Difference of cervical and shoulder muscle performance and its correlation with pain and body mass index in patients with chronic neck pain / 中国康复理论与实践

ObjectiveTo test the inter-tester reliability and test-retest reliability of MyotonPRO for evaluating neck and shoulder muscle performance parameters in patients with unilateral chronic neck pain, observe the difference of muscle performance between the healthy and affected sides of patients with chronic neck pain, and analyze the factors that cause the imbalance of muscle performance in patients with chronic neck pain. MethodsFrom January to June, 2023, 32 patients with unilateral chronic neck pain in Guangdong Second Traditional Chinese Medicine Hospital were selected. Two testers used the same MyotonPRO equipment to measure the muscle tone, muscle hardness and muscle elasticity on both sides of the sternocleidomastoid muscle and the upper trapezius muscle in the relaxed position. Tester 1 repeated the measurement after an interval of 30 minutes, and Tester 2 was measured within the time interval between the two measurements of Tester 1. The intraclass correlation coefficient (ICC), standard error of mean (SEM) and minimum detectable change (MDC) were calculated simultaneously. The measurement results were plotted into Bland-Altman diagram and systematic bias analysis was performed. The difference in muscle characteristics between the affected side and the healthy side was compared. At the same time, the Visual Analogue Scale (VAS) score and body mass index (BMI) of the subjects were collected for correlation analysis. ResultsExcept the sternocleidomastoid muscle elasticity of the affected side (ICC = 0.697), the inter-tester reliability of all other parameters was high to very high (ICC = 0.719 to 0.952, SEM = 0.04 to 6.53, MDC = 0.12 to 18.11). The test-retest reliability of all parameters was high (ICC = 0.883 to 0.981, SEM = 0.03 to 5.72, MDC = 0.09 to 15.84). Bland-Altman plot analysis showed that the scatter distribution was consistent. The muscle tone, muscle hardness and muscle elasticity of sternocleidomastoid muscle and upper trapezius muscle were higher on the affected side than on the healthy side (t > 2.846, P < 0.05). The asymmetry index of tension, hardness and elasticity of upper trapezius muscle and sternocleidomastoid muscle was significantly positively correlated with VAS score and BMI (r > 0.385, P < 0.05). ConclusionMyotonPRO has good inter-tester reliability and retest reliability in evaluating the muscle performance of both sides of patients with chronic neck pain. The muscle tone, muscle hardness and muscle elasticity of sternocleidomastoid muscle and upper trapezius muscle on the affected side were higher than on the healthy side, and the difference of muscle performance was positively correlated with pain and BMI.

Demonstration of kinesio taping effect by ultrasonography in neck pain

SUMMARY OBJECTIVE: This study aimed to demonstrate the effectiveness of kinesio taping in nonspecific neck pain and to assess whether ultrasonographic parameters of the upper trapezius muscle can be used in the follow-up of kinesio taping treatment. METHODS: This was a single-blind, prospective, randomized controlled trial study involving 60 participants with nonspecific neck pain. The participants were randomly assigned into two groups. Kinesio taping group (n=29) received a 4-week neck exercise program, with kinesio taping applied twice a week for a total of four times, and the exercise group (n=28) received a 4-week neck exercise program. Participants were evaluated according to pain intensity (Visual Analog Scale), cervical range of motion, and disability (Neck Disability Index). Also, trigger point diameter and upper trapezius muscle thickness were evaluated with ultrasonography. Before and after the therapy, as well as the first month, all measures were taken by an investigator other than the practitioner of the treatment program. RESULTS: The results showed that the Visual Analog Scale and Neck Disability Index scores in the kinesio taping group were statistically significantly improved when compared to the exercise group (p<0.05). In addition, the thickness of the upper trapezius muscle and the diameter of the trapezius muscle trigger point were statistically significantly improved in the kinesio taping group compared to the exercise group (p<0.05). In the kinesio taping group, there was no statistical significance in cervical range of motion as compared to the exercise group. CONCLUSION: The combination of kinesio taping and exercise therapy was effective in reducing nonspecific neck pain and neck disability. Also, this study showed that ultrasonographic evaluation of the trapezius muscle could be used in the follow-up of kinesio taping therapy.

