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Varol U, Valera-Calero JA, Sánchez-Jiménez E, Fernández-de-las-Peñas C, Ortega-Santiago R, Kobylarz MD, Navarro-Santana MJ. Levator Scapulae Stiffness Measurement Reliability in Individuals with and without Chronic Neck Pain by Experienced and Novel Examiners. SENSORS (BASEL, SWITZERLAND) 2024; 24:277. [PMID: 38203140 PMCID: PMC10781297 DOI: 10.3390/s24010277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 12/19/2023] [Accepted: 12/29/2023] [Indexed: 01/12/2024]
Abstract
The levator scapulae muscle is a key structure in the etiopathology of neck and shoulder musculoskeletal pain. Although previous studies used shear-wave elastography (SWE) for characterizing this muscle elasticity, limited evidence assessed the inter-examiner reliability of this procedure. This study aimed to analyze the inter-examiner reliability for calculating Young's modulus and shear wave speed in a cohort of participants with and without chronic neck pain. A diagnostic accuracy study was conducted, acquiring a set of SWE images at the C5 level in participants with and without neck pain (n = 34 and 33, respectively) by two examiners (one experienced and one novel). After blinding the participants' identity, examiner involved, and side, the stiffness indicators were calculated by an independent rater in a randomized order. Intra-class correlation coefficients (ICC), standard error of measurement, minimal detectable changes, and coefficient of variation were calculated. Both cohorts had comparable sociodemographic characteristics (p > 0.05). No significant levator scapulae elasticity differences were found between genders, sides, or cohorts (all, p > 0.05). Inter-examiner reliability for calculating Young's modulus and shear wave speed was moderate-to-good for assessing asymptomatic individuals (ICC = 0.714 and 0.779, respectively), while poor-to-moderate in patients with neck pain (ICC = 0.461 and 0.546, respectively). The results obtained in this study support the use of this procedure for assessing asymptomatic individuals. However, reliability estimates were unacceptable to support its use for assessing elasticity in patients with chronic neck pain. Future studies might consider that the shear wave speed is more sensitive to detect real changes in comparison with Young's modulus.
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Affiliation(s)
- Umut Varol
- Escuela Internacional de Doctorado, Universidad Rey Juan Carlos, 29222 Alcorcón, Spain; (U.V.); (M.D.K.)
| | - Juan Antonio Valera-Calero
- Department of Radiology, Rehabilitation and Physiotherapy, Universidad Complutense de Madrid, 28040 Madrid, Spain; (J.A.V.-C.); (M.J.N.-S.)
- Grupo InPhysio, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain
| | | | - César Fernández-de-las-Peñas
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, 28922 Alcorcón, Spain;
- Cátedra Institucional en Docencia, Clínica e Investigación en Fisioterapia: Terapia Manual, Punción Seca y Ejercicio Terapéutico, Universidad Rey Juan Carlos, 28922 Alcorcón, Spain
| | - Ricardo Ortega-Santiago
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, 28922 Alcorcón, Spain;
- Cátedra Institucional en Docencia, Clínica e Investigación en Fisioterapia: Terapia Manual, Punción Seca y Ejercicio Terapéutico, Universidad Rey Juan Carlos, 28922 Alcorcón, Spain
| | - Mateusz D. Kobylarz
- Escuela Internacional de Doctorado, Universidad Rey Juan Carlos, 29222 Alcorcón, Spain; (U.V.); (M.D.K.)
- Akademia Terapii Manualnej i Igłoterapii Suchej (ATMIS), 34-400 Nowy Targ, Poland
| | - Marcos José Navarro-Santana
- Department of Radiology, Rehabilitation and Physiotherapy, Universidad Complutense de Madrid, 28040 Madrid, Spain; (J.A.V.-C.); (M.J.N.-S.)
