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Osteotomy for congenital elevation of the scapula (Sprengel's deformity).

We report 12 consecutive cases of vertical scapular osteotomy to correct Sprengel's deformity, performed during a 16-year period, with a mean follow-up of 10.4 years. The mean increase in abduction of the shoulder was 53 degrees . The cosmetic appearance improved by a mean of 1.5 levels on the Cavendish scale. Neither function nor cosmesis deteriorated with time. We recommend the procedure for correction of moderate deformities with a functional deficit.

Adolescent↗

A comparison of torque production during dynamic strength testing of shoulder abduction in the coronal plane and the plane of the scapula.

Quantitative measurement of the shoulder abductors is important in a comprehensive assessment of shoulder muscle performance. Testing in traditionally accepted positions may be compromising to the glenohumeral static and dynamic stabilizers; therefore, there is a need to investigate testing in other planes of motion. The purpose of this study was to compare torque produced during isokinetic testing of shoulder abduction in the coronal plane and the scapular plane. Twenty female subjects with no previous shoulder pathology were tested at 90 degrees/sec and 210 degrees/sec in the coronal and scapular planes using the Cybex II isokinetic dynamometer. Both peak torque and mean peak torque of three trials were recorded. A t test for related samples (p < .05) revealed no significant difference in the peak and mean peak torque produced at each speed. Using a two-way analysis of variance with repeated measures, no significant difference was found in the peak torque produced between the two planes. However, torque production at 90 degrees/sec in both test positions was significantly higher than torque production at 210 degrees/sec (F1,19 = 159.610, p < .001). Although anatomical, functional, and clinical reasons have been proposed for performing exercise and testing procedures of the shoulder abductors in the scapular plane, the results of this study indicate that in healthy young women, there is no difference in torque production between the two planes.

Adult↗

Treatment of congenital elevation of the scapula. 10 (2-18) year follow-up of 37 cases of Sprengel's deformity.

We studied retrospectively and partially prospectively all 37 cases of Sprengel's disease who were treated between 1970 and 1990, 23 of whom were operated on. Many of the patients were severely handicapped by abnormal shoulder abduction and elevation. Neurological deficits were not found. 34 of our cases had other congenital malformations. Several operative techniques were used. In cases with only cosmetic problems we now prefer resection of part of the superior angle. In cases with impaired function we prefer the Woodward-procedure.

Adolescent↗

Hepatocellular carcinoma presenting as a solitary metastasis to the scapula. Case report and review of the literature.

Although primary hepatocellular carcinoma is uncommon, metastasis to the upper extremity as a presenting symptom is even more rare. Recent case reports and autopsy surveys document that extrahepatic spread of this carcinoma occurs in 30% to 78% of patients, who usually are without regional symptoms involving bone. Although metastatic spread to the lungs and lymph nodes occurs more commonly, the incidence of bone metastases has increased according to previous reports and is now estimated from 2% to 13%. This case report concerns widely disseminated hepatocellular carcinoma presenting initially without any other systemic signs except for shoulder pain and induration. Due to the aggressive nature of this tumor, early detection is crucial. Early diagnosis may offer the only real hope for establishing effective treatment and improving the chances for long-term survival.

Bone Neoplasms↗