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PubMed1997

Snapping scapula syndrome: three case reports and an analysis of the literature.

The snapping scapula syndrome is an infrequently described source of shoulder discomfort characterized by painful, audible, and/or palpable abnormal scapulothoracic motion. The syndrome may be caused by skeletal or soft-tissue abnormalities that interfere with articulation between the scapula and the rib cage. Often, no obvious source of the snapping can be identified with imaging studies. Three new cases with electrodiagnostic and imaging studies are presented. For the first time a critical analysis and review by diagnoses, gender, age, treatment, and outcome of 89 reported cases is presented. Accurate recognition of the syndrome may lead to prompt and long-term relief of symptoms by conservative or surgical treatment.

Adult↗
PubMed2002

Scapula fractures.

Scapula fractures are relatively rare fractures which are typically a result of high energy trauma. Associated multisystemic injuries, therefore, occur with a high frequency. The management of scapula fractures has historically been nonoperative, perhaps in part due to the paucity of information regarding outcomes, combined with a relative unfamiliarity with treating these injuries. It is likely, however, that intraarticular fractures, and certain other highly displaced variants, have a better outcome when treated operatively. A well-conceived diagnostic work-up and a properly executed plan of rehabilitation are requisite.

Biomechanical Phenomena↗
PubMed2002

Winging of the scapula in a child with hereditary multiple exostoses.

A female, 10 years of age, with hereditary multiple exostoses presented with shoulder drop and asymmetry. The results of neurologic examination were normal and winging was not accentuated by active maneuvers of the shoulder. Scapular exostosis was demonstrated to be the structural cause of scapular winging. Only a few cases of children with scapular winging caused by scapular tumors have been reported. However, tumors of the scapula should be excluded in children with static winging of the scapula.

Child↗
PubMed1996

Prefabrication of combined scapula flaps for microsurgical reconstruction in oro-maxillofacial defects: a new method.

Nowadays, in congenital or acquired large oro-maxillofacial defects, microsurgical reconstruction is mainly performed by revascularized osseous, osteocutaneous, or osteomyocutaneous distant flaps. The aims of reconstruction include not only restoration of stability and aesthetic contour, but also the restoration of a functioning 'chewing organ'. In addition to bulkiness of the flaps, the stepwise surgical procedure (microvascular reconstruction, osseointegration of implants, secondary correction of flaps including preprosthetic surgery, etc.) prevents physiological oral function for a long time, and has some implications for creating an alternative method of microsurgical reconstruction with newly designed flaps. For reconstruction in maxillary and midface defects we prefer the use of the scapula flap. Since modern diagnostic methods allow comprehensive planning and defining of all relevant anatomical and functional factors in advance, the 'simultaneous' microvascular reconstruction by prefabricated scapula flaps has become possible and offers some advantages. The tissue prefabrication results in osseointegrated implants and thin mucosal linings with stable peri-implant soft tissue conditions at the time of microsurgical reconstruction. Postoperatively, after immediate dental restoration full oral function is attained. The 'simultaneous' reconstruction improves the psychosocial situation of the patient considerably.

Adult↗
PubMedDate not supplied

Dynamic stabilization of winging scapula by direct split pectoralis major transfer: a technical note.

A new technique of split pectoralis major tendon transfer (sternal head) for symptomatic scapular winging is shown. Whereas other authors use a lengthening with autogenous grafts, we prefer a direct attachment of the split pectoralis major tendon. With the use of an anterior and a posterior incision, the tendon of the sternal head of the pectoralis major is mobilized and transferred directly to the inferior angle of the scapula. An anatomic study shows that the pectoralis major muscle usually seems to be suitable for this procedure. Direct transosseous fixation of the transferred split pectoralis major tendon appears to be an excellent operation for correcting winging scapula without the necessity of an autogenous graft and concern over stretching or tearing of the graft extension.

Cadaver↗
PubMed1995

Levator scapulae transfer and fascia lata fasciodesis for chronic spinal accessory nerve palsy.

