Trapezius muscle and neck pain

Trapezius muscle - m. trapezius

With bilateral contraction of all fibers, the muscle promotes extension of the cervical and thoracic spine. When the upper fibers contract, the scapula and clavicle (shoulder girdle) rise upward, while the scapula rotates its lower angle laterally. With a fixed scapula (by other muscles), the upper bundles of the trapezius muscle deflect the head to their side. With simultaneous contraction of the upper bundles on the right and left, extension of the head occurs, but only if the movement is resisted. The middle fibers bring the scapula to the spine. The uppermost middle bundles, which are attached to the acromion, also bring the scapula to the spine, but they are included in this movement after the upward rotation of the scapula has begun. The lower fibers lower the scapula. The middle and lower fibers stabilize the scapula during its rotation by other muscles.

Origin: Protuberantia occipitalis externa, Septum nuchae, spinous processes of the I - XI (XII) thoracic vertebrae

Insertion: Extremitas acromialis claviculae, Acromion and Spina scapulae

Innervation: spinal nerves C2-C4 - plexus cervicalis - n. Accessorius

Upper bundles of muscle

1. With the patient in a lying or sitting position, the upper bundles of the muscle are moderately relaxed by slightly tilting the head to the affected side. The free upper edge of the trapezius muscle is grasped in a pincer-like manner and pulled upward from the underlying supraspinatus muscle. The muscle is then firmly rolled between the fingers to reveal palpable elastic bands, provoke a local spasmodic response, and detect local tenderness. These can be found in the middle of the anterior edge of the upper (trapezius bundles (the main cause of tension headaches).
2. The trigger zone can also be detected by pincer palpation in the deeper fibers behind the trigger zone described above. They are located directly above the scapula near its midline.

Middle and lower muscle bundles

When examining other trigger zones of the trapezius muscle, the patient sits with his arms crossed in front of him so that the shoulder blades are spread apart and the spine is kyphosis. To identify tight bands, the doctor performs sliding palpation across the fibers, rolling them along the underlying ribs. Trigger zones can be localized:

1. in the lateral fibers of the lower bundles of the trapezius muscle in the area where the muscle fibers cross the medial border of the scapula, and in some cases at or below the inferior angle of the scapula. It is felt as a lump or knot; it may not be noticed unless the fibers are stretched by the displacement of the scapula in the anterior-superior direction,
2. in the upper fibers of the lower bundles of the trapezius muscle above the medial end of the infraspinatus muscle;
3. in the area located 1 cm medial to the attachment of the levator scapula muscle to the scapula, revealed by deep palpation of the superficial horizontal fibers of the middle bundles;
4. above the lateral end of the supraspinatus muscle near the acromion. To locate this less common trigger zone, it is necessary to perform deep palpation of the lateral fibers of the middle bundles of the trapezius muscle;
5. in the most superficial fibers of the middle bundles of the trapezius muscle in the area where these fibers intersect the muscle that lifts the scapula (rare).

Referred pain

From the upper muscle bundles:

Trigger points in the trapezius muscle are a common cause of headaches.

1. one-sided pain along the back of the neck to the mastoid process. With high intensity of reflected pain, it is also projected to half of the head with centers in the temporal region and behind the eye socket. In addition, it can capture the angle of the lower jaw (as in the presence of a trigger zone in the masseter muscle).
2. pain in the neck in the area lying slightly behind the zone of the reflected role described above.

From the middle and lower bundles:

1. deep diffuse muscle tension and pain in the suprascapular region;
2. burning pain along the vertebral edge of the scapula and medially to it;
3. reflected superficial burning pain in the medial part of the muscle between the trigger zone and the spinous processes of CVII-TIII;
4. sharp pain in the acromion or at the top of the shoulder;
5. an unpleasant sensation of trembling with a pilomotor reaction (goose bumps) on the lateral edge of the homolateral arm and sometimes on the thigh, in the form of a reflected vegetative phenomenon.