Osteochondroma of the ventral scapula causing scapular static winging and secondary rib erosion

Abstract

An osteochondroma is a benign tumour of bone, which is located mainly in the metaphysis of long bones. It does not commonly occur in the scapula. On the ventral surface of the scapula, it can produce various manifestations due to mass effect. We are reporting a rare presentation of an osteochondroma at superomedial angle of ventral aspect of the scapula in a 31-year-old female. She initially presented with a painful shoulder and radiating pain in the arm. The scapular mass produced pseudo winging of the scapula and erosion of the ribs on the same side. The patient was successfully managed by open excision, using a parascapular approach. The patient had no evidence of recurrence at one year's follow-up and is currently able to carry on her day to day activities without any discomfort.

Keywords: Exostoses bursata; Parascapular approach; Snapping scapula.

[Table/Fig-1]:

a) Pre operative Radiograph of the right shoulder, antero posterior view, showing bony mass arising from the supero medial region of the scapula. b) Pre operative Standard ‘Y ‘view or lateral view of the scapula provides better delineation of the tumour mass than the AP view

[Table/Fig-2]:

Pre operative MRI defining the boundaries of the tumour mass

[Table/Fig-3]:

a) Intra operative picture showing use of para scapular approach to reach the tumour mass. b), c), d) & e) Intra opeaitive images of resected tumour. f) & g) Intra operative images following resection of tumour, showing closure of the incision site

[Table/Fig-4]:

Intra operative images showing key steps of surgery (en bloc resection of the tumour)

[Table/Fig-5]:

a) Post Operative radiograph of the right shoulder (AP view) taken following tumour resection. b) Post Operative radiograph of the right shoulder (Standard Y view) taken following tumour resection. c) Post operative clinical image of the patient showing incision scar (Para scapular incision) extending along the medial and superior border of the right scapula

[Table/Fig-6]:

Follow up MRI scan images reveal no sigs suggestive of recurrence