Figure 1.  The middle to upper portion of levator scapulae lies in the posterior triangle, covered superiorly by SCM; anterior lies scalenus medius and posterior is splenius capitis. 
Inferior portion of levator scapulae is covered by trapezius.




Anatomy: Muscles related to the Levator Scapulae Origin & Insertion of Levator Scapulae muscle
Anatomy: Insertion and Origin of  Levator Scapulae muscle Surface Anatomy: Injection Sites for Levator Scapulae muscle


Video 1.  Use of ultrasound to inject levator scapulae

(vv)levator scapulae.mp4(tt)

The muscle is typically injected just ventral to the border of trapezius; if there insufficient activation, ask the patient to elevate their shoulder.

This muscle is organized in four bundles inserted onto the transverse processes of C1, C2, C3 and C4. These bundles are visible in ultrasonographic images and can be injected selectively with botulinum toxin to act at a given vertebral level.
The larger part of the muscle, where the four bundles meet, is located at its insertion into the medial border of the scapula. Injecting this point leads to a global action on the muscle but needs a careful approach because of the risk of hitting the pulmonary apex and causing a pneumothorax.