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Osteochondromas of the scapula are not rare in occurrence, especially in multiple hereditary exostosis. A scapular exostosis, excised from the ventral surface of the scapula in a 13-year-old girl, produced symptoms of shoulder pain.
To clarify the shoulder movement, changes of the tilting angle of the scapula were elevated radiographically in three dimensions during arm elevation. Utilizing data of the tilt of the glenoid fossa against the plane of scapula measured in dry bones, the direction of the glenoid fossa during arm elevation in living subjects was evaluated. The medial tilting angle was nearly constant at about 40 degrees from the resting position to an elevation of the arm to 150 degrees position. The average downward tilt was 12.46 degrees in the resting position; thereafter it gradually tilted backward. Horizontal tilt of the glenoid fossa following arm elevation was 46.15 degrees in the resting position, 46.15 degrees at 90 degrees of elevation, 38.79 degrees at 150 degrees of elevation, and 33.0 degrees at maximum elevation. These findings suggest that the "scapular plane" is the plane 40 degrees against the frontal plane in the range from 0 degrees to 150 degrees elevation of the arm, and that "zero position" is at 150 degrees elevation position in the scapular plane.
Fourteen patients with traumatic winging of the scapula were reviewed, all of whom had had injuries producing sudden depression of the shoulder girdle from either a direct blow to the top of the shoulder or downward traction on the arm. The diagnosis was commonly missed for a considerable interval. Seven patients recovered spontaneously within six months of injury. Three of the other seven patients were treated by reattachment of the insertion of the sternal portion of the pectoralis major muscle via a fascia lata graft to the lower pole of the scapula. In one of these patients a reoperation was needed, but all three ultimately recovered satisfactory function of the shoulder. Anatomical studies suggested that the injury results from compression of the long thoracic nerve against the second rib and not from entrapment of the nerve by the scalenus medius muscle.
The author have reviewed sixty nine cases of congenital elevation of scapula on whom scapuloplexy was performed. The degree of elevation was classified according to Rigault's criteria (1976). This operation gave excellent or good results in 68 per cent of cases, the improvement being slightly better from the aesthetic than from the functional point of view. The factors adversely influencing the results were: the degree of elevation, scoliosis, "pagoda" deformity, and insufficient surgical lowering. Osteotomy of the clavicle is necessary in the presence of neurological complications. In cases with scoliosis or "pagoda" deformity of the scapula it is desirable also to resect the supero-medial angle. The operation should be carried out before the patient reaches the age of ten years.
The authors have studied a series of 43 fractures of the scapula. They confirm the results are generally good. However, 12 displaced fractures of the neck of the scapula have been seen. All were treated conservatively with only one good result, the other results being fair or poor. These results are explained by the fact that displaced fractures of the neck disorganize the coraco-acromial arch. This type of fracture should be surgically treated as an articular fracture by open reduction and plate fixation. Fractures of the glenoid should also be treated surgically.
A flat incisura scapulae was registered on radiological examination of four cases of frozen shoulder. A modified X-ray technique was used to investigated 250 patients with spondylosis cervicalis in a morphological study of the incisura scapulae. Three types were found: Type I with a deep, sharp incisura, type 2 with a widened, balloon-sharped incisura and type 3 with a flat, barely-distinguishable incisura. The significance of the X-ray appearance is discussed.
Various angles viz. superior, medial, inferior, inferolateral, lateral, acromial and coracoid were studied in 42 scapulae of right side and 54 scapulae of left side. The angles have no correlation to that of opposite side. The correlation coefficient of each angle in relation to other angles on the same side was studied. Some of the angles showed significant correlation to that of the others.
In the medical literature we found published four cases of irradiation induced chondrosarcoma of the scapula. We present a fifth one and report about a 63 year old female patient. She underwent a left radical mastectomy for breast cancer. Pre- and postoperatively a local irradiation of 140,00 Gy was applied. After a disease free interval of 18 years a large tumor in the left scapula was histologically confirmed as a chondrosarcoma. All criterias of Cahan for an irradiation induced sarcoma are fulfilled.
We evaluated thirty patients with a fracture of the scapula in a prospective study over a seven-year period. Sixteen patients were found to have an associated pneumothorax, of which more than two-thirds were associated with a fracture of the left scapula. Ten of the pneumothoraces were delayed for one to three days. All of the scapular fractures were treated using a shoulder immobilizer, and early range-of-motion exercises of the involved extremity were instituted as tolerated. Information obtained from pulmonary auscultation and percussion, determination of initial values for arterial blood gases, and daily chest radiographs for three days after injury confirmed the diagnosis. Closed suction drainage using anteriorly or laterally placed thoracostomy tubes was performed successfully in all patients and avoided the potential sequelae of shock, respiratory failure, and pneumonia, as well as recurrence.
It is of general opinion that the mammalian coracoid bone reduced during the evolutional process and remained as a small tubercle on the distal part of the scapula. The cause of the caracoid bone reduction is supposed to result from certain changes in position of the free thoracic extremity from the segmental (as in reptiles) plane into the sagittal one, while the position of the shoulder girdle remained unchanged. However, this view does not coincide to the paleontological data which state that already in the Dinosauria and Theriodontia the thoracic extremities were situated in the parasagittal plane and, nevertheless their caracoids were well developed. There is also no agreement with numerous embryological, comparative-anatomical and electromyographic data concerning the osseous-muscular system of the thoracic extremities and the evolutional transformation of the brachial plexus. Owing to these data, it is possible to suggest that in the process of the mammalian evolution, the thoracic extremity together with the shoulder girdle made a turn around its longitudinal axis and, as a consequence, the caracoid with its musculature, moved from its abdominal position forward and upward on the lateral and spinal surface, and the scapula, correspondingly, in the caudoventral direction and gradually reduced.