Comparison of the clinical outcome of defect reconstruction after oral cancer resection using forearm flap and trapezius myocutaneous flap pedicled with the transverse cervical artery / 中华整形外科杂志

Objective@#To compare and analyze the effects of forearm flap and superior trapezius myocutaneous flap in repairing oral cancer defects.@*Methods@#56 cases of defect repair after oral cancer radical surgery were treated with the forearm flap (29 cases) and superior trapezius myocutaneous flap (27 cases). The success rate, postoperative quality of life and postoperative recovery time of the two groups were compared. The t-test was used for statistical analysis.@*Results@#The success rate of forearm flap group was 96.6%(28/29) compared to 96.3%(26/27) in the trapezius myocutaneous flap group (P=0.920). The postoperative recovery time was (9.4±2.7) d (forearm flap group) and (9.3±2.6) d (trapezius myocutaneous flap group), respectively (P=0.489). The score of postoperative quality of life was 576.3±76.2 (forearm flap group) and 568.4±79.3 (trapezius myocutaneous flap group), respectively (P=0.471). There was no significant difference in all comparisons (P>0.05).@*Conclusions@#The free forearm flap and the superior trapezius myocutaneous flap pedicled with the transverse cervical artery can be used to repair the oral cancer, and satisfactory function and ideal clinical effect can be achieved. Both two kinds of flaps have high success rate and good clinical practical value. The latter has little influence on the donor site, and can be used as the first choice.

Pain intensity and cervical range of motion in women with myofascial pain treated with acupuncture and electroacupuncture: a double-blinded, randomized clinical trial

BACKGROUND: Acupuncture stimulates points on the body, influencing the perception of myofascial pain or altering physiologic functions. OBJECTIVE: The aim was to evaluate the effect of electroacupuncture (EAC) and acupuncture (AC) for myofascial pain of the upper trapezius and cervical range of motion, using SHAM acupuncture as control. METHOD: Sixty women presenting at least one trigger point at the upper trapezius and local or referred pain for more than six months were randomized into EAC, AC, and SHAM groups. Eight sessions were scheduled and a follow-up was conducted after 28 days. The Visual Analog Scale assessed the intensity of local and general pain. A fleximeter assessed cervical movements. Data were analyzed using paired t or Wilcoxon's tests, ANOVA or Friedman or Kruskal-Wallis tests and Pearson's correlation (α=0.05). RESULTS: There was reduction in general pain in the EAC and AC groups after eight sessions (P<0.001). A significant decrease in pain intensity occurred for the right trapezius in all groups and for the left trapezius in the EAC and AC groups. Intergroup comparisons showed improvement in general pain in the EAC and AC groups and in local pain intensity in the EAC group (P<0.05), which showed an increase in left rotation (P=0.049). The AC group showed increases in inclination (P=0.005) sustained until follow-up and rotation to the right (P=0.032). CONCLUSION : EAC and AC were effective in reducing the pain intensity compared with SHAM. EAC was better than AC for local pain relief. These treatments can assist in increasing cervical range of motion, albeit subtly. .

An anatomic study of the branch from cervical plexus into the accessory nerve / 中华显微外科杂志

Objective To identify whether the branches of cervical nerve roots joined into the accessory nerve trunk or not.Methods In 10 adult cadavers (7 males and 3 females, including 20 laterals of brachial plexus nerves), we observe source of cervical plexus branches to the accessory nerve anatomically.In 10 clinical cases of males with brachial plexus nerve injures, in the supraclavicular approach of brachial plexus exploration, the part of the supraclavicular cutaneous nerve for histological specimen were cut off;in the posterior approach, electrical stimulation of the trunk and branches of cervical plexus were performed to observed istaltrapezius muscle contraction.After accessory nerve transfer, the residual terminal accessory nerve and branch of cervical plexus were taked for histological specimens;and observed and judged of each nerve sample by acetylcholinesterase (AchE) immunohistochemical staining.Results In 10 of 20 lateral cases, cervical plexus communicating branches were derived from the fourth cervical nerve root.The intraoperative electrical stimulation of the accessory nerve trunk, 10 cases of distal trapezius muscle were significantly shrink;electrical stimulation of the cervical plexus branch, 2 cases after stimulation of the mild distal trapezius contraction, the remaining 8 cases without trapezius muscle contraction.10 cases of supraclavicular nerve staining for AchE were negative, 10 cases of accessory nerve terminal branches of AchE staining were mixed,10 cases of branch AchE cervical plexus to the accessory nerve staining were negative.Conclusion The branches of the fourth cervical nerve root constantly joins into the accessory nerve, participating in the trapezius muscle inner vation, the fibers of the branches are sensorial fibers.

