Relationship between scapular elevation exercises with different alignments and activity of the trapezius and levator scapulae muscles.

[Purpose] This study aimed to examine whether scapular elevation exercises in sitting positions with different alignments lead to contractions of the trapezius and levator scapulae muscles. [Participants and Methods] The participants were 25 males, measured in four sitting positions with different alignments. Spine alignment was assessed by measuring the head protrusion, upper thoracic spine tilt, and pelvic tilt angles. Upper limb alignment was evaluated using the scapula tilt angle, scapula rotation angle, and distance between scapular spinous processes. Scapular elevation exercises were measured, and the thickness of the trapezius and levator scapulae muscles were measured in resting and elevated positions, with changes in muscle thickness. [Results] The trapezius muscle thickness was greater in the sitting position with less thoracic spine tilt and scapula tilt angles. Conversely, the levator scapulae muscle thickness was greater in the sitting position with more thoracic spine tilt and scapula tilt angles. [Conclusion] Scapular elevation exercises induce separate contractions of the trapezius and levator scapulae muscles by modifying the alignment of the spine and upper limbs.

A Rare Variation of the Levator Scapulae Muscle: A Case Report and Review of Literature.

Muscle variations in the posterior neck region are mainly categorized as variations in the origin and insertion of the muscles and the presence of accessory slips or rudimentary muscles. The levator scapulae muscle is a variable muscle with several different types of variations described throughout the literature. Herein, we report a rare unilateral case of an accessory slip from the levator scapulae. Aberrant muscle slip originates from the distal one-third of the levator scapulae. Then, it passes upwards and outwards above a vascular bundle containing a superficial branch of the transverse cervical artery and vein. The deviant muscle slip inserts onto the superior nuchal line. Muscle variations in the neck's posterior region and the levator scapulae's variations, as per se, have the utmost clinical significance since they might be mistaken for tumor mass. Moreover, such variations might be deceptive during surgical procedures in the region. Therefore, detailed knowledge of such complex muscular variations in the posterior region of the neck is paramount for surgeons and radiologists alike.

Ultrasound-guided Injection of the Levator Scapulae Muscle in a Cadaver Model.

BACKGROUND: Despite the advantages of ultrasound and previous anatomical data on neuromuscular junction locations, to the best of our knowledge, the feasibility and accuracy of precise ultrasound-guided injection techniques into the proposed injection site of botulinum neurotoxin for the levator scapulae muscle have not been assessed in any publication. OBJECTIVE: In the present cadaver-based study, the ultrasound-guided injection technique in the middle and distal portions of the levator scapulae muscle was evaluated to determine whether this method distributes injections properly to the target muscle in fresh cadavers. STUDY DESIGN: Cadaveric study. SETTING: A cadaver laboratory. METHODS: Twenty fresh cadavers were used. Real-time B-mode ultrasound scanning was performed interfaced with a linear array transducer. A mixture of 0.5 mL of dye and yellow filler was injected transverse in-plane with a 6 cm 21-G. needle. Each specimen was dissected to determine whether the dye was correctly targeted to the middle and distal portions of the levator scapulae muscle and to evaluate the accuracy of the injections and any complications. RESULTS: All 40 injections were successfully injected within the middle and distal portions of the levator scapulae muscle. When dissecting the cadavers, the dye spread was evenly distributed along the muscle fiber. LIMITATION: Despite successful injection into the middle and distal portions of the levator scapulae muscle, the usefulness of this technique was not verified in clinical practice. CONCLUSIONS: The ultrasound-guided injection technique presented in this study might facilitate precise visualization and localization of the levator scapulae muscle, thereby enhancing the effectiveness and safety of botulinum neurotoxin treatment in cervical dystonia.

Anatomical analysis of the intramuscular distribution patterns of the levator scapulae and the clinical implications for pain management.

