Shoulder Elevation (Differential Diagnosis Congenital Muscular Torticollis)

Figure scha_14a_n.jpg: 10.5-year-old boy with minimal inclination of the head to the right; more distinct is a right-sided shoulder elevation and prominent right scapula in the view from behind. Figure scha_14b_n.jpg: Thorax x-ray of a 9.7-year-old girl with right-sided shoulder elevation, hypoplasia of the right thoracic cavity, and scoliosis of the upper thoracic spine. In addition, anomalies of the ribs and vertebra are visible. Figure scha_14a_n.jpg and scha_14b_n.jpg: Both patients are examples of Sprengel's deformity. This complex of malformations may have some characteristics of congenital muscular torticollis and has a relation to the Klippel-Feil syndrome. Klippel-Feil syndrome, in which vertebra of the cervical spine are joined and/or totally or partially absent, leads to torticollis, restriction of motion, and is an important differential diagnosis of congenital muscular torticollis.