Surgical management of Sprengel’s deformity by a modification of Green’s procedure

A single center experience
  • Yu JiangEmail author
  • Yuan Guo
  • Zhenghua Zhu
  • Yukun Wang



Sprengel’s deformity is a rare congenital anomaly that can present in children, leading to cosmetic and functional impairment. This study investigated clinical results of this deformity among cases managed using a modified Green procedure.


From February 2008 to September 2015 a total of 34 patients with Sprengel’s deformity were treated with a modified Green procedure. The mean age of patients at the time of surgery was 4.8 years (range 2–12 years) and the average follow-up time was 6.1 years (range 4–10 years). The shoulder abduction, Cavendish classification, Rigault classification, scapular elevation, and postoperative complications were evaluated.


The mean shoulder abduction was 102.3° (range 70–140°) preoperatively and 142.6° (range 120–170°) postoperatively. The scapular elevation was 4.2 cm (range 2–6.5 cm) preoperatively and 1.35 cm (range 0–2 cm) postoperatively. Improvement by at least one Cavendish and/or Rigault grade was attained in all cases postoperatively. The differences in preoperative and postoperative shoulder abduction, scapular elevation, Cavendish grade and Rigault grade were statistically significant (p < 0.001).


The modified Green procedure is a relatively safe and reliable method in the treatment of severe Sprengel’s deformity, which ensures successful shoulder function as well as a good cosmetic appearance.


Surgical techniques Congenital elevation of the scapula Musculoskeletal abnormality Retrospective study Pediatrics 

Operatives Management einer Sprengel-Deformität mittels modifizierter Green-Technik

Eine Singlecenter-Erfahrung



Bei der Sprengel-Deformität handelt es sich um eine seltene kongenitale Anomalie, die bei Kindern auftreten kann und zu kosmetischen und funktionellen Beeinträchtigungen führt. In dieser Studie wurden die klinischen Ergebnisse dieser Deformität bei Fällen, die mit einer modifizierten Green-Technik behandelt wurden, untersucht.


Von Februar 2008 bis September 2015 wurden insgesamt 34 Patienten mit Sprengel-Deformität mittels der modifizierten Technik nach Green behandelt. Das mittlere Alter der Patienten zur Zeit der Operation war 4,8 Jahre (Range: 2–12 Jahre), und die durchschnittliche Follow-up-Zeit betrug 6,1 Jahre (Range: 4–10 Jahre). Die Schulterabduktion, Cavendish-Klassifikation, Rigault-Klassifikation, skapuläre Elevation sowie postoperative Komplikationen wurden bewertet.


Die mittlere Schulterabduktion betrug 102,3° (Range: 70–140°) präoperativ und 142,6° (Range: 120–170°) postoperativ. Die skapuläre Elevation lag bei 4,2 cm (Range: 2–6,5 cm) präoperativ und 1,35 cm (Range: 0–2 cm) postoperativ. Eine Verbesserung von mindestens einem Grad nach Cavendish und/oder Rigault wurde postoperativ in allen Fällen erreicht. Die Unterschiede in der präoperativen und postoperativen Schulterabduktion, skapulären Elevation, Cavendish- und Rigault-Grad waren statistisch signifikant (p < 0.001).


Die modifizierte Green-Technik ist ein relativ sicheres und zuverlässiges Verfahren in der Behandlung einer schweren Sprengel-Deformität, das sowohl eine gute Schulterfunktion sowie ein gutes kosmetisches Ergebnis ermöglicht.


Operationstechnik Kongenitale Elevation der Skapula Muskuloskeletale Abnormalitäten Retrospektive Studie Pädiatrie 


Compliance with ethical guidelines

Conflict of interest

Y. Jiang, Y. Guo, Z. Zhu and Y. Wang declare that they have no competing interests.

All procedures performed in studies involving human participants or on human tissue were in accordance with the ethical standards of the institutional and/or national research committee and with the 1975 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study. For images or other information within the manuscript which identify patients, consent was obtained from them and/or their legal guardians.