PURPOSE: The present study aimed to demonstrate the intramuscular nerve distribution of the levator scapulae muscle that is responsible for pain and to use this anatomic data to propose possible injection sites. METHODS: Twenty levator scapulae muscles were dissected from 16 Korean embalmed cadavers. The intramuscular nerve distribution of the levator scapulae muscle was identified by whole-mount nerve staining to preserve and stain the nerve fibers without damage. RESULTS: The posterior ramus of spinal nerves C3, C4, and C5 innervated the levator scapulae muscles. When the origin and insertion of the muscle were set to 0% and 100%, respectively, most of the intramuscular nerve terminals were located between 30 and 70%. This area may correspond to the cricoid cartilage of the sixth cervical vertebra. CONCLUSION: Most intramuscular nerve terminals can be found in the middle and distal portions of the levator scapulae muscle. Our findings improve our understanding of the intramuscular nerve distribution of the levator scapulae muscle and will aid in pain management in clinical practice.

Transfer of the anterior C3 levator scapulae motor nerve branch for spinal accessory nerve injury: illustrative case.

BACKGROUND: Injury to the spinal accessory nerve (Acc) results in loss of motor function of the trapezius muscle and leads to severe shoulder problems. A vast number of surgical strategies have been proposed to reinnervate (suture, grafting, and nerve transfers) or compensate (tendon and muscle transfers) the lost function of the trapezius muscle. OBSERVATIONS: The authors report a successful case of Acc reconstruction 5 months after the injury with the anterior C3 levator scapulae motor nerve branch transfer in omotrapezoid triangle of the neck. LESSONS: The advantages of the proposed technique over preexisting nerve transfers were discussed. We believe that this technique can be considered as an alternative to already existing techniques for proximal injuries to Acc.

The nerve to the levator scapulae muscle as donor in brachial plexus surgery: an anatomical study and case series.

OBJECTIVE: Nerve transfers are commonly used in treating complete injuries of the brachial plexus, but donor nerves are limited and preferentially directed toward the recovery of elbow flexion and shoulder abduction. The aims of this study were to characterize the anatomical parameters for identifying the nerve to the levator scapulae muscle (LSN) in brachial plexus surgery, to evaluate the feasibility of transferring this branch to the suprascapular nerve (SSN) or lateral pectoral nerve (LPN), and to present the results from a surgical series. METHODS: Supra- and infraclavicular exposure of the brachial plexus was performed on 20 fresh human cadavers in order to measure different anatomical parameters for identification of the LSN. Next, an anatomical and histomorphometric evaluation of the feasibility of transferring this branch to the SSN and LPN was made. Lastly, the effectiveness of the LSN-LPN transfer was evaluated among 10 patients by quantifying their arm adduction strength. RESULTS: The LSN was identified in 95% of the cadaveric specimens. A direct coaptation of the LSN and SSN was possible in 45% of the specimens (n = 9) but not between the LSN and LPN in any of the specimens. Comparison of axonal counts among the three nerves did not show any significant difference. Good results from reinnervation of the major pectoral muscle (Medical Research Council grade ≥ 3) were observed in 70% (n = 7) of the patients who had undergone LSN to LPN transfer. CONCLUSIONS: The LSN is consistently identified through a supraclavicular approach to the brachial plexus, and its transfer to supply the functions of the SSN and LPN is anatomically viable. Good results from an LSN-LPN transfer are observed in most patients, even if long nerve grafts need to be used.

Low-grade myofibroblastic sarcoma of the levator scapulae muscle: a case report and literature review.

