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- Scapula differentiates between C4 & C6 at 5 weeks
- Between 9-12 weeks descends to between the 2nd & 7th rib
Clinical
- Fullness in posterior clavicular area
- Limited abduction
- Abnormal shape to scapula
- Asymmetry of scapular height on x ray
- Prescence of omovertebral bone
Associated Annomalies
- Rotation of the scapula leaves the glenoid facing down & thus ↓ abduction
- 25% have omovertebral bone
- scoliosis in about 30-40%
- diatomatomyelia, rib anomalies, abnormal muscles, torticolis
- Klippel Feil – 24%
Presentation
- Missing abduction
- May be confused with Erb’s palsy due to limited abduction
General Priniples of Treatment
- Inferior translation of the scapula
- Resection of the superior supraspinous portion
- Release of the omovertebral bone
Operation
- Woodward procedure
- Longitudinal posterior incision from C1 to T9
- Elevate the latisimus off of the spinous process
- Elevate the rhomboid off the spinous process
- Elevating this sling of muscle lateral will unroof any omohyoid bone
- Excise omohyoid bone extra periosteal
- Now resect the superior portion of the scapula which serves to release the levator scapulae
- Draw the scapula down to its new level & then sew the trapezius back in place
- Post op if there is any concern re brachia plexus – morselize the clavicle
