title: A technical report on ultrasound-guided scapulocostal syndrome injection.
abstract: BACKGROUND
  We 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
  For 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.
  
  
  CONCLUSIONS
  Serratus posterior superior injection can confirm a diagnosis of scapulocostal syndrome and be therapeutically beneficial.
authors.affiliation: University Hospital Limerick, Dooradoyle, Limerick, Ireland. cianamccarthy@gmail.com.
authors.forename: C
authors.initials: C
authors.lastname: McCarthy
authors.affiliation: Department of Anaesthesia and Pain Medicine, University Hospital Limerick, Dooradoyle, Limerick, Ireland.
authors.forename: D
authors.initials: D
authors.lastname: Harmon
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D059350:Chronic Pain / Q000628:therapy*; D005260:Female; D006801:Humans; D007267:Injections / Q000379:methods*; D020069:Shoulder Pain / Q000628:therapy*; D014463:Ultrasonography / Q000379:methods*
keywords: Real-time; Scapulocostal syndrome; Serratus posterior superior; Technique; Ultrasound; Visualization