The effect of cyriax soft tissue release and myofascial release on pain pressure threshold, flexibility and muscle length in idiopathic adhesive capsulitis- a comparative study

Background: Adhesive capsulitis has been reported to affect 2-5% of the general population and up to 11-30% of subjects with diabetes and thyroid disease. Both myofascial release technique and cyriax soft tissue release technique are effective in patients with adhesive capsulitis. Aims and objective were to assess the effect of cyriax soft tissue release and myofascial release on pain pressure threshold, flexibility and muscle length in idiopathic adhesive capsulitis - a comparative study. Methods: In the present comparative study, total forty-eight (48) patients with Adhesive capsulitis with age between 40-60 years were included. They were randomly divided into two groups: group-A (n=24) and group-B (n=24). Both group received conventional treatment, in addition group-A received myofascial release technique and group-B received cyriax soft tissue release technique. Patients were evaluated pre-intervention (0 week) and post-intervention (4 week) for pressure pain threshold (by means of algometer), for muscle length (by means of measure tape) and for shoulder flexibility (by means of measure tape). Results: Result showed that there was statistically significant difference between MFR group and cyriax group in mean difference of PPT, muscle length and Apley’s test during 4-week intervention period (p<0.05). Conclusions: Cyriax along with conventional treatment is more effective for improving pressure pain threshold, improving muscle length and improving the flexibility of shoulder than myofascial release technique along with conventional treatment in patients with adhesive capsulitis.

Correlation Between Upper Trapezius, Levator Scapulae And Pectoralis Minor Muscle Length In Frozen Shoulder – A Cross-Sectional Observational Study

Background: Frozen shoulder is defined as the painful and disabling condition with unknown etiology. It has a limited shoulder range of motion due to decreased capsular flexibility and altered muscle function. Assessment on the frozen shoulder is needed, and it is vital to know the alteration in scapular muscles in the shoulder range of motion during arm elevation. The intention of conducting this study is to reach conclusions of tightness of a muscle in the upper trapezius, pectoralis minor muscle, and frozen shoulder levator scapulae showing limited ranges. Methods: In this cross-sectional observational study, 50 subjects of age 30 and above were assessed for muscle length in the frozen shoulder and unaffected shoulder. Subjects with shoulder pain with frozen shoulder stage 2 and above are allotted into the affected shoulder, and unaffected shoulder; both groups were assessed. The following parameters were measured: ROM of the shoulder, SPADI ratings, short pectoral thickness, levator scapulae length, and upper trapezium muscle length. Results: Decreased shoulder flexion, extension, abduction, and limited rotations were the problems associated with frozen shoulder. Pearson correlation coefficient for PMI and LSI shows Positive Correlation r = 40.6% on the affected side. Pearson correlation for PMI and UTI shows Positive Correlation r = 13.4%. Pearson Correlation for LSI and UTI shows Positive Correlation r= 28.1% on the affected side. Conclusion: There was a correlation between upper trapezius, levator scapulae, and pectoralis minor muscle length. Most of the affected side shoulder showed the tightness in the pectoralis minor muscle.

The levator scapulae muscle – morphological variations

Introduction: Anatomical variations of the levator scapulae are important and therefore clinically relevant. Thelevator scapulae are now believed to be the leading cause of discomfort in patients with chronic tension-typeneck and shoulder pain and a link between anatomical variants of the muscle and increased risk of developingpain has been speculated. The results obtained were compared with previous studies.Materials and methods: The study was conducted on 32 levator scapulae muscle of 16 cadavers over a period of3 years. The dissection of head and neck was done carefully to preserve all minute details, observing themorphological variations of the muscle in the department of Anatomy, Viswabharathi Medical College,Penchikalapadu, and Kurnool.Results: Total 32 levator scapulae muscles were used. All the sample values were measured to 2 decimal places.The average age of the cadavers in the sample was 82.87 years. The oldest cadaver in the sample was 100 yearsold and the youngest 61 years. Measurements of the proximal and distal attachments and the total length of themuscles were taken. Between 3 and 6 muscle slips were reported at the proximal attachment. Differences werealso observed between sides. The first report of a levator scapula muscle with 6 muscle slips at the proximalattachment was described.Conclusion: In our study we report 3 to 6 muscle slips in our study group. In order to improve the reliability of theresults of this study a greater number of specimens should be used, either through further dissection or inclusionof results from imaging techniques. The findings of the study should still be of great interest to cliniciansassociated with this area of the body. By doing this the speculated link between muscle variation and clinicaloutcomes such as myofascial pain syndrome could be investigated further. The potential applications andexpansions of this study are exciting and may begin to uncover the unexplained mechanisms behind myofascialpain syndrome.

