Examining Trapezius Muscle Pain: What Might Be the Triggers?

Trapezius muscle pain refers to discomfort or tenderness experienced in the trapezius muscle, which is a large muscle that extends from the base of the skull to the mid-back and across the shoulder blades. This type of pain can arise from injury of the muscle as well as referred pain from the cervical and thoracic spine. The most common causes and treatment options will be discussed below. 

Understanding the Trapezius Muscle Anatomy

The trapezius muscle is a large triangular-shaped muscle that covers a large portion of the neck, upper and middle back. It extends from the base of the skull down to the thoracic spine and laterally to the shoulder blades. The trapezius muscle plays a key role in various movements of the shoulders and neck, including stabilization, shrugging, pulling the shoulder blades together, and rotation of the neck.

Trapezius Zones

The trapezius muscle is divided into three parts, which are discussed below.

Upper Section

This portion of the muscle originates from the base of the skull and extends down the outer third of the collarbone. Its primary role is to elevate the shoulder girdle, as seen when shrugging the shoulders.

Middle Section

Muscle fibers run horizontally from the bottom of the neck and mid back to the scapular spine. Its primary function is to retract the scapula (pulls the shoulder blades together towards the spine). This action is essential for stabilizing the shoulders and maintaining proper posture.

Lower Section

The lower trapezius muscle starts from the lower thoracic vertebrae and extends to the scapular spine. Its main function is to depress the scapula, meaning it pulls the shoulder blades downward.

How Does the Muscle Work?

The trapezius muscle has many important functions. Its primary functions include shoulder movement such as elevating, retracting, and rotating the scapulae. It also stabilizes and supports the shoulders, allowing for proper arm and shoulder movement. 

The trapezius plays a role in maintaining proper posture. 

What Causes Pain in the Trapezius Muscle?

Trapezius pain, often experienced as discomfort, stiffness, or tenderness in the upper back and neck region, is a common complaint that can significantly impact daily activities and quality of life. Understanding the underlying causes of trapezius pain is essential for effective management and relief. The five major causes of trapezius pain are:

Muscle Strain or Overuse

Repetitive movements or excessive strain on the trapezius muscle, such as from carrying heavy loads, or prolonged periods of sitting at a desk, can lead to muscle strain and pain. Muscle strain or overuse can cause trapezius pain by inducing microtrauma, muscle tension, and changes in biomechanics, which can lead to inflammation and pain. 

Tension or Stress

Emotional stress or tension can cause the trapezius muscle to become tense and painful. Often there are small, painful trigger points in the muscle. 

Nerve Irritation

Pain perceived in an area different from where the actual tissue damage is occurring is termed referred pain. The most common example is a patient who has a heart attack and feels pain radiating down their arm. The actual tissue damage involves the heart but the pain is referred down the arm.

Conditions such as cervical radiculopathy, where nerves in the cervical spine are irritated or compressed, can lead to trapezius muscle pain. Another example is thoracic outlet syndrome, where compression of nerves in the shoulder region leads to trapezius muscle pain. 

Poor Posture

Extensive screen time on phones, tablets, and computers can compromise neutral spinal alignment and posture. Head forward posture and rounding of the shoulders can place excessive strain on the trapezius muscle, leading to trapezius muscle pain. 

Neck or Shoulder Injury

Trauma or injury to the neck or shoulders such as from a motor vehicle collision, fall, or sports injury can result in trapezius muscle pain and stiffness.

Medical Conditions That Can Cause Trapezius Muscle Pain

Muscle irritation, poor posture, and trauma are not the only causes of trapezius muscle pain. It is important to understand that there are a large number of other conditions that can cause trapezius muscle pain and stiffness. The most common causes include: 

When to Seek Medical Attention

Medical attention is warranted if trapezius muscle pain is severe, persistent, and is getting worse over time. Evaluation is also indicated for persistent neurologic symptoms such as numbness, tingling, weakness, and loss of sensation in the arms, hands, and other areas that have not improved after conservative care. 

Diagnosing the Root Cause of the Muscle Pain

Identifying the root cause of trapezius pain requires a comprehensive assessment. Important steps include:

• Medical history: A detailed medical history will be obtained, including the duration of symptoms, location, severity, quality of pain, aggravating factors, alleviating factors, onset, and treatment to date. 
• Physical examination: A thorough physical examination will be conducted to assess for signs of muscle tenderness, trigger points, muscle strength, range of motion, posture abnormalities, and neurological symptoms such as numbness or tingling. 
• Radiographic studies: These may include X-rays, CT scans, and MRIs, which can help identify any abnormalities such as fractures, disc injuries, nerve irritation or compression, tendon, and ligament injuries.
• Diagnostic studies: Electromyography (EMG) and nerve conduction tests (NCS) may be ordered to assess the function of the nerves supplying the trapezius muscle and to identify any nerve compression or damage.
• Laboratory tests: Blood tests may be helpful to screen for any underlying medical conditions such as infections and autoimmune or metabolic abnormalities that may be contributing to trapezius muscle pain. 

