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Background/Objectives: Frozen shoulder is a common shoulder disorder that often places limitations on the range of motion of the shoulder. The disease may induce neck pain due to overuse of the neck muscle in an attempt to compensate for lack of shoulder movement. In clinical practice, swelling and inflammation of the scalene and levator scapulae may be detected via sonography in patients with frozen shoulder. The aim of this study was, therefore, to determine whether the involvement of the scalene complex or levator scapulae could compensate for the limited motion of the shoulder in patients with frozen shoulder. Methods: We retrospectively reviewed the medical records of 362 patients with unilateral frozen shoulder. These patients were divided into four groups depending on the involvement of the scalene complex or levator scapulae muscle. The range of motion of the shoulder—encompassing flexion, abduction, and external rotation—was measured with a goniometer. We also performed an ultrasound scan on each shoulder. The involvement of the scalene complex and levator scapulae muscle was also assessed via musculoskeletal ultrasound. Results: The range of motion of the shoulder in terms of flexion, abduction, external rotation, and total range of motion differed significantly between the four groups (p < 0.05). Patients in whom the scalene complex or levator scapulae muscle was involved demonstrated a significantly wider range of motion in different shoulder directions than patients without the involvement of those muscles (p < 0.05). Conclusions: A greater range of motion in the shoulder can be obtained through the activation of the scalene complex or levator scapulae muscle, which act to compensate for the lack of shoulder movement in patients with frozen shoulder. These two muscles showed thickening and hypoechoic changes upon sonography. [ABSTRACT FROM AUTHOR]

Background/Objectives: Frozen shoulder is a common shoulder disorder that often places limitations on the range of motion of the shoulder. The disease may induce neck pain due to overuse of the neck muscle in an attempt to compensate for lack of shoulder movement. In clinical practice, swelling and inflammation of the scalene and levator scapulae may be detected via sonography in patients with frozen shoulder. The aim of this study was, therefore, to determine whether the involvement of the scalene complex or levator scapulae could compensate for the limited motion of the shoulder in patients with frozen shoulder. Methods: We retrospectively reviewed the medical records of 362 patients with unilateral frozen shoulder. These patients were divided into four groups depending on the involvement of the scalene complex or levator scapulae muscle. The range of motion of the shoulder—encompassing flexion, abduction, and external rotation—was measured with a goniometer. We also performed an ultrasound scan on each shoulder. The involvement of the scalene complex and levator scapulae muscle was also assessed via musculoskeletal ultrasound. Results: The range of motion of the shoulder in terms of flexion, abduction, external rotation, and total range of motion differed significantly between the four groups (p < 0.05). Patients in whom the scalene complex or levator scapulae muscle was involved demonstrated a significantly wider range of motion in different shoulder directions than patients without the involvement of those muscles (p < 0.05). Conclusions: A greater range of motion in the shoulder can be obtained through the activation of the scalene complex or levator scapulae muscle, which act to compensate for the lack of shoulder movement in patients with frozen shoulder. These two muscles showed thickening and hypoechoic changes upon sonography.

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. [ABSTRACT FROM AUTHOR]

Abstract 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 β-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

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 β-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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Background: The structure and function of the serratus anterior muscle are partitioned into three parts. If the morphological characteristics in each part can be demonstrated in more detail, the cause of dysfunction will probably be identifiable more accurately. The purpose of this study was to demonstrate the details of the structure and innervation in each part of the serratus anterior muscle. Materials and methods: This macroscopic anatomic study was conducted using ten sides from five cadavers. The structure and innervation in each part of this muscle were examined. Results: In the superior part, the independent branch was divided from a branch innervating the levator scapulae muscle. In the middle part, the long thoracic nerve descended on one-third of the anterior region between the origin and insertion. In the inferior part, the long thoracic nerve which ramified into many branches and branches from the intercostal nerves were distributed on all sides. Conclusion: This study demonstrated that the innervation of the serratus anterior muscle was different in each part. The difference indicates that the superior part has an intimate relation with the levator scapulae muscle while the middle and inferior parts could be the actual serratus anterior muscle. Moreover, the distribution of branches from the intercostal nerves shows that the inferior part has a connection with some trunk elements. Understanding these characteristics of innervation is useful to identify the cause of dysfunction. In addition, we assert that the constant distribution of branches from the intercostal nerves is significant for the morphology. [ABSTRACT FROM AUTHOR]

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 Cl vertebral attachment; medial band legth of 5.7 cm and lateral band width of 2. lcm. Regarding anatomic variations of the LSM, they may remain unnoticed or perhaps contribute for pathologic conditions of the neck and the back. [ABSTRACT FROM AUTHOR]