BACKGROUND: Low-grade myofibroblastic sarcoma (LGMS) is described as a distinct atypical myofibroblastic tumor often with fibromatosis-like features and predilection for the head and neck, especially the oral cavity and larynx. LGMS arising in the levator scapulae muscle is extremely rare. CASE PRESENTATION: A 69-year-old woman was admitted to our hospital because she noticed a hard mass in her left neck six months prior. Magnetic resonance images (MRI) showed a soft tissue tumor of the left levator scapulae muscle. A core needle biopsy showed cellular fascicles or a storiform growth pattern of spindle-shaped tumor cells with minimally atypia. Immunohistochemistry revealed focally positive for α-smooth muscle actin (α-SMA), negative for S-100, and a low-grade spindle cell sarcoma was suspected. Following a biopsy, the tumor was resected with a wide surgical margin. Immunohistochemical staining was a positive for vimentin and α-SMA and negative for desmin, CD34, nuclear ß-catenin, and h-caldesmon. LGMS diagnosis was determined based on the histopathological findings. The patient was alive with no evidence of disease eight years after the surgery. CONCLUSIONS: To the best of our knowledge, this is the first case report of LGMS arising in the levator scapulae muscle. In addition to the case report, 48 reports with 103 LGMS cases are reviewed and discussed. In previous reports of LGMS, there were 43 females and 60 males, with a mean age of 43.0 years (range, 2-75). There were 13 (12.6%) patients aged < 18 years, 67 (65.1%) patients aged 18 to 59 years, and 23 (22.3%) patients aged ≥60 years. The average tumor size was 4.4 cm (range: 0.4-22.0). The commonest sites of LGMS was the tongue. Tumor growth patterns were evaluated in 52 cases, and 44 cases (84.6%) showed infiltrative growth patterns. Local recurrence was 26.7%, and distant metastasis was 4.4%. Because of the locally aggressive feature, it is important to diagnose LGMS with biopsy and to excise the tumor with an adequately wide margin.

Changes in stiffness of the dorsal scapular muscles before and after computer work: a comparison between individuals with and without neck and shoulder complaints.

PURPOSE: The aim of this study was to compare the stiffness of the dorsal scapular muscles before and after computer work between individuals with and without neck and shoulder complaints. METHODS: Thirty subjects were divided into patient (n = 18) and control (n = 12) groups. The stiffness of the upper trapezius, levator scapulae, and rhomboid major was measured using ultrasound elastography before and after a 30-min typing task. The strain ratio of the muscle to an acoustic coupler was calculated (a lower strain ratio value indicates greater muscle stiffness). RESULTS: At baseline, the strain ratio of the upper trapezius in the patient group (3.762 ± 1.679) (mean ± SD) was significantly lower than that of the control group (7.763 ± 5.921) (p = 0.041). No significant change in the strain ratio of the upper trapezius after the typing task was observed in the patient group (4.158 ± 3.465) (p = 0.549). A significant decrease in the strain ratio of the levator scapulae after the typing task was observed in the patient group (before: 9.006 ± 7.079, after: 5.718 ± 2.847) (p = 0.022), whereas there was no significant change in the control group (p = 0.436). CONCLUSIONS: The increase in stiffness of the upper trapezius is an objective finding and may be a persistently altered condition in individuals with neck and shoulder complaints. The patterns of change in stiffness of the levator scapulae are different between individuals with and without neck and shoulder complaints.

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.

Comparison Between Neck and Shoulder Stiffness Determined by Shear Wave Ultrasound Elastography and a Muscle Hardness Meter.

The goals of this study were to compare neck and shoulder stiffness values determined by shear wave ultrasound elastography with those obtained with a muscle hardness meter and to verify the correspondence between objective and subjective stiffness in the neck and shoulder. Twenty-four young men and women participated in the study. Their neck and shoulder stiffness was determined at six sites. Before the start of the measurements, patients rated their present subjective symptoms of neck and shoulder stiffness on a 6-point verbal scale. At all measurement sites, the correlation coefficients between the values of muscle hardness indices determined by the muscle hardness meter and shear wave ultrasound elastography were not significant. Furthermore, individuals' subjective neck and shoulder stiffness did not correspond to their objective symptoms. These results suggest that the use of shear wave ultrasound elastography is essential to more precisely assess neck and shoulder stiffness.

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...