Anatomical basis of the myofascial trigger points of the trapezius muscle / Bases anatómicas de los puntos de gatillo miofasciales del músculo trapecio

This study aimed to bring the trapezius muscle, knowledge of the locations where the accessory nerve branches enter the muscle belly to reach the motor endplates and find myofascial trigger points (MTPs). Although anatomoclinical correlations represent a major feature of MTP, no previous reports describing the distribution of the accessory nerve branches and their anatomical relationship with MTP are found in the literature. Both trapezius muscles from twelve adult cadavers were carefully dissected by the authors (anatomy professors and medical graduate students) to observe the exact point where the branches of the spinal accessory nerve entered the muscle belly. Dissection was performed through stratigraphic layers to preserve the motor innervation of the trapezius muscle, which is located deep in the muscle. Eight points were identified: In all cases, these locations corresponded to clinically described MTPs. The eight points where common in these twelve cadavers. This type of clinical correlation between spinal accessory nerve branching and MPT is useful to achieve a better understanding of the anatomical correlation of MTP and the physiopathology of these disorders and may provide a scientific basis for their treatment, providing useful additional information to therapists to achieve better diagnoses and improve therapeutic approaches.

El objetivo de este estudio fue correlacionar los sitios de entrada de los ramos del nervio accesorio en el músculo trapecio con placas motoras y los puntos de gatillo miofasciales. A pesar de las correlaciones anatomoclínicas se constituyeren en la principal característica de los puntos de gatillo, no hay informes en la literatura describiendo sobre la distribución de los ramos del nervio accesorio y su relación anatómica con los puntos de gatillo. Ambos músculos trapecio de doce cadáveres adultos fueron disecados por los autores (profesores de anatomía y estudiantes de postgrado en Medicina) para observar el punto exacto donde los ramos del nervio accesorio espinal penetraban en el vientre muscular. La disección se llevó a cabo respetando las capas estratigráficas para preservar la inervación del músculo ubicada profundamente a éste. Ocho puntos fueron identificados: En todos los casos correspondieron a la descripción clínica de los puntos gatillo miofasciales y eran comunes a todos los cadáveres. Esta correlación anatomoclínica entre la ramificación del nervio espinal accesorio y los puntos de gatillo miofascial es útil para una mejor comprensión de la fisiopatología de los puntos gatillo y puede proporcionar una base para un abordaje diagnóstico y terapéutico racional para estos trastornos.

Tratamento do estresse psicológico pela acupuntura, avaliado pela eletromiografia do músculo trapézio / Psychological stress treated by acupuncture and evaluated by trapezius muscle electromyography

JUSTIFICATIVA E OBJETIVOS: O estresse é considerado um fenômeno da vida moderna, que pode estar presente na vida de todas as pessoas, independente de idade, sexo, classe social ou profissão. Esta pesquisa foi realizada visando propor um tratamento alternativo para o estresse, pelo tratamento com acupuntura, avaliando eletromiograficamente o músculo trapézio, direito e esquerdo, de indivíduos portadores de estresse psicológico, uma semana antes das avaliações e após a acupuntura. MÉTODO: Para a realização deste estudo foram selecionados 10 voluntários, submetidos a um questionário que avaliou os sinais de estresse psicológico. O músculo estudado foi o trapézio por refletir melhor os sinais de estresse. Este foi estudado bilateralmente e a ação muscular foi captada no repouso e durante atividade isométrica, realizando-se movimentos de elevação e abaixamento. Em cada uma das 10 sessões de acupuntura foi realizado o agulhamento do ponto C7; pontos obtidos a partir de um pentagrama e pontuar pontos de confluência do meridiano distinto afetado no pentagrama. RESULTADOS: Os valores de RMS, quando comparados antes e após o tratamento com acupuntura, no repouso e em elevação da escápula foram estatisticamente significativos (p < 0,01). CONCLUSÃO: Os músculos apresentaram menor atividade eletromiográfica após o tratamento, mostrando assim a eficácia da acupuntura em indivíduos portadores de estresse psicológico.

