Trapezius Myalgia

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Top Contributors - Nick Van Doorsselaer, Lauren Trehout, Abbey Wright, Elien Clerix, Camille Dewaele, Gayatri Jadav Upadhyay, Kim Jackson, Vanessa Rhule, Admin, Joao Costa, Rachael Lowe, Kirenga Bamurange Liliane, Aminat Abolade, Rishika Babburu, Ajay Upadhyay and Kai A. Sigel  

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Definition/Description

Trapezius Myalgia is chronic pain of the upper trapezius muscle, most frequent is neck pain. It is a complex and multifactorial condition. Musculoskeletal pain is often intensifying by mental and social stress at home or work. A biopsychosocial model plays an important role in the clinical management of chronic pain. It is a complex of different factors such neurobiological, psychological, coping styles, and contextual factors that contributes to the development and maintenance of chronic pain states12-13.

Clinically Relevant Anatomy

The trapezius muscle consists of 3 parts.
1. Trapezius pars descendens
2. Trapezius pars transversa
3. Trapezius pars ascendens

It is the upper part of the muscle, Trapzius pars descendens, that is painfull. The origin is found on the external occipital protuberance, Nuchal ligament and spinonus processes of 7th cervical and all thoracic vertebrae. The insertion is on the lateral third of the clavicula and acromion and spine of the scapula.

The function of the muscle is upward rotation of the glenoid cavity. The cranial fibers elevate the acromial end of the clavicula causing the glenoid cavity of the scapula to rotate upward (cranially).
Upward rotation of the scapula.
Extension of the head and to stabilize the scapula.

Epidemiology /Etiology

At the moment a large and increasing collection of epidemiologic findings has shown strong and consistent links between musculoskeletal disorders and several occupational ergonomic exposures like forceful exertions, highly repetitive motions, sustained static muscle loading, lack of sufficient rest, awkward body postures, localized mechanical stress and features of the work environment such as restrictive, high demand-low control jobs. However there is still less consensus about nature of the epidemiologic findings and the physical examination findings.

There has been done a lot of research on the aetiology of work related neck and shoulder disorders. Researchers agree that the disorders arise from both biomechanical and psychosocial factors. Within the biomechanical dimension the m. Trapezius plays an important role. This type of neck pain called ‘trapezius myalgia’ may be associated with a lot of changes. These changes can take place at both the peripheral and central level and can interact resulting in muscle pain and fatigue.2

At the peripheral level the changes occur at the muscular level. There have been seen mitochondrial disturbances in the type I fibres and also reduced capillary density and circulation.5,7 These changes can possibly cause interferences in the oxidative metabolism of the muscles. There has also been described transformations of oxidative type I fibres to quick-acting glycolytic type IIb fibres.12 These changes can explain the muscle fatigue and pain. In one study they also found a larger cross-sectional area of the type I one fibres of the upper trapezius which demonstrates a higher load of these fibres.6

At the central level a reorganization of the neuromotor control strategies takes place. This can be illustrated in the cervical flexors by a dysfunction of the deeper flexors and a loss of force and endurance of these muscles.10 Persons with complaints also show a delayed activation of the muscles of the neck with arm movements.4 The superficial cervical flexors show a higher muscle activation and are faster fatigued, which demonstrate a less efficient function of the stabilization mechanism of the neck.3 This phenomenon is also seen in the cervical extensors where the superficial upper trapezius shows a higher activation then the erector spinae. Szeto et al. (2005) demonstrate in their study that the greater recruitment of type II fibres in symptomatic persons could possibly explain the muscle fatigue. These patients also show a diminished ability to relax the trapezius muscle after work.11 Another study showed a higher EMG-activity and an impaired relaxation time in symptomatic persons.9

Not only the biomechanical factors play an important role in het onset of trapezius myalgia. In the literature an causal relationship has been described between psychosocial factors and the occurrence of neck and shoulder disorders. There is some evidence for a link between disorders and high quantitative and qualitative demands, lack of support of colleagues, low job control and low influence.1 They also demonstrated a relationship between mental stress at work and disorders.11
 

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