Upper portion of the trapezius muscle. Case from practice

Overexertion of the trapezius muscle causes pain and burning in the space between the base of the skull and the area between the shoulder blades. If you feel like there is an invisible but heavy burden on your shoulders, if you feel discomfort and pain in the shoulders, upper back, arms, if you suffer from frequent headaches - it is the trapezius muscle that may be the source of all these problems..

Trapezius muscle - location, functions, causes of pain

The trapezius muscle occupies a fairly large area in the upper back, its base is located at the occipital bone. The main functions of the trapezius muscle are movement of the shoulder blades and support of the arms.

The trapezoid consists of three parts:

• top;
• average;
• bottom.

This muscle is responsible for:

• moving the shoulder blades towards the spine;
• rotation of the shoulder blades to support the upper arm;
• movement of the shoulder blades down and up;
• moving the head and neck back;
• turning the head and neck to the sides;
• slight increase in the respiratory capacity of the lungs.

What can cause pain in the trapezius muscle?

Trapezius pain is a classic consequence of tension. Quite severe, burning and deep pain in the shoulders and neck are most common, but the trapezius muscle can also cause frequent headaches, especially in the temples, at the base of the skull or behind the eyes. Working with a laptop or computer, during which the elbows are suspended, often causes a burning sensation between the shoulder blades. Also the reasons for the appearance pain can be:

• tension (remember to relax your shoulders);
• poor posture and the habit of sitting with your head down (for example, looking at your phone);
• habit of holding the phone between your ear and shoulder;
• carrying a heavy bag or backpack;
• bra straps that are too tight;
• lactation;
• sleeping on your back or stomach with your head turned to the side;
• prolonged stay in a position with the head turned to one side;
• habit of hunching while working;
• working at a keyboard that is too high;
• constantly hanging your arms, especially when working at the computer;
• playing the violin, piano.

How to relieve pain in the trapezius muscle with self-massage

As you can see, the pain described above can occur in any person. It is important to remember that massages and exercises will help relieve them, but repeated activities that lead to trapezius muscle pain will make the situation worse over time. Therefore, watch your posture, strengthen all the muscles of the body, balance the load, try not to overexert yourself and do not forget about stretching.

Important! If you experience pain in the back, neck, head and/or shoulders, you should consult a doctor to rule out the presence of dangerous diseases and pathologies (for example, disc herniation or osteochondrosis).

Self-massage of the trapezius muscle

Sensitive (trigger) points or muscle knots that often appear on the trapezius:

Do not overdo the pressure; your task is to relieve tension without causing severe pain. Massage the indicated points for 10-30 seconds, in some cases you can feel the tense muscle relaxing.

Lie down on the bed, place your head and neck on the pillow so that your neck is level with your spine, and begin the massage.

The second method is to massage painful points with a tennis ball while lying down:

Or in a standing position:

Self-massage of the trapezius muscle, provided correct execution can relieve pain in the shoulders, neck, and between the shoulder blades. However, do not forget that the pain will still return (and possibly intensify) if you do not eliminate all the factors that cause trapezius overstrain. The site recommends that if pain occurs, the first step is to contact a qualified specialist who can accurately determine its cause and select the appropriate treatment. Self-massage will be an excellent way to relieve pain at home.

Attachment places:

Initial: spinous processes from the 6th to 12th thoracic vertebrae

Final: medial third of the spine of the scapula

Function: rotation of the scapula, provides inferior stabilization of the scapula; helps maintain spine extension, retracts the humeral process

Synergists:

Stabilizers: upper trapezius muscle

Innervation: axillary nerve, anterior roots C 2,3,4

Neurolymphatic reflex:Front: 7th intercostal space on the left.

Behind: Between T7-8 near the plate on the left

Neurovascular reflex: 1 inch above lambda

Nutrients: spleen concentrate or nucleoprotein extract, vitamin C, calcium

Meridian: spleen, pancreas

Time of maximum activity: 9-11 o'clock

Organ: spleen

Emotion: care

Subluxation: Th XII-LI

Neurological tooth:

Option

I.P.P. Standing or sitting. Shoulder joint in position F/E - 0°, Abd - 130°, and maximum external rotation. The elbow is fully extended, the hand is in a neutral position. The shoulder blade is completely pressed against the chest.

