Tag Archive for: modified Woodward’s procedure; neglected Sprengel deformity.

Modified Woodward’s Procedure in the Management of Neglected Sprengel’s Shoulder

Volume 8 | Issue 2 | May-August 2022 | Page: 02-05 | Tushar Nayak, Amrut Raje, Ashish Ragase, Love Kapoor , Venkatesan Sampath Kumar, Shah Alam Khan

DOI- https://doi.org/10.13107/ijpo.2022.v08i02.136

Authors: Tushar Nayak MS Ortho [1], Amrut Raje MS Ortho [2], Ashish Ragase MS Ortho [2], Love Kapoor MS Ortho [3], Venkatesan Sampath Kumar MS Ortho [1], Shah Alam Khan MS Ortho [1]

[1] Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India.
[2][ Department of Musculoskeletal Oncology, All India Institute of Medical Sciences, New Delhi, India.
[3] Department of Orthopaedics, N.C.I.; A.I.I.M.S, Jhajjar, Haryana, India.

Address of Correspondence
Dr. Tushar Nayak,
Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India.
E-mail: orthodrtushar@gmail.com


Introduction: With a less than ideal health infrastructure and a vast underprivileged population in our country, many cases of Sprengel’s deformity are initially missed and are subsequently untreated. Although for best surgical results, the patient must be under the age of five, many patients present late at out tertiary care center. Thus, we evaluated the clinical results of the modified Woodward’s Procedure in such neglected cases.
Methods: A retrospective study, of 16 patients aged 8-yr or above, with Sprengel’s deformity who underwent the modified Woodward’s procedure between 2006 and 2011. Clavicular osteotomy/morselization was avoided. The Cavendish scoring system was used to grade cosmesis and shoulder abduction was used to assess the functional outcome. The patients were prospectively followed up at two-years and after skeletal maturity.
Results: There were ten females and six males and the average age was 9.4 years. The mean follow up was 4.2 yr. Omo- vertebral bar excision was done in 13 (81.25%) patients. The mean increase in postoperative shoulder abduction and Cavendish grades at a 2-yr follow-up were, 19.1° and 1.32 grades, respectively. None of our patients needed Clavicular osteotomy/morselisation and none developed neurological abnormalities. The was no change in the values at skeletal maturity.
Conclusion: Satisfactory outcomes can be acquired by the Modified Woodward’s procedure in neglected Sprengel’s deformities. Besides a definitive cosmetic correction, the procedure also results in improvement of shoulder abduction. Clavicular Ostetomy/Morselization is not always required in cases presenting after the age of 8 years.
Keywords: Woodward’s procedure; Sprengel’s shoulder, Cavendish grading, modified Woodward’s procedure; neglected Sprengel deformity.


1. Woodward JW. Congenital elevation of the scapula: Correction by release and transplantation of muscle origins. JBJS. 1961;43(2):219–28.
2. Erken EHW, Barrow MS, Aden AA. CONGENITAL ELEVATION OF THE SCAPULA–SPRENGEL’S DEFORMITY. In: Orthopaedic Proceedings. The British Editorial Society of Bone & Joint Surgery; 2002. p. 79-f.
3. Khairouni A, Bensahel H, Csukonyi Z, Desgrippes Y, Pennecot GF. Congenital high scapula. Journal of Pediatric Orthopaedics B. 2002;11(1):85–8.
4. Samartzis D, Herman J, Lubicky JP, Shen FH. Sprengel’s deformity in Klippel-Feil syndrome. Spine. 2007;32(18):E512–6.
5. Wilkinson JA, Campbell D. Scapular osteotomy for Sprengel’s shoulder. The Journal of bone and joint surgery British volume. 1980;62(4):486–90.
6. Eulenberg M. Beitrag zur dislocation der scapula. Amlicht Ber Deutscher Naturforsch Aerzte Karlsbad. 1863;37:291–4.
7. Sprengel O. Die angeborene Verschiebung des Schulterblattes nach oben. Arch Klin Chir. 1891;42:545.
8. Crha B, Gál P. Surgical treatment of Sprengel’s deformity of the scapula. Scr Med (Brno). 2001;74(4):2456254.
9. Grogan DP, Stanley EA, Bobechko WP. The congenital undescended scapula. Surgical correction by the Woodward procedure. The Journal of bone and joint surgery British volume. 1983;65(5):598–605.
10. Wu SJ, Chin LS, Kuo JR. Clinical experience of the Woodward procedure in Sprengel’s deformity. Formos J Surg. 2010;43:81–6.
11. Cho TJ, Choi IH, Chung CY, Hwang JK. The Sprengel deformity: morphometric analysis using 3D-CT and its clinical relevance. The Journal of bone and joint surgery British volume. 2000;82(5):711–8.
12. Jindal N, Gupta P. Sprengel’s shoulder treated by the Woodward procedure: analysis of factors affecting functional and cosmetic outcome. Journal of children’s orthopaedics. 2012;6(4):291–6.
13. Ross DM, Cruess RL. The surgical correction of congenital elevation of the scapula. A review of seventy-seven cases. Clinical orthopaedics and related research. 1977;(125):17–23.
14. Majid OB, Alzaid SZ, Al-Zayed Z, Almonaie S, Albekairi AA, Ahmed M. Outcomes of Woodward’s Procedure for Sprengel’s Shoulder Using Neurophysiological Monitoring of the Brachial Plexus Without Clavicular Osteotomy: A Retrospective Study. Cureus [Internet]. 2021 Nov 21 [cited 2022 Jul 13];13(11). Available from: https://www.cureus.com/articles/75601-outcomes-of-woodwards-procedure-for-sprengels-shoulder-using-neurophysiological-monitoring-of-the-brachial-plexus-without-clavicular-osteotomy-a-retrospective-study
15. Jeannopoulos CL. Congenital elevation of the scapula. J Bone Joint Surg Am. 1952 Oct;34 A(4):883–92.
16. Robinson RA. The surgical importance of the clevicular component of Sprengel’s deformity. J Bone Joint Surg, A. 1967;49:1481.

How to Cite this Article:  Nayak T, Raje A, Ragase A, Kapoor L, Kumar VS, Khan SA | Modified  Woodward’s Procedure in the Management of Neglected Sprengel’s Shoulder | International Journal of Paediatric Orthopaedics | May-August 2022; 8(2): 02-05.  https://doi.org/10.13107/ijpo.2022.v08i02.136

(Article Text HTML)      (Full Text PDF)