Sprengel's deformity

A developmental abnormality in which the scapula doesn’t descend to its proper position or a high lying shoulder blade is called sprengel's deformity. In the intrauterine life it is lying in the cervical region then it descends. The associated muscles may be weak (trapezius, rhomboid muscles etc).

Sprengel's deformity

Presentation:

·         Shoulder asymmetry

·         Restricted shoulder abduction

·         Scapula is adducted and 2 – 10 cm elevated.

·         Inferior pole is deviated medially, the glenoid faces inferiorly, and the length of vertebral border is decreased.

Associated problems:

·         Poland syndrome

·         Klippel-Feil syndrome (short, webbed neck; decreased range of motion (ROM) in the cervical spine)

·         Scoliosis

Cavendish classification:

Based on the severity of the condition, a Sprengel deformity can be classified as follows (Cavendish grades).

Grade 1:

The deformity is very mild with clothes it cannot be seen. The shoulders are almost at level.

Grade 2:

This is mild deformity but the superomedial portion of the high scapula is visible as a lump.

Grade 3:

It is a moderate deformity. The affected shoulder is 2 – 5 cm higher than the opposite shoulder. It is visible.

Grade 4:

It is severe deformity. The scapula is very high with neck webbing and brevicollis.

Diagnosis:

Imaging Chest X – ray:

To confirm the diagnosis and to look for associated anomalies. 

 CT – Scan (thorax):

Omovertebral body can be seen, which is a bony bar that attaches the scapula to spine (cervical).

Management:

·         Physiotherapy to gain mobility

·         Definitive treatment is surgery

·         Repositioning of the scapula is done (modified green scapuloplasty and wood ward procedure)

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Tennis Elbow

In this condition there is trauma in the common extensor tendon (origin). The most common tendon is extensor carpi-radialis brevis. This condition occurs after unaccustomed supination and extension of wrist joint.

Presentation:

Usually there is pain on lateral epicondyle and on the extensor surface of the forearm.

Management:

1.       Analgesics

2.       Corticosteroid injection

3.       Tennis elbow splint/Physiotherapy

4.       Rarely surgery is indication (tendon repair is done)

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Springle shoulder

It is a developmental abnormality in which there is failure of descent of scapula to its mid thorax position.

Remember:

During development scapula is in the cervical region then it descends to the mid thoracic region.

Clinical features:

Abnormality lying scapula, the features depend on severity of problem it can be mild, moderate or severe. Sometimes it is associated with other deformities as well like scoliosis, Poland syndrome (pectoralis major muscle absent). In mild deformity clothes can cover it. In other condition the movements can be affected.

Diagnosis:

·         X – Ray

·         CT – Scan (thorax)

Omovertebral body can be seen, which is a bony bar that attaches the scapula to spine (cervical)

Management:

In mild cases physiotherapy is required to improve movements. Sometime surgery can be required in which the omovertebral body can be excised. If there are associated muscle abnormality it is corrected as well (in simple words re-positioning of scapula is done)

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Frozen shoulder

Frozen shoulder associations:

It is a condition characterized by pain and stiffing of the shoulder usually the joint capsule. The common muscles involved are Subscapularis and Supraspinatus.
Etiology

The exact cause of the disease isn’t known most commonly associated with IHD/DM/HTN/trauma cause it.

Clinical features:

Initially there is pain in shoulder joint later on leading to stiffening of the joint. Gradually the movements decreases (abduction and external rotation)

History and clinical examination:

The history and clinical examination will help in identification of this disease.

Management:

It may not require any treatment.

1.       Analgesics

2.       Steroid injection

3.       Physiotherapy

Surgical management:

Manipulation of the joint and joint wash with normal saline is the surgical management.

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