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A Possible Accessory Muscle of the Serratus Posterior Superior Muscle

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A Possible Accessory Muscle of the Serratus Posterior Superior Muscle Case Report A Possible Accessory Muscle of the Serratus Posterior Superior Muscle Kerrie Lashley 1,* and Guinevere Granite 2 1 Department of Anatomy and Cell Biology, George Washington University, Washington, DC 20037, USA 2 Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA; [email protected] * Correspondence: [email protected] Abstract: Anatomical variation is defined as the normal range of possibilities in the topography and morphology of body structures. In contrast, an anomaly is any structural or functional anatomical finding beyond the normal range of possibilities. This case study describes a muscular anomaly found in a 73-year-old preserved Caucasian male. We observed a left-sided anomalous muscle originating from the transverse process of the C1 (Atlas) vertebra and inserting onto the proximal attachment of the serratus posterior superior (SPS) muscle at the C7 level. We suggest that this anomaly is a result of early embryological development and hypothesize that the atypical neck muscle may reinforce the action of the SPS. This finding is rare and no reference of it can be found in the literature. Reporting anatomical anomalies is important for the medical literature and education. Keywords: accessory muscle to serratus posterior superior; muscular anomalies; variations in human myology; anatomical variations 1. Introduction Citation: Lashley, K.; Granite, G. A Muscular variations are common in the human body and are well-documented in Possible Accessory Muscle of the the literature. These variants occur within the normal range of possibilities that may be Serratus Posterior Superior Muscle. comprised of morphometric changes, supernumerary elements, consistency and spatial Reports 2021, 4, 2. https://doi.org/ orientation [1,2]. Muscular anomalies are much rarer, and anatomists observe them dur- 10.3390/reports4010002 ing routine cadaveric dissection or surgeons discover them inadvertently during surgical procedures [3]. Anomalies are typically asymptomatic and may go unnoticed during the in- Academic Editor: Eustace Johnson dividual’s life. With the development of non-invasive imaging techniques and the increase Received: 7 January 2021 in cadaveric studies, however, anatomic anomalies are being detected more frequently [2]. Accepted: 21 January 2021 Published: 25 January 2021 In this case study, we observed a rare unilateral anomalous muscle in the left posterior neck of a human cadaver. It was located deep to the rhomboid muscles and coursed superior and medial to the serratus posterior superior (SPS) muscle. In addition, we Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in found differences in the cervical origins of the right and left levator scapulae muscles published maps and institutional affil- (LSMs), resulting in muscular asymmetry in this individual. This anomalous muscular iations. development is uncommon, and we were unable to find a description of such a case in the literature. Therefore, it is important to provide a detailed description of this rare anomalous muscle. 2. Materials and Methods Copyright: © 2021 by the authors. Licensee MDPI, Basel, Switzerland. During cadaveric dissection, we detached the superficial extrinsic back muscles, in- This article is an open access article cluding the trapezius, latissimus dorsi, and the rhomboid muscles from their proximal distributed under the terms and attachments and reflected them. The levator scapulae muscle was not reflected. This conditions of the Creative Commons exposed the intermediate extrinsic back muscles, including the serratus posterior superior Attribution (CC BY) license (https:// (SPS). We detached the SPS from the spinous processes at the C7-T2 vertebral level. We creativecommons.org/licenses/by/ observed the anomalous muscle during the detachment of the SPS at its proximal attach- 4.0/). ments. Delicate dissection of the anomalous muscle allowed us clear definition and further Reports 2021, 4, 2. https://doi.org/10.3390/reports4010002 https://www.mdpi.com/journal/reports Reports 2021, 4, x FOR PEER REVIEW 2 of 5 observed the anomalous muscle during the detachment of the SPS at its proximal attach- Reports 2021, 4, 2 ments. Delicate dissection of the anomalous muscle allowed us clear definition2 of 5 and fur- ther examination of its attachment sites. We detached the deep intrinsic muscle, the sple- nius muscle, proximally from the nuchal ligament and spinous processes of C7-T6 verte- examinationbrae. We conducted of its attachment this dissection sites. We bilaterally. detached the deep intrinsic muscle, the splenius muscle, proximally from the nuchal ligament and spinous processes of C7-T6 vertebrae. We3. Case conducted Report this dissection bilaterally. 