Woodward operation for congenital elevation of scapula. A, Elevation of scapula, extensive origin of trapezius, and skin incision are shown. B, Skin has been incised in midline. Origins of trapezius and of rhomboideus major and minor have been freed from spinous processes, and these muscles have been retracted laterally. Levator scapulae, any omovertebral bone, and any deformed superior angle of scapula are to be excised. C, Remaining narrow attachment of trapezius superiorly has been divided at level of C4. Scapula and attached sheet of muscles have been displaced inferiorly, and aponeuroses of trapezius and rhomboids have been reattached to spinous processes at more inferior level. A redundant fold of trapezius aponeurosis is formed inferiorly. Fold of trapezius aponeurosis has been incised, and resultant free edges have been overlapped and sutured in place. Free superior edge of trapezius also has been sutured.(Modified from Woodward JW: Congenital elevation of the scapula: correction by release and transplantation of muscle origins: a preliminary report, J Bone Joint Surg 43A:219, 1961.) SEE TECHNIQUE 31.1.