Levator Scapulae Pain Syndrome, Trigger Points, Stretch

Levator Scapulae Location

Levator scapulae is located on each side of the neck; it extends from the shoulder blade (scapula) to the cervical spine.

Origin

Levator scapulae originates from the transverse processes of the first 4 cervical vertebrae (C1-C4) ^[1].

Insertion

Levator scapulae inserts to the upper part of the medial border of scapula ^[1].

Function (Action)

Elevates the medial border of scapula (and thus assist in shrugging) and downwardly rotates its lateral angle (and thus lowers the shoulder joint)
Pulls scapula upwards and medially (with the help of the trapezius and rhomboid muscles)
Bends the neck to the either side (laterally, ear to shoulder)
Fixes the neck when the head is bent forward
Assists in extending the neck
Reference: ^[1,3]

Innervation

Dorsal scapular nerve (C5)
Ventral primary rami of the spinal nerves C3 and C4
Reference: ^[1]

Blood Supply

Levator scapulae receives the blood via the dorsal scapular artery ^[2].

Picture 1. Levator scapulae anatomy: origin, insertion, action

Related anatomy:

Myofascial Pain and Trigger Points in Levator Scapulae

Myofascial pain is chronic pain that arises from the muscle sheath called fascia.

Symptoms

Symptoms and signs associated with pain in the levator scapulae muscle ^[3]:

Difficulty rotating the head toward the affected side
Difficulty abducting the arm (extending it sideways and above the shoulder level)
Subjective feeling of shortness of breath due to pain in the neck during inhalation
Trigger points at the angle of the neck on either side (about 1/2 inch and 1 and 1/2 inch above the medial angle of the scapula (Picture 2). Applying pressure on the trigger points causes pain that radiates to the nearby areas.

Picture 2. Levator scapulae trigger points location and pain distribution

Causes

Myofascial pain in the levator scapulae muscle can be caused by ^[3]:

Prolonged reading or writing with the neck bent forward or computer work with the keyboard positioned too high
Holding the phone between the ear and shoulder
Sleeping on the stomach with the head on a thick pillow
Repetitive overhead arm movements, such as during swimming
Carrying a heavy bag with a strap over the shoulder
Driving while holding the steering wheel at “10 and 2” position
Emotional stress, pneumonia or other cause of hyperventilation
Limping on one leg or using an improperly fitting walking cane or crutches

Differential Diagnosis

Apart from the levator scapulae, the pain in the angle of the neck can originate from:

Stiff neck from bad posture
Wry neck (torticollis) ^[4]
Strain of the sternocleidomastoid, trapezius or scalene muscles
Whiplash injury
Herniated disc in the neck
Herpes zoster (shingles)
Fibromyalgia
Snapping and SICK scapula syndrome and other causes of shoulder blade pain

Treatment

The following may relieve the pain in the elevator scapulae:

Massaging the area behind the angle of the neck with fingers or cane massager
Massaging with a tennis ball or lacrosse ball against a wall
Myofascial pain release performed by a physiotherapist

The effectiveness of acupuncture, dry needling and steroid injections in relieving pain in levator scapulae is not known. Analgesics and muscle relaxants probably do not work well.

Levator Scapulae Stretch

Regular stretching of the levator scapula can help prevent trigger points in the muscle, especially when started early after the pain onset. Spraying the sore muscle with vapocoolant spray reduces pain during stretching.

An example of a stretching exercise for levator scapulae:

Sit down with your back straight, turn the head to the right, place the right hand to the top of the head and bend the head down, so you will look toward your right hip. Do not push the head with the hand. Hold for several seconds and repeat 2 or 3 times on each side.

Video 1. Levator scapulae anatomy, function and causes of pain

Key Points

To prevent levator scapulae muscle pain, avoid holding your arms high during computer work and driving.
Use a thin pillow in bed.
Face with your work duties and avoid unnecessary stress.
When already in pain, try stretching exercises and massage rather than acupuncture, analgesics or injections.

References

Levator Scapulae Muscle Anatomy