A retrospective evaluation of the functional results after reconstructive treatment with levator scapulae transfer and scapulo-spinal fasciodesis by fascia lata slings for complete chronic trapezius palsy is presented. Five patients (ages 6 to 40 years) were operated on between 1988 and 1991 because of incapacitating pain and/or functional limitations. Treatment was recommended after failure to alleviate symptoms by a shoulder-girdle muscle-strengthening program or after unsuccessful nerve graft. The descriptions of the results are drawn from the last follow-up evaluation available for each patient (minimum: 14 months post-operative). They are expressed in terms of functional recovery, residual pain, and patient satisfaction. Three patients had an excellent result, with at least 80 percent of normal abduction and forward elevation of the arm, no residual pain, and a high satisfaction rate. One patient showed good improvement in function, with 90 percent of normal shoulder function, but complained of some residual pain. The last patient was not improved by the surgery. Levator scapulae transfer and scapulo-spinal fasciodesis by fascia lata slings, substitute for the function of the upper trapezius and enhance the function of the serratus anterior, thus helping to relieve pain and to improve shoulder function after chronic trapezius palsy. The procedure warrants consideration in patients who are not candidates for nerve repair and reconstruction.

Accessory Nerve↗
PubMedDate not supplied

Scapulothoracic bursectomy for snapping scapula syndrome.

Seventeen patients (9 women and 8 men) were prospectively evaluated to determine the results of open scapulothoracic bursectomy in the treatment of unremitting, painful scapular crepitus (snapping scapula syndrome). The mean duration of symptoms was 2 years (range, 4 months-6 years). Twelve related an injury history, and 5 had insidious onset of symptoms. Three had previous superomedial angle resections without relief. The mean age at surgery was 35 years (19-53 years), and follow-up averaged 2.5 years (2-6 years). The surgical approach reflected the rhomboid major from the medial scapula, giving access to the scapulothoracic bursa between the serratus anterior muscle and the rib cage. Only 4 cases required primary superomedial angle bone resection and one a revision resection. Mean outcome scores significantly improved preoperatively to postoperatively: American Shoulder and Elbow Surgeons score: from 48 to 91; Simple Shoulder Test: from 6.2 to 10.1; and Visual Analog Score for Pain: from 6.1 to 1.0 (P <.05). Return to work and sports averaged 3.5 months. Open scapulothoracic bursectomy allowed evaluation and treatment of all areas of potential pathology. Symptomatic crepitus was relieved, and pain relief and functional improvement were consistently achieved.

Adult↗
PubMed1987

Scapulothoracic dissociation (closed avulsion of the scapula, subclavian artery, and brachial plexus): a newly recognized variant, a new classification, and a review of the literature and treatment options.

Scapulothoracic (ST) dissociation is a closed complete traumatic forequarter amputation manifested by a flail pulseless arm and well-defined roentgenographic findings. These roentgenographic findings were previously reported to be lateral displacement of the scapula and either acromioclavicular separation (17) or displaced clavicular fracture (20). In this paper we present four patients with ST dissociation who had a previously unreported combination of roentgenographic findings: lateral displacement of the scapula and sternoclavicular separation. Polytrauma was present in all previously reported cases of patients with ST dissociation. We present one patient, however, in whom ST dissociation is an isolated finding. A review of the literature, and a review of treatment options that includes some combination of amputation, shoulder arthrodesis, prosthetic fitting, and reconstructive tendon transfers, are presented.

Adult↗
PubMed1992

Avulsion fractures of the scapula: report of eight cases.

Fractures of the scapula from indirect trauma represent 0.01% of all skeletal fractures treated in our Institute. They are avulsion fractures that result from the violent pulling of the muscles, the ligaments, or both on their bony insertion. In our series of eight cases any possible direct trauma to the scapula was carefully excluded. In all patients treatment did not represent a particular problem and it was always conservative. Clinical results were always good, with excellent recovery of shoulder function except in one case with a circumflex nerve lesion leaving a deltoid muscle deficit.

Adult↗
PubMed2001

The prefabricated scapula flap consists of syngeneic bone, connective tissue, and a self-assembled epithelial coating.

The reconstruction of maxillary defects is a challenge in plastic surgery. The so-called prefabricated scapula flap consists of syngeneic bone covered with syngeneic dermis and is used to reconstruct maxillary defects. After placing these flaps into the oral cavity, they are reepithelialized within a short time period, raising the question of the cellular origin of the "neomucosa." We therefore obtained sequential biopsy samples of the prefabricated flap and of the flap after being placed into the oral cavity and analyzed the keratin expression profile of epithelial cells. We expected that after placing the prefabricated flap into the oral cavity, keratinocytes from adnexal structures of the dermal component of the graft would migrate onto the surface and reepithelialize the flap. Unexpectedly, reepithelialization occurred earlier. The flap had acquired a mucosa-like epithelium at the interface between the Gore-Tex coating and the dermis while still being positioned within the scapular region. The keratin expression profile of this epithelium was very similar to that of mucosal epithelium. Thus, the prefabricated scapula flap not only consisted of bone covered with connective tissue, but was also covered with epithelial cells derived from adnexal structures of the dermal graft. This seems to be the reason for the rapid restoration of an intact mucosa and the excellent outcome achieved with this surgical technique.

