Sprengel Deformity Workup

  • Author: Mihir M Thacker, MBBS, MS(Orth), DNB(Orth), FCPS(Orth), D'Ortho; Chief Editor: Harris Gellman, MD   more...
 
Updated: Feb 17, 2012
 

Imaging Studies

  • Radiographs
    • The Sprengel deformity is best visualized on an anteroposterior (AP) view of the chest and both shoulders.
    • A lateral view of the cervical and thoracic spine must also be obtained to rule out associated spinal anomalies.
    • The scapular displacement can be measured by the method described by Leibovic et al, depicted in the image below.[31] On an AP radiograph of the chest, draw the following lines: Photo illustrating the Leibovic method for determiPhoto illustrating the Leibovic method for determining scapular rotation and position. ISA = inferior scapular angle; Line 1 = line drawn from the midpoint of the acromioclavicular joint to the midpoint of the sternoclavicular joint; Line 2 = line drawn from the midpoint of the acromioclavicular joint to the ISA; Line 3 = vertical line drawn along the spinous processes of the vertebrae; SSA = superior scapular angle.
      • Line 1 – From the midpoint of the acromioclavicular joint to the midpoint of the sternoclavicular joint
      • Line 2 – From the midpoint of the acromioclavicular joint to the inferior angle of the scapula
      • Line 3 – A vertical line along the spinous processes of the vertebrae
    • The superior scapular angle (SSA) is the angle between lines 1 and 2. The inferior scapular angle (ISA) is the angle between lines 2 and 3. These angles give the clinician an idea about the scapular rotation. As the scapula is derotated back toward normal, the SSA increases and the ISA decreases. The caudad displacement of the scapula is measured by a line drawn from the center of the acromioclavicular joint perpendicular to line 3. The vertebral body at which this intersects provides an idea regarding the level of the scapula. Because this result is not a numeric value, it is not affected by growth. However, the SSA, ISA, and the level of the scapula are measured preoperatively and compared with the postoperative follow-up values.
  • Computed tomography (CT) scan
    • CT scans with 3-dimensional (3-D) reconstruction may be performed to visualize the pathoanatomy of the affected region and to visualize the omovertebral bar.
    • CT scans may also help in planning surgery (eg, if the CT scan shows that the height-to-width ratio is markedly decreased, then the prominent convexity of the vertebral border along with the supraspinous portion of the scapula should be resected).[19]
  • Appropriate imaging studies should also be performed for any associated anomalies.[32]
Proceed to Treatment & Management
 
 
Contributor Information and Disclosures
Author

Mihir M Thacker, MBBS, MS(Orth), DNB(Orth), FCPS(Orth), D'Ortho  Assistant Professor of Orthopedic Surgery and Pediatrics, Thomas Jefferson University; Consulting Staff, Department of Pediatric Orthopedic Surgery, Alfred I duPont Hospital for Children; Orthopedic Oncologist, Helen F Graham Cancer Center and Christiana Care Health Services

Mihir M Thacker, MBBS, MS(Orth), DNB(Orth), FCPS(Orth), D'Ortho is a member of the following medical societies: Children's Oncology Group, Limb Lengthening and Reconstruction Society ASAMI-North America, Medical Council of India, Musculoskeletal Tumor Society, and Pediatric Orthopaedic Society of North America

Disclosure: Nothing to disclose.

Coauthor(s)

David S Feldman, MD  Chief, Pediatric Orthopedic Surgery, Associate Professor of Orthopedic Surgery, Director, Center for Children, Hospital for Joint Diseases, New York University Medical Center

David S Feldman, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Medical Association, American Orthopaedic Association, Pediatric Orthopaedic Society of North America, and Scoliosis Research Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Michael S Clarke, MD  Clinical Associate Professor, Department of Orthopedic Surgery, University of Missouri-Columbia School of Medicine

Michael S Clarke, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Academy of Pediatrics, American Association for Hand Surgery, American College of Surgeons, American Medical Association, Arthroscopy Association of North America, Clinical Orthopaedic Society, Mid-Central States Orthopaedic Society, and Missouri State Medical Association

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Robert J Nowinski, DO  Clinical Assistant Professor of Orthopaedic Surgery, Ohio State University College of Medicine and Public Health, Ohio University College of Osteopathic Medicine; Private Practice, Orthopedic and Neurological Consultants, Inc, Columbus, Ohio

Robert J Nowinski, DO is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American College of Osteopathic Surgeons, American Medical Association, American Osteopathic Association, Ohio Osteopathic Association, and Ohio State Medical Association

Disclosure: Tornier Grant/research funds Other; Tornier Honoraria Speaking and teaching

Dinesh Patel, MD, FACS  Associate Clinical Professor of Orthopedic Surgery, Harvard Medical School; Chief of Arthroscopic Surgery, Department of Orthopedic Surgery, Massachusetts General Hospital

Dinesh Patel, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons

Disclosure: Nothing to disclose.

Chief Editor

Harris Gellman, MD  Consulting Surgeon, Broward Hand Center; Voluntary Clinical Professor of Orthopedic Surgery and Plastic Surgery, Departments of Orthopedic Surgery and Surgery, University of Miami, Leonard M Miller School of Medicine

Harris Gellman, MD is a member of the following medical societies: American Academy of Medical Acupuncture, American Academy of Orthopaedic Surgeons, American Orthopaedic Association, American Society for Surgery of the Hand, and Arkansas Medical Society

Disclosure: Nothing to disclose.

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Clinical photograph of a child with Sprengel deformity and Klippel-Feil syndrome.
Posteroanterior chest radiograph. This image depicts bilateral Sprengel deformities.
Photo illustrating the Leibovic method for determining scapular rotation and position. ISA = inferior scapular angle; Line 1 = line drawn from the midpoint of the acromioclavicular joint to the midpoint of the sternoclavicular joint; Line 2 = line drawn from the midpoint of the acromioclavicular joint to the ISA; Line 3 = vertical line drawn along the spinous processes of the vertebrae; SSA = superior scapular angle.
 
 
 
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