BACKGROUND AND OBJECTIVES: Stress is a modern life phenomenon and may be present in the lives of anyone, regardless of age, gender, social class or profession. This research aimed at proposing an alternative treatment for stress with acupuncture, evaluating by electromyography right and left trapezius muscles of patients under psychological stress one week before evaluations and after acupuncture. METHOD: Participated in this study 10 volunteers submitted to a questionnaire to evaluate signs of psychological stress. The trapezius muscle was selected for best reflecting stress signs. The study was bilateral and muscle action was captured at rest and during isometric activities with raising and lowering movements. The following points were needled during each one of the 10 acupuncture sessions: C7 point, points obtained as from a pentagram and confluence points of the distinct meridian affected on the pentagram. RESULTS: RMS values, compared before and after acupuncture treatment, at rest and with elevation of the scapula were statistically significant (p < 0.01). CONCLUSION: Muscles have shown less electromyographic activity after treatment, thus showing the efficacy of acupuncture for patients under psychological stress.

Anatomic Confirmation of the Motor Fibers in the Cervical Nerves Innervating to the Trapezius Muscle / 체질인류학회지

This study aimed to confirm the presence of motor fibers in the cervical nerves distributing to the trapezius muscle. Thirteen cases were examined. Motor fibers were present in C3 in 7 of 9 cases (77.8%) and were absent in 2 of 9 cases (22.3%); the other 4 cases were damaged during dissection. C4 exhibited motor fibers in 9 of 10 cases (90.0%), whereas motor fibers were absent in 1 of 10 cases (10.0%); and 3 cases were damaged. The motor fibers in C3 were of medium size (57.1%; 4/7 cases), whereas those in C4 were large (44.4%; 4/9 cases). The average number of motor fibers in C3 and C4 were 114+/-112 and 219+/-167, respectively. These results show that C4 is more important in terms of the frequency and size of the cervical motor fibers distributing to the trapezius muscle.

Anatomic Confirmation of the Motor Fibers in the Cervical Nerves Innervating to the Trapezius Muscle / 체질인류학회지

This study aimed to confirm the presence of motor fibers in the cervical nerves distributing to the trapezius muscle. Thirteen cases were examined. Motor fibers were present in C3 in 7 of 9 cases (77.8%) and were absent in 2 of 9 cases (22.3%); the other 4 cases were damaged during dissection. C4 exhibited motor fibers in 9 of 10 cases (90.0%), whereas motor fibers were absent in 1 of 10 cases (10.0%); and 3 cases were damaged. The motor fibers in C3 were of medium size (57.1%; 4/7 cases), whereas those in C4 were large (44.4%; 4/9 cases). The average number of motor fibers in C3 and C4 were 114+/-112 and 219+/-167, respectively. These results show that C4 is more important in terms of the frequency and size of the cervical motor fibers distributing to the trapezius muscle.

Multiple Cervical Spinous Process Fractures in a Novice Golf Player

Avulsion of spinous process, also called Clay-shoveler's fracture, is most prevalent among those engaged in hard physical labor. To the best of the author's knowledge, only one case of multiple spinous process fractures of the upper thoracic spine in a novice golfer has been reported. A 45-year-old female presented with intractable posterior neck pain. The patient experienced a sharp, sudden pain on the neck while swinging a golf club, immediately after the club head struck the ground. Dynamic cervical radiographic findings were C6 and C7 spinous process fractures. Magnetic resonance imaging revealed C6 and C7 spinous process fractures without spinal cord pathology. The patient was treated with pain medications and cervical bracing. The patient's pain gradually improved. The injury mechanism was speculated to be similar to Clay-shoveler's fracture. Lower cervical spinous process fractures can be associated with a golf swing. If the patient complains of long lasting neck pain and has a history of golf activity, further study should be conducted to rule out lower cervical spinous fracture.

