CONGENITAL ELEVATION OF THE SCAPULA This deformity was first described by MeBurney and Sands and was communicated to the German literature by Sprengel in 1891.
The scapula is displaced upward and apparently turned around a sagittal axis. The deformity, which occurs less frequently on both .sideA, is attributed to secondary causes manifesting themselves as changed functional requirements from uneven traction of the inserting muscles.
The mesial upper angle is curved upward and away from the verte bral column, protruding like an exostosis from under the shortened trapezius. The head is generally inclined toward the affected side under the influence of considerable cervical scoliosis which corresponds to a compensatory thoracic curvature of the vertebral column.
These changes in the position of the head and vertebral column, which must be regarded as of secondary origin, vary in different cases, except that nearly always the arm cannot be raised above the horizontal line, pointing to the disturbed balance of the muscles which control the shoulder girdle.
The pathogenesis of this deformity is still unknown, but in all probability inhibition of development is again responsible. The scapula, which in the embryonal period was attached to the vertebral column in an elevated position, may have been arrested in its descent and, in the course of later development, may have undergone descent and torsion, as is still recognizable from the spiral structure of the brachial plexus (Hold).
This explanation is confirmed by the fact that this deformity is frequently accompanied by other malformations the etiology of which is better recognized. A woman with an abnormal pelvis, after a labor lasting seventy-two hours, gave birth to a child with bilateral talipes and elevation of the right shoulder. (Personal ease.) Putti described a case of syphilis with congenital elevation of the shoulder-blade, in which the latter remained connected with the first thoracic vertebra by an osseous bridge as a result of syphilitic intoxication of the germinal layer.
The treatment is principally directed against the occurrence of secondary manifestations, such as torticollis and scoliosis. The blood less and mechanical treatments do not practically influence the deform ity. There is greater hope for improvement in resection of the mesial upper scapular angle and plastic elongation of the shortened muscles (resection, after Sands), X-ray pictures being able to direct the operative measures reliably.
Congenital luxation of the humerus in the shoulder-joint is an occurrence of great rarity. It is probable that these ]orations have occurred during birth, as they are often associated with injuries to the regional nerve trunks.
Treatment.—Reposition of the dislocated part should be attempted, failing which operative treatment should be resorted to, taking the most prominent symptoms into special consideration (Hoffa, Kirmisson).
Deformities of the arm bones are very rare. In most cases they belong to one of the three groups which have been described in the beginning of this section.
Congenital luxation occasionally occurs at the olecranon, consisting principally of isolated luxation of the radius anteriorly. In this deform ity, too, there is usually an osseous bridge between radius and ulna, which distinctly points io an arrest of development. The radius stands in prouation as in quadrupeds, while the later supination has failed to occur. (Quadruped position; see Scapula.) Symptomatically this deformity naturally produces disturbed func tion of the elbow, the hand being permanently in pronation and unable to assume supination, while the forearm cannot be completely flexed at the elbow-joint.
The treat ment consists in the removal of the impediments to motion. Resection of the head of the radius Will effect an improvement, unless there are also bony bridges between both forearm bones at their distal ends. An X-ray picture will furnish the necessary information on the subject.