Scapular Abnormalities in Children: Treatment Options and Risks

Scapular abnormalities

Hello, doctor.
I have a daughter who, at 10 months old, was found to have her left scapula not lowered.
We visited Chang Gung Children's Hospital, where the doctor mentioned it is a rare condition and provided two recommendations: (1) surgery or (2) observation.
Now, at 1 year and 10 months, it is already noticeable that her shoulders are uneven, but there doesn't seem to be any limitation in her limb movement.
I would like to ask if it is possible to avoid surgery.
What are the potential consequences of not having the surgery? What risks are associated with the surgery? What is the optimal age for treatment? Thank you.

kiki, 20~29 year old female. Ask Date: 2001/05/21

Dr. Lin Junliang reply Orthopedics

Congenital scapular winging is the most common congenital anomaly of the shoulder, often associated with other abnormalities such as scoliosis, torticollis, renal anomalies, spinal deformities, and muscle hypoplasia.
Most patients experience limited shoulder abduction.
Treatment for scapular winging typically involves surgical intervention aimed at achieving better range of motion and improving appearance.
Non-surgical management is considered due to the limitations in mobility, cosmetic deformities, and potential psychological issues as the child grows.
However, surgical options must take into account the psychological trauma of surgery in children, the risk of failure, and the possibility of nerve injury.

Reply Date: 2001/05/21

More Info

Scapular abnormalities in children, particularly conditions like scapular winging or scapular dyskinesis, can present unique challenges for both the child and their caregivers. In your case, your daughter has been diagnosed with a condition where the left scapula has not descended properly, leading to asymmetry in her shoulder girdle. This condition can be associated with various underlying causes, including congenital muscular issues, nerve injuries, or developmental disorders.

Treatment Options
1. Observation: In many cases, especially if the child is not experiencing functional limitations, doctors may recommend a watchful waiting approach. This means monitoring the condition over time to see if it improves as the child grows. Children often have a remarkable ability to adapt, and if the asymmetry does not interfere with their daily activities or development, surgery may not be necessary.

2. Surgery: Surgical intervention may be considered if the condition leads to significant functional impairment, pain, or cosmetic concerns as the child grows. Surgical options can include scapular stabilization procedures or corrective surgeries to reposition the scapula. However, surgery carries inherent risks, including infection, nerve damage, and complications related to anesthesia.

Risks of Non-Intervention
If surgery is not performed, the potential risks depend on the severity of the condition and its impact on your daughter’s daily life. Some possible outcomes include:
- Functional Limitations: While you mentioned that your daughter currently does not show any limitations in her arm movements, there is a possibility that as she grows, the asymmetry could lead to compensatory movements that may affect her posture or lead to discomfort.

- Cosmetic Concerns: As she matures, the visual asymmetry may become more pronounced, which could affect her self-esteem or body image.

- Progressive Issues: In some cases, if the underlying cause of the scapular abnormality is progressive, it could lead to further complications, such as muscle imbalances or chronic pain.

Risks of Surgical Intervention
Surgery, while potentially beneficial, is not without its risks. These include:
- Infection: Any surgical procedure carries a risk of infection at the incision site.

- Nerve Damage: There is a risk of damaging surrounding nerves, which could lead to weakness or loss of function in the arm.

- Anesthesia Risks: Anesthesia, especially in young children, carries its own set of risks, including respiratory complications.

- Need for Further Surgery: Sometimes, initial surgeries may not yield the desired results, necessitating additional procedures.

Optimal Timing for Treatment
The "golden period" for surgical intervention can vary based on the specific diagnosis and the child's overall development. Generally, early intervention (before the age of 3) can be beneficial, as children's bones and muscles are still developing, and they may respond better to surgical corrections. However, the decision should be individualized based on the child's specific condition, growth patterns, and functional abilities.

Conclusion
In conclusion, the decision to proceed with surgery or continue with observation should be made collaboratively with your child's healthcare team, considering the potential benefits and risks of each option. Regular follow-ups with a pediatric orthopedic specialist can help monitor her progress and make timely decisions regarding her care. It is essential to weigh the functional implications against the risks of surgery and to consider your daughter's quality of life and personal preferences as she grows.

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