Surface electromyography signals from neck muscles during different craniocervical postures in a lateral recumbent position / 中华物理医学与康复杂志

Objective To survey cervical myoelectric signals during craniocervical flexion, neutral and extension postures, and to explore the evidence that proper head position can alleviate cervical muscle fatigue in a lateral recumbent position. Methods Surface electromyography (sEMG) signals were detected from the sternocleidomastoid, upper trapezius and erector spinae muscles of 30 young subjects bilaterally during craniocervical flexion,neutral and extension postures in the left lateral recumbent position. The integrated trace area (IEMG) and median frequency (MF) were estimated. Results The average IEMG of the sternocleidomastoid muscles was significantly lower in flexion than in extension bilaterally. The average IEMG of the erector spinae muscles was lower in extension than in flexion bilaterally, and the difference was again significant. The IEMGs of the upper trapezius muscle showed no significant difference on average in the three postures bilaterally. There was no significant MF difference in any of the muscles. Conclusions The muscles in the cervical back were less activated during craniocervical extension in a lateral recumbent position. A little cranicocervical extension is optimal while resting in a lateral recumbent position.

Use of electromyography to assess pain in the upper trapezius and lower back muscles within a fatigue protocol / Uso da eletromiografia na análise de dor dos músculos trapézio superior e lombares durante protocolo de fadiga

OBJECTIVE: The aim of this study was to investigate whether muscle fatigue indices obtained using surface electromyography and calculated in the time and frequency domains would be capable of objectively diagnosing pain and discriminating between subjects with and without pain in the upper trapezius muscle and the lower back muscles. METHODS: Forty-seven individuals underwent a muscle fatigue test for thirty-five seconds at 80% of the maximal voluntary contraction (MVC), while EMG and muscle force data were recorded. The RMS value and the median frequency (MF) were calculated within consecutive one-second windows. Linear regression analysis was used to obtain the slope coefficients and the respective y-axis intercept values, which were considered to be localized muscle fatigue indices. RESULTS: In the frequency domain, the slope coefficients were negative for both muscles, while in the time domain, the coefficient for the upper trapezius was positive and the coefficient for the lower back muscles was negative (p<0.01). Significant differences were also found in the frequency domain between subjects with and without pain in the upper trapezius (p<0.01). The subjects with pain had significantly lower force values than the subjects without pain (p<0.05), in both the upper trapezius and the lower back muscles. CONCLUSION: The force values associated with the fatigue indices (MF slope and y-axis intercept) were able to predict the presence of pain in the upper trapezius (p<0.05), but not in the lower back muscles.

OBJETIVO: A proposta do estudo foi investigar se índices de fadiga, obtidos a partir de eletromiografia de superfície, calculados no domínio do tempo e da frequência, são capazes de diagnosticar a dor objetivamente, discriminando entre sujeitos com e sem dor no trapézio superior e nos músculos lombares. MÉTODOS: Quarenta e sete indivíduos foram submetidos a um teste de fadiga muscular por 35s a 80% da contração voluntária máxima (CVM), enquanto EMG e força muscular foram registradas. O valor RMS e a mediana da frequência (MF) foram calculados em janelas consecutivas de 1s. Análise de regressão linear foi utilizada para obter os coeficientes de inclinação e seus respectivos valores de interseção no eixo y, os quais foram considerados índices de fadiga muscular localizada. RESULTADOS: Os coeficientes de inclinação analisados no domínio da frequência apresentaram comportamento similar, sendo negativos para ambos os músculos, enquanto que, no domínio tempo, o trapézio superior apresentou coeficientes positivos, e músculos lombares, coeficientes negativos (p<0,01). Diferenças significativas também foram identificadas no domínio da frequência entre os sujeitos com e sem dor no trapézio superior (p<0,01). Os indivíduos com dor apresentaram valores de força significativamente menores que os sujeitos sem dor (p<0,05), tanto nos músculos lombares quanto no trapézio superior. CONCLUSÃO: Os valores de força associados aos índices de fadiga (inclinação da MF e intersecção do eixo y) foram hábeis para predizer a presença de dor no trapézio superior (p<0,05), mas não nos músculos lombares.

