ASSESSMENT OF THE SPRENGEL DEFORMITY USING 3D CT SCANNING AND ITS IMPLICATIONS FOR SURGICAL PLANNING

Abstract

Introduction and Aims: There is a variety of different procedures advocated to address the problems of cosmesis and limited abduction in Sprengel’s shoulders which are based on an understanding of the morphology of the deformity from two-dimensional images. We have reviewed the morphology of the scapulae using 3D CT to determine whether there are sub-groups in which different treatments would be more appropriate.

Method: We assessed 14 consecutive patients (age two to 21 years) between 1996–2002, using a spiral CT scanner with 1.5mm and 3mm slices. These were then reconstructed to give 3D images. These images were then rotated and measured to determine the dimensions, elevation, rotation and shape of the scapula, compared to the normal side. We also looked for the presence of an omovertebral connection and superior hook, and at the range of movement of the shoulder and incidence of associated anomalies.

Results: There was marked variation in the elevation of the scapulae. Three of the 14 had a very abnormal, small, high scapula with multiple associated anomalies. We called these dysplastic. The other 11 scapulae were longer (105%, range 64–132%) and narrower (85%, range 50–133%). They were rotated so the glenoid faced caudally. One out of 11 had a superior hook. The location of the tether could be determined by the shape of the medial border. There is a sub-group of Sprengel’s with a dysplastic scapula and multiple associated abnormalities. These may represent a difference in aetiology. Within the non-dysplastic group there was a wide variation in the size, elevation, orientation and length of the supra spinous portion of the scapulae.

Conclusion: We believe that there are different subgroups of Sprengel shoulder in whom different procedures are indicated and that CT scanning with 3D reconstruction is essential to adequately plan the procedure.