Osteochondroma as a cause of scapular winging in an adolescent: a case report and review of the literature

INTRODUCTION

Winged scapula is defined as the prominence of the medial border of the scapula. The classic etiopathology of scapular winging are injuries to the spinal accessory or long thoracic nerves resulting respectively in trapezius and serratus anterior palsy. To the best of our knowledge, there are only few reports of scapular lesions being mistaken for winging of the scapula. We report a rare case of a large scapular osteochondroma arising from the medial border and causing a pseudowinging of the scapula.

CASE PRESENTATION

A 17-year-old Caucasian boy came to us complaining about a winged left scapula. The patient had a complete painless range of motion, but a large hard bony swelling was palpable along the medial border of his left scapula. A grating sensation was felt when his arm was passively abducted and/or elevated causing discomfort. A lesion revealed on X-rays was diagnosed as an osteochondroma of the medial border of his scapula. After preoperative examinations, he underwent open surgery in order to remove the lesion. A histological examination confirmed the clinical diagnosis of osteochondroma. A clinical examination 3 months later showed a full and painless range of motion, the absence of the grating sensation during passive abduction and elevation and the complete disappearance of his left shoulder deformity. After 2 years of follow-up, there were no clinical or radiological signs of recurrence.

CONCLUSIONS

Despite its rarity osteochondroma should be considered in the differential diagnosis for any adolescent presenting with a winging of the scapula.

[CT-guided percutaneous treatment of osteoid osteoma]

CT was used to localize and guide the percutaneous ablation of osteoid osteomas in 11 patients whose age ranged 5 to 63 years. The treatment was performed directly in the CT room ensuring maximum asepsis. General anesthesia was used in children and in vertebral and sacroiliac localizations, while the peripheral block was used in peripheral localizations. In the latter cases, an ischemic band was used to reduce bleeding. A dedicated drill resection system guided by a Kirschner guide wire was used for removal. The treatment was curative in the short period in all the patients, with complete symptom remission. Only one patient required retreatment after 6 months. In our series of patients no major complications, e.g., bleeding or infections, were observed. In 8 cases the resection yielded enough material for histology. To conclude, this technique can be considered a valuable alternative to surgery in the treatment of osteoid osteomas.