Reviving a Skewed Dyskinetic Scapula Secondary to Ventral Exostosis: A Case Report

Exostosis or osteochondroma of bone rarely arises in the scapula, and when located in the ventral aspect of the scapula, it disrupts the scapulothoracic biomechanics. Another concern is that, unlike the involvement of other sites, the morphology of the cartilage cap involved here appears distorted due to constant friction over the ribs, making the assessment of malignancy changes difficult through routine investigations. We report the case of a 23-year-old man who presented with a mispositioned left scapula and dyskinetic scapulothoracic movement that disrupted overhead activities. Magnetic resonance imaging (MRI) showed a 5 × 4 cm osteochondroma in the ventral surface of the scapula, with distorted and irregular cartilage cap, risking features of sarcomatous changes. The mass excised through an extensive periscapular approach showed mature osteochondroma without sarcomatous changes despite cartilage irregularity. The scapulothoracic rhythm was restored without any surgical site morbidity. This case study highlights the spectrum of symptomology produced by ventral surface scapular osteochondroma and the surgical methods to excise the osteochondroma to restore scapulothoracic rhythm. We reiterate that excision biopsy and histopathological examination of the distorted cartilage cap play an important role in the management of ventral surface scapular osteochondroma, along with reviving the normal scapulothoracic movement.