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  1. Introduction

    Periscapular pain is a common clinical presentation in clinic. Amongst other causes an entrapment neuropathy of the dorsal scapular nerve can cause these symptoms. These conditions can be treat with conservative treatment.

    The article is split into:

    • Anatomy of the dorsal scapular nerve.
    • Symptoms of the dorsal scapular neuropathy.
    • Pathology of dorsal scapular neuropathy.

    Anatomy of the dorsal scapular nerve

    Muir (2017) identified the course of the dorsal scapular nerve as:

    • Originates from the anterior ramus of the C5 nerve root directly or as the first branch of the superior trunk of the brachial plexus. Variations include sharing a common branching trunk with the long thoracic nerve, C4 nerve root or C4 and C5 nerve root.
    • Passes obliquely and inferiorly through the middle scalene without innervating it. Variations include the nerve piercing the middle and posterior scalene muscles.
    • Runs inferior and slightly laterally between the superior fibres of the upper trapezius medially and the levator scapulae laterally. Variations include the dorsal scapular nerve piercing the levator scapulae.
    • Passes deep to the upper trapezius fibres between the rhomboid major/minor and the serratus posterior superior muscle.
    • Runs inferiorly along the medial border of the scapula to the inferior medial border of the scapula.

    Variations in the course of the dorsal scapular nerve describes a looping of the nerve around the deep branch of the cervical artery and dorsal scapular artery.

    Symptoms of dorsal scapular neuropathy

    Muir (2017) listed the symptoms of dorsal scapular neuropathy as:

    • Pain, stiffness, dysesthesia in the scapular, thoracic and costovertebral area (& Sultan et al 2013)
    • Posterolateral arm symptoms
    • Notalgia paresthetica (NP): pruritis, numbness and tingling, and pain in the upper to mid-thoracic spine).
    • ‘SICK’ scapula: acronym for Scapular malposition, Inferior medial border prominence, Coracoid pain and malposition, and dysKinesis of scapular movement

    Pathology of dorsal scapular neuropathy

    Vascular (Muir 2017):

    Variations from the standard anatomical description of the dorsal scapular nerve can cause the nerve to become compressed by:

    • Deep branch of the cervical artery.
    • Dorsal scapular artery.

    Musculoskeletal

    If following the standard anatomical description the dorsal scapula nerve can become entrapped in the:

    • Scalene Medius (Muir 2017, Sultan et al 2013, Hanson & Auyong, 2013).
    • Rhomboids (Sultan et al 2013).

    Variations from the standard anatomical description of the dorsal scapular nerve can cause the nerve to become compressed by (Muir 2017):

    • Posterior Scalene.
    • Levator Scapulae.

    As well as the dorsal scapula nerve the long thoracic nerve can also course through the Scalene Medius (Hanson & Auyong 2013).

    Hester et al (2000) found the long thoracic nerve in close relation to a tight fascial band of tissue. This tissue arose from the inferior aspect of the brachial plexus, extended just superior to the middle scalene muscle insertion on the first rib, and to the proximal aspect of the serratus anterior muscle.

    Abduction and external rotation caused the long thoracic nerve to "bow-string" across this fascial band. This was postulated as dynamically compressing the long thoracic nerve (Hester al 2000)

    Winging of the scapula caused by a long thoracic or dorsal scapula neuropathy may:

    • Further compress the long thoracic nerve: (Hester et al 2000) found medial and upward migration of the superior most aspect of the scapula was found to further compress the long thoracic nerve.
    • Induce a stretch of the cutaneous medial branches of the dorsal primary rami of thoracic spinal nerves: this will refer further pain to the interscapular region (Sultan et al 2013).

    References

    Muir, B. Dorsal scapular nerve neuropathy: a narrative review of the literature (2017)

    Sultan HE, Younis El-Tantawi GA. Role of dorsal scapular nerve entrapment in unilateral interscapular pain. (2013).

    Hanson NA, Auyong DB.Systematic ultrasound identification of the dorsal scapular and long thoracic nerves during interscalene block. (2013). 

