Dr. Ebraheim’s educational animated video describes the anatomy of the dorsal scapular nerve.
The dorsal scapular nerve arises from the C5 nerve roots; it innervates the rhomboid major and minor muscles, and the levator scapulae.
The levator scapulae elevates the scapula and tilts the glenoid cavity inferiorly by rotating the scapula.
The rhomboids minor and major muscles connect the medial edge of the scapula to the spinal column.
The rhomboids pull the scapula towards the midline (scapular adduction) and they also pull the scapula superiorly with inward rotation, this movement is the opposite of the movement made by the serratus anterior muscle which is supplied by the long thoracic nerve.
The dorsal scapular nerve passes dorsally perforating the middle scalene muscle, then travels along the under surface of the levator scapula down to reach the rhomboid muscles.
Injury to the dorsal scapular nerve causes scapular winging.
The scapula may become displaced with upward rotation.
How do you examine for the rhomboids?
Have the patient bring the shoulder and the scapula together posteriorly then palpate the contracted romboids muscle.
Brachial Plexus injury:
Preganglionic injury:
• Which is root avulsion have the worst prognosis.
• It is usually associated with Horner’s syndrome (ptosis, miosis, anhydrosis) due to disruption of the sympathetic chain.
• You may have medial winging of the scapula due to involvement of the long thoracic nerve.
• You also have loss of the muscle function supplied by the dorsal scapular nerve (C5) and possible other cervical nerves such as C3, C4 that supply the levator scapulae.
• When you do an EMG in this situation, you will find loss of the cervical paraspinal muscles.
• This is very important because it is a sign that there is probably a preganglionic injury and a bad prognosis.
• Histamine test will be normal in these conditions.


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