Levator scapulae syndrome: an anatomic-clinical study.
ABSTRACT Twenty-two patients, all young females, presenting with a common clinical picture of pain over the upper medial angle of the scapula were studied. The dominant shoulder was the most commonly involved (82%). Pain radiated to the neck and shoulder, but rarely to the arm. Movements that stretched the levator scapulae on the affected side aggravated symptoms. Radiographs and bone scans of the shoulders and cervical spine were negative. Increased heat emission from the upper medial angle of the affected shoulder was found on thermography in more than 60% of the patients. Anatomic dissections of 30 cadaveric shoulders showed great variability in the insertion of the levator. A bursa was found between the scapula, the serratus, and the levator in more than 50% of the shoulders. This study suggests that this syndrome, leading to bursitis and pain, may be caused by anatomic variations of the insertion of the levator scapulae and origin of the serratus anterior. This may explain the constant trigger point and crepitation as well as the increased heat emission found on thermography. Local steroid injections relieved symptoms partially in 75% of those patients who underwent treatment.
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ABSTRACT: OBJECTIVE: To determine the contribution of dorsal scapular nerve (DSN) entrapment to interscapular pain. DESIGN: A descriptive research study. SETTING: Institutional practice. PARTICIPANTS: and methods: Fifty-five consecutive patients with unilateral interscapular pain were evaluated and were compared to 30 healthy controls. Patients were assessed clinically and electrophysiologically. Electrophysiological evaluation included motor conduction study of the DSN and electromyography of rhomboid major and levator scapula. Electrophysiological work up for exclusion of other disorders was carried out. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Not applicable. RESULTS: Unilateral interscapular pain was reported by all patients. Etiologies of pain varied among the studied patients. Scapular winging was observed in 9 patients (16.4%). Electrophysiological abnormalities consistent with DSN lesion were detected in 29 patients (52.7%). Twenty-five patients demonstrated electromyographic abnormalities recorded from rhomboid major and levator scapula. Prolonged latency of the compound 19 muscle action potential was found in 4 patients on the affected side. CONCLUSION: DSN entrapment is a frequent underlying causative factor for interscapular pain. Nerve entrapment, at scalenus medius, or its stretch during overhead activities induces nerve trunk pain secondary to sensitization of nociceptors within the nerve sheath. Myofacial pain syndrome of the rhomboids with entrapment of the nerve by taught bands is another source of pain. Lastly, the development of scapular winging may induce stretch of the cutaneous medial branches of the dorsal primary rami of thoracic spinal nerves. This would refer pain to the interscapular region. Awareness of possible DSN entrapment in cases of upper dorsalgia is highly indicated.Archives of physical medicine and rehabilitation 12/2012; · 2.18 Impact Factor
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ABSTRACT: Die Infrarotthermographie kann in der Rheumatologie und bei Erkrankungen des peripheren Nervensystems als nicht-invasive, bildgebende Methode von Nutzen sein. Die auf der Erfassung der Infrarotstrahlung basierende Temperaturmessung kann zur iagnosestützung, aber auch als Ergebnisparameter zur Überprüfung therapeutischer Maßnahmen verwendet werden. Die Infrarotthermographie ist bei der Arthritis der Knie, Sprung und Handgelenke, beim komplexen regionalen Schmerzsyndrom, beim Thoracic Outlet Syndrom und bei der Epikondylitis sowohl als diagnostische Methode als auch Ergebnisparameter voll akzeptiert. Diese bildgebende Methode kann auch bei Patienten mit Radikulopathie, Kompressionssyndromen peripherer Nerven, bei Erkrankungen der Fingergelenke, Muskelverletzungen, Fibromyalgie und M. Paget die Diagnosestellung unterstützen. Zur Diagnose von Schultererkrankungen und der medialen Epikondylitis sowie für das Monitoring der Fibromyalgie ist die Thermographie nicht geeignet. Für valide und verlässliche Ergebnisse muss die Thermographie in jedem Fall in standardisierter Weise durchgeführt werden. Summary Infrared (IR)- thermography may be applied as non invasive, imaging procedure in rheumatology and in diseases of the peripheral nerve system. Temperature measurements based on infrared radiation can be used as a technique to assist diagnosis or as an outcome measure to evaluate treatment effects. IR-Imaging is fully accepted as a diagnostic procedure and as outcome measure in patients suffering from arthritis in knee, wrist or ankle joints, complex regional pain syndrome, thoracic outlet syndrome and epicondylitis. The technique may be also useful to assist diagnosis in patients suffering from radiculopathy.entrapment syndrome of peripheral nerves, arthritis of small finger joints, muscle injuries, fibromyalgia and Paget´s disease. IR-Imaging is of little to no value in diagnosis of shoulder disorders or medial epicondylitis and should not be used for monitoring in fibromyalgia patients. However, IR-Imaging must be performed in a standardised way to achieve valid and reliable results.ÖZPMR: Österreichische Zeitschrift für Physikalische Medzin & Rehabilitation. 01/2010; 20(1):7-24.
- 10/2012: pages 25.1-25.14; , ISBN: 978-1-4398-7249-9