Adult↗
PubMed2002

Congenital high scapula.

Congenital high scapula is also known as Sprengel's deformity. The elevation of the scapula is accompanied by its rotation to a varus position. A series of 19 cases is presented, with 4 bilateral cases. A modified Woodward procedure was performed in all the surgical cases using the basic Woodward technique modified by correcting the tilting of the glena. The operative results were judged on cosmetic and functional criteria. The age of the patients and the presence of an omovertebral bone did not influence the results. Associated cervical spine anomalies were of negative prognosis. Results in this series showed only three fair or poor results; the other cases (79%) were all improved cosmetically and functionally with normal shoulder abduction following reorientation of the scapulo-humeral joint.

Abnormalities, Multiple↗
PubMed2006

Greenstick fracture of the scapula: a cause of scapular winging.

A case of an angulated, greenstick fracture of the scapula mimicking scapular winging in a skeletally immature 12-year-old boy is described. The bony deformity was visualized with plain radiography. CT was helpful in exclusion of a thoracic injury or an underlying neoplasm. Closed reduction yielded satisfactory results. Based on this 1 case only, we recommend consideration of closed reduction in children with significantly angulated greenstick fractures of the scapula without underlying thoracic pathology.

Child↗
PubMedDate not supplied

Stress fracture of the scapula in two horses.

Stress fracture of the scapula in two horses is described. Both horses had a history of acute lameness after strenuous exercise. Using elective nuclear scintigraphy focal increased radiopharmaceutical uptake in the affected scapula consistent with a fracture was identified. Standing radiography was nondiagnostic in both horses. Ultrasonographic findings in one horse were consistent with a minimally displaced incomplete fracture. Both horses were treated conservatively and returned to train and race successfully postinjury. Veterinary

Animals↗
PubMed1981

The scapula companion shadow.

Eight examples of a scapula companion shadow are reported, and the ability of these shadows to simulate disease is discussed. They are seen on erect chest radiographs and their occurrence is favored by the loss of soft-tissue thickness. They result from an unusual position of the scapula and may simulate pleural or soft-tissue lesions.

Adolescent↗
PubMed1981

Bilateral dysplasia of the neck of scapula and associated anomalies.

Nine cases of bilateral dysplasia of the neck of scapula, combined with a varying degree of hypoplasia and varus position of the humeral head as well as enlargement of the acromion are described. The relation between the clinical and radiologic findings is analysed. Bilateral dysplasia of the neck of scapula with its associated anomalies seems to be a hereditary entity, producing only slight discomfort to the patient. It might be more common than previously assumed.

Abnormalities, Multiple↗
PubMed2000

Intraosseous pneumatocyst of the scapula.

Intraosseous pneumatocyst is a gas-containing cyst-like lesion that occurs most frequently in the ilium, sacrum or vertebrae. We present a case involving the left scapula that was found incidentally on CT. To our knowledge, intraosseous pneumatocyst of the scapula has not been previously reported.

Aged↗
PubMed1983

The congenital undescended scapula. Surgical correction by the woodward procedure.

At The Hospital for Sick Children in Toronto, 21 undescended scapulae were corrected by the Woodward procedure in 20 patients over the past 18 years. The average age at operation was six years six months. The average follow-up period after operation was 8 years 9 months. Fifteen patients were girls and five were boys. All the patients had other associated abnormalities. Only one patient had a concomitant clavicular osteotomy. The average increase in glenohumeral abduction was 37 degrees. The average scapular lowering was two centimetres. Excellent or good cosmetic results were obtained in 80 per cent of patients. Ninety-three per cent of patients expressed satisfaction with the operative results. Complications were few. The Woodward procedure is a safe and relatively straightforward surgical means to effect a good cosmetic and functional improvement in a patient with a congenital undescended scapula. We do not recommend clavicular osteotomy as a routine, but it may be added to gain more correction with less risk of neurovascular compression.

Abnormalities, Multiple↗
PubMed1987

Treatment of winged scapula by pectoralis major transfer.

We report the transfer of the sternal part of the pectoralis major to the lower pole of the scapula in 15 patients with winged scapula. At follow-up after 1 to 16 years nine had a satisfactory result and were gainfully employed, though in four of these re-operation had been necessary. Two patients had fair results; the transplant functioned, but they had limited voluntary control. Four were failures: two had had paralysis of other shoulder girdle muscles in addition to the serratus anterior. The indications for the operation are discussed.

Adolescent↗