Sprengel Shoulder



Congenital elevation of shoulder




AD & Sporadic 


Tends to be in girls & on left

- like CDH


Associated with other congenital abnormalities




Failure of descent of arm bud

- arm bud appears in week 3 (level of C5 to T1)

- scapula develops in arm bud in week 5 (Opposite C5)

- descends over next 3/12


Usually by 3rd fetal month to level of T2 to T7


Clinical Features


Scapula small 

- scapula elevated

- superior angle rotated upwards & forwards

- shoulder musculature deficient


Limited shoulder abduction

- scapula joined to cervical spine by fibrous or bony bar

- Omovertebral bar


Usually presents as Neonate, but if mild presents later 


Associated Abnormalities




Klippel-Feil Syndrome (usually bilateral)

Cervical ribs

Fused or absent Thoracic ribs

Thoracic Vertebral anomalies

Hypoplastic Humerus or Clavicle




Small high scapula


Omovertebral bone

- can see bone linking scapula and hyoid


Bilateral abduction xray reveals lack of ST motion


Operative Management





Attempt to improve abduction range




Hypertrophic scar due to high strain on scar

Brachial Plexus Injury




1.  Scapula Resection


Simplest procedures

- only cosmetic

- excision of prominent angle (excise scapula above spine)

- excision of Omovertebral bar


2.  Woodward Procedure



- principle concern is brachial plexus palsy

- best outcome in children 3 - 8




A.  Midline incision

- clavicular osteotomy to protect brachial plexus

- excise omovertebral bar


B.  Mobilise scapula caudally


C.  Detach Trapezius & Rhomboids from spinous process insertion

- reattach to supraspinous ligaments more inferiorly

- dynamic force inferiorly on scapula


3.  Green Procedure


Osteotomy clavicle first

- avoiding plexus injury


Scapula release

- released from medial border of scapula

- reattach after scapula reduced