The serratus posterior superior arises by a thin aponeurotic tendon from the ligamentum nuchae and spinous processes of C7-T3, inserting via muscular slips onto the outer surfaces of ribs 2-5. The aponeurotic origin is thin and broad, blending with the rhomboid fascia.
The serratus posterior superior aponeurotic origin is a site of myofascial trigger points that refer pain to the posterior shoulder, medial scapular border, and ulnar forearm in a pattern mimicking C8 radiculopathy or thoracic outlet syndrome. Accurate identification of this muscle in the differential diagnosis of upper extremity pain is important. The aponeurosis is thin and requires careful surgical identification during posterior thoracic approaches.
Traction injury at the spinous process aponeurotic origin producing deep interscapular pain and referred arm aching, responsive to dry needling and thoracic mobility rehabilitation.
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