What is Trapezius Muscle Strain?

Trapezius Muscle Anatomy

The trapezius muscle is also known as a trapezoid. The muscle originates from the occipital bone as well as a cervical and thoracic vertebra. The lateral end of the muscle is attached to the spinous bone of the scapula. The trapezius muscles divided into three segments identified as an upper, middle, and lower segment. The muscle receives nerves from Cranial nerve XI as well as cervical C3 and C4 nerve.1

The Function of Trapezius Muscle

Movements of the Scapula- Trapezius muscle contraction causes movements of scapula and shoulder joint. Contraction of the upper segment of trapezius muscle elevates the scapula as well as assist in medial rotation of the scapula. The contraction of the middle portion of trapezius pulls and swings the scapula towards the cervical and thoracic spine. The lower segment of the trapezius muscle pulls the scapula downward and also rotates the scapula upward on the lateral or outer side. The rotation or swinging of scapula or shoulder blade is caused by contraction of the upper and middle segment of trapezius muscle as well as contraction of deltoid muscles. Thus, trapezius contraction helps to elevates, depresses, and retracts the scapula.1

Postural Stability- The wide span of trapezius muscles stabilizes the spine during standing and sitting posture.

Shoulder Joint Movement- Trapezius muscle contraction elevates and depresses the shoulder joint. Trapezius also assists in rotation of the upper arm at the shoulder joint.

Movements of the Spine (vertebral column)- During activities, vertebral column or spine rotates as well as bends or rotates on the right and left side. Trapezius muscle contraction causes rotation and lateral tilt of the vertebral column. During tilt or rotation of the upper body and spine, the contraction of the opposite side of trapezius muscle prevents the hyper tilt or rotation.

What Is Trapezius Muscle Strain?

Trapezius muscle strain causes moderate to severe pain. A micro tear of muscle fibers or muscle inflammation causes moderate to severe pain. Trapezius Strain is an annoying and discomforting medical condition in which the affected individual finds it challenging to move scapula (wing bone) and the shoulders in any direction.

Additionally, it is difficult to perform any overhead activity without experiencing pain or discomfort in the shoulder and scapula area. The person also finds it tough to move the neck because of pain felt around the attachment of trapezius muscle over the spine of a cervical vertebra. The trapezius muscle is one of the most massive muscles in the body and perhaps the most hardworking one. It is triangle in shape and passes from the neck and upper back to the shoulder and scapula. Repetitive and uncoordinated contractions of trapezius muscles during repetitive pushing, pulling or lifting overhead causes a strain in the trapezius muscle. Symptoms like pain and disability.

Trapezius Strain

What Causes Trapezius Muscle Strain?

The neck, shoulder, and upper back pain are very common among computer and manual workers. Such pain in individuals sitting in front of a computer monitor for several hours a day is caused by a strain of the trapezius, levator scapulae, neck extensors, and infraspinatus muscles.2 For some people, the soreness and pain aggravate over time and become chronic. Clinical research has confirmed that the most common type of neck/shoulder pain in computer workers is caused by muscle strain and myalgia.3

Trapezius muscle strain was observed in 38% of individuals suffering from upper back and shoulder pain.3

  1. Repetitive Action- Repetitive action of the upper arm that results in repeated rotation and movements of the shoulder joint causes upper neck and shoulder joint pain. The muscle irritation, micro tear, or inflammation of the trapezius muscle causes moderate to severe pain.
  2. Manual Worker- Constant lifting of a heavy object often causes non-coordinated muscle contraction. Active uncoordinated trapezius muscle contraction often causes a micro tear in muscles that results in mild to severe pain. Such pain is observed in swimmers, tennis players and baseball pitchers.
  3. Sustained Prolonged Muscle Contraction- Workers may seat for several hours in front of a computer monitor or monitoring security screen. Such posture causes prolonged trapezius muscle contraction that results in muscle fatigue. Muscle fatigue follows trapezius muscle strain.
  4. Multiple Sclerosis– Trapezius muscle strain is observed in patients suffering from musculoskeletal diseases. Multiple sclerosis causes the spasticity of skeletal muscles. Patient suffering with multiple sclerosis occasionally has sustained muscle contraction of trapezius muscle that frequently results in trapezius muscle strain.4
  5. Trapezius Muscle Injury- Direct impact or penetrating injury of trapezius muscle causes trapezius muscle tear that results in muscle strain. Such injury is observed during an automobile accident, work injury, domestic fall, and sports trauma.

