congenital high scapula
Introduction
Introduction to congenital high shoulder scapula This disease is a rare congenital malformation characterized by a higher position of the scapula, the shoulder joint of the affected side is higher than the healthy side, and the upper limb of the affected limb is limited in lifting activity, and can be combined with ribs, neck and thoracic vertebrae. Malformation, first described by Enlenber in 1863. In 1891, Sprengel reported 4 cases and discussed the cause, so this disease is also called Sprengel malformation. basic knowledge The proportion of illness: 0.002% Susceptible people: children Mode of infection: non-infectious Complications: short neck deformity
Cause
Causes of congenital high shoulder scapula
Genetic factors (40%)
This is the result of a decline in the scapula during the embryo. The sputum band is a limb bud of the cervical spine during the embryo, and gradually descends from the position of the corresponding neck 4-neck 6 to the 2-7 intercostal space from the fourth month of the embryo. For some reason, the normal decline of the scapula is blocked, resulting in a high shoulder deformity. Can occur on one side or on both sides.
Excessive amniotic fluid (30%)
For example, if the amount of amniotic fluid during pregnancy is too high, the intrauterine pressure will be too high, which will cause abnormal fetal development. If the scapula does not complete the descending process in the third month of the embryo and falls to the posterior side of the chest wall, it will form a high shoulder scapula.
Other factors (25%)
Congenital high shoulder scapula is also associated with muscle tissue defects or abnormal joints between the scapula and the vertebral body.
Various factors mainly affect the early stage of the embryo, especially the development of the cervical spine and upper limb buds and the decline of the scapula.
Prevention
Congenital high shoulder scrotalism prevention
The disease is a congenital disease, no effective preventive measures, early diagnosis and early treatment is the key to the prevention and treatment of this disease.
At the same time, it should be noted that the main treatment of high shoulder scapula requires post-operative care. The focus is to correctly guide the shoulder function exercise. The good rehabilitation training is of great significance for restoring and improving the function. Active exercise, combined with passive functional exercise and partial massage, while guiding parents to participate, familiar with training methods, steps, perseverance, can improve the efficacy and promote the early recovery of children.
Complication
Congenital high shoulder complication Complications, short neck deformity
The disease is mainly complicated by dysfunction:
Dysfunction depends on the degree of deformity, and Cavendlish is divided into four levels according to the degree of deformity.
Level 1: The deformity is not obvious, the shoulders are at the same level, and the appearance is close to normal after dressing.
Level 2: The deformity is lighter, the shoulders are close to the same level, but the deformity can be seen after dressing, and the bulging mass can be seen at the neck.
Level 3: Moderate malformation, the shoulder joint can be 2~5cm higher than the contralateral side, and the deformity is easy to see.
Grade 4: severe deformity, high shoulder, the upper inner corner of the scapula is almost opposite to the occipital bone, sometimes combined with short neck deformity, the classification of deformity has certain reference significance for treatment.
Symptom
Congenital high shoulder scapula symptoms Common symptoms Thoracic deformity Short neck spine angulation deformity
The clinical manifestations of this disease are mainly that the child can find the shoulder height increase after 1 year old. The "high" refers to the relationship between the shoulder blade and the anus. It has a short neck shape and the shoulder joint abduction function is obviously affected. Limits, the shoulders of the affected limbs are underdeveloped muscles. Older patients can have spinal and thoracic deformities. The scapula develops less, the lower corners rise, the upper and lower diameters become shorter, the transverse diameter becomes wider, and the abduction of the shoulder joints is limited. It is not unrelated to the position and developmental deformity of the scapula, such as:
1 The height of the shoulder strap exceeds the height of the chest, and the inner upper corner is even bent forward.
2 The medial edge of the scapula is close to the spinous process of the vertebral body.
3 shoulder vertebrae.
4 abnormalities of the muscles around the scapula.
Examine
Congenital high shoulder scrotum examination
The disease is mainly X-ray examination:
The X-ray showed an increase in the position of the scapula, and the upper scapula was elevated from the first thoracic vertebra to the fourth cervical vertebra. The scapula developed less, the orthotopic position was approximately square or triangular, and the inner upper corner became sharp, and the inner lower corner was adducted and reversed. When the hour hand rotates, the scapula of the affected side develops less, the lower corner increases, the upper boundary can exceed the height of the thorax, the width between the scapula and the margin of the spine (transverse diameter) increases, the lower corner turns to the ankle, and the upper upper edge turns to the spine. It has a bone bridge with the spine and other thoracic and vertebral deformities.
Diagnosis
Diagnosis and diagnosis of congenital high shoulder scapula
The disease can be diagnosed according to clinical and examination, no need to identify.
However, it is necessary to judge the level of dysfunction according to the degree of deformity. For the identification of this point, it has a direct effect on the treatment of this disease. Some scholars are divided into four levels according to the degree of deformity.
Level 1: The deformity is not obvious, the shoulders are at the same level, and the appearance is close to normal after dressing.
Level 2: The deformity is lighter, the shoulders are close to the same level, but the deformity can be seen after dressing, and the bulging mass can be seen at the neck.
Level 3: Moderate malformation, the shoulder joint can be 2~5cm higher than the contralateral side, and the deformity is easy to see.
Grade 4: severe deformity, high shoulder, the upper inner corner of the scapula is almost opposite to the occipital bone, sometimes combined with short neck deformity, the classification of deformity has certain reference significance for treatment.
