Lesion of the levator scapulae muscle

Pain is felt unilaterally in the upper scapular area, mostly of the dominant shoulder.¹ It is activity-related: neck movements as well as shoulder girdle or arm movements may be of influence. So are prolonged postures such as sitting with the head in slight flexion as happens during computer work.

On examination the pain is elicited during resisted elevation of the shoulder. The neck examination may be slightly positive. Palpation shows the lesion to lie at the insertion on the superior angle of the scapula.

The lesion usually lies at the tenoperiosteal insertion at the superior angle and the medial border of the scapula next to the superior angle and responds equally well to deep transverse friction or to infiltration with 20 mg of triamcinolone.

Lesion of the trapezius muscle

A muscular lesion in the trapezius is as uncommon as pain in the trapezius is common. Usually pain in that area is referred from the cervical spine: it is the most common localization of cervical dural pain (see p. 123). Because this phenomenon is often accompanied by extrasegmental tenderness, examination based on palpation will easily result in the wrong diagnosis of ‘trapezius syndrome’. Proper functional testing, however, usually turns out to be negative, showing that no focal lesion is present.

Muscular lesions do occur, however, but are very uncommon. They give rise to rather localized pain which can be provoked by testing against resistance: resisted elevation of the shoulder is painful, together with resisted neck extension and/or side flexion.

The lesion responds to local infiltration of a local anaesthetic or to deep friction.

Lesion of the serratus anterior muscle