Recurrent Ventral Scapular Osteochondroma Presenting with Pseudo-winging in an Adolescent: A Case Report and Follow-up of a Previously Published Case.

Introduction: Osteochondroma is the most common benign bone tumor, but involvement of the scapula is uncommon. Lesions arising from the ventral surface of the scapula may remain clinically occult until they produce pain, crepitus, snapping, or static scapular pseudo-winging. Recurrence after surgical excision is rare and is generally related to residual cartilage cap or incomplete resection, particularly in skeletally immature patients. We report a recurrent ventral scapular osteochondroma in an adolescent previously treated for pseudo-winging, emphasizing diagnostic vigilance and complete excision. Case Report: A male adolescent previously underwent excision of a symptomatic ventral osteochondroma of the left scapula at 11 years of age. The index episode had presented as painful static scapular pseudo-winging with normal neurovascular examination and imaging demonstrating an osteochondroma arising from the ventral inferior scapular region. After an initially favorable outcome, he re-presented at 14 years of age with recurrent pain and deformity of the scapular region. Clinical examination again demonstrated static pseudo-winging rather than dynamic neuromuscular winging. Imaging confirmed recurrence of a ventral scapular osteochondroma. Complete surgical excision was performed through a posterior parascapular approach. The post-operative course was uneventful, with resolution of pain and restoration of normal scapular contour and scapulothoracic motion. Conclusion: Recurrent ventral scapular osteochondroma is rare but should be considered when pseudo-winging reappears after previous excision. This case underlines the importance of distinguishing static pseudo-winging from true dynamic scapular winging, obtaining appropriate cross-sectional imaging, and achieving complete resection at the base of the lesion to minimize recurrence risk.