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The trapezius is a large, flat, fan-shaped muscle that runs from the base of the neck down to the middle of the back. It is divided into three sections: descending (superior), ascending (inferior), and middle. The muscle is involved in various movements, including lifting the arm, throwing, and rotating the shoulder. Given the muscle's extensive use, it is essential to understand how to palpate it to identify any injuries or issues. Palpation involves gently feeling the muscle to assess its tension, range of motion, and any reproduction of symptoms. This process is crucial for diagnosing and treating trapezius-related issues, such as trapezius myalgia, which causes pain, stiffness, and tightness in the upper trapezius muscle.
| Characteristics | Values |
|---|---|
| Muscle type | Skeletal (superficial) |
| Number of trapezius muscles | One on each side of the upper back |
| Shape | Trapezoid |
| Sections | Three (descending/superior, ascending/inferior, middle) |
| Function | Supports the body and enables movement |
| Nerve | Cranial nerve XI (spinal accessory nerve) |
| Sensation | C3 and C4 cervical nerves in the neck |
| Pain causes | Stress, nerve damage, posture issues, injury, irritation |
| Treatment | Stretching, yoga, Pilates, gentle exercise, manual therapy |
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What You'll Learn
Trapezius muscle anatomy
The trapezius muscle is a large, triangular, paired muscle located on the posterior aspect of the neck and thorax. The muscle is made up of long muscle fibres that span a large width of the upper back. Each trapezius muscle has three sections: the descending (superior), ascending (inferior), and middle. The upper section connects to the skull and neck (cervical spine), while the middle and lower sections attach to the bones in the thoracic spine. The trapezius muscle has several origin points along the midline of the posterior neck and back. The superior fibres attach to the medial third of the superior nuchal line, the external occipital protuberance of the occipital bone, and the nuchal ligament, which is attached to the spinous processes of the C1-C6 vertebrae. The middle fibres originate from the spinous processes of T1-T4 vertebrae and their intervening supraspinous ligaments, running horizontally towards the shoulder. The inferior fibres originate from the spinous processes of the T4-T12 vertebrae and their respective supraspinous ligaments.
The trapezius muscle is involved in various movements of the head, neck, and upper back, including turning the head to either side, maintaining and adjusting posture, twisting the torso, shrugging the shoulders, and moving the shoulder during arm elevation. It also plays a crucial role in stabilising the scapula and controlling its movement during shoulder and upper limb actions. The trapezius works in conjunction with several other muscles, including the rhomboids, levator scapulae, serratus anterior, deltoid, and pectoralis minor, to produce coordinated movements and ensure smooth and controlled scapular and shoulder function.
The trapezius muscle has an extensive vascular supply, which makes it useful for musculocutaneous tissue flap harvesting for reconstructive purposes. It is also susceptible to pain and injuries, with overuse, injuries, and nerve damage being common causes of trapezius muscle pain. Symptoms of trapezius issues can include muscle spasms, pain between the shoulder blades, limited mobility, neck and shoulder stiffness, and swelling.
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Palpating the upper trapezius
The trapezius muscles are two large muscles that sit on either side of the upper back. They start at the base of the neck and extend across the shoulders and down to the middle of the back. The upper trapezius is the section that connects to the skull and neck (cervical spine).
Palpation is a widely used diagnostic tool for assessing the upper trapezius muscle. It involves gently touching and feeling the muscle to assess its condition. The right hand stabilizes the lateral third of the patient's right clavicle and acromion while palpating the muscle. The therapist then slowly flexes and rotates the mid and lower cervical spine with the left hand. The hand stabilizing and the hand moving the body part sense the tension in the muscle. This test is then repeated on the other side for comparison.
Palpation of the upper trapezius can help to identify areas of tenderness, muscle spasms, or decreased range of motion. It can also be used to assess muscle tonicity, which is the ability of the muscle to contract and relax. By palpating the upper trapezius, a therapist can detect areas of increased tension or tightness, which may be contributing to pain or limited mobility.
In addition to manual palpation, time-domain near-infrared spectroscopy (TD-NIRS) is a technique that can be used to assess the upper trapezius muscle. This method provides insights into soft tissue oxygenation and structure, offering an objective way to evaluate the validity and reliability of palpation as a diagnostic tool. By combining manual palpation with TD-NIRS, therapists can gain a more comprehensive understanding of the upper trapezius muscle and provide effective treatments for any issues identified.
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Palpating the middle trapezius
To palpate the middle trapezius, the therapist should first explain the procedure to the client and ensure they are comfortable. The client can be in a standing, sitting, or lying prone position, with the therapist standing at the side of the table, at the level of the client's shoulder. The therapist should then ask the client to relax and place their fingers on the muscle superficial to the spine of the scapula.