Four cases of neurogenically induced winging of the scapula are described. Systematic clinical evaluation enabled the affected nerve or nerves to be defined in each case, particular attention being directed to the presence or absence of deformity at rest, the direction of rotation of the winging scapula, and the movement of the arm that produced maximal scapular winging. EMG studies were performed on all 4 cases and serial spinal accessory nerve conduction studies on the 2 patients with involvement of this nerve. Both techniques proved useful adjuncts to clinical evaluation and provided confirmatory diagnostic information. The accessory nerve conduction studies were of further value in assessing the extent and type of neural damage, the rate of recovery and the prognosis.
Fractures of the scapula are rare and mainly result from a severe direct trauma. Most fractures may be treated non-operatively, only severely displaced and unstable fractures of the neck and/or the clavicula, unstable intraarticular fractures of the glenoid or open fractures (especially in combination with neurovascular lesions) should be fixed operatively. A dislocated fracture of the clavicula or glenoid should be approached first ventrally. Displaced fractures of the neck and body may also require an open reduction and fixation through a dorsal approach. Careful preoperative planning and anatomical studies are required to prevent intraoperative damage of innervation and vascularization. Cannulated single screws, 1/3 tubular plates or 3.5 LC-DC plates are recommended for the stable fixation of the scapula, whereas a Bosworth screw or a hook plate are helpful to stabilize the lateral clavicula and the acromioclavicular joint. Postoperative treatment: Temporary immobilization in a Gilchrist or Desault bandage for about 3 to 4 days thereafter careful passive and active mobilization.
In forty patients treated at The University of Texas Medical Branch Hospitals for fifty-two fractures of forty-one scapulae from 1961 through 1973, most of the fractures were the result of vehicular accidents. The thirty-eight fractures involving only the body, neck, or spine of thirty scapulae (without involvement of the acromion, glenoid, or coracoid process) were successfully treated with a sling and early active motion. Three other fractures involving body were associated with three fractures involving the glenoid. The eleven fractures of the acromiom, glenoid, or coracoid process resulted in loss of motion in ten of the eleven shoulders. For fractures of this type we now recommend immobilization in 60 degrees of abduction, 25 degrees of flexion, and 25 degrees of external rotation, with early active abduction exercises. Open reduction is rarely indicated, only when there is disruption of the glenohumeral joint.
Of 77 cases of surgically treated congenital high scapula, the procedure was scapular resection in 36, and scapula relocation in 41. Seventeen had a Woodward-type repair, 14 a Shrock procedure, four cases a Green repair and 6 cases had Petries modification of the Green repair. Follow-up was from two to 14 years with a mean of 11 years. Preoperatively, the mean of shoulder abduction was 90 degrees. Post-operatively, proximal resection increased shoulder abduction to 126 degrees but did not change scapular position. Scapular relocation increased abduction to a mean of 134 degrees and shoulder position was altered from a mean of 1.8 inches of elevation as compared to the normal side, to a mean of 0.5 inches of residual elevation. Significant loss of initial correction occurred in 14 out of 36 cases of proximal resection and 9 of 41 patients with scapular relocation.
This paper presents a review of all patients admitted to the orthopedic department of Frederiksberg University Hospital during a period of 10 years with a diagnosis of fracture of the scapula-a total of 18. All medical records and roentgenograms were reviewed retrospectively. We found, in agreement with the literature reviewed, an extremely high frequency-88% in our study-of high-energy trauma as a cause of scapular fractures. In 88% of the cases the scapular fracture was associated with other lesions; fractures of the ipsilateral humerus or ribs were seen with the highest incidences (44%). All patients were treated conservatively, resulting in satisfactory conditions of their scapula and shoulder girdles.
Scapular clicking with shoulder motion has been described for a variety of conditions. Two unusual cases, a lymphangioma of the thoracic wall in a 42-year-old man and an aneurysmal bone cyst of the scapula in an 8-year-old boy, are presented. The lymphangioma was treated by marginal excision of the lesion and the aneurysmal bone cyst, by excision of the infraspinal portion of the scapula with resolution of symptoms.
A 34-year-old woman presented with a right winged scapula 8 months after developing systemic lupus erythematosus (SLE) with subacute cutaneous manifestations. The patient experienced severe shoulder pain followed by weakness of the right arm in the typically winged scapula fashion. Electromyography of the serratus anterior showed long thoracic nerve palsy. Clinical and laboratory signs did not reveal any associated disease. Paralysis of the long thoracic nerve has never been described before in SLE.
Extract and measure the scapular every part from the fetus that was carried into Saga medical college, the data was processed statistically. Also, the morphological characteristic of scapula of the fetus was clarified by image processing that a computer is used. The result was as follows. A scapular morphological length and also height become big in proportion to the height of fetus. Index of height-length of a fetus was big compared with adult, this trend is remarkable especially in a early stage of development of a fetus. Spinal axis angle of a fetus was also bigger than that of adult and it remarkable differ from an anthropoid very small ane. In general, the scapular shape of a fetus was short length with wide-spreading side and this form resembles to scapula of Jomon period people. The width of cartilage part tend to decrease as ossification progress fast width-wise with growth. However, area of cartilage part tend to become big, because the growth of a cartilage part is going fast lengthwise.