Institut für Anatomie, Universität Leipzig, Liebigstr 13, 04103 Leipzig, Germany.
Institut für Anatomie, Universität Leipzig, Liebigstr 13, 04103 Leipzig, Germany.
Ann Anat. 2022 Aug;243:151938. doi: 10.1016/j.aanat.2022.151938. Epub 2022 Mar 31.
Pain over the superior angle of the scapula is a common musculoskeletal symptom. It is often accompanied by radiating pain to the neck, head, and shoulder. The aetiologies can be varied but may also be idiopathic in nature. To explore the fascial connections of this region, we studied 26 unembalmed, -two Thiel and one alcohol body-donors of science, by dissection, histological probes, and plastinations. When removing the descending and transverse fibres of the trapezius, a large prominent triangular area of white connectives is revealed, varying in mass. A subdivision of these connectives can be further dissected to prove that the rhomboid minor and levator scapulae muscles are interconnected and enclosed by connectives. Between these two muscles a bridge of connective tissue, containing fat, is observed. These connectives end cranially at the surface of the splenius capitis, and at the midline, containing vessels and nerves, as supported by histology and plastinations. This unification is separate from the rhomboid major muscle but overlaps with the latter dorsally. It connects to the superior angle of scapula and its upper medial borders, respectively, and cranially to the root of the spine of the scapula. Beneath the united levator scapulae and rhomboid minor, described here, the serratus posterior superior and possibly serratus anterior form a hypomochlion or fulcrum at the superior angle of the scapula. Any tension on this unified entity can unbalance this fulcrum. Investigating the connections between these two unified muscles may help explain the often idiopathic nature of superior scapular pain, and the success or failure of surgery, and other treatments.
肩胛骨上角的疼痛是一种常见的肌肉骨骼症状。它常伴有向颈部、头部和肩部放射的疼痛。其病因多种多样，但也可能是特发性的。为了探索该区域的筋膜连接，我们通过解剖、组织学探针和塑化研究了 26 名未经防腐处理的、2 名 Thiel 和 1 名酒精尸体供体。当去除斜方肌的降支和横行纤维时，会发现一个大而突出的白色连接三角区域，其质量不一。这些连接可以进一步细分，以证明菱形肌和肩胛提肌是相互连接的，并被连接组织包裹。在这两块肌肉之间，观察到一个含有脂肪的连接组织桥。这些连接组织在颅侧终止于头半棘肌的表面，在中线处，包含血管和神经，这一点得到了组织学和塑化的支持。这种联合是与菱形肌分开的，但在背部与后者重叠。它连接到肩胛骨的上角及其上内侧缘，在颅侧连接到肩胛骨脊柱的根部。在联合的肩胛提肌和菱形肌下方，描述了这里的上后锯肌和可能的前锯肌在肩胛骨的上角形成一个下悬带或支点。这个统一实体上的任何张力都可能使这个支点失去平衡。研究这两块联合肌肉之间的连接可能有助于解释肩胛骨上角疼痛的常见特发性性质，以及手术和其他治疗的成败。