Common Pain Relief Methods

Trapezius muscle pain can be debilitating, compromising daily activities and function. Common pain relief methods for trapezius muscle pain include:

Ice Therapy

Ice can be effective in alleviating trapezius muscle pain by reducing inflammation, numbing the area, and temporarily decreasing nerve irritation. Ice can be applied for 15-20 minutes at a time, several times per day. 

Medications

Medications for trapezius muscle pain include the following:

• NSAIDs are potent anti-inflammatory medications that can reduce inflammation and pain. Common examples include Advil, Motrin, and Naproxen. However, these medications have significant negative side effects and should be avoided.
• Muscle relaxants can help decrease muscle spasms and promote relaxation in the trapezius muscle. Examples include Flexeril (cyclobenzaprine), Robaxin (methocarbamol), and Zanaflex (tizanidine).
• Oral steroids are very powerful anti-inflammatory agents that can reduce inflammation and pain. However, they should be avoided as they do not address the underlying problem and have a significant number of side effects.

Topical Analgesic Creams

Topical analgesic creams can provide temporary relief. Examples include Biofreeze, Bengay, Icy Hot, and Voltaren gel.

Corticosteroids Injections

Corticosteroid injections are a type of treatment often used to reduce inflammation and relieve pain. They suppress the immune response that triggers inflammation, thereby reducing swelling, redness, and pain. Common examples include prednisone, dexamethasone, and methylprednisolone. These medications have significant negative side effects and should also be avoided. They do not address the underlying cause but simply mask the symptoms.

Therapies

Conservative therapies, when appropriate, should be first-line treatment. Examples include:

Physical Therapy

Physical therapy can be helpful in the treatment of trapezius muscle pain due to strain or overuse. Options include stretching, posture correction, and spinal alignment. 

Massage

Massage can be an effective treatment option as it can increase blood flow, relax muscles, release painful trigger points, and improve range of motion.

Acupuncture

Acupuncture can be beneficial in effectively alleviating trapezius muscle pain by targeting specific points to reduce muscle tension, improve blood circulation, promote relaxation, and encourage the body’s natural healing process.

The Centeno-Schultz Clinic Regenerative Treatment Approach

Physicians at the Centeno-Schultz Clinic are experts in the evaluation and treatment of cervical and thoracic spine injuries, including trapezius muscle pain. Identifying the underlying cause of the trapezius muscle pain is critical and provides for the best clinical outcomes. Treating the symptoms with medications and other treatment modalities does not address the underlying problem and in most cases only provides temporary relief. 

Treat the Root Cause of Trapezius Pain

Trapezius muscle pain can be debilitating, compromising function and quality of life. 

The pain may arise from muscle strain, overuse, or poor posture. It is also important to understand that persistent trapezius pain may be arising from a different area of injury that warrants your attention. Examples include cervical and thoracic disc injuries, facet injuries, shoulder arthritis, rotator cuff tears, nerve root irritation, spinal stenosis, and cervical ligament laxity.

At the Centeno-Schultz Clinic, we are committed to identifying the underlying cause of pain and dysfunction. This starts with a physician securing a detailed medical history, performing a thorough physical examination, reviewing radiographic studies, and, when appropriate, performing an in-office ultrasound examination. 

Treatment options are directed at treating the underlying condition and include X-ray or ultrasound-guided PRP (platelet rich plasma) or bone marrow concentration. Not all regenerative medicine clinics, PRP, and bone marrow injections are the same. The concentration of the PRP, the injection technique, understanding the anatomy, and experience matter. Choose wisely. 

Thoracic Spine Physician and Expert

John Schultz, MD

John R. Schultz M.D. is a national expert and specialist in Interventional Orthopedics and the clinical use of bone marrow concentrate and PRP for orthopedic injuries. He is board certified in Anesthesiology and Pain Medicine and underwent fellowship training. Dr. Schultz has extensive experience with same day as well as culture expanded bone marrow concentrate and sees patients at the CSC Broomfield, Colorado Clinic, as well the Regenexx Clinic in Grand Cayman. Dr. Schultz emphasis is on the evaluation and treatment of thoracic and cervical disc, facet, nerve, and ligament injuries including the non-surgical treatment of Craniocervical instability (CCI).

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