Levator Scapulae Syndrome


 Original Editor ­ Andeela Hafeez

Top Contributors - Andeela Hafeez, Rachael Lowe, Tony Lowe, Kim Jackson, Alexander De Bock, WikiSysop, Eugenie Lamprecht, Robin Meynendonckx, Shwe Shwe U Marma, 127.0.0.1, Kishan Muthukuda and Evan Thomas

Introduction   

Levator Scapulae Syndrome is an historical name for "pain over the upper medial angle of the scapula" that is still used in clinical practice in some places around the world.  This terminology (and use of the word syndrome) describes is a set of signs and symptoms that often present together without identifying the cause of the pain and dysfunction i.e chronic fatigue syndrome, irritable bowel syndrome.  These days we prefer to use our clinical reasoning skills to identify possible causative factors that we can address during treatment.

Clinically Relevant Anatomy

The levator scapulae muscle extends from C1-4 to the medial aspect of the scapula, between the superior angle and the root of the spine. It's function is to assist with various neck, arm and shoulder movements such as shoulder elevation and cervical side flexion.

Description

Often this muscle can become tense and painful leading to reduced motion in the area. The dominant shoulder is most commonly involved (82%) and pain radiated to the neck and shoulder, but rarely to the arm.

Causes

• Cervical spine dysfunction.
• Altered shoulder biomechanics or poor posture.  
• Repetitive arm motions such as in swimming, throwing, or racquet sports.
• Carrying bags with straps over the shoulder.
• In anxiety many people who experience the effects of these trigger points also complain of a shortness of breathe like that associated with panic attacks. 
  

Sign and Symptoms

• Neck pain, which may extend to the head causing a headache.
• Pain and restricted range of movement, especially reduced cervical flexion and side flexion to the contralateral side.
• Deep, achy pain and/or tightness on the upper back along the top of the shoulder blade or neck.
  
• Increased muscle tone and trigger points.

Trigger points

The Levator Scapulae can present with two trigger points located in the lower half of the muscle. The lower trigger point lies just above the superior angle of the scapula and upper trigger point lies 1-3 inches above the lower trigger point. Both trigger points lie deep to the upper trapezius muscle.  Both trigger points refer pain laterally to the shoulder and along the medial aspect of the shoulder blade.

Examination

With this presentation of pain and trigger points in the levator scapulae it is important to complete a full assessment of the cervical spine as pain in this region is often referred from the cervical spine.

You must also rule out the thoracic spine and shoulder.  The phenomenon of levator scapulae pain of cervical origin being reproduced on shoulder movement has long been clinically recognised.

Flexibility Test

Movements that stretched the levator scapulae on the affected side aggravated symptoms.

Treatment

 In general, levator scapulae syndrome can often be treated conservatively, first by ceasing any physical activity that could exacerbate the condition and taking rest until the symptoms have diminished.
Limiting arm and shoulder movements can be beneficial.
Anti-inflammatory pain medication can help to reduce aching and any swelling,
while icing the area approximately 3 times per day can provide non-medicinal relief.

Electrotherapy

Medium frequency appears to be most effective, but any current which can tire and sedate the muscle is effective. This is done to relax the muscle and soften fibres.
Pulsed ultrasound (0.8 to 1.8 w/cm2) using Ibuprofen ointment, or other sedative and anti-inflammatory gel.

Rehabilitation

As long as there are no complications and you rest appropriately, the injury should soon begin to clear up. When you are pain free, you will be able to commence physical therapy with the doctor's approval. This stage is important for gradually replacing the lost strength in the neck and building up flexibility in the area before attempting to return to activity. Levator Scapulae Syndrome responds very well Active Release Techniques (ART), which is very effective in breaking up the scar tissue adhesion formation in Levator Scapulae and surrounding muscles, allowing the muscles to stretch and contract normally again (keep in mind it is these scar tissue adhesion that are causing the muscle to be tight and restricted in the first place).

Stretching exercises
                                         

Strengthening exercises

It is also important that biomechanical problems that may be contributing to the condition, such as neck or shoulder muscles imbalances, postural problems, or upper back mobility are identified and corrected as these are usually the causes of increased stress on the Levator Scapulae in the first place. addressing these mechanical problems provides a long term solution of the problem and minimise the chances of reoccurrence