    Hester P, Caborn DN, Nyland J. Cause of long thoracic nerve palsy: a possible dynamic fascial sling cause. (2000)

  2. Scope

    This document refers to personal data, which is defined as information concerning any living person (a natural person who hereafter will be called the Data Subject) that is not already in the public domain.

    The General Data Protection Regulation (GDPR) which is EU wide and far more extensive than its predecessor the Data Protection Act, along with the Privacy and Electronic Communications Regulations (PECR), seek to protect and enhance the rights of EU data subjects. These rights cover the safeguarding of personal data, protection against the unlawful processing of personal data and the unrestricted movement of personal data within the EU and its storage within the EEA.

    1 - Your Practice Kirkbymoorside Natural Health Centre, based at Kirkbymoorside Natural Health Centre, Bethel Chapel, Tinley Garth, Kirkbymoorside, Ryedale, North Yorkshire, YO62 6AR, United Kingdom, which hereafter for the purposes of this Privacy Notice will be referred to as the Osteopaths, is pleased to provide the following information:

    2 - Who we are
    The Osteopaths diagnose and treat health conditions. Treatments are carried out in accordance with the Institute of Osteopathy’s patient charter http://www.iosteopathy.org/osteopathy/the-patient-charter/. The practice may also provide other treatments, about which our staff will be pleased to provide more details.

    3 - Personal Data
    a) For the purposes of providing treatment, Osteopaths may require detailed medical information. We will only collect what is relevant and necessary for your treatment. When you visit our practice, we will make notes which may include details concerning your medication, treatment and other issues affecting your health. This data is always held securely, is not shared with anyone not involved in your treatment, although for data storage purposes it may be handled by pre-vetted staff who have all signed an integrity and confidentiality agreement. To be able to process your personal data it is a condition of any treatment that you give your explicit consent to allow Osteopaths to document and process your personal medical data. Contact details provided by you such as telephone numbers, email addresses, postal addresses may be used to remind you of future appointments and provide reports or other information concerning your treatment. As part of our obligations as primary healthcare practitioners there may be circumstances related to your treatment, on-going care or medical diagnosis that will require the sharing of your medical records with other healthcare practitioners e.g GPs, consultants, surgeons and/or medical insurance companies. Where this is required we will always inform you first unless we are under a legal obligation to comply.
    b) For marketing purposes, the Osteopaths may also use the contact details provided by you to respond to your enquiries, including making telephone contact and emailing information to you which the practice believes may be of interest to you.
    c) In making initial contact with the practice you consent to Osteopaths maintaining a marketing dialogue with you until you either opt out (which you can do at any time) or we decide to desist in promoting our services. Osteopaths may occasionally also act on behalf of its patients in the capacity of data processor, when we may promote other practitioners based at our premises, who may not be employed by us. Osteopaths do not broker your data and you can ask to be removed from our marketing database by emailing or phoning the practice using the contact details provided at the end of this Privacy Notice.
    d) Some basic personal data may be collected about you from the marketing forms and surveys you complete, from records of our correspondence and phone calls and details of your visits to our website, including but not limited to, personally identifying information like Internet Protocol (IP) addresses.
    e) Osteopaths’ website uses cookies, which is a string of information that a website stores on a visitor’s computer, and that the visitor’s browser provides to the website each time the visitor returns. WordPress.org uses cookies to help Osteopaths to identify and track visitors and their website access preferences. Osteopaths’ website visitors who do not wish to have cookies placed on their computers should set their browsers to refuse cookies before using Osteopaths’ website.
    f) Osteopaths will only collect the information needed so that we can provide you with the services you require, the business does not sell or broker your data.

    4 - Legal basis for processing any personal data
    To meet our contractual obligations obtained from explicit Patient Consent and legitimate interest to respond to enquiries concerning the services provided.

    5 - Legitimate interests pursued by Osteopaths
    To promote treatments for patients with all types of health problems indicated for osteopathic care.

    6 – Consent
    Through agreeing to this privacy notice you are consenting to Osteopaths processing your personal data for the purposes outlined. You can withdraw consent at any time by using the postal, email address or telephone number provided at the end of this Privacy Notice.

