Trapezius

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Trapezius
Trapezius.png
The trapezius muscle (pl.: trapezii) is a surface muscle of back, shown in red above and below.
Trapezius Gray409.PNG
Details
Origin Medial one-third of superior nuchal line, external occipital protuberance, spinous processes of vertebrae C7-T12, Nuchal ligament [1]
Insertion Posterior border of the lateral one-third of the clavicle, acromion process, and spine of scapula
Artery Superficial branch of transverse cervical artery or superficial cervical artery [2]
Nerve Accessory nerve (motor)
cervical spinal nerves C3 and C4 (motor and sensation) [3]
Actions Rotation, retraction, elevation, and depression of scapula
Antagonist Serratus anterior muscle, latissimus dorsi, pectoralis major
Identifiers
Latin musculus trapezius
TA98 A04.3.01.001
TA2 2226
FMA 9626
Anatomical terms of muscle

The trapezius [4] is a large paired trapezoid-shaped surface muscle that extends longitudinally from the occipital bone to the lower thoracic vertebrae of the spine and laterally to the spine of the scapula. It moves the scapula and supports the arm.

Contents

The trapezius has three functional parts: an upper (descending) part which supports the weight of the arm; a middle region (transverse), which retracts the scapula; and a lower (ascending) part which medially rotates and depresses the scapula.

Name and history

The trapezius muscle resembles a trapezium, also known as a trapezoid, or diamond-shaped quadrilateral. The word "spinotrapezius" refers to the human trapezius, although it is not commonly used in modern texts. In other mammals, it refers to a portion of the analogous muscle.

Structure

Position of trapezius and its parts:
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Superior fibers of the trapezius
Middle fibers of the trapezius
Inferior fibers of the trapezius Trapezius animation small2.gif
Position of trapezius and its parts:
  Superior fibers of the trapezius
  Middle fibers of the trapezius
  Inferior fibers of the trapezius

The superior or upper (or descending) fibers of the trapezius originate from the spinous process of C7, the external occipital protuberance, the medial third of the superior nuchal line of the occipital bone (both in the back of the head), and the ligamentum nuchae. From this origin they proceed downward and laterally to be inserted into the posterior border of the lateral third of the clavicle.

The middle fibers, or transverse of the trapezius arise from the spinous process of the seventh cervical (both in the back of the neck), and the spinous processes of the first, second, and third thoracic vertebrae. They are inserted into the medial margin of the acromion, and into the superior lip of the posterior border of the spine of the scapula.

The inferior or lower (or ascending) fibers of the trapezius arise from the spinous processes of the remaining thoracic vertebrae (T4–T12). From this origin they proceed upward and laterally to converge near the scapula and end in an aponeurosis, which glides over the smooth triangular surface on the medial end of the spine, to be inserted into a tubercle at the apex of this smooth triangular surface.

At its occipital origin, the trapezius is connected to the bone by a thin fibrous lamina, firmly adherent to the skin. The superficial and deep epimysia are continuous with an investing deep fascia that encircles the neck and also contains both sternocleidomastoid muscles.

At the middle, the muscle is connected to the spinous processes by a broad semi-elliptical aponeurosis, which reaches from the sixth cervical to the third thoracic vertebræ and forms, with that of the opposite muscle, a tendinous ellipse. The rest of the muscle arises by numerous short tendinous fibers.

It is possible to feel the muscles of the superior trapezius become active by holding a weight in one hand in front of the body and, with the other hand, touching the area between the shoulder and the neck.[ citation needed ]

Innervation

Motor function is supplied by the accessory nerve. [5] Sensation, including pain and the sense of joint position (proprioception), travel via the ventral rami of the third (C3) and fourth (C4) cervical spinal nerves. [5] Since it is a muscle of the upper limb, the trapezius is not innervated by dorsal rami, despite being placed superficially in the back.

Function

Contraction of the trapezius muscle can have two effects: movement of the scapulae when the spinal origins are stable, and movement of the spine when the scapulae are stable. [5] Its main function is to stabilize and move the scapula. [5]

Scapular movements

The upper fibers elevate the scapulae, the middle fibers retract the scapulae, and the lower fibers depress the scapulae. [5]

In addition to scapular translation, the trapezius induces scapular rotation. The upper and lower fibers tend to rotate the scapula around the sternoclavicular articulation so that the acromion and inferior angles move up and the medial border moves down (upward rotation). The upper and lower fibers work in tandem with serratus anterior to upwardly rotate the scapulae, and work in opposition to the levator scapulae and the rhomboids, which effect downward rotation.