I.P.V. – behind the patient's back. The stabilizing hand controls the movement of the scapula.

Contact point: lower third of the forearm.

Direction of influence: along an arc, caudo-ventro-medially.

Option

I.P.P. – lying down. The hand position is the same.

I.P.V. – on the side of the patient, on the side of the muscle being tested.

Contact point: there

Direction of influence: Same

Errors I.P.P.

1. shoulder in flexion – activation of the posterior portion of the deltoid, infraspinatus, and serratus anterior muscles; shoulder in extension – activation of other portions of the trapezius and rhomboid muscles

2. abduction less than 130° – activation of the middle portion of the trapezius, rhomboid muscles

3. External rotation is not performed or it is not complete – activation of the posterior portion of the deltoid, infraspinatus muscles

4. elbow in flexion position – activation of the MFC of the arm

5. the hand is bent or straightened - activation of the MFC of the hand

Errors I.P.V

1. the doctor is in front of the patient - distortion of the direction of influence

2. no control of scapula movement (complete lack of stabilization or stabilization elsewhere) – distortion of test interpretation, activation of trunk muscles

Place of contact

1. contact of the hand or wrist joint – activation of the MFC of the hand (see figure)

Direction of influence

1. medial pressure – additional stabilization of the joint

2. pressure with a lateral component, cranially – additional stretching of muscle fibers

3. ventral pressure – additional stretching of the muscle, activation of other portions of the trapezius, rhomboids and levator scapulae muscles

4. caudal pressure – activation of the upper trapezius, supraspinatus, levator scapulae, and serratus anterior muscles

Rhomboid muscle.

Attachment sites: Large rhomboid muscle

Initial: spinous processes from the 2nd to 5th thoracic vertebrae.

Final: medial border of the scapula from the spine to the inferior angle.

Function: adduction of the scapula and slight elevation of its medial border. The lower fibers of the muscle contribute to the rotation of the cavity shoulder joint down. As the arm abducts, the rhomboids relax and allow scapular abduction, then they contract and stabilize the scapula as it rotates and continues to abduct.

Insertion: Rhomboid minor

Initial: nuchal ligament, spinous processes of C7 and T1.

Final: medial border of the scapula at the root of the spine of the scapula.

Function: adduction and slight elevation of the scapula.

Synergists: all portions of the trapezius muscle, the latissimus muscle and the levator scapulae muscle.

Stabilizers: upper and lower portions of the trapezius muscle, levator scapulae muscle, back extensors, abdominal muscles

Innervation: dorsal scapular nerve, C4-5

Neurolymphatic reflex: anterior – 6th intercostal space, from the midclavicular line to the sternum on the left; posterior – between T6, 7, at the plate on the left.

Nutrients: vitamin A

Meridian: liver

Time of maximum activity: 1-3 hours

Organ: liver (sometimes stomach)

Emotion: anger, discontent, aggression

Subluxation:

Neurological tooth:

MFC – deep dorsal chain of the arm, spiral chain of the torso

Option

I.P.P. – Sitting. Shoulder in position E - 0°, Abd - 0°, Rint/ext - 0°). Elbow bent 140°, hand in neutral position. The patient pulls the scapula towards the spine and lifts it.

I.P.V. - standing at the patient's side, on the opposite side of the muscle being tested. The stabilizing arm immobilizes the shoulder and thumb controls the movement of the medial edge of the scapula.

Contact point:

Direction of influence: along an arc ventro-laterally.

Option

I.P.P. – lying on your stomach. The hand is in the same position.

I.P.V. – standing on the side of the couch, on the opposite side of the muscle being tested. The stabilizing hand stabilizes the shoulder and controls the movement of the medial edge of the scapula with the thumb.

Contact point: back surface forearms, slightly higher elbow joint

Direction of influence: along an arc ventro-laterally.

API errors

1. Shoulder in flexion – activation of the pectoralis major muscle, the anterior portion of the deltoid muscle

2. shoulder in internal rotation – activation of the pectoral muscles; in external rotation – activation of the widest and round muscles

3. elbow bent less than 140° - activation of the pectoralis major and latissimus muscle

4. holding your breath – activation of the deep MFC

5. the hand is bent – ​​activation of the anterior MFC of the hand; the hand is extended – activation of the posterior MFC of the hand; the hand is pronated – activation of the pectoralis major muscle; the hand is supinated – activation of the anterior superficial MFC of the hand.