Temporomandibular joint dysfunction and trapezius muscle fatigability

INTRODUCTION: It has been suggested that pain increases trapezius muscle activation in patients with temporomandibular joint dysfunction (TMD). Changes in muscle activation might change muscle resistance to fatigue. The purpose of this study was to evaluate the fatigability of the trapezius muscle in patients with TMD. METHOD: Fourteen patients with TMD (clinically diagnosed and referred by a dentist) and eleven healthy subjects performed a fatigue test consisting of shoulder elevation performed at 70 percent of the maximal voluntary isometric contraction, which was maintained for 30 seconds. Electromyographic signals were obtained from the upper portion of the trapezius muscle (sampling frequency: 2000 Hz/channel). Consecutive segments of three seconds in duration each were extracted from the electromyographic signal and analyzed in the frequency domain using a Fast Fourier Transform algorithm. Linear regression analysis was applied to the consecutive median frequencies for each subject. The slope of the regression line was used to describe muscle fatigability. RESULTS: No changes were observed in fatigability between the right and left trapezius of either group or between the left trapezius of the healthy and TMD groups. The linear regression for median frequencies in the right trapezius of the TMD group showed a slope of -0.15 ± 0.33 (mean ± SD), which was smaller than the slope for the healthy group (-0.44 ± 0.46; p= 0.049). These results suggested that the fatigability of the right trapezius was lower in the TMD group than in the healthy group.

INTRODUÇÃO: Tem sido sugerido que a dor aumenta a ativação do músculo trapézio em pacientes com disfunção temporomandibular (TMD). Mudanças na ativação do músculo podem alterar a resistência à fadiga. O objetivo do estudo foi investigar a fatigabilidade do músculo trapézio em pacientes com TMJ. MÉTODOS: Quatorze indivíduos com TMD (diagnosticados clinicamente e encaminhados pelo especialista odontólogo) e onze indivíduos saudáveis realizaram um protocolo de fadiga que consistiu em uma contração isométrica submáxima de elevação do ombro, em um nível de 70 por cento da contração voluntária máxima, mantida por um período de 30 segundos. O sinal eletromiográfico (EMG) foi obtido da porção superior do músculo trapézio, (taxa de amostragem de 2000Hz/canal). Três segundos consecutivos do sinal EMG foram analisados no domínio da freqüência usando a Transformada Rápida de Fourier (FFT). Uma análise de regressão linear foi aplicada para valores consecutivos da freqüência mediana (MF) de cada sujeito, e a inclinação da regressão linear foi utilizada para descrever a fatigabilidade muscular. RESULTADOS: Nenhuma diferença foi observada na fatigabilidade do músculo trapézio direito e esquerdo para ambos os grupos e entre o trapézio esquerdo do grupo saudável e com TMD. A MF do músculo trapézio direito do grupo com disfunção apresentou valores de inclinação da reta de regressão linear de -0,15 ± 0,33 (média ± SD), os quais foram menores que os valores do grupo saudável (-0,44 ± 0,46; média ± SD; p= 0,049). Esses resultados sugerem que a fatigabilidade do trapézio direito é menor no grupo com TMD do que no grupo saudável.

Winged Scapula Caused by Rhomboideus and Trapezius Muscles Rupture Associated with Repetitive Minor Trauma: A Case Report

We experienced a rare case of winged scapula that was caused by the rupture of the rhomboideus major and the lower trapezius muscles without any nerve injury in a 12 yr old female after she had carried a heavy backpack. Electrodiagnostic study revealed that the onset latencies, amplitudes and conduction velocities were normal in the long thoracic nerve, the spinal accessory nerve and the dorsal scapular nerve. The needle EMG findings were normal as well. An explorative operation was performed and the rupture of the rhomboideus major and lower trapezius muscles was detected. Direct surgical repair of the ruptured muscle was carried out and the deformity was corrected. The anatomical and functional restoration was satisfactorily accomplished.

