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Sprengel deformity (SD), undescended scapula or high scapula is the most common congenital abnormality of the shoulder girdle. The aim of this article is to review the literature for updates on the surgical management of SD. The etiological theories of SD remain to be based on a developmental arrest of the intrauterine normal descent of the scapula. The deformity often coexists with other syndromes and medical conditions including Klippel-Feil syndrome, scoliosis, and rib abnormalities. The imaging evaluation is based on chest X-ray, CT with 3-D reconstruction and MRI to determine the deformity and its association with omovertebral bone. The plan for treatment is judged by the Cavendish classification of clinical cosmetic appearance, as well as shoulder functional impairment. Mild cases need no surgical intervention, however, there are several surgical procedures preserved for moderate to severe cases with near similar postoperative outcomes. The commonly performed procedures include Green's and Woodward procedures with further modifications to enhance the early mobilization and to reduce the associated brachial plexus injury. The use of minimally invasive techniques for SD is limited but it may take its place in the future.
