Fig. 164.—Congenital elevation of Left Scapula in a girl: also shows hairy mole over Sacrum.
(Mr. D. M. Greig's case.)
When the deformity is bilateral, which is rare, the neck is short and thick, the chin lies close to the sternum, and the arms can scarcely be raised to the horizontal.
Gymnastic exercises and the wearing of a brace to hold the shoulders back and down may be followed by some improvement, but, as a rule, it is necessary to mobilise the scapula by operation. An X-ray photograph should first be taken, because, when the scapula is connected with the spine by a bridge of bone, this must be resected. The muscles attached to the vertebral border and spine of the scapula are divided, the bone is drawn down to its proper position, and the parts are fixed by plaster bandages.
Winged Scapula.—This condition consists in a marked displacement backwards of the lower angle and vertebral border of the scapula, when the patient attempts to raise the arm from the side ([Fig. 165]). Under normal conditions, in making this movement the serratus and rhomboid muscles pull forward the vertebral border and inferior angle of the scapula, and so fix the bone firmly against the chest wall. When these muscles are paralysed, as a result of anterior poliomyelitis, neuritis, or injury of the long thoracic nerve of Bell, or of the fifth and sixth cervical nerve-roots through which they receive their supply, the patient is unable to abduct the arm, and the deltoid having lost its point d'appui, its contraction merely results in tilting the angle of the scapula backward ([Fig. 165]).
Fig. 165.—Winged Scapula; the patient is holding the arms out in front.
Treatment.—In the majority of recent cases the condition yields to the administration of strychnin and other muscle and nerve tonics, and the use of massage and the faradic current. The application of a carefully adjusted padded belt is sometimes useful. The method of treatment by stitching the latissimus dorsi over the lower angle of the scapula is based on the erroneous assumption that the displacement is due to the slipping of that muscle off the bone; at the same time, it must be admitted that the operation sometimes diminishes the deformity and adds to the patient's comfort.
A more efficient method consists in detaching the clavicular portion of the pectoralis major from its insertion, and stitching it to the serratus anterior so as to make it take on the function of this muscle, or stitching it to the axillary border of the scapula. Success has also followed suture of the vertebral border of the scapula to the subjacent ribs (Eiselsberg).