Trapezius

Description

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 muscle is divided into three parts: descending (superior), ascending (inferior), and middle[1]. The muscle contributes to scapulohumeral rhythm through attachments on the clavicle and scapula, and to head balance through muscular control of the cervical spine.


Trapezius Gray.PNG
Trapezius animation.gif


Origin

The muscle attaches to the medial third of superior nuchal line; external occipital protruberance, nuchal ligament, and spinous processes of C7 - T12 vertebrae[2].

Insertion

The muscle inserts on the lateral third of clavicle, acromion, and spine of scapula[2].

Nerve Supply

  • Spinal root of accessory nerve (CN XI) (motor)[2]
  • Cervical nerves (C3 and C4) (pain and proprioception)[2]

Blood Supply

Transverse cervical artery (cervicodorsal trunk)[2][1]

Function

The superficial muscles of the back (trapezius, latissimus dorsi, rhomboids, levator scapula, serratus anterior) contribute to extension and side flexion of the axial skeleton. The cervical extensor muscles (descending trapezius and cervical erector spinae) counterbalance the pull of gravity on the head, as the head tends to be pulled into flexion due to its anterior centre of gravity[3]

Action

  • Descending part: elevates pectoral girdle[1]
  • Middle part: retracts scapula[1]
  • Ascending part: depresses shoulders[1]
  • Descending and ascending together: rotates scapula upwards[1]
  • Bilateral contraction: extends neck[4]
  • Unilateral contraction:
    • Ipsilateral side flexion of neck[4]
    • Middle part: assists with ipsilateral side flexion and contralateral axial rotation of upper thoracic region[4]

functional contributation

The trapezius muscle is a postural and active movement muscle, used to tilt and turn the head and neck, shrug, steady the shoulders, and twist the arms. The trapezius elevates, depresses, rotates, and retracts the scapula, or shoulder blade.[5]

Trigger Point Referral Pattern

                                                               Trapezius1.jpg            Trap23.jpg

                                                         

                                              Trap4567.jpgTrap4567.jpg

Techniques

Palpation

superficial, can palpate upper, middle and lower
Upper is frequently involved in neck injuries
Hold the sloping superior lateral portion between fingers and thumb and palpate from
origin (O) toward the clavicle/acromion and its insertion (I)
With patient (pt.) standing: abduct shoulders to 90 degrees and retract shoulder girdle.
Slightly bend the trunk forward so antigravity.
Upper can also be seen with elevation and lower with depression [6]

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 and barrier. 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. [7]

Strength Testing

[8]

Treatment

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.

Pressure

You can also apply some pressure to the area along your shoulders and between the shoulder blades. If there is an area that is more tender, apply pressure for ten seconds and then release so that the muscle can relax.[9]

Recent Related Research (from Pubmed)

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References

  1. 1.0 1.1 1.2 1.3 1.4 1.5 Moore KL, et al. Essential clinical anatomy. 4th ed. Baltimore, MD: Lippincott Williams and Wilkins, 2011.
  2. 2.0 2.1 2.2 2.3 2.4 Department of Radiology, UW Medicine. Trapezius. www.rad.washington.edu/academics/academic-sections/msk/muscle-atlas/upper-body/trapezius (accessed 27 January 2014).
  3. Kisner C, Colby LA. Therapeutic exercise: foundations and techniques. 6th ed. Philadelphia: F.A. Davis Company, 2012
  4. 4.0 4.1 4.2 Neumann DA. Kinesiology of the musculoskletal system: foundations for rehabilitation. 2nd ed. St. Louis, MO: Mosby Elsevier, 2010.
  5. http://www.healthline.com/human-body-maps/trapezius-muscle
  6. https://www.fgc.edu/wp-content/uploads/2011/12/palpation-of-muscles.pdf
  7. http://activepotentialrehab.com/docs/pdf/sample_upperextremity11_21.pdf
  8. Physiotutors. Trapezius Strength Test. Available from: https://www.youtube.com/watch?v=9tfVeIhlY-o
  9. http://www.ehow.com/about_5446034_trapezius-muscle-pain.html