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The neurological examination
Published in Michael Y. Wang, Andrea L. Strayer, Odette A. Harris, Cathy M. Rosenberg, Praveen V. Mummaneni, Handbook of Neurosurgery, Neurology, and Spinal Medicine for Nurses and Advanced Practice Health Professionals, 2017
Levator scapulae muscle (Figure 11.1c) Innervation: Dorsal scapular (C5) and cervical (C3 and C4) nerves.Function: Raises scapula and inclines neck to corresponding side if scapula is fixed.Physical examination: The patient tries to shrug the shoulders (arrows) against resistance.
Vertebral artery reconstruction
Published in Sachinder Singh Hans, Alexander D Shepard, Mitchell R Weaver, Paul G Bove, Graham W Long, Endovascular and Open Vascular Reconstruction, 2017
The levator scapulae muscle is exposed by removing the fibroadipose tissue overlying it. Once the anterior edge of the levator scapulae muscle is identified, the anterior ramus of C2 becomes visible. With the ramus as a guide, a right-angle clamp is slid under the levator scapulae muscle and then divided. The C2 ramus divides into three branches after crossing the vertebral artery. The ramus should be cut (Figure29.6) before it branches. This exposes the V3 segment of the vertebral artery that can then be freed from the surrounding venous plexus over a 1-2-cm length.
Arthroscopic resection of the superomedial scapula and scapulothoracic bursectomy
Published in Andreas B. Imhoff, Jonathan B. Ticker, Augustus D. Mazzocca, Andreas Voss, Atlas of Advanced Shoulder Arthroscopy, 2017
Several neurovascular structures are at risk if surgical intervention is considered in the treatment of snapping scapula syndrome. The accessory spinal nerve and transverse cervical artery are both localized near the superomedial angle of the scapula, and are therefore in close proximity during surgical removal of the superomedial angle. The accessory nerve enters the levator scapulae muscle near the superomedial angle and runs along the medial scapular border under the trapezius muscle.4 The transverse cervical artery is separated by the levator scapulae muscle. The artery branches into the dorsal scapular artery running along the medial border of the scapula with the dorsal scapula nerve, the suprascapular artery, and a superficial branch that runs with the accessory spinal nerve.4 The dorsal scapula artery and nerve course deep to the levator scapulae, the rhomboid major and minor, 1 cm medial to the medial border of the scapula (Figure 43.2). Portals should be placed below the scapular spine and at least 3 cm medial to the medial border of the scapula to avoid these structures. The long thoracic nerve runs on the superficial aspect of the serratus anterior muscle, and therefore it should not be at risk during scapulothoracic debridement if debridement is confined to the scapulothoracic space, since the deep aspect of the muscle borders this space. Finally, the suprascapular artery and nerve are at risk as they enter the suprascapular notch. The distal between the superior medial angle tip and the medial aspect of the suprascapular notch is 4.4 cm, with the shortest distance of 2.4 cm.21 Resection can therefore be considered safe if it is limited to only 2 cm in a medial to lateral direction from the superomedial corner.
Effects of an active intervention based on myofascial release and neurodynamics in patients with chronic neck pain: a randomized controlled trial
Published in Physiotherapy Theory and Practice, 2022
Irene Cabrera-Martos, Janet Rodríguez-Torres, Laura López-López, Esther Prados-Román, María Granados-Santiago, Marie Carmen Valenza
Primary outcome measure values are shown in Table 2. Between-group comparisons showed no significant differences at baseline in the percentage of active trigger points per muscle and side (p > .05). Significant changes were found in the TrP examination after the 4-week intervention program. Specifically, there was a significant reduction bilaterally in the percentage of active myofascial trigger points in the suboccipital muscle (p = .002 in the right and p = .001 in the left muscle) and the levator scapulae muscle (p = .007 in the right and p = .001 in the left muscle). A significant reduction was also found in the percentage of active myofascial trigger points in the left scalene muscle (p = .027). Interestingly, in the left levator scapulae muscle, the percentage dropped from 93.8% at baseline to 31.2% at post-intervention, compared to the control group (92.7 to 92.4%). No significant differences were found in the trapezius muscle (p = .264 in the right and p = .385 in the left muscle).
Mechanisms of Modulation of Automatic Scapulothoracic Muscle Contraction Timings
Published in Journal of Motor Behavior, 2021
Samuele Contemori, Roberto Panichi, Andrea Biscarini
The scapular protraction led to shorten contraction onset time of the MD, especially when linked with the scapular elevation (Figure 5). In question is how scapular protraction and elevation might influence the MD timing of contraction. Either the protracted scapular posture or the active scapular elevation, executed from an adducted shoulder position, may lead to a downward scapula-on-thorax rotation (Choi et al., 2015; Neumann, 2010; Singla & Veqar, 2017). Further, the scapular elevation facilitates the activation of the levator scapulae muscle more than the UT (Moseley et al., 1992; Smith et al., 2004). Notably, the levator scapulae is involved in the downward rotation of the scapula (Neumann, 2010). That is, the initial scapular elevation with the arm at the side that anticipated the glenohumeral abduction could cause an initial downward scapular rotation, which might justify the earlier MD contraction recorded in the protracted scapular position with active scapular elevation (see below).
Feasibility and significance of stimulating interscapular muscles using transcutaneous functional electrical stimulation in able-bodied individuals
Published in The Journal of Spinal Cord Medicine, 2021
Naaz Kapadia, Bastien Moineau, Melissa Marquez-Chin, Matthew Myers, Kai Lon Fok, Kei Masani, Cesar Marquez-Chin, Milos R. Popovic
The motor points and electrode positioning for FES for the various muscles were as follows (Fig. 1(a,b)): Serratus Anterior (SA): Electrode between the latissimus dorsi and the pectoralis major, on the muscular bulk of the serratus between the 4th and 9th ribs.Upper Trapezius (UT): On the superior aspect of the shoulder blade, away from the supero-medial angle of the scapula to limit stimulation of the levator scapulae muscle.Lower Trapezius (LT): Medially and in line with the muscle fibers next to the spine of T8-T12 vertebrae below the inferior tip of the scapula, to limit stimulation of the rhomboids.Anterior and middle deltoid: on the bulk of the muscle, one proximal and one distal.