Praveen Tittal1, Inder Pawar2, Sudhir K Kapoor3. 1. Specialist, Department of Orthopaedics, PGIMSR, ESI Hospital, 396, Sanskriti Apartment, Sector 19B, Dwarka, New Delhi 110075, India. 2. Associate Professor, Department of Orthopaedics, PGIMSR, ESI Hospital, New Delhi, India. 3. Dean and Head of Department, Department of Orthopaedics, PGIMSR, ESI Hospital, New Delhi, India.
Abstract
UNLABELLED: Winging of the scapula due to benign lesion of ventral surface of scapula is one of the rare cause and difficult to diagnose in first place. We present two unusual cases of pseudo winging of scapula due to benign lesions of scapula. First case was of 23 year old male with solitary osteochondroma of ventral surface of scapula. Second was 38 year old female with hemangioma involving subscapular muscles. Both the patients presented to us with dull aching pain over right scapular and shoulder region of 6 months duration with gradually increasing pseudo-winging of scapula. On examination there was mild tenderness over superomedial border of scapula with scapular snapping(5) or 'clunk' on hyper abduction of shoulder. Further radiographic evaluation of right scapular region revealed solitary osteochondroma of ventral surface of right scapula in first case whereas MRI revealed hemangioma of subscapular muscles in second case. Hemangioma was initially treated by weekly injecting sclerosing agent (Inj. Polidocanol) locally for 4 weeks. Both lesions were later treated by excision and subsequent follow up revealed disappearance of pain and winging of scapula. CONCLUSION: Winging of the scapula due to solitary osteochondroma and subscapular hemangioma of the scapula may present with an initial diagnostic difficulty but appropriate knowledge of literature and diagnostic acumen can give excellent results.
UNLABELLED: Winging of the scapula due to benign lesion of ventral surface of scapula is one of the rare cause and difficult to diagnose in first place. We present two unusual cases of pseudo winging of scapula due to benign lesions of scapula. First case was of 23 year old male with solitary osteochondroma of ventral surface of scapula. Second was 38 year old female with hemangioma involving subscapular muscles. Both the patients presented to us with dull aching pain over right scapular and shoulder region of 6 months duration with gradually increasing pseudo-winging of scapula. On examination there was mild tenderness over superomedial border of scapula with scapular snapping(5) or 'clunk' on hyper abduction of shoulder. Further radiographic evaluation of right scapular region revealed solitary osteochondroma of ventral surface of right scapula in first case whereas MRI revealed hemangioma of subscapular muscles in second case. Hemangioma was initially treated by weekly injecting sclerosing agent (Inj. Polidocanol) locally for 4 weeks. Both lesions were later treated by excision and subsequent follow up revealed disappearance of pain and winging of scapula. CONCLUSION: Winging of the scapula due to solitary osteochondroma and subscapular hemangioma of the scapula may present with an initial diagnostic difficulty but appropriate knowledge of literature and diagnostic acumen can give excellent results.