6. shoulder raised – activation of the upper trapezius and levator scapula muscles

7. head in lateroflexion to the test side - activation of the scalene muscles and lateral MFC

IPV mistakes

1. The stabilizing arm does not control the medial angle of the scapula - distortion of test interpretation

2. the stabilizing arm does not fix the shoulder - activation of the upper trapezius and levator scapula muscles.

3. doctor on the side of the muscle being tested - changing the direction of influence

Contact location errors

1. Contact for olecranon - activation of the posterior MFC of the hand

2. contact for the middle part of the humerus - activation of the posterior MFC of the arm, a painful reaction is possible due to irritation of the neurovascular bundle

The trapezius muscle is a triangular flat muscle, which, with its wide base, faces the posterior midline and occupies posterior region neck and upper back. Its base faces the spine, its apex faces the acromion of the scapula. Together, both trapezius muscles on both sides of the back are shaped like a trapezoid. The upper bundles of muscles are shaped like a coat hanger.

Anatomy

Where is the trapezoid? The trapezius muscle is located on the surface.

It consists of 3 parts:

• the upper part is located in the neck area;
• middle - on top of the shoulder blades;
• the lower one is located between the shoulder blades and under the shoulder blades.

The anatomy is clearly visible in the photo and you can see where the attachment of the tendon bundles is located.

The tendon bundles of the trapezius muscle are short and run:

• from the external occipital protrusion;
• from the medial third of the superior nuchal line of the occipital bone;
• nuchal ligament;
• from the spinous processes of the seventh cervical of all thoracic vertebrae;
• from the supraspinous ligament.

From these places, the bundles are directed laterally, converging towards the center, forming a place of attachment on the bones shoulder girdle. The upper bundles go down laterally, the place of attachment is the posterior surface of the outer third of the clavicle.

The middle bundles run horizontally from the spinous processes of the vertebrae outward, the place of attachment is the acromion and scapular spine.

The lower bundles go upward laterally, transforming along the way into a tendon plate, forming a place of attachment on the scapular spine. At the level of the lower border of the neck, the muscle is widest.

At the level of the process of the 7th cervical vertebra, the muscles form a pronounced tendon area.

Top part The trapezius muscle is exactly what people think of under the trapezius muscle itself. The upper part rotates and leads to the spine and also elevates/depresses the scapula (shrug) and assists with most movements of the neck and head. The top layer shapes and controls shoulder movements.

Slouching causes tension in the upper trapezius muscle in its stretched state. This leads to pain in the neck and headaches.

The middle and lower parts bring the scapula to the spine - the so-called. retraction of the shoulder blades.

Motor innervation of the trapezius is provided by the spinal portion of the accessory nerve. Innervation: accessory nerve and cervical plexus (C III - C IV).

Functions of the trapezius muscle

The trapezius muscle is responsible for several functions:

1. simultaneous contraction of parts of the trapezius brings the scapula closer to the spine;
2. contraction of the upper fascicles raises the scapula;
3. contraction of the lower muscle bundles lowers the scapula;
4. the upper and lower bundles, simultaneously contracting, rotate the scapula;
5. when contracted on both sides, the muscle extends the cervical spine and helps tilt the head back;
6. with unilateral contraction, the face turns slightly.

Pain in the trapezius muscle

Pain in the trapezius muscle is very common, because it is in this segment that stress points often occur.

The trapezius is called one of the most painful muscles: myalgia here, according to statistics, takes 2nd place, giving way to 1st pathologies manifested in the lumbosacral region.

The trapezoid consists of layers and fibers of different structures. Overstrain, spasm and weakness in these segments provoke painful sensations.

Causes of pain:

• muscle overstretching during training or sudden movement in a cold room;
• bruise or contusion;
• tendonitis, inflammation, myositis or the appearance of painful seals resulting from degenerative processes at the site of attachment to the vertebrae cervical spine;
• permanent trauma is associated with some monotonous professional movements of gymnasts, dancers or frequent wearing of heavy backpacks, it can cause swelling;
• static overvoltage typical for working positions of drivers and office workers. Scoliosis and other postural abnormalities can lead to this pathology;
• hypothermia can provoke myositis;
• stress and depression cause muscle strain, myositis;
• any muscle neuralgia may be accompanied by a headache.