The therapist will then palpate along the muscle to locate the trigger point in the middle trapezius. Trigger points are typically identified by feeling for a taut band or a twitch response in the muscle belly. In the middle trapezius, a common location for trigger points is approximately 1 to 2 inches medial to the acromion process of the scapula. Once the trigger point is located, the therapist can apply gradual pressure with their thumb to release the trigger point. This may cause referred pain along the back of the neck, around the side of the head, and behind the eye, so it is important to communicate with the client to ensure the pressure is within their pain tolerance.
After releasing the trigger point, the therapist can perform stretches or exercises to improve the range of motion and flexibility of the middle trapezius. One such stretch is to ask the client to roll their shoulders back and squeeze their shoulder blades together, and then raise their shoulders up towards the ceiling and lower them down gently. This can be repeated in sets of 15-20 repetitions every hour to decrease trapezius muscle pain and improve flexibility.
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Palpating the lower trapezius
To palpate the lower trapezius, the therapist should begin by stabilizing the patient's right clavicle and acromion with their right hand. This involves gently holding the lateral one-third of the clavicle, which is the bony part of the shoulder located at the base of the neck. Once stabilized, the therapist can then use their left hand to slowly and gently flex, side-flex, and rotate the mid and lower cervical spine.
During this process, the therapist should pay close attention to the tension in the muscle. They can assess the range of motion and the end feel, noting any reproduction of symptoms. This test can then be repeated on the other side for comparison. Palpation of the lower trapezius can help identify issues such as muscle spasms, cramps, or tenderness, which may be indicative of underlying conditions or injuries.
In addition to palpation, range-of-motion exercises and stretches can be beneficial for the lower trapezius. These exercises can include shoulder shrugs, one-arm rows, upright rows, and reverse flies. It is important to perform these exercises correctly and not to overdo them to avoid further strain or injury. Maintaining proper posture is also crucial to prevent extra tension on the lower trapezius and other upper back muscles.
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Exercises for trapezius pain relief
The trapezius muscles are part of your shoulder girdle and are responsible for moving and rotating your shoulder blade, stabilizing your arm, and extending your neck. Sitting with poor posture, driving, and extended periods of computer work or phone usage can cause neck pain and stress, which can affect the trapezius muscles.
- Sit upright in a chair with correct posture. Roll your shoulders back so that your shoulder blades feel like they are being pinched together. Then, raise your shoulders up towards the ceiling and lower them down gently. This can be done in repetitions of 15-20 every hour to decrease trapezius muscle pain.
- Place your left hand on the right side of your head and apply gentle pressure, pulling your head towards your shoulder. Hold for 30 seconds, then switch to the other side. Repeat 3-5 times per side.
- Lie down on your stomach with your feet shoulder-width apart and rest your hands one on top of the other under your chin. Lie flat and rest your forehead on your stacked hands. Visualize lengthening your spine and releasing any tension in your upper back and neck.
- Lift your head and place your hands on the floor next to your shoulders, keeping your arms parallel and your elbows close to your body. Press the tops of your feet into the floor and inhale deeply as you begin to lift your head and chest. If possible, straighten your arms. Keep your neck and head in a straight line.
- Lift your right hand up and over your head, resting your hand on your left cheekbone. Breathe as you sit here for at least 30 seconds. Gently release this side, and then ease your left ear toward your left shoulder and complete the stretch on the other side, breathing deeply through it.
If you are experiencing neck stiffness or pain, a physical therapist can assess your posture and range of motion and prescribe a combination of neck strain exercises customized for you.
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Frequently asked questions
The trapezius is a large, fan-shaped muscle that runs from the base of the neck down to the middle of the back. It is divided into three sections: descending (superior), ascending (inferior), and middle. It is used almost constantly throughout the day, especially during activities like lifting or throwing.
To palpate your trapezius muscles, have your patient stand or sit with correct posture. Stabilize the lateral one-third of their right clavicle and acromion with your right hand, palpating the muscle. Gently and slowly flex, left side-flex, and right-rotate the mid and lower cervical spine with your left hand. Sense the tension in the muscle with both hands. Assess the range of motion and end feel, and note the reproduction of any symptoms. Repeat this process on the left side.
The trapezius muscle can be injured or irritated, causing pain, muscle spasms, and decreased mobility. Common issues include stress, slouching, and nerve damage. To avoid problems, it is important to exercise, stay flexible, and maintain a healthy lifestyle.