- Grupo InPhysio, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain
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Kim SH, Lee HJ. Unusual insertion of the levator scapulae muscle: a case report. Anat Cell Biol 2023; 56:398-400. [PMID: 37482889 PMCID: PMC10520857 DOI: 10.5115/acb.23.118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 05/24/2023] [Indexed: 07/25/2023] Open
Abstract
The current case report describes an uncommon insertion of the levator scapulae (LS), which broadly attaches to multiple structures, including the serratus posterior superior, ligamentum nuchae, and the 6th and 7th spinous processes of the cervical vertebrae. The most superior portion of this aponeurosis merged with the ligamentum nuchae at the C7 level. The middle and inferior portions of the head were inserted (or fused) into the tendon of the rhomboid minor as well as the fibers of the serratus posterior superior muscle. Consequently, recognizing this anatomical variation, characterized by an additional slip of the LS attaching to the 7th vertebra and other muscular structures, is crucial not only for anatomists but also for surgeons performing procedures on the posterior neck related to cervical or shoulder pain and cervical dystonia.
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Affiliation(s)
- Sang-Hyun Kim
- Catholic Institute for Applied Anatomy, Department of Anatomy, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyung-Jin Lee
- Catholic Institute for Applied Anatomy, Department of Anatomy, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Gaydarski LL, Georgiev GP, Olewnik Ł, Karauda P, Landzhov B. A Rare Variation of the Levator Scapulae Muscle: A Case Report and Review of Literature. Cureus 2023; 15:e42355. [PMID: 37621798 PMCID: PMC10445243 DOI: 10.7759/cureus.42355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/23/2023] [Indexed: 08/26/2023] Open
Abstract
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.
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Affiliation(s)
- Lyubomir L Gaydarski
- Department of Anatomy, Histology and Embryology, Medical University of Sofia, Sofia, BGR
| | - Georgi P Georgiev
- Orthopaedics and Traumatology, University Hospital Queen Giovanna - ISUL, Sofia, BGR
| | - Łukasz Olewnik
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Lodz, POL
| | - Piotr Karauda
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Lodz, POL
| | - Boycho Landzhov
- Department of Anatomy, Histology and Embryology, Medical University of Sofia, Sofia, BGR
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A Possible Accessory Muscle of the Serratus Posterior Superior Muscle. REPORTS 2021. [DOI: 10.3390/reports4010002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Anatomical variation is defined as the normal range of possibilities in the topography and morphology of body structures. In contrast, an anomaly is any structural or functional anatomical finding beyond the normal range of possibilities. This case study describes a muscular anomaly found in a 73-year-old preserved Caucasian male. We observed a left-sided anomalous muscle originating from the transverse process of the C1 (Atlas) vertebra and inserting onto the proximal attachment of the serratus posterior superior (SPS) muscle at the C7 level. We suggest that this anomaly is a result of early embryological development and hypothesize that the atypical neck muscle may reinforce the action of the SPS. This finding is rare and no reference of it can be found in the literature. Reporting anatomical anomalies is important for the medical literature and education.
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Zhang L, Guo X, Liu Y, Ou M, Lin X, Qi J, Xu Y, Wang G, Fu S. Classification of the superior angle of the scapula and its correlation with the suprascapular notch: a study on 303 scapulas. Surg Radiol Anat 2018; 41:377-383. [PMID: 30554321 DOI: 10.1007/s00276-018-2156-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 12/07/2018] [Indexed: 11/25/2022]
Abstract
PURPOSE The aims of this study had been to classify the superior angle of the scapula based on morphological features, and to investigate its correlation with the suprascapular notch. METHODS 303 samples of Chinese dried scapular specimens were collected from the Department of anatomy, Southwest Medical University. According to the anatomical morphological characteristics of the superior angle of the scapula, the morphological classification was performed to explore its correlation with the suprascapular notch (SSN). RESULTS The superior angle of the scapula was classified into three types (Hilly shape, Mountain Peak shape and Chimney shape). There were 143 cases of Hilly shape (47.20%), 144 cases of Mountain shape (47.52%), and 16 cases of Chimney shape (5.28%). The angle of Hilly shape (93.36° ± 7.76°) was significantly larger than the Mountain Peak shape (86.60° ± 6.61°) and the Chimney shape (86.22° ± 7.20°), and the difference was statistically significant (P < 0.05). The type I-III of Rengachary's classification to SSN was low risk of suprascapular nerve entrapment, while the type IV-VI was high risk of suprascapular nerve entrapment. Compared with the Mountain Peak shape and the Chimney shape, the Hilly shape corresponds to more types I-III of suprascapular notch but to fewer types IV-VI (P < 0.05). CONCLUSIONS The superior angle of the scapula was divided into three types: Hilly shape (47.20%), Mountain Peak shape (47.52%) and Chimney shape (5.28%). The Mountain Peak shape might be more likely to result in inability of the levator muscle with acute or chronic overload mechanisms, and the risk of suprascapular nerve entrapment in Mountain peak shape was higher than that of Hilly shape. And, it might have a potential effect on neck pain.