In addition, pain and swelling can be caused by protrusions, herniated intervertebral discs, facet syndrome, neuralgia, and spinal contusion. The neuralgic nature of pain in fibromyalgia may be accompanied by sleep disturbances, morning stiffness in the neck, and the patient wakes up more tired than when he goes to bed.

Features of pain:

• aching character;
• subside only after a course of treatment;
• may be reflected upward, into the neck, into the back of the head, and a tension headache may be present;
• may limit neck and head movements;
• intensifies with pressure.

Symptoms of pain:

If the pain is localized in the upper layer, the person develops the following posture: shoulders raised up with the neck tilted towards the pain.

The patient turns his head, rubs the location of the pain. In these places, neuralgia of the facial nerve manifests itself in a similar way;

Pain in the middle layer is felt between the shoulder blades and intensifies when it is necessary to hold the item with outstretched arms;

The pain of the lower layer is manifested by pressing sensations in the lower neck.

Diagnostics

Diagnosis should exclude dangerous pathologies, radicular compression syndromes, and other symptoms. It is necessary to separate pain in the trapezius from similar symptoms of migraine and vascular diseases. Pathology is diagnosed by palpation, which helps to identify trigger points, hypertonicity and spasmodic areas. The spasmodic tissue feels like a dense cord along which pain points are located.

Near the spasmodic areas, swelling begins to develop, which compresses the closest nerve (usually the intercostal nerve) and muscle neuralgia develops, characterized by sharp pain. The muscle ceases to be innervated and ceases to produce necessary movements. In this case, neuralgia goes away on its own as soon as the effect on the nerve of the spasmed muscle stops.

The doctor also collects anamnesis and finds out from the patient the relationship between pain and overexertion, hypothermia or a static posture.

To clarify pain symptoms more clearly, a muscle test is used:

1. The patient raises his shoulders up, and the doctor presses down on them while simultaneously palpating the muscles.
2. The patient pulls his shoulders back, and the doctor provides resistance while palpating the muscle.
3. The patient raises his hand and points it back, the doctor resists the movement and palpates the muscle.

All the information and symptoms obtained in combination make it possible to accurately diagnose the pathology.

Treatment

Treatment of pain in the trapezius muscle is, first of all, the use of manual techniques, including massage of the trapezius muscle. However, according to recent research, manual techniques only affect shortened muscles, which reduces pain, but does not eliminate the root cause of the disease. Over time, the pain appears again.

The mechanism responsible for the development of pronounced clinical manifestations of the disease is complex and multifactorial, therefore it is necessary to influence the disease from all sides.

When treating pain in the trapezius muscle, psycho-emotional correction should be carried out simultaneously, since in 85% of diseases myalgia is accompanied by a depressive state.

It could be aromatherapy, autogenic training, breathing techniques. Correction of vascular pathologies of the brain is carried out with nootropics and amino acids. Then manual therapy, acupuncture and massage for the trapezius muscle are prescribed. The patient must perform the free time relaxation exercises.

To treat myofascial syndrome, it must destroy the pathological overtension in the trigger. The patient should avoid postures that provoke overload; the use of corsets to correct posture is recommended. If the pain is severe, lidocaine or other injectable painkillers are prescribed. According to indications, drug treatment with myelorelaxants is prescribed.

The effectiveness of the therapy depends on the earliest possible contact with a doctor and how responsibly the person treats the treatment.

2.13.1. Functional anatomy (Fig. 18A-B)

Characteristics Beginning of muscle End of muscle

Anatomy of insertions Vertical fibers - medial All fibers converge with each other and

one third of the superior nuchal line is attached to the acromion

occipital bone, outer end of the clavicle. Wherein

occipital protuberance. vertical fibers

Medial fibers - the nuchal ligament attaches more medially
from the spinous processes of Ci-V. relative to the medial fibers,

crossing each other in
frontal plane.

