Levator Scapulae Muscle
The levator scapulae is a long muscle, which is located at the back and side of the neck. It is known to end at the top of the shoulder. Its Latin name indicates its function of lifting the scapula. Regardless of muscular development, this long muscle is difficult to see. It is most likely visible in the elderly and individuals with lean muscles, especially when the neck is laterally bent, when the shoulder is slightly raised, or when the arm is carrying weight.
An inverted V is created by the levator scapulae along with the sternomastoid muscle. The upper end of the levator scapulae passes deep into the sternomastoid. The fibers of the levator scapulae wrap around the cervical spine and attach onto the transverse processes. When the fibers contract, the processes are pulled posteromedially. Hence, the neck's anterior surface faces the same side of the body.
Levator scapulae is a long muscle that belongs to the shoulder girdle. It is known to reside at the side and back of the neck. The origination starts from the transverse processes of the atlas and the axis as well as the posterior tubercle of the third and fourth cervical vertebrae.
At the medial border and the superior angle of the scapula is the insertion. The upper part of the levator scapulae is positioned below the splenius capitis and the sternocleidomastoid muscle. Under the trapezius lies the lower part of the muscle. The middle part of the levator scapulae lies in the lateral cervical region, which is uncovered. The levator scapulae can also be easily palpitated in the middle areas. The branch of the brachial plexus, which is the dorsal scapular nerve is said to innervate the levator scapulae muscle.
- It helps in the elevation of the scapula.
- Pulls the entire scapula and elevates the arm, wherein it brings the arm back to its original position.
- If the scapula is stable, then it can lead to a lateral flexion, which involves contraction or bending of the cervical vertebral column.
- It tilts the scapula upwards at a smaller angle and thereby moves the inferior angle away from the back.
- Lower rotation of the glenoid is possible because of the combined effort of the levator scapulae muscle with rhomboid and pectoralis minor muscle.
- Works with other muscles in securing and strengthening the scapula and its glenoid cavity.
- Helps the muscles in the shoulder joint to work effectively and efficiently.
- The biarticulate levator scapulae muscle leads into passive insufficiency by completing the scapula depression and upward rotation.
- Similarly, by elevation of the scapula and downward rotation, the biarticulate levator scapulae muscle enters active insufficiency.
- The levator scapulae muscle tends to hold back the scapula against the trunk.
The middle part of levator scapulae muscle is innervated by the spinal accessory nerve. Also, the levator scapulae are innervated by the fourth and fifth cervical nerves and the dorsal scapular branch. This dorsal spinal branch goes much deeper.
The levator scapulae muscle creates motion such as elevation, downward rotation, and scapular retraction at the scapulocostal joint. This motion takes place in one line of pull and in an oblique plane. It can also combine motion such as extension, ipsilateral rotation at the spinal joints, and lateral flexion.
Eccentric Antagonist Functions
- It slows scapular depression, protraction, and upward rotation.
- It restrains flexion, contralateral protraction, and opposite side flexion of the neck.
- Isometric stabilization functions
- It stabilizes the scapula and the upper cervical spinal joints
Rarely, the dorsal scapular nerve develops an isolated lesion with consequent paralysis of the levator scapulae muscle. The levator scapulae muscle is also more prone to stiffening and chronic pain. This happens due to poor posture in daily life. Bad posture may happen due to sleeping on one side without proper head support, carrying heavy shoulder bags, sitting at a desk for a long time, and improper lifting.
The trigger points are said to be activated when the muscles are strained due to longer periods time of looking down to read a book, write, or work on a computer. The neck moves almost 600 times in an hour regardless of whether you are sleeping or awake. While the flexible cervical spine moves around, it has to support the head, which is quite heavy. One of the muscles affected is the levator scapula. It is frequently responsible for a stiff neck. This pain is usually triggered at the angle of the neck and the superior border of the scapula.
Problems occur due to the trigger points. For example, when you sleep in a wrong position and wake up with pain, it is likely due to the levator scapulae. The angle of the neck is the primary area of trigger point, but some trigger points may extend to the back shoulder. Studies have revealed that levator scapulae muscles are mostly affected by the trigger points. Due to actions that can cause a strain such as holding the telephone pinned between the ears and shoulder for a long time can aggravate the pain.
Months of treatment are usually required, so it is better to eliminate the habit. Keeping the shoulder elevated can keep the muscle in a shortened position and make it weak, which can also cause a trigger point to occur. Chronic distress can also cause trigger points. When long hours are spent driving, the muscle gets overloaded since the hands are held on the steering wheel top in the 10” and 2” position. The muscles get fatigued when the shoulders hunched up.
Looking down to read or write can also cause a strain on the levator scapulae muscle since they control the forward flexion of the head. To keep the forearm in line with the computer keyboard, the muscle gets strained. Trigger points may get activated and cause pain. In such cases, either the seat should be raised to bring it in line with the keyboard or the keyboard should be brought down such that it is line with the forearm.
While copying and pasting a document on a computer, we tend to repeatedly turn our neck toward the side and then back to the screen, which may also cause a strain. It also causes a stiff and painful neck and the head rotation to the same side is restricted. If the problem worsens, then the person may not be able to turn his or her head toward the same side at all times. Sometimes, the person may experience pain while trying to look behind. This pain is likely caused by the trigger points of the levator scapulae muscle. Moreover, the muscle may resist head rotation toward the side since the muscle is short and stiff.
One can experience this pain when the body is at rest since the trigger points are still active. The primary sign is restriction of the rotation of the neck. Flexion is affected to a larger extent, but the extension might be unaffected. If the levator scapular rotation is not restricted, then most likely, it is not due to trigger points. The trigger points of the upper trapezius might also cause trigger points of the levator scapulae and vice versa. Same goes with the trigger points of the ipsilateral rhomboids and supraspinatus muscles.
The levator scapulae muscle has two trigger points. The most tender trigger point is the one located above the attachment to the upper angle of the shoulder blade. Constant pain may be experienced if there is an inflammation and additional bursa in this area. In such cases, an ice application may be helpful. Avoid applying pressure or a self-massage. The difficult trigger point to locate and treat is the central trigger point since the trapezius also has to be dealt with. A quick way to see if the levator scapula is tight is to see the patient from the back.
The levator scapulae muscle tends to be likely released when the shoulder is hunched or one side higher than the other. The shoulder motion can also be assessed. By releasing the levator scapulae with the help of a massage and stretching, the ability to rotate and abduct will improve, which will decrease the stress on the glenohumeral joint for movement.
Relation with Other Structures
Inferiorly deep to the trapezius and superiorly deep to the sternocleidomastoid superiorly lies the levator scapulae muscle. The attachment of the levator scapulae to the scapula is superior to the attachment of the rhomboids. Anterior to the transverse process attachment of the splenius cervicis and posterior to the transverse process attachment of the scalenes is the transverse process attachment of the levator scapulae.
Approximately at the midpoint, there is a twist in the fibers. Increased density is created on the middle part of the muscles. The scapulae get abducted by the levator scapulae at the scapulocostal joint. This is due to the fact that the levator scapulae muscle is attached more interiorly to the cervical transverse processes than to the scapular attachment. Thus, some sources believe that levator scapulae can pull the scapula anteriorly. Because some people do not have a good sense of area where the transverse process of atlas is located, many find it difficult palpitating the superior aspects of the levator scapulae. The transverse process of the atlas is located on the posterior border of the ramus of the mandible and inferior to the ear and anterior to the mastoid process of the temporal bone.