Shoulder Resources

Sprengel shoulder (R) Sprengel shoulder (R)


Definition
Failure of descent of the scapula resulting in congenital elevation. The scapula is usually hypoplastic and misshapen.

Embryology
The scapulae usually complete their descent from the neck by the 3 rd month of fetal life. ( just remember end of 1 st trimester)

Epidemiology
Most common congenital anomaly of the shoulder.

Associations
• Klippel-Feil syndrome
• Glenohumeral instability from repeated capsular stretching to compensate for poor scapulothoracic motion
• Omovertebral connection, either fibrous or bony, in 1/3. This extends from the superior medial angle of the
scapula to the spinous process of one of the lower cervical vertebra.
• Scoliosis and hemivertebrae
• Rib synostosis
• Clavicular abnormalities
• Renal anomalies
• Hypoplasia of shoulder girdle musculature

Clinical
The shoulder is elevated on the affected side; the scapula looks and feels abnormally high, smaller than usual and somewhat prominent.
The main functional deficit is limitation of shoulder abduction to 90 to 100 degrees.

Management
Often a cosmetic problem only with little functional limitation.
Mild cosmetic deformity can be treated by excision of the superior medial angle of the scapula.
The Woodward procedure lowers the scapula and can increase shoulder abduction by up to 60 degrees. The procedure is usually performed in children less than 6. Operations to lower the scapula risk injury to the brachial plexus if performed too late.
The Woodward procedure involves releasing the trapezius and rhomboid muscles first. Any omovertebral connection is released and the attachment of levator scapulae released. The scapula is then moved inferiorly until its spine is level with the opposite scapula and the trapezius and rhomboid muscles reattached.
This procedure is sometimes combined with morsellization of the clavicle if there is a real possibility of BPI.

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