Download Trigger points in Trapezius Muscle (Upper, Middle

Trigger points in Trapezius Muscle (Upper,
Middle and lower Fibres)
Anatomy of trapezius
Origin (Medial attachment)- Medial third of superior nuchal line, external occipital
protuberance, nuchal ligament, spinous process of C7- T12 vertebrae.
Insertion (lateral attachment)- Lateral third of the clavicle, acromion and spine of the scapula.
Innervation- spinal accessory nerve and c3, c4 spinal nerves.
Action- Descending part (superior): elevates, Ascending (inferior) part: depresses, and middle
part (or all parts together retracts the scapula; descending part and ascending part acting together
rotates the glenoid cavity superiorly.
What is a trigger point? It is a hyperirritable spot in a skeletal muscle which is associated with
a hypersensitive nodule which is palpable in a taut band. Pain is felt in that area when
compressed and give rise to various symptoms, such as referred pain, referred tenderness, motor
dysfunction and autonomic phenomenon
What would cause trapezius to develop a trigger point?
TrPs in upper trapezius- are result of acute of chronic over use of muscle. Like chronic postures
of elevation of the shoulder girdle. Anteriorly held head, sitting at the computer, crimping phone
between the shoulder and the ear. Resisting depression of the shoulder girdle, when the upper
extremity is carrying weight, Trauma, compression forces (e.g. carrying heavy purse on
shoulder, tight bra strap)
TrPs in middle trapezius- activated by chronic rounded shoulder posture, when driving or
holding the steering wheel
TrPs in lower trapezius- activated by chronically pressing the shoulder girdle.
Result of a trigger point in the trapezius.
Upper trapezius- stiff neck, restricted contralateral lateral flexion and ipsilateral rotation at the
neck, elevated shoulder girdle, pain at the end of contralateral rotation of the neck, tension
headaches
Middle trapezius-produces weakness and inhibition in the middle fibres resulting in chronically
protracted shoulders, goosebumps on the arms and sometimes in the thigh.
Lower Trapezius TrPs- produces burning pain, weakness and inhibition in the lower fibres
resulting in elevated shoulders.
Associated TrPs
Upper trapezius- scalenes, splenius capitis and cervices, levator scapulae, rhomboids,
semispinalis capitis, temporalis, masseter, and the contralateral trapezius.
Middle trapezius- pectoralis major and minor, erector spinae, transversospinalis muscles of the
trunk
Lower trapezius- latissimus dorsi and ipsilateral upper trapezius.
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Trigger points in all parts of the trapezius may cause spinal joint Dysfunction.
TrPs in trapezius are incorrectly assessed as cervical disc syndrome, temporomandibular
joint syndrome or occipital neuralgia.
Trapezius is the muscle most commonly found to have trigger points (especially the
upper trapezius)
Muscolino, J. E. (2016). The muscle and bone palpation manual with trigger points, referral
patterns, and stretching. St. Louis, MO: Elsevier Mosby.