Advanced testing, such as electromyographic analysis, will demonstrate injury to the rhomboid and levator muscles. [1][2][3] Once the nerve leaves C5 it commonly pierces the middle scalene muscle, and continues deep to levator scapulae and the rhomboids (minor superior to major). Many people can continue with their normal home, work, and recreational activities with minimal limitations. Some restrictions may be placed upon certain lifts or intense lifting. scapular region is often associated with a cervical nerve root block. Region: Scapular region. Graston Technique for breaking up muscle spasms and scar tissue in neck and shoulder muscles. Alternative and conservative treatments address the offending muscles or soft tissue adhesions that are compressing the nerve and producing nerve damage. After several treatments with massage therapy, Graston technique, or Active Release Technique, the symptoms improve. Medial lip of intertubercular sulcus. The two major nerves of the posterior scapular region are the suprascapular and axillary nerves (see Fig. The prevalence was similar across anatomical regions for single scapular fracture and was higher with multiple fractures. The dorsal scapular nerve may share a common trunk with the long thoracic nerve. Match. The excessive motion and movement of the scapula shifts the glenohumeral joint angle and produces more stress and strain on all of the shoulder muscles, including the deltoid, teres minor, teres major, infraspinatus, supraspinatus, subscapularis, bicep, or coracobrachialis muscles. A lack of scapular stabilization often creates many shoulder sprains and strains. Dorsal surface of lateral margin of scapula below teres minor. The first involves potential nerve compression in the cervical region where the nerve actually perforates the middle scalene muscle and curves around the posterior scalene before making its way into the upper-thoracic and mid-scapular region. Gateways to the posterior scapular region: Dorsal scapular spaces-serves as a pssageway between the anterior and posterior compartments of the arm and between the posterior compartment of the arm and the axilla Boundaries: Superior- teres major Medial-long head triceps Lateral- lateral head tricpes Contents: Propunda brachii artery and vein Radial nerve If the scapula cannot be held firmly in a fixed position, the muscles that are contracting off of it cannot properly control the shoulder or glenohumeral joint motion. Clinically this seems very likely because of the importance these muscles play in shoulder stabilization. innervate the superficial pectoral muscle . The rotator cuff muscles are located in the posterior scapula region and serve to stabilise the glenohumeral joint. TRAPEZIUS MUSCLE: It is innervated by the spinal accessory nerve. An MRI provides information on the soft tissue of the cervical spine, discs, and neck muscles. Throwing athletes may notice the early shoulder fatigue and assume the repetitive microtrauma has lead to shoulder glenoid articular damage, arthritis, cartilage damage, costoclavicular syndrome, suprascapular nerve syndrome, axillary nerve damage, or spinal accessory nerve damage. The latter is one of three arteries branching off the thyrocervical trunk, a branch of the first part of the subclavian artery, with the other two branches being the suprascapular artery, and the inferior thyroid artery. Outer margin of acromion. Deltoid, supraspinatus, infraspinatus, teres major, teres minor, subscapularis. Methods: In the anatomic study, 11 Japanese adult cadavers were dissected to examine the numbers and courses of the cutaneous nerves from C3 to C8 dorsal rami. These muscles are heavily involved in scapular stabilization. Nerves that innervate intrinsic muscles of the scapular region:4-Supra scapular nerve: The suprascapular nerve arises from the upper trunk (formed by the union of the fifth and sixth cervical nerves. Created by. These sports medicine soft tissue techniques quickly decrease muscle soreness and pain by enhancing muscle flexibility. The dorsal scapular nerve arises from the brachial plexus, usually from the plexus root (anterior/ventral ramus) of the cervical nerve C5. A trained sports injury professional will examine the entire system and provide appropriate treatment to correct the injured area, in addition to the dysfunctional system that led to shoulder pain and weakness. Seventy-six percent of the dorsal scapular nerve originates from the C5 ventral ramus, which travels behind a major portion of the brachial plexus where it pierces the medial scalene muscles. Eventually the compensation mechanisms become overwhelmed and shoulder sprains and strains develop. PECTORAL AND SCAPULAR REGIONS THE SCAPULA: • Supraspinatus Fossa: Depression in the scapula, above the scapular spine. The suprascapular nerve is a nerve that branches from the upper trunk of the brachial plexus. rfriedberger2 PLUS. Without direct injury or trauma, many of these injuries or conditions could produce shoulder and radiating pain. Activities that overwork and cause injury to the scalene muscles often produce strain on the facet joints and produce mild joint pain symptoms. [1], It provides motor innervation to the rhomboid muscles, which pull the scapula towards the spine and levator scapulae muscle, which elevates the scapula.[2][3]. Most people are unaware of the lack of shoulder stabilization that has increased strain on the rotator cuff muscles and tendons during this time. From the superior angle of the clavicle it runs with an artery along the medial margin of the scapula and underneath the rhomboid muscles. Some may notice changes in shoulder abduction, extension, or reaching above their heads. It provides motor innervation to the rhomboid muscles, which pull the scapula towards the spine and levator scapulae muscle, which elevates the scapula. Therapy and treatment addresses the overcompensation mechanisms and restores proper neuromuscular control of the scapular and shoulder muscles. Muscles and tendons develop scar tissue or fascial adhesions between the fibers, which further prevents their normal sliding motions and contractile movements. The dorsal scapular nerve, which routinely arises from the fifth cervical nerve root (C5), was seen to receive contributions from C5 as well as sixth cervical nerve (C6), while the long thoracic nerve arose from C6 and seventh cervical nerves (C7) only. 5 Applied Aspect. The suprascapular nerve originates in the base of the neck from the superior trunk of the brachial plexus. Because dorsal scapular nerve entrapment leads to dysfunction in scapular stabilization, the first recognized symptom is tendinopathy in shoulder muscles or upper thoracic spine joint pain. Subscapularis (it is not considered one of the posterior muscles, it is found anteriorly on the scapula) Subscapular fossa Lesser tubercle Upper and lower subscapular nerves. Compression of the nerve anywhere along its path produces symptoms in the muscles downstream from the compression. Continued muscle spasms alter neck and back posture, leading to more strain and spasm of the scalene and neck muscles. Once the offending component of the dorsal scapular nerve compression is removed, treatment focuses on increasing muscle strength, endurance, and stabilization of this scapula. Teres Major. Cervical and thoracic joint pain may be contributing to the development of the neck and back pain. 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