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A case of atypical insertion of the levator scapulae

100%

Loukas M., Louis R. G. J., Merbs W.

Folia Morphologica

2006

tom 65

nr 3

232-235

Anatomical variations in the musculature of the spine have the potential to cause functional and postural abnormalities, which in turn could lead to chronic myofascial and skeletal pain. We present a unilateral case of a 71-year-old Caucasian female in which the left levator scapulae muscle gave rise to an accessory head that inserted, by way of a flat aponeurotic band, to the ligamentum nuchae, the tendon of the rhomboideus major and the superior aspect of the serratus posterior superior muscle. The innervation was provided by a branch of the dorsal scapular nerve. By exerting unilateral traction on the vertebrae and surrounding musculature, this unusual variation might have resulted in clinical consequences including scoliosis and movement abnormalities of the head and neck as well as myofascial pain syndrome.

Identification of greater occipital nerve landmarks for the treatment of occipital neuralgia

76%

Loukas M., El-Sedfy A., Tubbs R. S., Louis R. G. J., Wartmann C. T., Curry B., Jordan R.

Folia Morphologica

2006

tom 65

nr 4

337-342

Important structures involved in the pathogenesis of occipital headache include the aponeurotic attachments of the trapezius and semispinalis capitis muscles to the occipital bone. The greater occipital nerve (GON) can become entrapped as it passes through these aponeuroses, causing symptoms of occipital neuralgia. The aim of this study was to identify topographic landmarks for accurate identification of GON, which might facilitate its anaesthetic blockade. The course and distribution of GON and its relation to the aponeuroses of the trapezius and semispinalis capitis were examined in 100 formalin-fixed adult cadavers. In addition, the relative position of the nerve on a horizontal line between the external occipital protuberance and the mastoid process, as well as between the mastoid processes was measured. The greater occipital nerve was found bilaterally in all specimens. It was located at a mean distance of 3.8 cm (range 1.5–7.5 cm) lateral to a vertical line through the external occipital protuberance and the spinous processes of the cervical vertebrae 2–7. It was also located approximately 41% of the distance along the intermastoid line (medial to a mastoid process) and 22% of the distance between the external occipital protuberance and the mastoid process. The location of GON for anaesthesia or any other neurosurgical procedure has been established as one thumb’s breadth lateral to the external occipital protuberance (2 cm laterally) and approximately at the base of the thumb nail (2 cm inferior). This is the first study proposing the use of landmarks in relation to anthropometric measurements. On the basis of these observations we propose a target zone for local anaesthetic injection that is based on easily identifiable landmarks and suggest that injection at this target point could be of benefit in the relief of occipital neuralgia.

Ograniczanie wyników

2 Folia Morphologica

2 Louis R. G. J.

2 Loukas M.

1 Curry B.

1 El-Sedfy A.

1 Jordan R.

1 Merbs W.

1 Tubbs R. S.

1 Wartmann C. T.

2 2006

Wyniki wyszukiwania

A case of atypical insertion of the levator scapulae

Identification of greater occipital nerve landmarks for the treatment of occipital neuralgia