Trapezius

Original Editor - Daphne Jackson

Lead Editors - Lucinda hampton, Andeela Hafeez, Kim Jackson, Kai A. Sigel, Joao Costa, Daphne Jackson, WikiSysop, Kirenga Bamurange Liliane, Rachael Lowe, Evan Thomas and Tarina van der Stockt

Introduction

The trapezius is a broad, flat, superficial muscle extending from the cervical to thoracic region on the posterior aspect of the neck and trunk. The human trapezius muscle has an origin that is more extensive than that of any other body muscle.

The muscle is divided into three parts: descending (superior), ascending (inferior), and middle. The muscle contributes to scapulohumeral rhythm through attachments on the clavicle and scapula, and to head balance through muscular control of the cervical spine.

In people who are chronically stressed or anxious the trapezius suffers. Hunching the shoulders and holding tension in the shoulders and neck, puts constant strain on the trapezius. Hence the trapezius is a major source of headache pain, usually a tension headache. 

Tearing or straining the trapezius is uncommon, usually only happening in bodybuilders lifting too heavy a weight. They also occurs in high velocity accidents eg motor vehicle accident.

Anatomy

Take a look at this 2 minute video first.

Origin

The muscle attaches to the medial third of superior nuchal line; external occipital protruberance, nuchal ligament, and spinous processes of C7 - T12 vertebrae.

Insertion

The muscle inserts on the lateral third of clavicle, acromion, and spine of scapula.

Nerve Supply

• Spinal root of accessory nerve (CN XI) (motor)
• Cervical nerves (C3 and C4) (pain and proprioception)

Blood Supply

Transverse cervical artery (cervicodorsal trunk)

Function

The trapezius is a muscle made up of particularly long muscle fibers that spanning a large width of the upper back. Functionally, this enables the trapezius to assist in mainly postural attributes, allowing and supporting the spinal column to remain erect when the person is standing.

Shoulder pain and dysfunction are among the most common orthopedic problems managed by physiotherapists, and the trapezius plays an important role in the shoulder.

• Appropriate kinematics of the scapula is crucial for optimal shoulder joint function, eg enabling repetitive movements of the hand over the head.
• Trapezius and Serratus anterior are the main muscles that optimize scapula position and scapulohumeral rhythm.
• If the scapula stabilizing muscles are weakened eg trapezius, the normal position and kinematics of the scapula become altered.

The trapezius muscle is also used for active movements eg side bending and turning the head, elevating and depressing the shoulders, and internally rotating the arm.

• Upper traps is frequently involved in neck injuries.
• Tearing or straining the trapezius is uncommon, usually only happening in bodybuilders lifting too heavy a weight.

Action

• Descending part: elevates pectoral girdle
• Middle part: retracts scapula
• Ascending part: depresses shoulders
• Descending and ascending together: rotates scapula upwards
• Bilateral contraction: extends neck
• Unilateral contraction:
  • Ipsilateral side flexion of neck
  • Middle part: assists with ipsilateral side flexion and contralateral axial rotation of upper thoracic region

Physiotherapy

Palpation: Trapezius muscle is superficial and all three portions can be palpated.

1. Hold the sloping superior lateral portion between fingers and thumb and palpate from
   origin, toward the clavicle/acromion, and its insertion.
2. With patient standing: abduct shoulders to 90 degrees and retract shoulder girdle.
3. Slightly bend the trunk forward so antigravity.
4. Upper traps can also be seen with elevation and lower with depression

Upper traps is frequently involved in neck injuries

Length Tension Testing

Patient: Positioned in supine lying with the arms resting by the side and the knees flexed.
Therapist: Standing at the head of the bed.
Action: The therapist supports the posterior aspect of the head with both hands and then passively flexes the craniovertebral joint. The right hand stabilizes the lateral one third of the patient’s right clavicle and acromion palpating the muscle. The therapist then gently and slowly flexes, left side flexes and right rotates the mid and lower cervical spine with the left hand. The hand stabilizing and the hand moving the body part senses the tension in the muscle. The amount of range and the end feel is assessed and the reproduction of any symptoms is noted. This test is then repeated on the contralateral side and compared.

Treatment

Below are some treatment ideas.

Exercises

1. Shoulder blade squeeze

2. Shrug

3. Upright row

4. Pushup

Stretching

Sit upright in a chair and make sure that your posture is correct. These stretches can be done in repetitions of 15-20 every hour to decrease trapezius muscle pain. Begin by rolling the shoulders back so that the shoulder blades feel like they are being pinched together. Then raise your shoulders up towards the ceiling and lower them down gently. You can then bend your neck from side to side by tilting your head towards your shoulder and counting to 3, then repeating in each direction.

Massage

Pain in the shoulder and neck can be prevented or reduced with massage.It is possible to reduce trapezius muscle pain through self-massage. Reach back with one hand and find your trapezius muscle. Beginning at the base of the neck, try to knead the trapezius muscles.

Trigger Points

There are six main trigger points of the trapezius, two in each portion of the muscle, plus one unusual one which causes only autonomic phenomena.See Trigger Points