    7 – Disclosure
    Osteopaths will keep your personal information safe and secure, only staff engaged in providing your treatment will have access to your patient records, although our administration team will have access to your contact details so that they can make appointments and manage your account. Osteopaths will not disclose your Personal Information unless compelled to, in order to meet legal obligations, regulations or valid governmental requests. The practice may also enforce its Terms and Conditions, including investigating potential violations of its Terms and Conditions to detect, prevent or mitigate fraud or security or technical issues; or to protect against imminent harm to the rights, property or safety of its staff.

    8 - Retention Policy
    Osteopaths will process personal data during the duration of any treatment and will continue to store only the personal data needed for eight years after the contract has expired to meet any legal obligations. After eight years all personal data will be deleted, unless basic information needs to be retained by us to meet our future obligations to you, such as erasure details. Records concerning minors who have received treatment will be retained until the child has reached the age of 25.

    9 - Data storage
    All Data is held in the United Kingdom. Osteopaths do not store personal data outside the EEA.

    10 - Your rights as a data subject
    At any point whilst Osteopaths are in possession of, or processing your personal data, all data subjects have the following rights:

    • Right of access – you have the right to request a copy of the information that we hold about you.
    • Right of rectification – you have a right to correct data that we hold about you that is inaccurate or incomplete.
    • Right to be forgotten – in certain circumstances you can ask for the data we hold about you to be erased from our records.
    • Right to restriction of processing – where certain conditions apply you have a right to restrict the processing.
    • Right of portability – you have the right to have the data we hold about you transferred to another organisation.
    • Right to object – you have the right to object to certain types of processing such as direct marketing.
    • Right to object to automated processing, including profiling – you also have the right not to be subject to the legal effects of automated processing or profiling.


    In the event that Osteopaths refuses your request under rights of access, we will provide you with a reason as to why, which you have the right to legally challenge. At your request Osteopaths can confirm what information it holds about you and how it is processed.

    11 - You can request the following information:

    • Identity and the contact details of the person or organisation (Osteopaths) that has determined how and why to process your data.
    • Contact details of the data protection officer, where applicable.
    • The purpose of the processing as well as the legal basis for processing.
    • If the processing is based on the legitimate interests of Osteopaths and information about these interests.
    • The categories of personal data collected, stored and processed.
    • Recipient(s) or categories of recipients that the data is/will be disclosed to.
    • How long the data will be stored.
    • Details of your rights to correct, erasure, restrict or object to such processing.
    • Information about your right to withdraw consent at any time.
    • How to lodge a complaint with the supervisory authority (ICO).
    • Whether the provision of personal data is a statutory or contractual requirement, or a requirement necessary to enter into a contract, as well as whether you are obliged to provide the personal data and the possible consequences of failing to provide such data.
    • The source of personal data if it wasn’t collected directly from you.
    • Any details and information of automated decision making, such as profiling, and any meaningful information about the logic involved, as well as the significance and expected consequences of such processing.

    12 - To access what personal data is held, identification will be required
    Osteopaths will accept the following forms of identification (ID) when information on your personal data is requested: a copy of your driving licence, passport, birth certificate and a utility bill not older than three months. A minimum of one piece of photographic ID listed above and a supporting document is required. If Osteopaths is dissatisfied with the quality, further information may be sought before personal data can be released.All requests should be made to darren.osteopathy@yahoo.co.uk or by phoning 01751 430 335 or writing to us at the address further below.

    13 Complaints
    In the event that you wish to make a complaint about how your personal data is being processed by Osteopaths you have the right to complain to us. If you do not get a response within 30 days, you can complain to the ICO.

    The details for each of these contacts are:

    Darren Chandler

    Address: Kirkbymoorside Natural Health Centre, based at Kirkbymoorside Natural Health Centre, Bethel Chapel, Tinley Garth, Kirkbymoorside, Ryedale, North Yorkshire, YO62 6AR, United Kingdom
    Telephone: 01751 430 335  or email:  darren.osteopathy@yahoo.co.uk

    ICO
    Wycliffe House, Water Lane, Wilmslow, SK9 5AFTelephone +44 (0) 303 123 1113 or email: https://ico.org.uk/global/contact-us/email/