chest; there is little
or no impairment of function.

#Displacements of the Scapula.#--_Congenital Elevation of the Scapula_
(Sprengel's shoulder, 1891).--This abnormality is rare, and is not
usually recognised till several years after birth. In one variety
there is a bridge of bone or fibrous tissue connecting the superior
angle of the scapula with the spinous process of one of the cervical
vertebrae, and there may be a false joint at one end of the bridge
permitting a certain amount of movement of the scapula. Associated
abnormalities in the vertebrae and in the ribs are shown in skiagrams.
In the more common type, the scapula seems to be held in its elevated
position by shortening of the muscles attached to its body, and it is
often rotated so that its lower angle is close to the spine and its
axillary border nearly horizontal, or the axillary border may lie in
close to the ribs, and the vertebral border project from the chest
wall. The shoulder is generally higher and farther forward on the
affected side, and there is a moderate degree of scoliosis. There is a
want of purchase in the movements of the shoulder and upper arm.

[Illustration: FIG. 164.--Congenital elevation of Left Scapula in a
girl: also shows hairy mole over Sacrum.

(Mr. D. M. Greig's case.)]

When the deformity is bilateral, which is rare, the neck is short and
thick, the chin lies close to the sternum, and the arms can scarcely
be raised to the horizontal.

Gymnastic exercises and the wearing of a brace to hold the shoulders
back and down may be followed by some improvement, but, as a rule, it
is necessary to mobilise the scapula by operation. An X-ray photograph
should first be taken, because, when the scapula is connected with the
spine by a bridge of bone, this must be resected. The muscles attached
to the vertebral border and spine of the scapula are divided, the
bone is drawn down to its proper position, and the parts are fixed by
plaster bandages.

_Winged Scapula._--This condition consists in a marked displacement
backwards of the lower angle and vertebral border of the scapula, when
the patient attempts to raise the arm from the side (Fig. 165). Under
normal conditions, in making this movement the serratus and rhomboid
muscles pull forward the vertebral border and inferior angle of the
scapula, and so fix the bone firmly against the chest wall. When these
muscles are paralysed, as a result of anterior poliomyelitis,
neuritis, or in