Comparison of Two Different Photobiostimulation on Pain and Functional Ability in Patients with Myofascial Trigger Points (Levator Scapulae Muscle)

Objective: Myofascial trigger point (MTP) is a characteristic of myofascial pain syndrome (MPS) which is the most common muscle pain disorder. Myofascial pain syndrome is pain arising from one or more trigger points (TP) which are hyperirritable spots in skeletal muscle that are associated with a hypersensitive palpable nodule in taut bands. Aim of the present study is to compare the effectiveness of 780 nm Ga-Al-As LLLT and 904 nm Gallium Arsenide laser therapy on a trigger point in the levator scapulae muscle. Methods: Total of 50 subjects were selected on the basis of the inclusion and exclusion criteria and were recruited randomly to the 3 groups (A, B, C). Group A (experimental group) received 780 nm low-level laser therapy and stretching exercises. Group B (experimental group) received 904 nm low-level laser therapy and stretching exercises. Group C (controlled group) received only stretching exercises. Results: No significant difference in VAS and NDI from 0 to 2nd week in all the 3 groups i.e. Group A, B, and C indicating that rate of improvement in all the 3 groups was the same. Conclusion: Present study does not conclude that stretching is an effective intervention as a significant difference in the rate of improvement was found in the group which received Ga-As laser with stretching. Since the duration over which accumulation of rate of improvement took place was small thus it could not produce any significant difference overall at the end. Hence Ga-As LLLT can be used in adjunct with stretching exercises as cost-effective conservative treatment of MTP in levator scapulae muscle.

Variaciones musculares del cuello: fascículo accesorio del músculo elevador de la escápula / Muscular variations of the neck: accessory fascicle of the levator scapulae muscle

El músculo elevador de la escápula ha sido descrito como un músculo plano conformado por fascículos que se originan en los procesos transversos de C1 a C4. Sin embargo, se han descrito variaciones anatómicas de este músculo, que incluyen a sus fascículos vertebrales, orígenes en la cabeza o terminando en músculos vecinos a su inserción usual. Durante la disección rutinaria de un cadáver formolizado de un individuo masculino, chileno, de 75 años de edad, observamos en su lado izquierdo, un fascículo accesorio del músculo elevador de la escápula, el cual tenía su origen en la vértebra C5 y terminaba en la fascia del músculo serrato anterior. En ambos lados el músculo elevador de la escápula provino de las vértebras C1-C4. El fascículo accesorio se originó desde el tubérculo posterior del proceso transverso de la quinta vértebra cervical, conformando un músculo que se dirigió medial e inferiormente, paralelo al músculo elevador de la escápula, para insertarse en la fascia del músculo serrato anterior, inferior a la inserción del músculo mencionado, en el ángulo superior de la escápula. Es importante comunicar las variaciones anatómicas para complementar el conocimiento de las mismas, las que pueden explicar ciertos trastornos físicos y dolorosos en la región cervico-escapular.

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 C1­C4 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.

An unusual anatomical variation of the levator scapulae muscle / Una variación anatómica inusual del músculo elevador de la escápula

Clinical and surgical importance of the levator scapulae muscle (LSM) requires a better knowledge of its anatomic variation mainly because of the possibility of new findings related to the embryologic development. This article reports a case of a left-sided LSM with atypical attachments in a 58-year-old preserved Caucasian female body. The muscle presented a bifurcation at its midpoint downward path. Its medial band attached to the anterior aspect of the left rhomboideus major muscle while its left band was fixed in the superior angle of the scapula after releasing a muscle expansion to the serratus anterior muscle. The morphometric analysis revealed LSM maximal width of 3.6 cm, bifurcation point located 6.6 cm apart from the C1 vertebral attachment; medial band legth of 5.7 cm and lateral band width of 2.1cm. Regarding anatomic variations of the LSM, they may remain unnoticed or perhaps contribute for pathologic conditions of the neck and the back...

Debido a la importancia clínica y quirúrgica del músculo elevador de la escápula, se hace necesario conocer mejor sus variaciones, principalmente la posibilidad de encontrar hallazgos relacionados con su desarrollo embriológico. Se presenta el caso de un músculo elevador de la escápula del lado izquierdo encontrado en un cadáver de sexo femenino de 58 años. El músculo elevador de la escáula presentaba una bifurcación en el punto medio en su trayectoria más baja. La banda medial se fijaba en la parte anterior del músculo romboides mayor izquierdo; mientras que su banda lateral se fijaba en el ángulo superior de la escápula después de enviar una expansión hasta el músculo serrato anterior. El análisis morfométrico reveló un ancho máximo de 3,6 cm, punto de bifurcación situado 6,6 cm bajo la inserción vertebral C1; longitudes de la banda medial 5,7 cm y lateral de 2,1cm. Las variaciones anatómicas del músculo elevador de la escápula pueden pasar inadvertidas, pero también pueden contribuir con algunas condiciones patológicas del cuello y espalda...