Motor Innervation of the Trapezius Muscle: The Intraoperative Motor Conduction Study / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: In radical neck dissection, sacrifice of the spinal accessory nerve creates a definite deficit of the shoulder function. To demonstrate the presence of motor input from the spinal accessory and the cervical plexus to the trapezius muscle, intra-operative motor nerve conduction study was performed. SUBJECTS AND METHOD: Twenty-four patients were studied on completion of the operation. In each patient, the entire length of the spinal accessory nerve, the upper cervical plexus and some cervical plexus branches running to the trapezius were preserved independently. Compound muscle action potentials were measured for each part of the trapezius muscle on stimulation of the spinal accessory, C2, C3 and C4 nerves. RESULTS: By stimulating the spinal nerve, evoked responses were obtained from all 24 patients in the upper, middle and lower trapezius. C2 contributions were seen in 2 out of 24 patients, supplying all three parts of the muscle in 0. C3 contributions were seen in 11 out of 24 patients, supplying all three parts of the muscle in 8. C4 contributions were seen in 20 out of 24 patients, supplying all three parts of the muscle in 16. CONCLUSION: The spinal accessory nerve provides the most important and consistent motor input and C2, C3 and C4 also provide motor input to the trapezius muscle. But they were not consistently present and did not innervate all three parts of the trapezius muscle. Compared with other studies, it is interesting to note that C4 gives more consistent motor input to the trapezius muscle than other cervical branches.

An Anatomic Variation of the Trapezius Muscle in a Korean: The Cleido-occipitalis Cervicalis

A variation of the trapezius muscle was observed in a Korean female adult cadaver during routine student dissection. The lateral, upper three-fourths of the descending portion of the trapezius muscle were separated from the remainder of the muscle. This single, isolated bundle fused above the insertion of the midpoint of the clavicle, and attached to the clavicle as a separate tendon. The remaining descending portion inserted into the clavicle and scapula as usual. This abnormal muscle bundle is considered as a variant of the cleido-occipitalis cervicalis, and formation of this variation is discussed based on the embryological development of the relative muscular structures.

Avaliação funcional do músculo trapézio e nervo espinhal pós-esvaziamento cervical através da eletroneuromiografia: estudo de 25 pacientes / Functional evaluation of trapezius muscle and spinal nerve after neck dissection through eletro-neuromiography: study of 25 patients

OBJETIVO: Foram estudados 25 pacientes portadores de neoplasias malignas da cabeça e pescoço (20 de vias aerodigestivas superiores e cinco da glândula tireóide), submetidos a esvaziamentos cervicais uni ou bilaterais (33 procedimentos), sendo 15 supra-omohióideos, 11 funcionais e sete em campos alargados. MÉTODO: Através da eletroneuromiografia (ENM), foram avaliados funcionalmente o músculo trapézio e o nervo espinhal após os diferentes procedimentos, aos 30 e 180 dias. RESULTADOS: Foram aferidos para as três formas de linfadenectomia 94 por cento de desnervação do músculo trapézio, severa em 68 por cento e moderada 32 por cento (p = 0,001), portanto valores significativos. Quanto à avaliação do tipo de lesão do nervo espinhal, após 30 dias observou-se lesão de axônio (axonotmese) em 31 dos 33 procedimentos. Com relação à reinervação, esta foi detectada após 180 dias, sendo boa (21 por cento), moderada (72 por cento) e ruim (7 por cento) para valores de p = 0,001 de significância estatística. CONCLUSÕES: A eletroneuromiografia foi um método efetivo na avaliação da unidade neuromuscular e o tipo de esvaziamento cervical conservador não foi determinante de alterações destas estruturas.

BACKGROUND: Twenty fire patients with malignant head and neck neoplasias (20 from superior aerodigestive tract and 5 from thyroid gland), were submitted to 33 unilateral or bilateral neck node dissection (15 supraomohyoid, 11 modified and 7 wide field), at the Head and Neck Service of Hospital Araújo Jorge, Goiânia, Goiás, Brazil. METHOD: Eletroneuromiography (ENM) of the trapezius muscle after spinal nerve dissection. RESULTS: In spite of surgical dissection, 94 percent of trapezius muscle desnervation were detected, being 38 percent severe and 62 percent moderate, (p = 0,001). The degree of lesion for spinal nerve after 30 days, showed axoniumtmese in 31 of 33 procedures, and after 180 days, 21 percent of severe, 72 percent of moderate and 7 percent of unsatisfactory reinervation were diagnosed (p = 0,001). CONCLUSIONS: ENM is an effective method of evaluation of neuromuscular unit (trapezius muscle/spinal nerve) and the type of neck node dissection was not determinant of structural nerve alteration.

