Module 67, Pediatric Orthopaedist Level

This is a 5 year and 3 month old white female was the product of a full-term normal spontaneous vaginal delivery with a diagnosis of CHARGE syndrome (defects of the eyes, ears, heart, choanal atresia (primordal oronasal opening into the brain, mental retardation, and genital hypoplasia). She presented for evaluation of a webbed neck, left side worse than right. The child has developmental delay and began walking at 4 years of age. She had undergone previous surgery for strabismus and an atrial septal defect. Physical exam revealed defects of the eyes and ears, the neck was shortened and webbed (left worse than right). The back, shoulders and scapula were elevated (left worse than right). The scapula was rotated down and away from spine. Shoulder abduction was 110 degrees on right and 100 degrees on left.

Question 67A

A good treatment option at this time would be to work on physical therapy to gain shoulder joint range of motion and muscle strength.

Question 67B

If surgery is to be considered, its only goal is to improve the cosmetic appearance of the girl.

Question 67C

The best way to evaluate the amount of mobility in these scapula is to obtain a CT scan and look for omovertebral bones.

Question 67D

If surgery is being considered, resecting the omovertebral bones or fibrous adhesions which bind the scapula to the vertebra is an important part of the procedure.

Question 67E

Excising the superior border of the scapula is an important aspect of the procedure to improve function of the shoulder.