Orthopedics - Oleksa A.P. 2006

Chest Deformities
Snapping Scapula

Sprengel's deformity (snapping scapula) was first described by Voelcker (1869), while in 1930 Astrakhansky V.A. published a description of 12 cases, followed by Novachenko M.P. with 9 cases in 1968. Over 47 years of surgical practice, we have treated more than 10 patients who sought medical attention complaining of a clicking or crunching sound during shoulder or scapular movements.

We must agree with the opinion of certain authors (Astrakhansky V.A., Novachenko M.P.) who believe that this crepitus is merely one of the clinical symptoms associated with various Disorders of the shoulder girdle and does not constitute a distinct nosological entity.

V. Astrakhansky suggests referring to this condition as "crepitant antiscapular bursitis".

Küttner quite reasonably points out that the sensation of crepitus may be caused by a "mucous bursa hygroma" (bursitis), exostoses of the scapula or underlying rib, or periostitis thereof. We observed osteochondroma of the scapula in two patients and an exostosis of the fifth rib in another, which was clearly visible on oblique tangential radiographs of the scapula. The crunching sound varies in intensity and can sometimes be heard at a distance when the patient moves their arm and scapula, or when the palm is placed over the scapular region during movement. The character of the sound also varies: from distinct clicking during scapular motion and Muscle tension, to a snapping sensation, and even resembling the sound of "a horse chewing oats," as described by Galvani.

Palpation can also help determine that the sound originates in the area of the inferior angle of the scapula or slightly above it.

Upper limb function remains normal, and patients experience no pain in the scapular region, although M.P. Novachenko notes that arm function may be impaired, sometimes accompanied by tremor during movement.

Antiscapular bursitis is difficult to detect when it is not visible on standard radiographs. In such cases, Astrakhansky identifies an "acoustic Resonance phenomenon" — a decrease in pitch and muffling of the scapular crepitus during deep inspiration. Novachenko considers this phenomenon, described by Astrakhansky, to be decisive in diagnosing antiscapular bursitis.

Treatment. We disagree with M.P. Novachenko's assertion (1968) that the treatment for snapping scapula is exclusively surgical. We have achieved good outcomes in several patients following conservative treatment for two to three weeks. Mandatory measures include plaster immobilization of the upper limb and scapula, as well as thermal therapy applied to the scapular region (UHF therapy, ozocerite-paraffin Applications, mud therapy).

Surgery is strictly indicated when an exostosis or osteoma is detected on the scapula or the underlying rib. Surgical management involves a vertical linear incision of the Tissues near the vertebral border of the body and the inferior angle of the scapula. Dissection of the Muscles provides access to the subscapular region. If an osteoma or exostosis is found on the scapula—most commonly at its inferior angle—the affected area is resected within healthy bone margins. Since subperiosteal rib resection is technically challenging in such cases, we limited the Procedure to the resection of the exostosis. We were dissatisfied with the surgical results in two patients with prescapular bursitis because no actual bursa was found, yet the crepitus disappeared postoperatively.

Scalenus Anticus Syndrome

Scalenus anticus syndrome was first described in 1927 by Adson and Coffey. Patients seek medical help due to supraclavicular pain that intensifies with HEAD movements. Upon examination, the patient holds the head in a forced, stiff posture, while palpation reveals tension in the scalene muscles, localized tenderness, and protective contraction of m. sternocleidomastoideus.

Vascular and neurological disorders may subsequently develop.

Scalenus anticus syndrome can be caused by the presence of congenital Cervical Ribs, though this is not a mandatory finding.

The onset of the syndrome in the presence of cervical ribs is attributed to their progressive ossification, as it typically manifests in individuals over the age of 18 (Bieziņš A.P., 1968). The syndrome may also result from muscle spasm, decreased elasticity of Blood Vessels and nerves as the body matures, or the Cytology/cytology/16.html">Early stages of cervical spondylosis. In such cases, scalenus anticus syndrome is effectively managed with conservative treatments (massage, thermal therapy, analgesics, antispasmodics, etc.). However, the syndrome associated with cervical ribs does not respond to conservative therapy; therefore, in cases of recurrent or persistent pain, surgical intervention—removal of the cervical rib—becomes necessary.