DOI: http://dx.doi.org/10.18203/issn.2455-4510.IntJResOrthop20205578

Contrasting presentation of solitary scapular osteochondroma: a report of three cases and review of literature

Ajay Alex Varughese, Ritesh Arvind Pandey, Rajesh Paul, Bobby John

Abstract


Scapular osteochondroma can have unusual manifestations like pseudo-winging and snapping syndrome in ventrally located lesions. Dorsally located lesions cause a cosmetic blemish and difficulty in lying supine. We present a series of 3 cases of scapular osteochondroma with varying presentations. One was a ventral surface (subscapular) osteochondroma which presented with pseudo winging and snapping syndrome and 2 were dorsal surface osteochondromas which presented with prominence at the back and difficulty in lying supine. All were treated surgically with good functional and cosmetic results. Surgical resection of tumor is the treatment of choice. An appropriate surgical approach should be chosen depending on the location of tumor. We propose the use of trapezius sparing approach and splitting the scapular apophysis for subscapular osteochondroma in children as it produces less soft tissue damage, is easy to repair and allows early rehabilitation.

 


Keywords


Scapular osteochondroma, Pseudo-winging, Subscapular, Exostosis, Trapezius sparing

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References


Fletcher CD, Unni KK, Mertens F, editors. Pathology and Genetics of Tumours of Soft Tissue and Bone. 4th ed. Lyon, France: IARC Press; 2002.

Pongkripetch M, Sirikulchayanonta V. Analysis of bone tumors in Ramathibodi Hospital, Thailand during 1977-1986: Study of 652 cases. J Med Assoc Thail. 1989;72(11):621-8.

Barbosa CS, Araújo AB, Miranda D. Incidence of primary benign and malignant neoplasms and bone pseudotumoral lesions. An epidemiologic analysis of 585 cases diagnosed at the Faculdade de Medicina of the Universidade Federal de Minas Gerais. AMB Rev Assoc Med Bras. 1991;37(4):187-92.

Alatassi R, Koaban S, Almugebel I, Alshehri A. Scapular osteochondroma with winging: A case report. Int J Surg Case Rep. 2018;45:138-42.

Sivananda P, Rao BK, Kumar PV, Ram GS. Osteochondroma of the ventral scapula causing scapular static winging and secondary rib erosion. J Clin Diagn Res. 2014;8(5):LD03-5.

Chun DI, Cho JH, Choi IH, Yi Y, Kim JY, Kim JH, et al. Osteochondroma of ventral scapula associated with chest pain due to rib cage compression: A case report. Medicine. 2018;97(17):e0510.

Mohsen MS, Moosa NK, Kumar P. Osteochondroma of the scapula associated with winging and large bursa formation. Med Princ Pract Int J Kuwait Univ Health Sci Cent. 2006;15(5):387-90.

Aalderink K, Wolf B. Scapular osteochondroma treated with arthroscopic excision using prone positioning. Am J Orthop Belle Mead NJ. 2010;39(2):E11-4.

Kwon OS, Kelly JIV. Delayed presentation of osteochondroma on the ventral surface of the scapula. Int J Shoulder Surg. 2012;6(2):61-3.

1Nascimento AT do, Claudio GK. Snapping scapula. Arthroscopic resection of osteochondroma of the subscapularis superomedial angle. Case report and literature review. Rev Bras Ortop. 2017;52(2):220-3.

Tittal P, Pawar I, Kapoor SK. Pseudo-winging of scapula due to benign lesions of ventral surface of scapula - Two unusual causes. J Clin Orthop Trauma. 2015;6(1):30-5.

Tungdim PH, Singh II, Mukherjee S, Pertin T. Excision of Solitary Osteochondroma on the Ventral Aspect of Left Scapula Presenting as Pseudowinging in a 4-year-old Boy: A Rare Case Report. J Orthop Case Rep. 2017;7(1):36-40.

Tomo H, Ito Y, Aono M, Takaoka K. Chest wall deformity associated with osteochondroma of the scapula: a case report and review of the literature. J Shoulder Elbow Surg. 2005;14(1):103-6.

Danielsson LG, el-Haddad I. Winged scapula due to osteochondroma. Report of 3 children. Acta Orthop Scand. 1989;60(6):728-9.

Mahajan S, Mahajan N, Singh P, Bashir A, Sharma Romesh C. Scapula a rare localization of osteochondroma: a case report. Internet J Orthop Surg. 2008;14(1):13.

Godfrey J, Hamman R, Lowenstein S, Briggs K, Kocher M. Reliability, validity, and responsiveness of the simple shoulder test: psychometric properties by age and injury type. J Shoulder Elbow Surg. 2007;16(3):260-7.

Essadki B, Moujtahid M, Lamine A, Fikry T, Essadki O, Zryouil B. Solitary osteochondroma of the limbs. Clinical review of 76 cases and pathogenic hypothesis. Acta Orthop Belg. 2000;66(2):146-53.

Samilson RL, Morris JM, Thompson RW. Tumors of the scapula. A review of the literature and an analysis of 31 cases. Clin Orthop. 1968;58:105-15.

Frost NL, Parada SA, Manoso MW, Arrington E, Benfanti P. Scapular osteochondromas treated with surgical excision. Orthopedics. 2010;33(11):804.

Parsons TA. The snapping scapula and subscapular exostoses. J Bone Joint Surg Br. 1973;55-B(2):345–9.

Rinaldi E. Acquired winged scapula due to solitary bursal exostosis of the scapula. Arch Putti Chir Organi Mov. 1966;21:127–33.

Carlson HL, Haig AJ, Stewart DC. Snapping scapula syndrome: three case reports and an analysis of the literature. Arch Phys Med Rehabil. 1997;78(5):506–11.

Vaishya R, Dhakal S, Vaish A. A solitary osteochondroma of the scapula. Case Reports. 2014 Feb 21;2014:bcr2013202273.

Nekkanti S, Moogali A, Meka A, Nair M. An Unusual Presentation of Osteochondroma on the Dorsal Surface of the Scapula: A Review of Two Patients. J Orthop Case Rep. 2018;8(3):38–41.

Ruland LJ, Ruland CM, Matthews LS. Scapulothoracic anatomy for the arthroscopist. Arthrosc J Arthrosc Relat Surg Off Publ Arthrosc Assoc N Am Int Arthrosc Assoc. 1995;11(1):52–6.

Brown C, Buckingham R. A new surgical approach to remove subscapular exostoses in children. Ann R Coll Surg Engl. 2011;93(3):258–9.

Stevens J, Stirling P, Patton JT. Trapezius-sparing Approach to Osteochondromas on the Ventral Surface of the Scapula. Tech Shoulder Elb Surg. 2018;19(3):124.