What Are The Symptoms Of Trapezius Muscle Strain?

The main presenting feature of a Trapezius Muscle Strain is a pain in the muscles of the neck, upper back, and arm. The pain frequently radiates from the scapula and shoulder joint to the back of the neck and posterior thoracic wall.

  1. Pain- The pain caused by trapezius muscle strain is frequently observed in the neck, thoracic region, over the medial side of the scapula and shoulder area. The pain is mild to moderate at rest and becomes severe to very severe with activities. The character of the pain caused by trapezius strain is stabbing and burning pain. Restriction of neck movement and resting the shoulder joint, relieves the discomfort and pain caused by trapezius strain. In some cases of Trapezius Strain, the affected individual may also experience neck pain, which may give rise to headaches.
  2. Tenderness- Examination of the back of the neck, back of the upper chest and shoulder joint causes moderate to severe pain during palpation and deep pressure. Pain intensity increases following the examination for prolonged periods of time.
  3. Restricted Movement Of Back And Shoulder Joint- Most individuals suffering from trapezius strain restricts the movement of back, neck, and shoulder joint. The restriction is involuntary and triggers by increased pain during activities. Symptoms caused by trapezius strain tend to get worse with activities, and the individual is not able to perform his or her daily tasks effectively either at home or at work.
  4. Muscle Spasm– The trapezius is a large muscle. Trapezius muscle strain, in most cases, is restricted to one of the three segments. The muscle strain causes the spasm of the adjacent muscle. Muscle spasm causes muscle tightness. Muscle tightness is felt as a firm muscle mass during an examination.
  5. Swelling- The contraction or spasm of trapezius muscle causes swelling. The swollen muscle feels firm to hard when examined with fingers or hands.
  6. Insomnia– Individual suffering with trapezius strain is unable to sleep on back and recliner. The pain aggravates in supine or lateral position. Moderate to severe pain interferes with sleep and individual suffering with trapezius strain is unable to sleep. The inability to sleep causes chronic daily insomnia.

How Is Trapezius Muscle Strain Diagnosed?

Trapezius muscle strain needs careful evaluation. The pain caused by trapezius muscle strain spreads over the neck, upper thorax, and shoulder joint. The trapezius strain pain is occasionally misdiagnosed as disc disease, spinal stenosis, or shoulder joint disease. The following steps are necessary to diagnose trapezius muscle strain.

  1. History of Illnesses- Detailed documentation and understanding of all symptoms is necessary to conclude a correct diagnosis. The area of pain and tenderness suggests pain originates in the trapezius muscle. History of trauma and muscle diseases helps to diagnose pain caused by trapezius muscle strain.
  2. Examination- Careful examination of back muscle, spine, and shoulder joint is essential to rule out radicular pain, radiculopathy, disc diseases, spinal stenosis, and muscle diseases.
  3. Radiological Examination- The images of X-ray, CT Scan, and MRI are carefully studied to rule out disc and spine diseases as well as shoulder joint disease.
  4. Electromyogram (EMG)- The neurologist performs EMG studies of the trapezius and other back muscles.6 The EMG results are evaluated to rule out myalgia, myofascial pain syndrome, and fibromyalgia.
  5. Ultrasound Examination- Ultrasound examination helps to evaluate muscle thickness, elasticity, and blood flow.5 The images show bleeding, tear, inflammation, and muscle edema.

How Is Trapezius Strain Treated?

How Is Trapezius Muscle Strain Treated?

The treatment of a Trapezius Strain is dependent on the extent of the strain. Various treatment options are selected to treat trapezius strain. The main aim of treatment is to relieve discomfort and restore the flexibility and movement of the affected neck, upper back, and shoulder joint.