An example of trapezius function is an overhead press. When activating together, the upper and lower fibers also assist the middle fibers (along with other muscles such as the rhomboids) with scapular retraction/adduction.

The trapezius also assists in abduction of the shoulder above 90 degrees by rotating the glenoid upward. Injury to cranial nerve XI will cause weakness in abducting the shoulder above 90 degrees.

Spinal movements

When the scapulae are stable, a co-contraction of both sides can extend the neck.

Clinical significance

Dysfunction of the trapezius can result in winged scapula, sometimes further specified as "lateral winging" [6] and in an abnormal mobility or function of the scapula (scapular dyskinesia). [7] There are multiple causes of trapezius dysfunction.

Palsy

Trapezius palsy, due to damage of the spinal accessory nerve, is characterized by difficulty with arm adduction and abduction, and associated with a drooping shoulder, and shoulder and neck pain. [8] Intractable trapezius palsy can be surgically managed with an Eden–Lange procedure.

Facioscapulohumeral muscular dystrophy

The trapezius muscle is one of the commonly affected muscles in facioscapulohumeral muscular dystrophy (FSHD). The lower and middle fibers are affected initially, and the upper fibers are commonly spared until late in the disease. [9]

Underdevelopment

Although rare, underdevelopment or absence of the trapezius has been reported to correlate to neck pain and poor scapular control that are not responsive to physical therapy. [10] Absence of the trapezius has been reported in association with Poland syndrome. [11]

Society and culture

Exercises

It is mainly used in throwing, with the deltoid muscle and rotator cuff.

Related Research Articles

<span class="mw-page-title-main">Atlas (anatomy)</span> First cervical vertebra of the spine which supports the skull

In anatomy, the atlas (C1) is the most superior (first) cervical vertebra of the spine and is located in the neck.

<span class="mw-page-title-main">Scapula</span> Bone that connects the humerus (upper arm bone) with the clavicle (collar bone)

The scapula, also known as the shoulder blade, is the bone that connects the humerus with the clavicle. Like their connected bones, the scapulae are paired, with each scapula on either side of the body being roughly a mirror image of the other. The name derives from the Classical Latin word for trowel or small shovel, which it was thought to resemble.

<span class="mw-page-title-main">Brachial plexus</span> Network of nerves

The brachial plexus is a network of nerves formed by the anterior rami of the lower four cervical nerves and first thoracic nerve. This plexus extends from the spinal cord, through the cervicoaxillary canal in the neck, over the first rib, and into the armpit, it supplies afferent and efferent nerve fibers to the chest, shoulder, arm, forearm, and hand.

<span class="mw-page-title-main">Spinal nerve</span> Nerve that carries signals between the spinal cord and the body

A spinal nerve is a mixed nerve, which carries motor, sensory, and autonomic signals between the spinal cord and the body. In the human body there are 31 pairs of spinal nerves, one on each side of the vertebral column. These are grouped into the corresponding cervical, thoracic, lumbar, sacral and coccygeal regions of the spine. There are eight pairs of cervical nerves, twelve pairs of thoracic nerves, five pairs of lumbar nerves, five pairs of sacral nerves, and one pair of coccygeal nerves. The spinal nerves are part of the peripheral nervous system.

<span class="mw-page-title-main">Sternocleidomastoid muscle</span> Cervical muscle

The sternocleidomastoid muscle is one of the largest and most superficial cervical muscles. The primary actions of the muscle are rotation of the head to the opposite side and flexion of the neck. The sternocleidomastoid is innervated by the accessory nerve.

<span class="mw-page-title-main">Upper limb</span> Consists of the arm, forearm, and hand

The upper limbs or upper extremities are the forelimbs of an upright-postured tetrapod vertebrate, extending from the scapulae and clavicles down to and including the digits, including all the musculatures and ligaments involved with the shoulder, elbow, wrist and knuckle joints. In humans, each upper limb is divided into the arm, forearm and hand, and is primarily used for climbing, lifting and manipulating objects.

