Surgical Treatment of Sprengel's Deformity in Adolescents and Adults.

Abstract

Background: Most patients with congenital shoulder girdle abnormalities receive treatment in childhood, with limited treatment reports in older populations. The aim of this study was to describe the surgical treatment and outcomes for adolescents and adults with Sprengel's deformity (SD).

Methods: A retrospective review was conducted on patients treated for SD, a congenital shoulder girdle abnormality, by a single surgeon between 2011 and 2018. Patient demographics, surgical findings, procedures, complications, active range of motion, visual analog scale (VAS) pain scores, Single Assessment Numeric Evaluation (SANE), and 5-point Likert scale satisfaction were recorded. Univariate statistics were used to compare preoperative and postoperative outcomes.

Results: Fourteen patients with an average age of 23.9 ± 10.1 years and a mean follow-up of 5.4 years (range 1-9 years) were included for analysis. All patients had unilateral pathology. Mean VAS pain scores improved from 6.3 ± 2.6 to 1.2 ± 0.9 (p < 0.001). The SANE score improved from 36.8% ± 9.6% to 77.5% ± 6% (p < 0.001). Average postoperative satisfaction was 4.8 ± 0.4. Forward elevation improved from 97° ± 18.1° to 137° ± 14° (p < 0.001), while abduction, external rotation, and internal rotation remained similar. Surgical treatments included reattachment of the lower trapezius to its anatomical insertion (N = 13), latissimus dorsi transfer to the medial scapular spine (N = 13), medial scapular border resection (N = 12), split pectoralis major transfer (N = 12), rhomboid and/or levator scapulae advancement (N = 12), anlage excision (N = 6), excision of a coracoclavicular ligament bony bridge (N = 1), and upper serratus advancement to the superomedial scapular border (N = 1). Only 1 patient underwent scapulothoracic fusion.

Conclusion: In children, treatment of SD focuses on scapular distalization due to greater soft-tissue plasticity, while in older individuals, this was unfeasible due to stiffer soft-tissue and multiple periscapular muscular deficiencies. This series demonstrates treatment strategies in older patients, involving osseous resections and tendon transfers, resulting in significant improvements over a mean 5.4-year follow-up. Given the rarity of SD in older populations, multicenter studies are warranted to further validate this approach.

Level of evidence: Case Series; Level IV. See Instructions for Authors for a complete description of levels of evidence.