The Woodward procedure was first described in 1961 and is stated more frequently in the literature than any other surgical procedure for Sprengel deformity [14]. In the Woodward procedure, the trapezius, rhomboid and levator scapulae muscles are detached from their origin along the spinous processes. The scapula is lowered and derotated with reattachment of the muscle to the spinous processes in a more inferior position. The muscles attached on the superior and medial borders of the scapula are reflected extraperiosteally. The procedure is accompanied with excision of any omovertebral connection present and a clavicle osteotomy if required.

Walstra et al. [15] reviewed seven patients (eight shoulders) who underwent the Woodward procedure and reported the long-term results at three different time intervals. The mean age at the time of surgery was 8.75 years (range: 3.4–15.1 years). At a mean follow-up of 13.5 years (range: 8–26 years), the mean shoulder abduction improved by 56° (range: 95°–175°). Cosmesis improved by at least one grade on the Cavendish scale in all patients. Other outcome measures such as the Constant, the DASH (Disabilities of the Arm, Shoulder and Hand) scores and simple shoulder test were also recorded. No long-term complications occurred in this case series. The authors concluded that the Woodward procedure is effective in improving shoulder function and cosmetic appearance in patients with Sprengel deformity in the long-term.

Similarly, Siu et al. [16] reviewed eight patients (nine shoulders) who underwent the Woodward procedure. At a mean follow-up of 113 months (range: 78–140 months), the mean shoulder abduction was 157° (range: 125°–180°). Cosmesis improved significantly on the Cavendish scale and all patients were satisfied with the results. The Constant score was also recorded for the patients. No complications were noted in this case series.

Other case series in the literature report the results of the Woodward procedure with satisfactory improvement in the mean shoulder abduction and cosmetic appearance according to the Cavendish grade [1, 6].

The Green procedure is one of the classic surgical procedures for the treatment of Sprengel deformity [18]. In the Green procedure, the muscles on the medial border of the scapula are detached from their insertions. The trapezius muscle is elevated extraperiosteally and reflected medially. The underlying medial and superior scapular musculature (latissimus dorsi, serratus anterior, levator scapulae, supraspinatus and rhomboids) are resected extraperiosteally. The supraspinatus fossa is excised to avoid damage to the neurovascular bundle. The omovertebral connection when present is also excised. The scapula is freed and mobilized distally to the appropriate level. Once the scapula is in the desired position, the muscle insertions are re-attached to the scapula lengthening each muscle as required. In the Green procedure, the scapula is both lowered and rotated. Muscle insertion is modified distally rather than proximally which provides better biomechanical outcome [19].