A 10 Year-old With A Winged Scapula--but Not From What You Might Think - Page #4
 

Working Diagnosis:
Osteochondroma on the undersurface of the right scapula causing winging. Progressive nature of the pseudowinging was caused by the gradual growth of the osteochondroma.

Treatment:
She was taken to the OR for surgical removal of the osteochondroma. The procedure was a 2-3 cm incision over the medial border of the scapula, down to the subperiosteal level and around the undersurface of the osteochondroma where a Hohmann retractor and osteotome was used to dissect without difficulty. Bone wax was placed on the the stalk of the osteochondroma.

Outcome:
Patient had a successful outcome and was sent home the same day of surgery. She has returned to full participation in all of her activities and she has required no additional follow-up.

Author's Comments:
A few things to remember about osteochondroma:
-a part of the growth plate forms an outgrowth (it may have a stalk, but not always)
-growth usually stops at maturity
-it is the most common benign bone tumor
-account for 35-40% of all bone tumors
-85-90% of those with osteochondroma have single lesions
-commonly diagnosed between ages 10-30 years
-males and females equally effected
-it doesn't result from an injury
-can occur at the ends of any long bone & along the pelvis & bones that make up the shoulder (most common sites are distal femur, proximal tibia, and proximal humerus)
-malignant degeneration is extremely rare--approximately 1% with solitary osteochondroma and 5% for those with multiple hereditary exostosis--will become low-grade chondrosarcoma

Editor's Comments:
A plain X-ray will show the bony growth. A magnetic resonance imaging (MRI) scan can be used to look for cartilage on the surface of the bony growth. Such cartilage in an adult patient should be checked for cancer if it is larger than two centimeters in size, or if there is pain. A computed tomography (CT) scan may also be used.

References:
-Bone Tumors and Tumor-Like Lesions (2009). In Kumar (Eds.), Robbins and Cotran Pathologic Basis of Disease, (8th ed.) (pp. 1223-35). Philadelphia, PA: Sander/Elseveir.
-Cartilage Lesions (2007). In Canale & Beaty (Eds.), Campbell's Operative Orthopaedic, (11th ed.) (pp. 859-62). Philadelphia, PA: Mosby/Elsevier.
-Esenkaya, I (2005). Pseudowinging of the scapula due to subscapular osteochondroma. Orthopedics, 28 (2), 171-2
-Frost, N.L., et al (2010). Scapular Osteochondromas Treated with Surgical Exision. Orthopedics, 33 (11).
-Martin, R.M., David E. Fish. (2008). Scapular winging: anatomic review, diagnosis, and treatments. Current Review Musculoskeletal Medicine, 1, 1-11.

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