Medical Imaging Analysis Report

I. Radiological Findings

This patient is a 7-year-old female, presenting with restricted mobility of the left shoulder joint and upper limb. On examination, there is visible asymmetry and deformity of the left shoulder, accompanied by limited neck movement on the same side. Based on the provided X-ray, CT, and MRI images, the main radiological features are as follows:

• An abnormal bony/fibrous connection (indicated by the yellow arrow) can be seen between the cervical vertebrae and the medial border of the left scapula. CT 3D reconstruction clearly illustrates this “band-like” structure that extends from the lower cervical spine (approximately C5-C6) to the medial border of the scapula.
• The left scapula is positioned higher, shows a rotated, slightly smaller, and triangular shape consistent with Sprengel’s deformity.
• A “winged” appearance of the shoulder is noted, and there are signs of underdevelopment of the shoulder girdle musculature.
• No obvious segmental defects of the vertebral bodies were observed, but congenital variations in the relevant structures are visible.
• On MRI axial images, the soft tissues around the scapula appear relatively atrophic, corresponding to the abnormal scapular position.

II. Potential Diagnoses

Based on the above radiological findings and the patient’s clinical characteristics, the following potential diagnoses may be considered:

1. Sprengel’s Deformity (Congenital High Scapula) with Omovertebral Bone
   This condition is a rare congenital deformity in children, characterized by an elevated, smaller scapula and restricted shoulder movement. Approximately 30–50% of Sprengel’s deformities are associated with a fibrous or bony connection from the cervical or upper thoracic vertebrae to the medial border of the scapula (known as the omovertebral bone). The images in this case show these features, which is highly indicative of this diagnosis.
2. Other Congenital Shoulder Girdle Deformities
   Such as abnormal development of the shoulder or clavicle, although most do not exhibit the distinct bony connection between the cervical vertebrae and scapula. Usually, only underdevelopment of the clavicle or acromion is observed, which differs from the presentation in this case.

III. Final Diagnosis

Considering the patient’s age, symptoms (restricted mobility and abnormal appearance of the left shoulder), radiological findings (elevated and rotated scapula, abnormal bony/fibrous connection from the cervical spine to the medial border of the scapula), and typical forms reported in the literature, the most likely diagnosis is:

“Sprengel’s Deformity with Omovertebral Bone”

This diagnosis adequately explains the patient’s restricted shoulder movement and deformity. Mild anemia noted in blood tests does not affect this skeletal diagnosis.

IV. Treatment and Rehabilitation Plan

For pediatric patients with Sprengel’s deformity combined with omovertebral bone, the treatment goals include improving shoulder joint function, reducing the deformity, and preventing further muscle and skeletal developmental abnormalities. The main treatment strategies are as follows:

1. Conservative Treatment
• If the child’s shoulder function is acceptable, with no significant pain or neurological symptoms, conservative management can be considered first.
• This includes physical therapy and exercises to strengthen the shoulder joint and shoulder girdle muscles (such as passive stretching, active range-of-motion exercises, scapular stabilization training, etc.).
• Regular monitoring of skeletal growth and shoulder range of motion is advised to assess the need for further surgical intervention.
2. Surgical Treatment
• If marked limitation in shoulder abduction (less than 110–120°) or significant impact on appearance and daily function is present, surgery is recommended between ages 3–8 to achieve better postoperative function and cosmesis.
• Surgery may include removal of the omovertebral bone and related soft tissue release, or even repositioning of the scapula.
• Comprehensive preoperative imaging (especially CT 3D reconstruction and MRI) is crucial in planning the surgical approach.

Rehabilitation and Exercise Prescription

Regardless of whether conservative or surgical treatment is chosen, rehabilitation therapy is essential. It should follow the FITT–VP principle (Frequency, Intensity, Time, Type, Progression, Volume, and Individualization) to incorporate a progressive and safe regimen, for example:

• Training Frequency (F): 3–5 times a week.
• Training Intensity (I): Start with low-intensity, short-duration activities, such as active/passive range-of-motion exercises for the shoulder joint, each lasting 5–10 minutes. Intensity can be gradually increased as range of motion and muscle strength improve.
• Training Time (T): Based on the child’s tolerance, 15–20 minutes per session is recommended, divided into multiple sets. Postoperative rehabilitation should follow a gradual increase under medical supervision.
• Training Type (T):
  • Exercises to improve shoulder flexion, extension, abduction, and internal/external rotation range of motion.
  • Strengthening exercises (isometric and isotonic) for the shoulder girdle muscles (trapezius, middle and lower rhomboids, etc.) to enhance scapular stability.
  • Elastic band training may be introduced cautiously, avoiding painful ranges.
• Progression (P) and Volume (V): Gradually increase the number and difficulty of exercises based on the child’s response, moving from passive stretching to active resistance training while avoiding excessive strain that could lead to soft tissue injury.
• Individualization (I): If the child has other underlying conditions, such as anemia or reduced cardiopulmonary function, training volume and intensity should be appropriately adjusted under medical supervision.

In summary, rehabilitation should be carried out under the guidance of professional rehabilitation or orthopedic specialists to ensure functional improvements without causing secondary injury.

Disclaimer: This report provides a reference-based medical analysis derived from existing information and does not replace in-person consultation or professional face-to-face medical evaluation and treatment. A specific treatment plan should be determined based on actual clinical conditions under the guidance of a qualified physician.