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Affiliation(s)
- Lei Zhang
- Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, China.,Academician Workstation, Luzhou, Sichuan, China
| | - Xiaoguang Guo
- Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, China.,Academician Workstation, Luzhou, Sichuan, China
| | - Yang Liu
- Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, China.,Academician Workstation, Luzhou, Sichuan, China
| | - Min Ou
- Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, China.,Academician Workstation, Luzhou, Sichuan, China
| | - Xiaoyan Lin
- Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, China.,Academician Workstation, Luzhou, Sichuan, China
| | - Ji Qi
- School of Traditional Chinese Medicine, Southern Medical University, Guangzhou, China
| | - Yanxiao Xu
- School of Traditional Chinese Medicine, Southern Medical University, Guangzhou, China
| | - Guoyou Wang
- Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, China. .,Academician Workstation, Luzhou, Sichuan, China.
| | - Shijie Fu
- Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, China. .,Academician Workstation, Luzhou, Sichuan, China.
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Beger O, Dinç U, Beger B, Uzmansel D, Kurtoğlu Z. Morphometric properties of the levator scapulae, rhomboid major, and rhomboid minor in human fetuses. Surg Radiol Anat 2018. [DOI: 10.1007/s00276-018-2002-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Gonzales JR, Iwanaga J, Oskouian RJ, Tubbs RS. Variant Prevertebral Muscle: Unique Cadaveric Findings. Cureus 2017; 9:e1515. [PMID: 28959510 PMCID: PMC5612579 DOI: 10.7759/cureus.1515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The levator scapulae muscle typically runs from the transverse process of the atlas to the superior angle of the scapula. In this paper, we describe a rare finding identified during a dissection of a male cadaver, wherein a continuation of the right levator scapulae ran past its normal attachment to the C1 transverse process, fusing with the inferior attachment of the rectus capitis lateralis muscle. No variants were found on the opposite side, and the innervation of the levator scapulae muscle variant was typical of that of a normal levator scapulae. We also describe other related variants of the cranial levator scapulae muscle, hypothesize the embryologic origin of our finding, and finally discuss potential clinical relevance of levator scapulae muscle variants.
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Affiliation(s)
| | | | - Rod J Oskouian
- Neurosurgery, Complex Spine, Swedish Neuroscience Institute
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Anatomic variations of levator scapulae in a normal cohort: an MRI study. Surg Radiol Anat 2016; 39:337-343. [PMID: 27515303 DOI: 10.1007/s00276-016-1727-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Accepted: 08/01/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE Accessory attachments of the levator scapulae (LS) muscle have been described in the literature in previous cadaveric studies, but there is little knowledge about the incidence and distribution. Knowledge of LS accessory attachments is relevant to clinicians working in the fields of radiology, surgery, neurology, and musculoskeletal medicine. The purpose of this study was to explore the incidence and spectrum of LS caudal accessory attachments in vivo using magnetic resonance (MR) imaging in a young cohort. METHODS MR images of the cervical spine were obtained from 37 subjects (13 males and 24 females) aged 18-36 years using an axial T1-weighted spin echo sequence acquired from a 3-Tesla MR scanner. The LS muscle was identified, and the presence of caudal accessory attachments was recorded and described. RESULTS LS caudal accessory attachments were identified in 16 subjects (4 right, 6 left, and 6 bilateral; 12 female). Ten had unilateral accessory attachments to the serratus anterior, serratus posterior superior or the first/second rib. Four had bilateral accessory attachments to serratus anterior. One had bilateral accessory attachments to serratus posterior superior and unilateral accessory attachment to serratus anterior. One had bilateral attachments to both muscles. CONCLUSIONS Both unilateral and bilateral LS caudal accessory attachments were present in nearly half of the subjects examined. They were relatively more frequent in females than males. The findings indicate that these accessory attachments are common, and in some cases, those accessory attachments can occur bilaterally and to more than one site.
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