SPRENGEL SHOULDER

INTRODUCTION:-

In this condition sacpula fails to decend down from its initial high position in the embryo.
Here the scpula lies more supriorly. It is hypoplastic and improperly shaped . It is assocoated with other    congenital deformity like cervical rib.


ANATOMY:-

Some vital structures are at risk during the extensive dissection that is required as part of the relocation procedure. These structures include the following

Dorsal scapular nerve
Spinal accessory nerve
Suprascapular nerve

The dorsal scapular nerve courses close to the superomedial border of the scapula in the plane between the rhomboid and the erector spinae. The dorsal scapular nerve remains anterior to the serratus anterior and the subscapular muscles.
There exists a risk of injuring the dorsal scapular nerve during dissection of the periscapular muscles at the superomedial angle of the scapula, and when the trapezius and rhomboid muscles are reflected off as a single unit from the spine in the Woodward procedure (see Treatment). Therefore, staying subperiosteal during the process of freeing the periscapular muscles is essential, especially at the superomedial angle of the scapula.
The spinal accessory nerve is located between the trapezius and rhomboid muscles and therefore is theoreticallyat  risk; however, because this nerve is sandwiched between the two muscles, it is rarely ever injured when these muscles operate as a unit.
The suprascapular nerve runs in the suprascapular notch of the scapula and may be injured if the dissection is carried too far laterally when the superior portion of the scapula is resected. By staying at least 1 cm medial to the notch, injury to the nerve during the procedure can be avoided.

ETIOLOGY:-
This is may be due to imperfect descent of the shoulder girdle by third month or a band of muscle from the skull to the scapula which fails to grow.

CLINICAL FEATURE:-
The scpula high 2 to 10 cm, ther is no functional impairment, all the shoulder girdle movement  are normal, torticolis may be present, crania bifida and spina bifida may be present.

EXAMINATION:-
Radiograph :
Plain x-ray show the level and extended of disability.
TREATMENT:-
Mild deformity– no treatment required.
For severe case surgery done after 3 year and this consist of releas of the muscle from the scapula or trsfer of the origin of the trapezius muscle.

PHYSIOTHERAPY TREATMENT:-
For pain relief – ultrasound and TENS are helpful.
Mobilization – Gental relex passive movement of the shoulder girdle.
Strengthning – muscle of shoulder girdle by isometric and isotonic exercise like shoulder shruge,shoulder rotation,push up,arm support,forearm support,bridging.

Be the first to comment

Leave a comment

Your email address will not be published.


*