Modified Woodward Procedure for Sprengel Deformity of the Shoulder: Long-Term Results

Abstract

Sprengel deformity of the shoulder is characterized by elevation and medial rotation of the inferior pole of the scapula. Surgical treatment is recommended in significantly involved patients to improve cosmetic appearance and function of the involved shoulder. We report long-term results of a Woodward procedure modified by excision of the prominent superomedial border of the scapula for correction of this deformity in 15 patients. Preoperatively, the total abduction of the shoulder averaged 115 degrees, and on follow-up the abduction had improved to an average of 150 degrees. In all patients except one, there was marked improvement in appearance as assessed on Cavendish scale. All patients except two had achieved skeletal maturity at the last follow-up. Eighty-six percent of patients expressed satisfaction with operative results. Our data support the concept that correction achieved by a modified Woodward procedure is not altered by growth and is maintained beyond skeletal maturity.

Sprengel's Deformity: Surgical Correction by a Modified Green Procedure

“…Sprengel deformity is the most common congenital deformity of the shoulder 3 , 10 . It is the result of a scapula blocked from its normal descent, probably between the ninth and 12 th weeks of pregnancy, causing a bone to be in an abnormal position and usually hypoplastic, and the periescapular muscles present varying degrees of hypoplasia and degenerative changes 2 , 3 , 6 , 7 , 11 .…”

“…Skeletal deformities are frequently associated with Sprengel deformity, ranging from 67% to 100% 1 , 3 , 4 , 16 , 21 . Seven of our cases (78%) had associated deformities, the most frequent of which were in the spine (scoliosis and Klippel-Feil syndrome) and changes in the ribs.…”

“…The morcellation (osteotomy) of the clavicle associated with the procedure for lowering the scapula is regarded as a first surgical procedure for many authors, and can be performed in severe deformities to avoid compression of the brachial plexus 1 , 2 , 3 , 16 . In our study, this procedure was not performed, since there were no such problems.…”

“…Congenital elevation of the scapula is a rare condition of unknown etiology that results from the abnormal termination of the caudal migration of the scapula in the embryonic period 1 , 2 , 3 , 4 . Eulenberg first described this condition in 1863, and after the publication of Kolliker's study in 1891, which credited Sprengel for this finding, it was referred to as the Sprengel deformity 1 , 2 , 5 , 6 .…”

Prenatal ultrasonographic diagnosis of Sprengel's deformity.

“…The trapezius and rhomboid muscles are reattached to lower spinous processes than their congenital origin, and the superior scapula margin is resected. 15 In the Green procedure, the trapezius and rhomboid muscles are detached from their insertions on the scapula. The omovertebral bone and any fibrous bands are resected.…”