Sprengel's shoulder

An otherwise healthy 5-year-old boy was referred for shoulder asymmetry and limited range of motion on the left. According to the boy’s mother, he hardly ever complained about it, and was a good swimmer. Physical examination revealed left scapular elevation; glenohumeral function was good, apart from forward elevation (150 degrees). Frontal chest radiograph (Fig. A) and left shoulder plain film (Fig. B) showed elevation of the left scapula with medial rotation of its inferior angle, pointing towards the spine (arrow). This was connected to the posterior elements of the sixth cervical vertebra by a bony bar ( arrowheads), which was better appreciated on a lateral radiograph of the cervical spine (Fig. C). The right shoulder girdle was normal (Fig. A, dotted arrow). No other abnormality was seen.