Upper Extremity

Sprengel Deformity

Sprengel deformity is the congenital elevation of the scapula. There are varying degrees of severity; it is usually unilateral. There is restricted scapulothoracic motion (especially with abduction), so most of the shoulder motion is through the glenohumeral joint. There is usually associated hypoplasia of the periscapular muscles. Webbing of the neck and low posterior hairline can be associated problems. There is an association with congenital syndromes, such as Klippel-Feil anomaly, so a thorough history and examination are necessary. Mild forms with a cosmetic deformity and mild loss of shoulder motion do not need surgical correction. Severe forms may have a bony connection (omovertebral) between the scapula and lower cervical spine. Moderate and severe forms may need surgical repositioning of the scapula in early childhood to improve cosmesis and function.

Clavicular Fractures

Clavicle fractures may be seen in neonates as a result of birth injury (see Chapter 58 ) or in childhood with falls or direct trauma to the clavicle. Fractures most commonly occur in the distal third of the clavicle. In the case of a posteriorly displaced medial clavicle fracture, computed tomography (CT) may be necessary to evaluate great vessels. A simple sling for 3–6 weeks is commonly effective. Surgery may be indicated for older adolescents with significant shortening or displacement, skin tenting, or neurovascular compromise.

Brachial Plexus Injuries

Obstetric brachial plexus palsy is discussed in Section 11. Brachial plexopathy is an athletic injury, commonly referred to as a stinger or burner . The symptoms are often likened to a dead arm . There is pain (often burning), weakness, and numbness in a single upper extremity. There are three mechanisms of injury:

• 1.

  Traction caused by lateral flexion of the neck away from the involved upper extremity

• 2.

  Direct impact to the brachial plexus at Erb point

• 3.

  Compression caused by neck extension and rotation toward the involved extremity

Symptoms are always unilateral and should resolve within 15 minutes. It is paramount to assess the cervical spine for serious injury. Bilateral symptoms, lower extremity symptoms, persistent symptoms, or recurrent injury are all signs of more serious injury requiring a more extensive work-up. Athletes may return to activity if there are no red flags on history or physical examination and the athlete has full pain-free range of motion and strength in the neck and affected extremity.