  1. 1.
    Pinsky HA, Pizzutillo PD, Mac Ewen GD (1980) Congenital elevation of the scapula. Orthop Trans 4:288–289Google Scholar
  2. 2.
    Ross DM, Cruess RL (1977) The surgical correction of congenital elevation of the scapula: a review of seventy-seven cases. Clin Orthop Relat Res 125:17–23Google Scholar
  3. 3.
    Cavendish ME (1972) Congenital elevation of the scapula. J Bone Joint Surg Br 54B(3):395–408CrossRefGoogle Scholar
  4. 4.
    Mooney JF 3rd, White DR, Glazier S (2009) Previously unreported structure associated with Sprengel’s deformity. J Pediatr Orthop 29:26–28CrossRefGoogle Scholar
  5. 5.
    Farsetti P, Weinstein SL, Caterini R et al (2003) Sprengel’s deformity: long-term follow-up study of 22 cases. J Pediatr Orthop B 12:202–210PubMedGoogle Scholar
  6. 6.
    Jeannopolous CL (1961) Observations on congenital elevation of the scapula. Clin Orthop 20:132–137Google Scholar
  7. 7.
    Green WT (1957) The surgical correction of congenital elevation of the scapula, (Sprengel’s deformity). J Bone Joint Surg Am 39:149–151Google Scholar
  8. 8.
    Woodward JW (1961) Congenital elevation of the scapula. Correction by release and transplantation of muscle origins. A preliminary report. J Bone Joint Surg 43A:219–228CrossRefGoogle Scholar
  9. 9.
    Leibovic SJ, Ehrlich MG, Zaleske DJ (1990) Sprengel’s deformity. J Bone Joint Surg Am 72:192–197CrossRefGoogle Scholar
  10. 10.
    Mears DC (2001) Partial resection of the scapula and a release of the long head of triceps for the management of Sprengel’s deformity. J Pediatr Orthop 21:242–245PubMedGoogle Scholar
  11. 11.
    Bellemans M, Lamoureux J (1999) Results of surgical treatment of Sprengel’s deformity by a modified Green’s procedure. J Pediatr Orthop B 8:194–196CrossRefGoogle Scholar
  12. 12.
    Rigault P, Pouliquen JC, Guyonvarch G et al (1976) Congenital elevation of the scapula in children: anatomopathological and therapeutic study apropos of 27 cases [French]. Rev Chir Orthop Reparatrice Appar Mot 62:5–26PubMedGoogle Scholar
  13. 13.
    Carson WG, Lovell WW, Whitesides TE Jr (1981) Congenital elevation of the scapula. Surgical correction by the Woodward procedure. J Bone Joint Surg Am 63:1199–1207CrossRefGoogle Scholar
  14. 14.
    Eulenberg M (1863) Beitrag zue Dislocation der Scapula. Amtliche Berichte uber die Versammlungen deutscher Naturforscher und Aerzte fur die Jahre, vol 37, pp 291–294Google Scholar
  15. 15.
    Sprengel’s R (1891) Die angeborene Verschiebung des Schulterblattes nach oben. Arch Klin Chir 42:545–549Google Scholar
  16. 16.
    Schrock RD (1926) Congenital elevation of the scapula. J Bone Joint Surg Am 8:207–215Google Scholar
  17. 17.
    Wilson MG, Mikity VG, Shinno NW (1971) Dominant inheritance of Sprengel’s deformity. J Pediatr 79:818–821CrossRefGoogle Scholar
  18. 18.
    Floemer F, Magerkurth O, Jauckus C et al (2008) Klippel-Feil syndrome and Sprengel’s deformity combined with an intraspinal course of the left subclavian artery and a bovine aortic arch variant. AJNR Am J Neuroradiol 29:306–307CrossRefGoogle Scholar
  19. 19.
    Genin G (2008) Anomalies osseuses constitutionnelles. Sauramps Médical, ParisGoogle Scholar
  20. 20.
    Fullbier L, Tanner P, Henkes H et al (2010) Omovertebral bone associated with Sprengel’s deformity and Klippel-Feil syndrome leading to cervical myelopathie. J Neurosurg Spine 13:224–228CrossRefGoogle Scholar
  21. 21.
    Greitemann B, Rondhuis JJ, Karbowski A (1993) Treatment of congenital elevation of the scapula. 10 (2–18) year follow-up of 37 cases of Sprengel’s deformity. Acta Orthop Scand 64:365–368CrossRefGoogle Scholar
  22. 22.
    Doita M, Iio H, Mizuno K (2000) Surgical management of Sprengel’s deformity in adults. Clin Orthop 371:119–124CrossRefGoogle Scholar
  23. 23.
    Aydinli U, Ozturk C, Akesen B et al (2005) Surgical treatment of Sprengel’s deformity: a modified Green procedure. Acta Orthop Belg 71:264–268PubMedGoogle Scholar
  24. 24.
    Andrault G, Salmeron F, Laville JM (2009) Green’s surgical procedure in Sprengel’s deformity: cosmetic and functional results. Orthop Traumatol Surg Res 95:330–335CrossRefGoogle Scholar
  25. 25.
    Gonen E, Simsek U, Solak S et al (2010) Long-term results of modified Green method in Sprengel’s deformity. J Child Orthop 4:309–314CrossRefGoogle Scholar
  26. 26.
    Harvey EJ, Bernstein M, Desy NM et al (2012) Sprengel’s deformity: pathogenesis and management. J Am Acad Orthop Surg 20:177–186CrossRefGoogle Scholar
  27. 27.
    Chung SMK, Farahvar H (1976) Surgery of the clavicle in Sprengel’s deformity. Clin Orthop Relat Res 116:138–141Google Scholar
  28. 28.
    McMurtry I, Bennet GC, Bradish C (2005) Osteotomy for congenital elevation of the scapula (Sprengel’s deformity). J Bone Joint Surg Br 87:986–989CrossRefGoogle Scholar
  29. 29.
    Ahmad AA (2010) Surgical correction of severe Sprengel’s deformity to allow greater postoperative range of shoulder abduction. J Pediatr Orthop 30:575–581CrossRefGoogle Scholar

Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2019

Authors and Affiliations

  1. 1.Department of pediatric orthopedicsBeijing Jishuitan Hospital, the Fourth Medical College of Peking UniversityBeijingChina

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