2.13.2. Violation of statics when shortening the upper portion of the trapezoid
muscles (Fig. 54)

Changing position

ipsilateral side Beginning of muscle End of muscle

Direction of displacement of places Dorso-lateral parts of the head - Acromial process of the clavicle -

attachments are predominantly caudo-ventral and cranio-dorso-medial.

concentric contraction slightly laterally. The muscle seems to curl up

muscles Nuchal ligament and spinous processes towards the acromion

upper cervical Ci-v - process.

predominantly ipsilateral and

slightly caudoventral.

Change in the position of places Lateral displacement of the spinous clavicle The clavicle is displaced medially,
attachment of processes Ci-v leads to compression of the intraarticular disc

lateroflexion of the upper cervical sternoclavicular joint,

department relative to the cervicothoracic At the same time acromial
transition, but the process of the clavicle is slightly displaced

volume. This is due to the fact that cranial and dorsal

lateroflexion of the cervical spine relative to the acromion
occurs in combination with the process of the scapula,

synkinetic rotation in the same
side, and caudolateral
the direction of muscle pull causes them
counterrotation, violating this
synkinesis.

Ventral displacement of the cervical
vertebrae leads to straightening
cervical lordosis. In the same time
Caudal-ventral displacement of the occiput
leads to extension of the head
relative to the cervical region with
formation of local
hyperlordosis in the upper cervical
level.

Direction of center shift Head and upper cervical region - Acromyl end of the clavicle -
severity of the region ventro-ipsilaterally. dorsocranial.

Cervicothoracic junction and upper
thoracic region - dorso-contra-
laterally.

Changing position
neighboring regions

Associated dysfunctions
joints and ligaments

On the lower cervical and upper thoracic
department is formed “C”-shaped
scoliosis with convexity of the arch at the level
cervicothoracic junction in
contralateral side and
hyperkyphosis of the upper thoracic region.

Functional blocks of spinous

processes C|-v.

Hypermobility - cervical
cranial and cervicothoracic
transitions.

Shoulder girdle with the same name
the sides rise up and
moves back.

Functional block acromio-
clavicular joint.
Hypermobility - sterno-
clavicular joint.

Body position when
examination of the ipsilateral
sides

Origin of muscle

End of muscle

Front view

Side view

Back view

The head is displaced ipsilaterally.
The ipsilateral ear is displaced
forward, lowered and clearly visible, and
contralateral - shifted back,
raised and often its outlines are not visible.
The nose is displaced contralaterally.
The lateral contour of the neck is straightened.

The head is shifted forward.
The ipsilateral ear is displaced
ventro-caudal.

Cervical spine is displaced
ipsilateral relative
shoulder girdle, and the head is tilted in
ipsilateral side
relative to the neck. Wherein
the contralateral ear is displaced upward
and back. At the cranial level
cervical junction visible
transverse fold (sign
extension), on the cervical and upper
the thoracic level shows a “C”-shaped
scoliosis with convexity at the level
cervicothoracic junction in
contralateral side.

The shoulder girdle is rotated so that
ipsilateral shoulder girdle displaced
dorsally, reduced transversely
size and raised up.
The acromion process is displaced
dorsocranial. Side contour
bodies at its level forms
step-like deformation
sternoclavicular level
articulations. The relief is smoothed.

Acromial end of clavicle together
with ipsilateral shoulder girdle
displaced dorso-cranially. Cervical
lordosis is smoothed.

Increased convexity at the level
cervicothoracic junction and upper
thoracic spine.

Ipsilateral shoulder girdle
displaced dorsocranially and
reduced in transverse size.
Lateral contour of the neck and shoulder girdle
straightened. At the level of the acromion-
clavicular joint - local
bulging of the lateral contour.

2.13.4. Violation of the dynamics of the shortened upper portion of the trapezoid
muscle during its advanced contraction (Fig. 56)

Atypical motor pattern "Shoulder abduction"

Subsequence
muscle activation

Direction of movement
in the joints

Visual criteria

1. Upper portion
trapezius muscle.

Sternoclavicular joint -
contralateralflexion, external
rotation of the clavicle relative
shoulder blades.

Head - extension,
Cervical spine - anterior displacement,
ipsilateroflexion, counterrotation.
Shoulder joint - flexion,
adduction.

