Addressing Asymmetrical Scapula in a 10-Year-Old After Clavicle Injury - Orthopedics

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Addressing asymmetrical scapula in a child following a clavicle injury is a concern that many parents share, especially when they notice visible differences in shoulder height or scapular positioning. In your daughter's case, the asymmetry following a closed clavicle fracture is not uncommon, particularly when the injury involves immobilization and changes in muscle tone or posture during the healing process.


Understanding the Condition
When a child suffers a clavicle fracture, the immobilization required for healing can lead to muscle atrophy or changes in the way the muscles around the shoulder girdle function. The shoulder girdle consists of the clavicle, scapula, and the muscles that stabilize and move these bones. If one side is immobilized for an extended period, the muscles on that side may weaken, leading to a noticeable difference in the position of the scapula.

In your daughter's case, the right scapula being lower than the left could be due to several factors:
1. Muscle Atrophy: The muscles around the shoulder may weaken due to disuse during the healing period.

2. Postural Changes: Children often adapt their posture to compensate for pain or discomfort, which can lead to asymmetrical positioning of the shoulders and scapulae.

3. Healing Process: As the clavicle heals, the surrounding structures may take time to adjust back to normal alignment.


Potential Solutions
1. Physical Therapy: Engaging a physical therapist who specializes in pediatric rehabilitation can be highly beneficial. They can provide exercises tailored to strengthen the muscles around the shoulder girdle, improve posture, and promote symmetrical development of the scapulae. Exercises may include:
- Scapular retraction and protraction exercises.

- Strengthening exercises for the rotator cuff and shoulder stabilizers.

- Stretching exercises to improve flexibility and range of motion.

2. Posture Correction: Encouraging good posture during daily activities can help. This includes:
- Ensuring that she sits and stands with her shoulders back and down.

- Avoiding slouching or leaning to one side.

3. Monitoring Growth: As your daughter grows, her body will continue to develop, and sometimes asymmetries can correct themselves naturally. Regular follow-ups with her pediatrician or orthopedic specialist can help monitor her progress.

4. Bracing or Support: In some cases, a brace or support may be recommended to help maintain proper alignment during the healing process. However, this should be discussed with her healthcare provider to ensure it is appropriate for her specific situation.

5. Surgical Consultation: If the asymmetry persists or worsens, or if there are functional limitations, a consultation with an orthopedic surgeon may be warranted. They can assess whether any surgical intervention is necessary to correct the alignment.


Conclusion
While the asymmetry in your daughter's scapula is concerning, it is often a temporary issue that can be addressed with appropriate interventions. The key is to ensure she receives proper rehabilitation and monitoring as she heals. Encourage her to engage in physical activities that promote overall strength and coordination, and maintain open communication with her healthcare providers to ensure her recovery is on track. With time and the right approach, many children experience significant improvement in their shoulder symmetry and function.