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BILATERAL UNDESCENDED SCAPULA WITH OMOVERTEBRAL

BONE
PARKER C. CARSON
J Bone Joint Surg Am. 1938;20:477-480.

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 BILATERAL UNDESCENDED SCAPULA WITH
OMOVERTEBRAL BONE

BY PARKER C. CARSON, M.D., SPRINGFIELD, MASSACHUSETTS

From- the Shriners’ Hospitalfor Crippled Children, Springfield

Congenital elevation of the scapula with omovertebral bones is an

uncommoim congenital anomaly. In 1908 Horwitz reviewed the literature
and found twenty-seven cases. Shore surgically removed! a unilateral
omovertebral bone, and Jackson reported a similar case, describing the
condition as being costal in origin and attached to the scapula by cartilage.
Jackson’s contention that the term “congenital elevation of the scapula”
is a mismmomer appears quite sound, since, as he points out, emhryologic#{225}lly
the condition represents failure of the bone to descend. Bilateral occur-
rence of the condition appears to be exceedingly rare, and the following
case is present-ed for this reason.

CASE REPORT

A twelve-year-old girl was admitted to the Shriners’ Hospital for treatment of a bi-
lateral deformity of the shoulders, a left club foot, and bilateral hallux valgus; all of
these conditions had been present since birth. Time past history and family history were
not significant.

Physical Examination
Time general examination showed
a well-nourished adolescent girl in good imealth.
Orthopaedic examination revealed a short, thick neck with no limitation of movements.
(See Figure 1.) The right scapula was imigh with a very prominent acromion process
anteriorly. Time superior border was at about the level of the fifth cervical vertebra, and
the inferior angle was at the level of the fifth rib. Time scapula was slightly movable.
It measured five and one-half inches from the superior border to the imuferior angle and
sevemm inches from the acromion process to time medial angle. No defimiite omovertebral
bone was palpated. The right clavicle was markedly angulated anteriorly iiu its distal
third. Time left scapula was immobile and firmly attached at about the seventh
cervical vertebra. A definite process was palpated from the medial angle to the spinous
process. The superior border was somewhat lower timan the right with a less prominent
acromion process. The scapula measured five incimes from the superior border to the
inferior angle. A definite medial angle was not palpated. The inferior angle was at the
fourth rib. A definite scoliosis to time right, centering at the tenth thoracic vertebra,
with moderate rotation was present. Time lumbosacral articulation was rigid. The
superior extremities were normal with the exception of limitation of abduction and cir-
cunmduction at the shoulder joints above the level of the joints. The inferior extremities
were normal except for an equinovarus of the left foot with a marked eavims. The left
ankle joint was rigid in equinus at 1 10 degrees. Bilateral hallux valgus present.
Neurological examimmation was essentially normal.

P’reoperative Roentgenographic Examination

An anteroposterior roentgenogram of both shoulders (Fig. 2), includimug the lower
cervical spine, showed long transverse processes of the sixth cervical vertebra with spina
bifida of the fifth, sixth, and seventh cervical vertebrae. These processes articulated

VOL. XX. NO. 2. APRIL 1938 477

478 P. C. CARSON

with the medial margins of both scapulae; this was most marked on the left, where the
articulation closely resembled a sacro-iliac joint.
An obiique roentgenogram of the shoulders and scapula failed to show on time right
any articulation between the transverse process of time scapula; on time left, however, there
was a definite articulation, slightly wider than a sacro-iliac articulation, but otherwise
________________________ very similar to it.
An anteroposterior
roentgenogram of the timo-

racic spine revealed 5COli-

Osis of the mid-thoracic
spine four centimeters to
the right.
An anteroposterior
roentgenogram of time lum-
bar spine and pelvis dis-
closed sacralization of time
transverse process of time
fifth lumbar vertebra on
time right.
Amuteroposterior and
lateral roentgenograms
simowed rather marked hal-
lux valgus of both feet, pes
cavus of the left foot, and
pes planus of time right foot,
but the bones of the right
foot appeared normal.

Operation
11 tI:.373.ll Ill
An operation for re-
section of the armomalous
FIG. 1 bony process between the
Patient before operation. scapula and the sixth
cervical vertebra was done.
A transverse incision was made beginning at the spine of time left scapula; this was carried
to thme spinous process of the seventim cervical vertebra and over and across to the spine of
the rigimt scapula. The base of the spine of the scapula and the adjacent body of time bone
were exposed by subperiosteal dissection, disclosing imnmediately the anomalous process;
this was attached to the medial angle thmroughout its length by a cartilaginous plate wimich
showed no evidence of joint formation. The process measured approxinmately two aiud
one-half inches at its attachment to the scapula; it tapered dowlm to about timree-fourtims
of an mcii in size and was attached to, or a part of, time transverse process of time sixth
cervical vertebra. The scapular end of the bone was freed by cutting through time
cartilaginous layer ; then suhperiosteal dissection was carried down to time vertebral
origin of this process, where it was removed near the vertebra with a Gigli saw. Small
remaining fragments were trimmed with bone cutters. When the bone was renmoved, time
scapula showed relatively normal mobility. The dissection was then shifted to the right
side where a similar procedure was carried out. The anomalous process on this side,
approximately three inches in length, showed a pseudarthrosis with the scapula, the tip
having a cartilaginous plate without a definite joint fornuation. The process on this side
more nearly resembled a rib and, at its vertebral end, there was a constriction similar to
the neck of the rib and an irregular faceted articular end. The direct attachment of timis
end to the vertebra was not examined, since the direct exposure would require a consider-
able amount of dissecting which appeared to he unnecessary. The bone was removed
subperiosteally. The scapula on this side, however, did not show the marked increased

THE JOURNAL OF BONE AND JOINT SURGERY

 BILATERAL UNDESCENDED SCAPULA 479

FIG. 2
Preoperative roemmtgemmogranm, slmowimmg long transverse processes of time sixthm cervi-
cal vertebra withi spina i)ifida of time fifthm, sixthm, and sevemmthm cervical vertebrae.
Time pm’ocesses articulate withi time medial margins of both scapulae.

FIG. 3
Postoperative roelmtgemmogmamn, shmowimmg cormiplete renmoval of time i)Omie wimicim
articulated with time scapulae ammd a shigimt scoliosis of time cervical spine to the left.

\‘OI.. XX. NO. 2, APRIL 1938

480 i. C. CARSON

mobility that was found on the left, and posterior displacement of the scapulae was
probably inhibited by the clavicles.

Postoperative Roentgenographic Examination

A postoperative roentgenogram of both shoulders and cervical spine (Fig. 3) re-

vealed complete removal of the bone which articulated with the scapulae. The cervical
spine showed a slight scoliosis to the left.

End Result
The postoperative course was uneventful. Both scapulae are freely movable. The
left is well displaced backward with the inferior angle at the fifth rib. The position of the
right is unchanged. Functionally, the patient can raise both arms well above the level
of the shoulder joints, with better results on the left.

REFERENCES

HORWITZ, A. E. : Congenital Elevation of the Scapula. Sprengel’s Deformity. Am. J.

Orthop. Surg., VI, 260, 1908.
JACKSON, B. H. : Undescended Scapula with an Omovertebral Bone. Radiology, XIX,
67, 1932.
SHonam, B. R. : Congenital Elevation of the Scapula. Surg. Olin. North America, XI,
667, 1931.

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