• C McCarthy and D Harmon.
• University Hospital Limerick, Dooradoyle, Limerick, Ireland. cianamccarthy@gmail.com.
• Ir J Med Sci. 2016 Aug 1; 185 (3): 669-672.

IntroductionWe describe a case report and technique for using an ultrasound scanner and a linear transducer to guide serratus posterior superior (SPS) muscle injection. A 43-year-old female presented with chronic pain centered under the right upper portion of her scapula impacting her activities of daily living.Methods And MaterialsFor the ultrasound-guided SPS muscle injection, the patient was placed in the prone position. The transducer was oriented in a transverse orientation at the level of the C6-T1 vertebrae. Here the SPS muscle attaches to the lower portion of the ligament nuchae and the intervening interspinous ligaments. The muscle fibers run inferiorly and laterally to attach to the 2nd-5th ribs which were identified along with the lateral portion of the serratus posterior superior muscle which is covered by the scapula. Real-time imaging was used to direct a spinal needle into the trigger points of the SPS muscle, where solution was injected under direct vision. The patient's pain symptoms improved significantly.ConclusionSerratus posterior superior injection can confirm a diagnosis of scapulocostal syndrome and be therapeutically beneficial.

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