Congenital high riding scapula, also known as Sprengel deformity, involves a developmental failure of the scapula to descend. The scapula is rotated so the inferior tip is displaced in a medial direction. This prevents shoulder abduction because of the downward angulation of the glenoid. A variety of surgical procedures have been proposed for correction and repositioning of the scapula. The authors present a technical variation for severe Sprengel deformity. There were 15 shoulders and 11 patients that underwent the procedure. The age ranged from 2 to 15 years with a mean age of 5 years. The authors assessed the scapula with regard to appearance and radiologic positioning along the chest wall. The follow-up was over three years.
The scapula was released and repositioned and secured with an absorbable suture from the superomedial scapula into the spinous process of the lower thoracic spine usually T11 or T12. Postoperative immobilization was minimal with the patient placed in a sling for comfort. Beginning on the first or second postoperative day, active range of motion was instituted until maximum abduction was gained.
The results are quite impressive. Postoperatively, there was improvement in the position of the scapula, and all patients and their families expressed satisfaction about the results. Subjective evaluation was 9 very good and 6 good. Postoperative abduction ranged from 90-170 degrees with a mean gain of 49 degrees. Mild complications were noted.
Sprengel deformity is difficult to treat. The timing of the procedure and appropriate procedure remains controversial. In this series, the authors report uniform good results with resection of superomedial border of the scapula and repositioning in an inferior direction. The careful reattachment of the trapezius and rhomboid muscles was integral to their procedure. This procedure appears to be an appropriate option for those patients with Sprengel deformity that lack greater than 90 degrees of shoulder abduction. In those patients that have motion greater than 90 degrees, the risk and benefit ratio should be carefully assessed.