Sprengel Deformity Workup

Updated: Oct 01, 2018
  • Author: Mihir M Thacker, MBBS, MS(Orth), DNB(Orth), FCPS(Orth), D'Ortho; Chief Editor: Harris Gellman, MD  more...
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Workup

Imaging Studies

Radiography

The Sprengel deformity is best visualized on an anteroposterior (AP) view of the chest and both shoulders (see the image below). A lateral view of the cervical and thoracic spine must also be obtained to rule out associated spinal anomalies.

Posteroanterior chest radiograph. This image depic Posteroanterior chest radiograph. This image depicts bilateral Sprengel deformities.

The scapular displacement can be measured by using the method described by Leibovic et al (see the image below). [33] On an AP radiograph of the chest, three lines are drawn as follows:

  • 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
Photo illustrating the Leibovic method for determi 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.

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.

CT and MRI

Computed tomography (CT) with three-dimensional (3D) reconstruction may be performed to visualize the pathoanatomy of the affected region and to visualize the omovertebral bar. [34] CT may also help in planning surgery (eg, if the 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). [17]

Magnetic resonance imaging is currently employed in this setting as well. [35]

Appropriate imaging studies should also be performed for any associated anomalies. [36]