2. • IN THIS CONDITION SCAPULA FAILS TO
DESCEND DOWN FROM ITS INITIAL HIGH
POSITION IN THE EMBRYO
• HERE THE SCAPULA LIES MORE SUPERIORLY.
IT IS HYPOPLASTIC AND IMPROPERLY
SHAPED
• IT IS ASSOCIATED WITH OTHER CONGENITAL
ANOMALIES LIKE CERVICAL RIB, ETC.
3. ETIOLOGY:
• THIS MAY BE DUE TO IMPERFECT DESCENT OF THE
SHOULDER GIRDLE BY THIRD MONTH OR A BAND
OF MUSCLE FROM THE SKULL TO THE SCAPULA
WHICH HAS FAILED TO GROW.
4. CLINICAL FEATURES:
• THE SCAPULAR MUSCLES ARE POORLY DEVELOPED AND MAY BE
REPRESENTED BY FIBROUS BANDS.
• IT MAY BE ACCOMPANIED BY SCOLIOSIS (THORACIC CURVE) WITH CONVEXITY
ON THE INVOLVED SIDE.
• THE MOVEMENT OF SCAPULA IS MARKEDLY LIMITED DUE TO THE FIBROUS
BANDS OR A BONY BAR RESULTING IN LIMITATION OF SHOULDER ABDUCTION
AND ELEVATION.
• HOWEVER, THE FUNCTIONAL DISABILITY IS USUALLY MINIMAL.
• VERY LITTLE IMPROVEMENT CAN BE OFFERED BY WAY OF CORRECTIVE
EXERCISES
5. • THE SCAPULA IS HIGH BY 2 TO 10 CM, THE DEFORMITY IS OBVIOUS
• CAVENDISH’S GRADING
• GROUP 1—VERY MILD
• GROUP 2—MILD, SHOULDER SLIGHTLY UNALIGNED
• GROUP 3—MODERATE, SHOULDER HIGH.
• GROUP 4—SEVERE, WITH SUPERIOR ANGLE OF SCAPULA NEAR THE
OCCIPUT.
7. TREATMENT:
• FOR CASES WITH MILD DEFORMITY NO
TREATMENT IS REQUIRED.
• FOR SEVERE CASES SURGERY IS DONE AFTER 3
YEARS AND THIS CONSISTS OF RELEASE OF
MUSCLES FROM THE SCAPULA OR TRANSFER OF
ORIGIN OF THE TRAPEZIUS MUSCLE
8. PT MANAGEMENT:
• MEASURES TO CONTROL PAIN
• USUAL METHODS LIKE ULTRASONIC, TENS, ETC. ARE HELPFUL.
• MEASURES FOR MOBILIZATION
• GENTLE RELAXED PASSIVE MOVEMENTS OF THE SHOULDER GIRDLE MUSCLES.
• EARLY MOBILITY OF THE SHOULDER IS AIMED AT.
• MEASURES TO STRENGTHEN THE MUSCLES
• THE MUSCLES AROUND THE SHOULDER GIRDLE ARE STRENGTHENED BY SUITABLE
ISOMETRIC AND ISOTONIC SHOULDER EXERCISES