  1. Conservative Treatment

    1. Rest & Restriction Of Activities- The neck, upper thoracic, and shoulder pain becomes less severe during the restriction of activities of back, neck, and shoulder joint. The irritation and injury of trapezius muscle heal faster if movements are restricted.
    2. Cold Therapy– Cold therapy helps to reduce pain. Cold therapy also prevents or lessens the bleeding causing less swelling as well as hematoma and bruises. Cold therapy is provided by applying a cold towel or ice bag over the most painful area of neck and thorax.
    3. Heat Therapy- Heat therapy involves the application of a hot towel or rubber bag that contains hot water. Heat therapy helps to relieve pain once the inflammation is treated.
  2. Yoga Therapy & Stretching-

    Yoga therapy and stretching helps to reduce the pain during the initial phase. The stretching helps to relieve muscle spasm and improves joint shoulder movement.

  3. Medications

    1. NSAIDs– The non-steroidal anti-inflammatory medication helps to treat trapezius muscle strain. The micro muscle tear, muscle fatigue, and inflammation is treated much better with NSAIDs treatment. The medications prescribed are Motrin, Naproxen, and Celebrex.
    2. Tylenol- The mild to moderate pain treated with Tylenol. The muscle inflammation may not respond to Tylenol.
    3. Opioids- The opioids are avoided if an individual is suffering from mild to moderate pain. Occasionally severe pain is treated with opioids. The opioids are prescribed for 1 to 3 weeks. Opioids cause dependence and addiction in most patients.
    4. Muscle Relaxants– The muscle spasm and muscle tear treated with muscle relaxants. Muscle relaxants cause drowsiness and sleepiness. Muscle relaxants avoided in patients who are taking opioids.
  4. Physical Therapy-

    The physical therapy helps to build the coordination and strength of muscles. Physical therapy is advised two or three times a week for six weeks.

  5. Interventional Therapy- The corticosteroid medication injected in most painful muscle mass using 25 G needle. The procedure is performed under the guidance of X-Ray or ultrasound.

  6. Surgical Treatment- The surgical treatment is recommended if neck, thoracic, and shoulder joint pain responds to trigger point injection and all other options of therapy are not able to relieve pain. The treatment involves fasciotomy of most tender muscle and also nerve ablation of the branch of the nerve that supplies trapezius muscle.7

  7. Exercises- Once the pain is relieved, then the most physical therapist will recommend exercises to strengthen the muscle. Such trapezius muscle exercises prevent the recurrence of trapezius strain and pain.

References:  

  1. Anatomy, Back, Trapezius

    Jared Ourieff; Amit Agarwal., https://www.ncbi.nlm.nih.gov/books/NBK518994/ 

  2. Association between Neck/Shoulder Pain and Trapezius Muscle Tenderness in Office Workers

    Mikkel Brandt, 1 Emil Sundstrup, 1 Markus D. Jakobsen, 1 Kenneth Jay, 1 Juan C. Colado, 2 Yuling Wang, 3Mette K. Zebis, 4 and Lars L. Andersen 1 ,*, Pain Res Treat. 2014; 2014: 352735.

  3. Clinical signs and physical function in neck and upper extremities among elderly female computer users: the NEW study.

    Juul-Kristensen B, Kadefors R, Hansen K, Byström P, Sandsjö L, Sjøgaard G. European Journal of Applied Physiology. 2006;96(2):136–145.

  4. Isolated Trapezius Strain in a Patient with Multiple Sclerosis and Spasticity

    Eric C. Wang1 and Felix S. Chew1\\Radiol Case Rep. 2006; 1(3): 96–98.

  5. Ultrasonography for the assessment of the upper trapezius properties in healthy females: a reliability study

    Hakimeh Adigozali,1 Azadeh Shadmehr,2 Esmail Ebrahimi,3 Asghar Rezasoltani,4 and Farrokh Naderi5, Muscles Ligaments Tendons J. 2016 Jan-Mar; 6(1): 167–172.

  6. Trapezius muscle pressure pain threshold and strain in the neck and shoulder regions during repetitive light work.

    Nakata M1Hagner IMJonsson B., Scand J Rehabil Med. 1993 Sep;25(3):131-7.

  7. Surgical fasciectomy of the trapezius muscle combined with neurolysis of the Spinal accessory nerve; results and long-term follow-up in 30 consecutive cases of refractory chronic whiplash syndrome

    N Ake Nystrom,1,2 Lloyd P Champagne,3 Michael Freeman,4 and Elisabet Blix5, J Brachial Plex Peripher Nerve Inj. 2010; 5: 7.

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