Definition
Rare congenital abnormality
Failure of descent of shoulder
Epidemiology
AD & Sporadic
Tends to be in girls & on left
Associated with other congenital abnormalities
- scoliosis
- diastematomyelia
- klippel-Feil Syndrome (usually bilateral)
- cervical ribs / fused or absent thoracic ribs
- thoracic vertebral anomalies
Etiology
Failure of descent of arm bud by 3rd fetal month
Clinical
Scapula small and elevated
- superior angle rotated upwards & forwards
- shoulder musculature deficient
Limited shoulder abduction
- scapula joined to cervical spine by fibrous or bony bar
- Omovertebral bar
X-ray
Small high scapula
Omovertebral bone - bone linking scapula and hyoid
Operative management
Indications
Cosmesis
Improve abduction range
Options
Scapula resection
Shoulder relocation
Scapula resection
Cosmetic procedure
- excision of prominent scapula above spine)
- excision of omovertebral bar
Scapula relocation
Woodward procedure
- clavicular osteotomy to protect brachial plexus
- excise omovertebral bar
- mobilise scapula caudally
- detach trapezius & rhomboids from spinous process insertion
- reattach more inferiorly to create dynamic inferior force
Green procedure
- clavicular osteotomy
- medial scapula release
- 40 cases Sprengel treated with modified Green procedure
- mean age 5 years
- mean improvement abduction 36 degrees
- one transient brachial plexus injury
- complications: wound gaping / pleural tear / scapula winging
- 42 cases Sprengel treated with modified Green procedure
- +/- clavicular osteotomy
- clavicular osteotomy improved abduction by mean 25 degrees
- complications 7%, 2 reoperations
- 70% high satisfaction