Congenitally high scapula
Introduction
Introduction to congenital high shoulder A high shoulder is a high position of the scapula, which is often poorly developed and abnormally shaped. The disease was first reported by Eulenberg, and later Sprengel gave a detailed introduction, so it is also called Sprengel malformation. Congenital high shoulder is less common, the incidence is mostly unilateral, more common on the left side, bilateral is very rare, high shoulder sputum often accompanied by other congenital anomalies, such as neck ribs, poor rib formation and cervical spine abnormalities. basic knowledge The proportion of illness: 0.004% Susceptible people: young children Mode of infection: non-infectious Complications: congenital muscular torticollis
Cause
Congenital high shoulder scapular cause
(1) Causes of the disease
1. Embryonic developmental disorder, the period of embryonic limb buds appears in the third week of pregnancy, and the scapula primordia can be seen at the 5th week, which is equivalent to the neck 3-7 to the chest 1-2 level. This stage is the spine development. The critical period is also the period when the scapula begins to develop. At the 6th week of the embryo, the original scapula begins to form. By the 9th week, the scapula begins to move down. By the 2nd month, the decline is completed. It is located in the 2nd to 7th thoracic spinous processes. Level, for some reason, the scapula can not be lowered to the normal position, it can cause high scapula, often accompanied by deformity of the cervical vertebrae and surrounding clavicle, ribs and other structures.
2. The factors that cause developmental disorders, and what causes the scapula to not fall to the normal position, are still unclear. There may be many reasons for this, and Horwitz considers it to be a variant of embryonic development:
1 too much or too little amniotic fluid, so that the pressure in the uterus is increased, which affects the decline of the scapula.
2 There is an abnormal connection between the scapula and the spinous process of the spine, mostly fiber band or cartilage connection.
3 muscle lack, not enough to pull down the shoulder blade.
4 The development of the scapula is stopped, and the size and shape of the scapula are abnormal, causing muscle tension disorder.
Engel believes that the fourth ventricle fluid overflow during embryonic development is not absorbed and forms a pressure and inflammatory reaction in the limb bud, which makes it difficult to lower the scapula.
(two) pathogenesis
Pathological changes include bone and muscle, the position of the scapula is high, the volume is small, and the shape of the scapula of the fetal scapula or early vertebrates is maintained, that is, the longitudinal diameter is small, the transverse diameter is large, the upper ganglia is inclined forward, the upper scapula is inside and inside. The margin is widened. Between the shoulder blade and the spine, there is often extra bone, called the scapular vertebral body bone. This is a diamond-shaped bone plate or cartilage plate, called the "bone bridge". It starts from the upper corner of the shoulder blade and reaches the spine. On the lamina, one or several cervical vertebrae, sometimes the vertebral body and the scapula or vertebral body are only connected by fibers, forming a good "joint". Because the connection is tight, the scapula is bound and cannot be rotated. The move is limited.
The scapular muscles are often missing, or poorly developed, or partially fibrotic. In addition, they are often accompanied by other congenital malformations, such as rib deficiency or fusion, cervical ribs, cervical spine abnormalities (Klippel-Feil) syndrome, and hemivertebra. , spina bifida, clavicle dysplasia and so on.
Prevention
Congenital high shoulder protection
1. Take early and regular prenatal care and guidance seriously, and conduct general medical examinations and laboratory tests.
2. Gynecological examination, to understand whether there is abnormality in the soft birth canal, such as the presence or absence of vaginal transverse mediastinum; whether the cervix or uterus is abnormal, such as myoma, old fissure, etc.; whether there is any inflammatory infection of the external genital tract, pelvic genital organs have No disease such as ovarian tumors, inflammation, mass, etc.; if it is affected by pregnancy or childbirth, what should be done and when to treat it.
3. Daily daily living should be regular, avoid overwork, ensure sleep time, and have appropriate activities every day.
4. Keep the indoor air fresh, do not go to the air and dirty environment, avoid smoking and drinking.
5. Avoid mental stimulation, maintain a good mood, and find that you have a psychologically bad state and seek medical advice in a timely manner.
6. Pay attention to cold and warm, prevent diseases, and take medication according to your doctor's advice.
Complication
Congenital high scapular complication Complications congenital muscular torticollis
Can be complicated by muscular torticollis. The torticollis refers to the cervical deviation caused by the contraction of one side of the sternocleidomastoid muscle, the head tilted to the affected side, and the face turned to the healthy side as the main manifestation of the disease. The torticollis can be divided into congenital muscular torticollis and congenital bony torticollis. The former is a congenital neck deformity caused by the contraction of the head and neck caused by the contraction of the sternocleidomastoid muscle on one side, which is quite common; the latter is the torticollis caused by the deformity of the cervical vertebrae, which is rare.
Symptom
Congenital high scapular symptoms Common symptoms Short neck and thoracic deformity Frozen shoulder
The left side of the disease is more common, showing shrug and short neck. From the back, the most prominent clinical manifestation is asymmetrical shoulder joint. The affected shoulder scapula is forward and upward, generally displaced 3~5cm, in the supraclavicular region. I can touch the upper part of the scapula. The shoulder blade itself is shorter than the normal side. It is flat and wide. The lower end rotates to the spinous process of the thoracic spine. The clavicle is upward and inclined outward. The neck of the affected side is fuller and shorter. Sometimes it can be The scapula and the spine touch the vertebral body bone or fiber bundle between the scapula and the spine. When the upper arm is lifted, the scapula and the humerus rotate outward synchronously, which is called shoulder- synergy. When there is a high shoulder, this synergy disappears. The ankle joint movement is generally normal, while the lateral movement and rotational activity of the scapula are limited. The scapular muscle system often has insufficient muscle strength. The sternocleidomastoid muscle contracture can occur with the torticollis. Other common accompanying malformations include the cervical spine side. Convex, congenital cervical fusion and so on.
Cavendish is divided into four levels according to the degree of deformity:
1. Level 1: The deformity is very light, the shoulder joints on both sides are in the same plane, the deformity is not obvious, and the appearance of the patient is almost normal after dressing.
2. Secondary: The deformity is light, the shoulder joints on both sides are at the same horizontal plane, or close to the same horizontal plane. However, after the patient is dressed, the deformity can also be seen, and there is a mass at the affected neck.
3. Third grade: The deformity is medium, the shoulder joint is 2~5cm higher than the contralateral side, and the deformity is easy to see.
4. Grade 4: severe deformity, high shoulder joint, the upper inner corner of the scapula is almost in contact with the occipital bone, sometimes combined with short neck deformity.
Malformation grading is often not easy to achieve completely in clinical practice, especially in patients with bilateral malformations, but depending on the degree of deformity, different treatment methods are used, and grading has certain reference significance.
Examine
Congenital high shoulder examination
Mainly for X-ray examination, chest radiographs including cervical vertebrae should be taken routinely. It can be seen that the scapula of the affected side is higher than the normal side. The scapular vertebral body bone can sometimes be seen on the oblique slice. CT or MRI can also be used for individual cases.
Diagnosis
Diagnosis and differentiation of congenital high shoulder
According to medical history, clinical manifestations and X-ray examination, diagnosis is not difficult.
The clinical manifestations of this disease are similar to the pterygopalatine scapula, but the latter can be caused by various factors such as progressive muscular dystrophy, anterior serratus paralysis caused by chest long nerve injury, and calving, due to muscle weakness of the scapula, atrophy Therefore, when the arms are stretched out, the two shoulder scapulas are lifted like a bird's wing. Therefore, the name is similar to that of the disease, but the shoulder blades must be fixed to the spinous processes at the same time.