The patient lifts and rotates
outward to the scapula and collarbone along with
humerus.
At the same time it produces
ipsilateroflexion and counterrotation
head, moving it forward.
Next comes inflection
shoulder joint. On the cervical and
"C"-shaped scoliosis.

1. Deltoid
   (clavicular portion).
2. Supraspinatus muscle.

Atypical motor pattern "Extension of the head and neck"

Sequence Direction of movement
activation of muscles in joints

Visual criteria

1. Shortened top portion
trapezius muscle

Head - extension,
ipsilateroflexion, counterrotation.
Cervical spine -
anterior displacement,
ipsilateroflexion, counterrotation.
Sternoclavicular joint -
counterlateroflexion. Outdoor
rotation of the clavicle relative
shoulder blades.

Patient performs head extension
at the same time as her
ipsilateroflexion and
counter-rotation. Next is the cervical region
moves forward at the same time
performing ipsilateroflexion and
counterrotation.

The shoulder girdle rises up
along with the hand and shoulder blade and
rotates outward: On the cervical and
the upper thoracic region intensifies
"C"-shaped scoliosis.

1. Contralateral upper
   portion trapezoidal
   muscles
2. Back extensor

Characteristic

Origin of muscle

Dimon

Hello. I am studying in gym(but the work is sedentary). There have been cases when, after doing exercises on the muscles of the shoulder girdle, it was as if the left side of the trapezius was “shot”. Afterwards it hurt slightly, so I attributed it to a sprain and quickly relieved the symptoms with Diclofenac or Dolobene ointments. However, after the new year, discomfort in the area of ​​the left side of the trapezius began to persist for a long time: it could not bother during the day, but appeared in a certain position of the body, for example, when the left hand was pulled forward or down, expressed in the form of nagging pain. I tried to “feel” for the source of pain in the area of ​​the left side of the trapezius and near the spine, but to no avail. Therefore, I applied ointments over a fairly large area. Then the pain began to “radiate” behind the triceps of the left arm, and then in the forearm. I tried to use the ointment there too, tried to drink diclofenac and other painkillers - it practically did not help in those very “uncomfortable” positions of the body or hands. Afterwards, the nagging pain became somewhat weaker, but with the same positions of the body or arms, a slight numbness (tingling) began, and then cramps of the triceps of the left arm, the left pectoral muscle and the left side of the latissimus, and the force of the contractions was quite strong. The left side has become weaker. At that moment, they pointed out to me a possible pinched nerve in the cervical spine (the symptoms are similar, but the pain in the neck and arm was not constant). I don’t have the opportunity or time to go for a massage, but I try to massage the trapezius area near the spine on my own, I do head tilt exercises (I don’t experience any pain while doing it). The cramps have become smaller, the numbness is less frequent, and there is almost no pain. But I can't tense my left one pectoral muscle as if partial atrophy had occurred. The essence of the question: how (ointment, medications, B vitamins, specific exercises) can I help recovery (final relief from pain, cramps, recovery muscle tone)?

Hello! You need to see a neurologist to find out the cause of muscle atrophy, which occurs more often against the background of a lack of functional activity of the root (disc entrapment). Muscle atrophy is an indication for surgery for a disc herniation, but first you need to perform an MRI of the cervical spine and try to find a combined conservative treatment for you using modern medicines and techniques. - Anti-inflammatory therapy (50 mg 3 times a day (suppositories - 2 times a day) Movalis 1t 2 times a day Nise 0.1 2 times a day) - Local applications (50% pp + novocaine 0.5% -10.0 + hydrocortisone 75 mg) - medications that relieve muscle spasm: (Sirdalud 2 mg - 3 rubles per day Miolastan 100 mg - 3 rubles per day Botox 25-75 units intramuscularly, Baclofen 10 mg - 3 rubles per day) - Stimulation of microcirculation (Trental 0.4 - 3 rubles per day Teonicol 0.3 g - 3 rubles per day 1.0- 6.0 i/m Actovegin 2.0 - i/m) - Antioxidant therapy (Tocopherol (Vit E) - 0.3 g per day Vitamin C 0.5 g per day (Tioctacid, Espalipon, Berlition) 0.6 g per day - 3- 4 months Mexidol 0.125g - 3 rubles a day - 1 month or more).