosmetic and functional problem due to limited shoulder abduction. Treatment options include excision of the prominent superior angle, scapular relocation procedures and subtotal scapulectomy. Excision of the superomedial angle results only in cosmetic improvement. Subtotal scapulectomy and relocation procedures are associated with ugly scars, extensive bleeding and high incidence of brachial plexus injuries. Vertical scapular osteotomy (VSO) is another surgical option that provides cosmetic and functional improvement. The aim of this study is to assess medium to long term results of VSO in treatment of CHS.MethodsThis is a prospective case series study. Seven children with CHS were treated at our unit. Age ranged from 5–13 years with an average of 8.4 years. All children were females with unilateral affection. All children underwent a VSO as described by Campbell. We used the Cavendish grading system together with combined shoulder abduction for assessment. Follow up averaged 4.6 years.ResultsAll children and parents were extremely satisfied with the results of surgery. All patients experienced an improvement in global shoulder abduction with an average gain in abduction of 52.9°. All patients experienced an improvement in cosmetic appearance with better shoulder levelling. The Cavendish grade improved in all patients.ConclusionThis study emphasizes the results of previous authors demonstrating that CHS can be treated successfully with a VSO. The procedure is simple and its results are reproducible.     

Nonunion of a scapula body fracture in a high school football player

We report the case of a 16-year-old boy who sustained a minimally displaced fracture of the inferior angle of the scapula during a high school football game. This fracture progressed to symptomatic nonunion and persistent pain. Treatment included curettage of loose, fibrous tissue interposed at the fracture site; fragment excision; range-of-motion exercises started early in the postoperative period, and progressive scapula strengthening. Four and a half months after initial injury, the patient returned to all activities and was asymptomatic.     

Dynamic winged scapula

Author describes the paralysis of the serratus muscle in consequence of the paralysis of the long thoracic nerve. The form of appearance is the winged of "flying" scapula. Beside the presentation of the literary and anatomical data the own cases are described. Only conservative therapy was made, an operation was in no case necessary.     

The winged scapula

Twenty-five patients with 23 different types of winging of the scapula are described. A simple clinical and etiologic classification of the winged scapula is proposed based on the study of these patients in conjunction with a review of the literature. Winging of the scapula is either static or dynamic. Static winging is due to fixed deformity in the shoulder girdle, spine, or ribs. Dynamic winging is due to a neuromuscular disorder. The great variety of lesions that produce winging of the scapula may be classified anatomically into four types: Type I, nerve; Type II, muscle; Type III, bone; and Type IV, joint. Winging of the scapula is a surprisingly common physical sign, but because it is often asymptomatic it receives little attention. However, symptoms of pain, weakness, or cosmetic deformity may demand attention, and it is hoped that this classification will help in the diagnosis and assessment of these patients.