3. CaseDuring Report routine dissection of the neck and back regions, we found a unilateral anom- alousDuring muscle routine occurring dissection within of the a neck73-year-old and back Caucasian regions, we male found human a unilateral cadaver. anoma- The anom- lousalous muscle muscle occurring originated within from a 73-year-old the left Caucasian transverse male process human of cadaver. the atlas The and anomalous extended inferi- muscleorly to originated insert onto from the the SPS left (Figure transverse 1). The process left of SPS the presented atlas and extended its common inferiorly anatomy: to proxi- insertmal attachments onto the SPS from (Figure the1). spinou The lefts processes SPS presented of C7-T2 its common vertebra anatomy:e and its proximal distal attachments attachmentsto the superior from borders the spinous of processesthe second of C7-T2through vertebrae fifth ribs. and itsThe distal tendinous attachments fibers to theof the anom- superior borders of the second through fifth ribs. The tendinous fibers of the anomalous alous muscle inserted superficially, and slightly perpendicular onto the left SPS proximal muscle inserted superficially, and slightly perpendicular onto the left SPS proximal end. Theend. fused The fused fibers offibers the twoof the muscles two muscles attached attach to theed spinous to the processspinous of process the C7 vertebraof the C7 vertebra (Figure(Figure2). 2). The The anomalous anomalous muscle muscle shared shared a common a common attachment attachment at the transverse at the transverse process process ofof thethe atlas atlas with with the the upper upper portion portion of the of splenius the splenius cervicis cervicis muscle andmuscle two and of the two upper of the upper muscularmuscular slips slips of of the the left left LSM LSM (Figure (Figure2). In2). length,In length, the anomalousthe anomalous muscle muscle measured measured 12.5 12.5cm cmand and 0.65 0.65 cm cm wide wide with with a a consistent consistent width width throughout throughout its muscleits muscle belly. belly. FigureFigure 1. 1.Overview Overview of theof the Posterior Posterior Intermediate/Deep Intermediate/Deep Neck. Accessory Neck. Accessory Serratus Posterior Serratus Superior Posterior Supe- (ASPS)rior (ASPS) Muscle; Muscle; Atlas transverse Atlas transverse process (C1);process Spinous (C1) process; Spinous of cervicalprocess vertebra of cervical 7 (C7); vertebra Erector 7 (C7); SpinaeErector (ES) Spinae Muscles; (ES)Levator Muscles; Scapulae Levator Muscle Scapulae (LSM); Muscle Scapula (LSM (Scp);); Scapula Serratus (Scp Posterior); Serratus Superior Posterior (SPS)Superior Muscle; (SPS Splenius) Muscle; capitis Splenius (Sct) Muscle; capitis Splenius (Sct) Muscle; cervicis Splenius (Scr) Muscle. cervicis (Scr) Muscle. InIn combination combination with with this this rare rare finding, finding, there werethere some were noteworthy some noteworthy differences differences in the in the cervical origins of the left LSM compared to the right. The left sided LSM exhibited four cervical origins of the left LSM compared to the right. The left sided LSM exhibited four main muscular slips with distal attachments to the superior angle of the scapula but varied inmain the numbermuscular of muscularslips with slips distal and attachments cervical origins. to the The superior observed angle variabilities of the ofscapula the left but varied LSMin the are number as follows: of muscular (1) muscular slips slips and 1 and cervical 2 shared origins. a common The observed cervical origin variabilities at C1; (2) of the left theLSM third, are broaderas follows: muscular (1) muscular slip, bifurcated slips 1 midway, and 2 shared with one a common muscular cervical slip of cervical origin at C1; (2) originthe third, at C3 broader and the othermuscular at C4; slip, and(3) bifurcated the fourth midway, muscular slipwith originated one muscular from C5; slip no of cervical LSMorigin muscle at C3 slips and originated the other from at C4; C2 (Figureand (3)3A). the The fourth right-sided muscular LSM slip had fouroriginated muscular from C5; no slipsLSM that muscle originated slips originated from the transverse from C2 processes (Figure 3A). of C1–C4 The right-sided vertebrae, respectively, LSM had four and muscular slips that originated from the transverse processes of C1–C4 vertebrae, respectively, and were relatively consistent in size and shape (Figure 3B). The muscular asymmetry in the present case produced a five-headed left LSM and a four-headed right LSM. Reports 2021, 4, 2 3 of 5 Reports 2021, 4, x FOR PEER REVIEW 3 of 5 were relatively consistent in size and shape (Figure3B). The muscular asymmetry in the present case produced a five-headed left LSM and a four-headed right LSM. Reports
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