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: A descriptive study of the anatomical characteristics of the upper serratus anterior. To delineate the upper serratus anterior with comparison to classical descriptions of the anatomy of the muscle as a whole. Although the serratus anterior has a major role in scapulothoracic stability, description of the separate function and anatomy of the upper, middle, and lower portions of the muscle has been limited. Bilateral anatomical dissection of 8 cadavers (3 female and 5 male) exposed 13 serratus anterior and surrounding structures for review. The number of serrations, attachment sites, length, and girth of the upper serratus anterior were measured. The upper serratus anterior presented with dual serrations and single serrations in 7 (54%) and 6 (46%) of 13 observations, respectively. Attachments to both first and second ribs were noted in 6 (46%) of the 13 observations. The remaining proximal attachments were to the second rib only, the first rib only, and dual attachments to the second and third ribs. In all cases, cranial attachments were to the superior scapular angle blending with the levator scapulae attachment. Length ranged from 4.8 to 9.0 cm (mean +/- SD, 6.9 +/- 1.2 cm). The girth ranged from 3.0 to 8.5 cm (mean +/- SD, 6.1 +/- 1.5 cm). One or more branches of the long thoracic nerve were observed to consistently innervate the upper serratus anterior fibers. The upper serratus anterior demonstrated wide variation in anatomy and was noted to be distinct in appearance and peripheral innervation from the middle and lower serratus anterior.Journal of Orthopaedic and Sports Physical Therapy 09/2003; 33(8):449-54. · 2.38 Impact Factor
- Medical Infrared Imaging. Principles and Practices, Edited by Mary Diakides, Joseph D Bronzino, Donald R Peterson, 10/2012: chapter 25: pages 25.1-25.14; CRC Press, Taylor & Francis Group., ISBN: 978-1-4398-7249-9
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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