100 STUDY OF A HUMAN SPIN A BIFIDA MONSTER WITH 



more bent at its distal end than the right. This shortening of the clavicle on the 

 side of the abnormal scapula is frequent in Sprengel's deformity. The hunched 

 position of the shoulders, so prominent externally in this case, may be seen to be 

 due to the defective cervical and upper thoracic vertebrae, which lie crumpled to 

 half their normal length under the scapulae, their normal relations to these bones 

 being quite changed. 



MUSCLES. 



The region of abnormal musculature corresponds, as would be supposed, to 

 the skeleton derangements. This is limited to the neighborhood of the axial 

 skeleton, where the affected muscles are both under and intermingled with an un- 

 usually large amount of fascia. On superficial dissection, the topmost layer of 

 muscles is well formed, except for the trapezius, which is represented similarly on 

 the two sides by thin strap-like bands of muscle, 3 by 1 cm. The fibers run parallel 

 with the long diameter, from the origin of the muscle, situated in fascia lying over 

 the everted and crumpled cervical and thoracic vertebral arches, to their insertion 

 on the acromial extremity of the clavicle, the acromion, and spine of the scapula. 

 Those fibers which insert on the scapular spine have become folded under the others, 

 owing to the contracted and lowered origin of all the fibers. A condition of the 

 trapezius similar to this has been noted in a case of total rachischisis given by 

 Krnnauner, in which case, also, lordosis and marked shortening of the spine were 

 the underlying skeletal conditions. As Kermauner says, the association of this 

 variety of muscle and bone defect is only natural, "for, with the marked shortening 

 of the trunk, there necessarily exists a reduction in the cranio-caudal diameter of 

 the muscles of this region." 



Upon further dissection, the condition of the underlying muscles was deter- 

 mined. The rhomboidei are represented bilaterally by very thin and short muscles, 

 only 3 mm. in length. They arise from the connective tissue over the fused and 

 everted arches of the thoracic vertebra?, and arc inserted in fascia along the inferior 

 vertebral borders of the scapula?. (In Le Double's work a reduction in the thick- 

 ness of these muscles is recorded.) The two levator scapula? are present. They 

 arise from the fused transverse processes of the upper cervical vertebra? and are 

 inserted in fascia along the superior vertebral margins of the scapula?. There is 

 no reduction in the size of either muscle. They are directed horizontally out 

 instead of slanting downwards as usual. This is due to the scapula? lying directly 

 over the cervical vertebra?. A cross-section of the left muscle at its origin is shown 

 in figure 21. Figure 18 shows the left scapula and the rhomboideus and levator 

 scapula? muscles inserted in fascia which forms a sheet between the irregular pro- 

 jections of the vertebral margins of the bone. The abnormal spicule of bone is 

 attached to the scapula at the median angle between the insertions of the levator 

 scapulae and the rhomboideus. 



On each side most of the dorsal muscles consist of an irregular longitudinal 

 bundle which extends along the sides of the vertebra? from sacrum to occiput and 

 which sends scattered projections on to the ribs. Under this bundle in the lumbar 

 region the quadratus lumborum and psoas muscles lie undisturbed. On the left 



