Scapulocostal syndrome (levator scapulae syndrome)
What is it? Presentation of condition:
What is the cause?
2. Secondary - a complication of pre-existing neck or shoulder lesions
3. Static - occurring in severely disabled patients who are unable to control the scapulothoracic relationship.
Signs and Symptoms/Rule in:
Pain referral pattern:
- The hallmark of the scapulocostal syndrome is pain. The pain may be localized to the medial superior border of the scapula, or it may radiate up into the neck and cause headache. It is described as a painful musculoskeletal syndrome that mainly affects the posterior shoulder area. Pain could radiate to the occiput or spinous processes of C3 and C4, it could appear to originate at the root of the neck and radiate into the shoulder joint, or it could radiate down the arm into the hand, usually along the posteromedial aspect of the upper arm and along the ulnar distribution in the forearm and hand. Researchers concluded that this syndromes pain presentation can alternatively radiate along the course of the fourth and fifth intercostal nerves and could mimic angina pectoris on the left and cholecystitis on the right.
What is the cause?
- Russek classified the syndrome into three types:
2. Secondary - a complication of pre-existing neck or shoulder lesions
3. Static - occurring in severely disabled patients who are unable to control the scapulothoracic relationship.
Signs and Symptoms/Rule in:
- Muscular, reflex, sympathetic, or sensory findings are usually absent in the examination. The classic finding is a trigger point elicited by digital pressure at the medial scapular border in a line extending from the scapular spine.
- Trigger point pain should be done with the arm adducted, with the palm of the affected hand flat on the opposite shoulder and crossing in front of the chest. Extension and internal rotation of the arm will elicit the pain. Secondary trigger point pain may be seen in the trapezius ipsilateral and rhomboid muscle ipsilateral. There may be diffuse tenderness over the chest wall that should be mild.
Pain referral pattern:
- The pain may be localized to the medial superior border of the scapula, or it may radiate up into the neck and cause headache. Pain could radiate to the occiput or spinous processes of C3 and C4, it could appear to originate at the root of the neck and radiate into the shoulder joint, or it could radiate down the arm into the hand, usually along the posteromedial aspect of the upper arm and along the ulnar distribution in the forearm and hand. Researchers concluded that with this syndrome the pain alternatively could radiate along the course of the fourth and fifth intercostal nerves and could mimic angina pectoris on the left and cholecystitis on the right.