Levator scapulae syndrome: an anatomic-clinical study.

Orthopaedic B Department, Ichilov Hospital, Sourasky Medical Center, Tel Aviv.
Bulletin (Hospital for Joint Diseases (New York, N.Y.)) 02/1993; 53(1):21-4.
Source: PubMed


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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    • "El músculo LE participa en un delicado equilibrio con músculos de la región en los movimientos escapulares y mantención de la postura de la columna vertebral. Según Menachem et al. (1993) variaciones al patrón común de origen o inserción podrían estar asociadas a dolor crónico en el miembro superior o en el hombro. "
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    ABSTRACT: The levator scapulae muscle has been described as a flat muscle composed by fascicles originating from the transverse processes of C1 through C4. However, anatomical variations of this muscle are described, including its vertebral fascicles arising in the head or ending in neighboring muscles to the usual insertion. During routine dissection of a formolized cadaver of a 75 year-old Chilean male individual, we observed on the left side, an accessory fascicle of levator scapulae muscle, which had its origin in the C5 vertebra and ended at the serratus anterior muscle fascia. On both sides of the levator scapulae muscle came from C1–C4 vertebrae. The accessory muscular fascicle originated from the posterior tubercle of the transverse process of the fifth cervical vertebra, which runs medially and downward, parallel to the levator escapulae, and inserted to the serratus anterior muscle fascia, inferior to the insertion of the mentioned muscle, in the superior angle of the scapula. It is important to communicate anatomical variations to complement the knowledge of them, which may explain certain painful conditions in the cervico-scapular region.
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    • "Pathological conditions such as muscle spasms or myofascial trigger points may become visible as regions of increased temperature (Fischer and Chang 1986). An anatomic study from Israel proposed that in the case of the levator scapulae muscle, the frequently seen hot spot on thermograms of the tender tendon insertion on the medial angle of the scapula could be caused by an inflamed bursae and not by a taut band of muscle fibres (Menachem et al 1993). Acute muscle injuries may also be recognized by areas of increased temperature (Schmitt and Guillot 1984) due to inflammation in the early state of trauma. "
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