Trapezius muscle and neck pain

Trapezius muscle - m. Trapezius

With bilateral reduction of all fibers, the muscle promotes extension of the cervical and thoracic spine. When the upper fibers contract, the scapula and clavicle (humeral girdle) rise upward, while the scapula turns laterally with its lower corner. With a fixed scapula (other muscles), the upper tufts of the trapezius muscle tend to deflect the head to their side. With simultaneous contraction of the upper tufts to the right and left, an extension of the head occurs, but only if the movement is resisted. Middle fibers lead the scapula to the spine. The uppermost middle tufts that attach to the acromion also lead the scapula to the spine, but they are included in this movement after the blade rotation is started upward. The lower fibers lower the blade downward. The middle and lower fibers stabilize the scapula while rotating it with other muscles.

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

Attachment: Extremitas asromialis claviculae, Acromion and Spina scapulae

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

Upper muscle beams

1. In a patient lying or sitting down, the upper muscle beams are moderately relaxed by a slight deflection of the head to the affected side. The free upper edge of the trapezius muscle is grasped in a pincer-like fashion and pulled upward from the supraspinous muscle underlying it. Then the muscle is rigidly rolled between the fingers in order to identify palpable elastic bands, provoking a local convulsive response, and detecting local soreness. They can be found in the middle of the anterior margin of the upper (bunches of trapezius muscle (the main cause of tension headache).
2. Trigger zone can also be detected with the help of tick-like palpation in deeper fibers behind the above-described trigger zone. They are localized directly over the scapula near its midline.

Middle and lower muscle beams

In the study of other trigger zones of the trapezius muscle, the patient sits crossed in front of him in such a way that the scapula is spread out, and the spine is kyphosed. To identify tight cords, the doctor performs a sliding palpation across the fibers, rolling them along the underlying ribs. Trigger zones can be localized:

1. in the lateral fibers of the lower tufts of the trapezius muscle in the area of intersection of the medial edge of the scapula with the muscle fibers, and in some cases at or below the lower angle of the scapula. It feels like a lump or knot; it can be overlooked if the fibers are not stretched by the displacement of the blade in the front-top direction,
2. in the upper fibers of the lower tufts of the trapezius muscle above the medial end of the subacute muscle;
3. in the region located 1 cm medially from attachment to the scapula of the muscle lifting the scapula, is revealed with deep palpation of the surface horizontal fibers of the middle bundles;
4. above the lateral end of the supraspinatus near the acromion. To find this less frequent trigger zone, it is necessary to carry out deep palpation of lateral fibers of middle trapezoidal muscle bundles;
5. in the most superficial fibers of the middle trapezium muscle bundles in the region of the intersection of these muscles with the muscle that lifts the scapula (is rare).

Reflected pain

From the upper muscle bundles:

Trigger zones in the trapezius muscle are a frequent cause of headaches.

1. unilateral pain along the posterior edge of the neck to the mastoid process. With a high intensity of reflected pain, it is also projected into half of the head with centers in the temporal region and behind the orbit. In addition, it can capture the angle of the lower jaw (as in the presence of a trigger zone in the masticatory muscle).
2. pain in the neck in a zone lying slightly behind the reflected role region described above.

From the middle and lower beams:

1. a deep diffuse strain of the mouse and pain in the suprapatrubular region;
2. Burning pain along the vertebral margin of the scapula and more medial than it;
3. Reflected superficial burning sting 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-skin) on the lateral margin of the homolateral arms and sometimes on the thigh, in the form of a reflected vegetative phenomenon.