Static winging of the scapula caused by osteochondroma in adults: a case series

Journal of Medical Case Reports

Henning Madry¹  Dieter Kohn¹  Ekkehard Fritsch¹  Konstantinos Anagnostakos¹  Patrick Orth¹ 

[1] Department of Orthopaedic Surgery, Saarland University Medical Center, Kirrberger Strasse, Building 37-38, Homburg/Saar D-66421, Germany

关键词: Scapular winging;    Scapula alata;    Osteochondroma;   

Others  :  1195315
DOI  :  10.1186/1752-1947-6-363

 received in 2012-07-06, accepted in 2012-09-28,  发布年份 2012

【 摘 要 】

Introduction

Although palsy of the long thoracic nerve is the classical pathogenesis of winging scapula, it may also be caused by osteochondroma. This rare etiopathology has previously been described in pediatric patients, but it is seldom observed in adults.

Case presentation

We describe three cases of static scapular winging with pain on movement.

Case 1 is a Caucasian woman aged 35 years with a wing-like prominence of the medial margin of her right scapula due to an osteochondroma originating from the ventral omoplate. Histopathological evaluation after surgical resection confirmed the diagnosis. The postoperative course was unremarkable without signs of recurrence on examination at 2 years.

Case 2 is a Caucasian woman aged 39 years with painful scapula alata and neuralgic pain projected along the left ribcage caused by an osteochondroma of the left scapula with contact to the 2nd and 3rd rib. Following surgical resection, the neuropathic pain continued, demanding neurolysis of the 3rd and 4th intercostal nerve after 8 months. The patient was free of symptoms 2 years after neurolysis.

Case 3 is a Caucasian woman aged 48 years with scapular winging due to a large exostosis of the left ventral scapular surface with a broad cartilaginous cap and a large pseudobursa. Following exclusion of malignancy by an incisional biopsy, exostosis and pseudobursa were resected. The patient had an unremarkable postoperative course without signs of recurrence 1 year postoperatively.

Based on these cases, we developed an algorithm for the diagnostic evaluation and therapeutic management of scapula alata due to osteochondroma.

Conclusions

Orthopedic surgeons should be aware of this uncommon condition in the differential diagnosis of winged scapula not only in children, but also in adult patients.

【 授权许可】

   
2012 Orth et al.; licensee BioMed Central Ltd.

【 图 表 】

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【 参考文献 】

• [1]Velpeau A: Traité d′anatomie chirurgicale, ou anatomie des regions, considérée dans ses rapports avec la chirurgie. 1st edition. Paris: Crevot; 1825:303.
• [2]Overpeck DO, Ghormley RK: Paralysis of the serratus magnus muscle caused by lesions of the long thoracic nerve. JAMA 1940, 114:1994-1996.
• [3]Cooley LH, Torg JS: Pseudowinging of the scapula secondary to scapular osteochondroma. Clin Orthop 1982, 162:119-124.
• [4]Fiddian NJ, King RJ: The winged scapula. Clin Orthop 1984, 185:228-236.
• [5]Murphey MD, Choi JJ, Kransdorf MJ, Flemming DJ, Gannon FH: Imaging of osteochondroma: variants and complications with radiologic-pathologic correlation. Radiographics 2000, 20:1407-1434.
• [6]Danielsson LG, El-Haddad I: Winged scapula due to osteochondroma. Report of 3 children. Acta Orthop Scand 1989, 60:728-729.
• [7]Fageir MM, Edwards MR, Addison AK: The surgical management of osteochondroma on the ventral surface of the scapula. J Pediatr Orthop B 2009, 18:304-307.
• [8]Kwon OS, Kelly JI: Delayed presentation of osteochondroma on the ventral surface of the scapula. Int J Shoulder Surg 2012, 6:61-63.
• [9]Campanacci M, Bacchini P, Bertoni F: Bone and Soft Tissue Tumors: Clinical Features, Imaging, Pathology and Treatment. 2nd edition. Wien: Springer; 1999.
• [10]Samilson RL, Morris JM, Thompson RW: Tumors of the scapula: a review of the literature and an analysis of 31 cases. Clin Orthop 1968, 58:105-115.
• [11]Ermiş MN, Aykut US, Durakbaşa MO, Ozel MS, Bozkuş FS, Karakaş ES: Snapping scapula syndrome caused by subscapular osteochondroma. Eklem Hastalik Cerrahisi 2012, 23:40-43.
• [12]Ameri E, Behtash H, Omidi-Kashani F: Isolated long thoracic nerve paralysis – a rare complication of anterior spinal surgery: a case report. J Med Case Rep 2009, 3:7366-7369.
• [13]Garrison RC, Unni KK, McLeod RA, Pritchard DJ, Dahlin DC: Chondrosarcoma arising in osteochondroma. Cancer 1982, 49:1890-1897.
• [14]Jeon IH, Neumann L, Wallace WA: Scapulothoracic fusion for painful winging of the scapula in nondystrophic patients. J Shoulder Elbow Surg 2005, 14:400-406.
• [15]Iceton J, Harris WR: Treatment of winged scapula by pectoralis major transfer. J Bone Joint Surg Br 1987, 69:108-110.