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.
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