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Muscle Name: Trapezius

Muscle Group: Face & Throat

Symptoms and Referred Pain:  
The pain patterns for the three different fiber directions of the trapezius are very distinct and varying.

The upper trapezius refers pain into the head along the back and side of the neck and into the head. When the referral is more intense it will also extend through the side of the head and concentrate in the temple and behind the eye. The pain may also travel to the angle of the jaw.

The middle trapezius fibers can harbor trigger points that refer a superficial, burning pain that is concentrated between the trigger points and the spinous processes (part of the vertebrae) of C7-T3. Pain is also referred to the acromion (top of the shoulder).

There is an area in the middle trapezius that can produce a sensation described as “the chills”. This area, when stimulated, can cause goose bumps to appear on the lateral arm of the same side, and may be felt in the thigh as well.

The lower trapezius fibers harbor trigger points that go overlooked with regards to upper cervical pain. The pain may be referred as far up as the high cervical region around the base of the skull. Pain from the lower trapezius may also be referred to the upper shoulder blade and top of the shoulder.

If you have trigger points in the trapezius muscle, you may complain of headaches that go up the side of the neck and center in the temporal area. You may also have a stiff neck and be uncomfortable in heavy clothing because the weight of the clothes rest on the trapezius, causing irritation. Burning sensations may be felt as a result of the middle trapezius as well as making the shoulder intolerant of a heavy overcoat or heavy purse carried by a shoulder strap.

The lower trapezius then refers pain into the upper neck, but does not restrict the neck motion.

Muscle Description: Common Name: Trapezius

There are three divisions of the trapezius muscle – upper, middle, and lower.

The upper trapezius extends (allows a person to tilt the head back to look up) and laterally flexes (ear to the shoulder) to the same side.

The middle trapezius fibers work primarily on the scapula to adduct (move closer to the midline) and upwardly rotate to allow for arm movement.

The lower trapezius fibers work to assist in adducting and upwardly rotating the scapula, as well as to stabilize the scapulas during certain movement.

Self Treatment:
  • Correction of arm rests if short upper arms are evident
  • Correction of lower limb length inequality
  • Use of a headset or speaker phone for phone conversation will release tension on the trapezius and other neck muscles and will free the hands to complete other tasks
  • Have workstation ergonomics set up properly
  • Invest in a trackball style mouse, in which the cursor is controlled by the thumb, thus allowing the shoulder to relax into the arm rest and relieving tension
  • While working on a computer or desk in which posture may influence pain, you can set a timer across the room that will go off every 20-30 minutes, allowing you to get up, stretch, and reset the timer
  • Use a scarf to keep the neck warm in cold climates or in places prone to drafts, including airplanes
  • Carry purses and bags with strap across the body with the strap resting on the acromion (bone on the top of the shoulder), which is the bone on the top of the shoulder
  • A walking cane should be fitted properly
  • Tight bras should be replaced or loosened
  • When driving a vehicle the hands should rest on the bottom of the wheel with the palm down verses being high on the wheel
  • Close attention should be paid to the position in which the shoulders are held. Some individuals “carry stress” in the form of unconscious sustained elevation of their shoulders or immediately elevate their shoulders under certain stress and activate their headaches or pain complaint. Activities that should be monitored are at the workstation, driving, and even relaxing

How You May Have Injured This Muscle:
  • Trigger points may be activated by sudden trauma including falls and whiplash injuries
  • A walking cane that is at an improper length
  • Use of a telephone (when holding up to the shoulder)
  • High keyboard on a computer workstation or keyboard that is set on a table top with the monitor
  • Prolonged use of a computer mouse
  • Short upper arms*
  • Lower limb length inequality (one leg shorter)
  • Cold drafts on the neck
  • Sewing with the arms unsupported
  • Bra that is too tight
  • Heavy purse, backpack, or coat
  • Sleeping on the back with the head rotated to one side
  • Emotional distress
  • Arm rests that are too high
  • Driving a vehicle with the hands high on the steering wheel
  • ANY position in which the shoulders are held up for periods of time may perpetuate trigger points in this muscle


*Short upper arms occur when the elbows of a person are not long enough to reach their iliac crests (the upper aspect of the hip bone) when standing. Short upper arms are characteristic of Native American body structure, but not limited to that race. This condition perpetuates TrPs in the shoulder girdle by placing undue stress on shoulder elevator muscles.

Activities to Avoid: By avoiding the listed of activities, you will decrease the stress placed on this muscle and allow it to heal faster.

In general, you should be pain free for 2 weeks before slowly introducing these activities again. If you have any questions, please consult a licensed health care provider.

  • Holding the phone up to the ear on the affected side or pinching the phone between the ear and the side of the affected shoulder.
  • Working on a keyboard or mouse on top of a desk.
  • Avoid sleeping on the stomach

Other Possible Disorders: This is a partial list of common medical conditions that may cause similar pain to what you are experiencing. It is important have a health care professional rule out these conditions prior to treating only this muscle group.

  • Temporomandibular disorder (TMJD)
  • Tension headache
  • Occipital neuralgia
  • Cervicogenic headache
  • Chronic intractable behind pain of the neck and/or back
  • Bursitis
  • Articular dysfunction of C2, C3, or C4
  • C6, C7, T1, and sometimes T2 dysfunction
  • T6 or T7 dysfunction
   

References : 
Simons DG, Travell JG, Simons LS, Myofascial Pain and Dysfunction: The Trigger Point Manual, vol 1, 2nd Ed. Baltimore: Williams and Wilkins, 1999.
Travell JG, Simons DG, Myofascial Pain and Dysfunction, vol 2. Baltimore: Williams & Wilkins, 1992.