Comparative study on the effects of different neck dissection methods on shoulder function / 实用口腔医学杂志

Objective:To evaluate the shoulder functions of four groups of patients who underwent different kinds of neck dissections.Methods:40 patients who underwent neck dissection were included,7 patients preserved both accessory nerve and the cervical branches,8 preserved accessory nerve,11 preserved cervical branches and 14 sacrificed both of them.All patients were assessed subjectively at 2 weeks and 6 months after operation,using a questionnaire and an electromyograghy method.Results:The patients whose accessory nerves were preserved had a significant functional rehabilitation of the shoulder,while those who preserved only the cervical branches had a better result than the RND 6 months postoperation.Conclusion: Preservation of the branches from C2-C4 to trapezius muscle during the modified neck dissection should be taken into consideration to improve shoulder functions.

Applied anatomy of superior trapezius myocutaneous and spina scapulae osteomyocutaneous flaps pedicled with transverse cervical artery / 实用口腔医学杂志

Objective:To study the anatomic basis of superior trapezius myocutaneous and spina scapulae osteomyocutaneous flaps pedicled with transverse cervical vessel.Methods:The blood vessels,the size of the superior trapezius muscle and the spina scapulae were dissected and examined in 32 adult corpses.Results:The superior trapezius muscle was in the shape of trapezium.The border length (mm) of A,B,C and D was 174.63,157.18,86.98 and 80.95 in average respectively.The area of the muscle was 126.78 cm2 on the average.The spina scapulae was 131.21 mm in average length.The length (mm) of transverse cervical artery trunk, superficial cervical artery trunk and its ascending artery,spina scapulae branch artery was 42.50,27.80,43.12,28.75 in average,their external diameter(mm) was 2.71,2.39,1.96 and 0.50 respectively.Entering the muscle,the ascending artery had 3～6 branches with the external diameter of 0.5 mm or more.The venous vessels were following the copartner artery.Conclusion:The superior trapezius muscle and the spina scapulae may be made for the myocutaneous and osteomyocutaneous flaps pedicled with transverse cervical artery used in oral and maxillofacial reconstruction.

Study of the Shoulder Function after Neck Dissection / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Radical neck dissection (RND) has been a standard treatment for the head and neck cancer with metastasis to the cervical lymphatics. The sacrifice of the spinal accessory nerve which innervates the trapezius muscle creates a definite impairement of the shoulder function. Therefore, the modified radical neck dissection (MRND) has been introduced in order to minimize the postoperative morbidities. But, even if the spinal accessory nerve has been preserved, the impaired shoulder function has been reported in some studies. The degree of the shoulder dysfunction after RND tended to be minimal in a few patients. The purpose of this study was to evaluate the shoulder function according to the various types of the neck dissection in 39 cases of 24 patients. MATERIALS AND METHODS: The shoulder functions were evaluated using clinical examinations and the electrodiagnostic method of the trapezius muscles. The results of each test according to the types of neck dissection were compared. RESULTS: We observed a significant correlation between the clinical parameters and electrodiagnostic results. The functional results of the trapezius muscle in the group of modified radical neck dissection were better than that of the radical neck dissection. In the RND group, 80% of the cases presented incomplete denervation of the trapezius muscle, so it might provide a evidence of innervation of the other nerves to this muscle. In the MRND group, 45% of the cases presented partial denervation of the trapezius muscle, indicating that it might have been caused by damage during the operations. CONCLUSION: We found that careful manipulation of the nerve should be required in order to preserve the spinal accessory nerve. Rehabilitative therapy can also improve the shoulder function after neck dissection. Further studies including anatomic dissection and intraoperative electrophysiologic evaluation of the innervation in the trapezius muscle should be performed.