<span class="mw-page-title-main">Levator scapulae muscle</span> Slender skeletal muscle at the back and side of the neck

The levator scapulae is a slender skeletal muscle situated at the back and side of the neck. It originates from the transverse processes of the four uppermost cervical vertebrae; it inserts onto the upper portion of the medial border of the scapula. It is innervated by the cervical nerves C3-C4, and frequently also by the dorsal scapular nerve. As the Latin name suggests, its main function is to lift the scapula.

<span class="mw-page-title-main">Rhomboid major muscle</span> Skeletal muscle in the human back

The rhomboid major is a skeletal muscle of the back that connects the scapula with the vertebrae of the spinal column. It originates from the spinous processes of the thoracic vertebrae T2–T5 and supraspinous ligament; it inserts onto the lower portion of the medial border of the scapula. It acts together with the rhomboid minor to keep the scapula pressed against thoracic wall and to retract the scapula toward the vertebral column.

<span class="mw-page-title-main">Rhomboid minor muscle</span> Skeletal muscle of the upper back

In human anatomy, the rhomboid minor is a small skeletal muscle of the back that connects the scapula to the vertebrae of the spinal column. It arises from the nuchal ligament, and the 7th cervical and 1st thoracic vertebrae and intervening supraspinous ligaments; it inserts onto the medial border of the scapula. It is innervated by the dorsal scapular nerve.

<span class="mw-page-title-main">Cervical vertebrae</span> Vertebrae of the neck

In tetrapods, cervical vertebrae are the vertebrae of the neck, immediately below the skull. Truncal vertebrae lie caudal of cervical vertebrae. In sauropsid species, the cervical vertebrae bear cervical ribs. In lizards and saurischian dinosaurs, the cervical ribs are large; in birds, they are small and completely fused to the vertebrae. The vertebral transverse processes of mammals are homologous to the cervical ribs of other amniotes. Most mammals have seven cervical vertebrae, with the only three known exceptions being the manatee with six, the two-toed sloth with five or six, and the three-toed sloth with nine.

<span class="mw-page-title-main">Serratus anterior muscle</span> Muscle on the surface of the ribs

The serratus anterior is a muscle of the chest. It originates at the side of the chest from the upper 8 or 9 ribs; it inserts along the entire length of the anterior aspect of the medial border of the scapula. It is innervated by the long thoracic nerve from the brachial plexus. The serratus anterior acts to pull the scapula forward around the thorax.

<span class="mw-page-title-main">Semispinalis muscles</span> Group of three muscles belonging to the transversospinales

The semispinalis muscles are a group of three muscles belonging to the transversospinales. These are the semispinalis capitis, the semispinalis cervicis and the semispinalis thoracis.

<span class="mw-page-title-main">Splenius capitis muscle</span>

The splenius capitis is a broad, straplike muscle in the back of the neck. It pulls on the base of the skull from the vertebrae in the neck and upper thorax. It is involved in movements such as shaking the head.

<span class="mw-page-title-main">Erector spinae muscles</span> Human muscle group

The erector spinae or spinal erectors is a set of muscles that straighten and rotate the back. The spinal erectors work together with the glutes to maintain stable posture standing or sitting.

<span class="mw-page-title-main">Pull-down (exercise)</span> Strength training exercise

The pull-down exercise is a strength training exercise designed to develop the latissimus dorsi muscle. It performs the functions of downward rotation and depression of the scapulae combined with adduction and extension of the shoulder joint.

<span class="mw-page-title-main">Spine of scapula</span> Bony plate on the scapula

The spine of the scapula or scapular spine is a prominent plate of bone, which crosses obliquely the medial four-fifths of the scapula at its upper part, and separates the supra- from the infraspinatous fossa.

<span class="mw-page-title-main">Winged scapula</span> Skeletal muscle condition around the shoulder blade

A winged scapula is a skeletal medical condition in which the shoulder blade protrudes from a person's back in an abnormal position.

<span class="mw-page-title-main">Outline of human anatomy</span> Overview of and topical guide to human anatomy

The following outline is provided as an overview of and topical guide to human anatomy:

The Eden–Lange procedure is an orthopedic procedure to alleviate the symptoms of trapezius palsy when more conservative measures, such as spontaneous resolution and surgical nerve repair are not promising. The rhomboid major, rhomboid minor, and levator scapulae muscles are transferred laterally along the scapula to replace the functions of the lower, middle, and upper fibers of the trapezius, respectively. The transferred muscles hold the scapula in a more medial and upwardly rotated position, without winging.

References

  1. Rockwood, Charles A. (January 1, 2009). The Shoulder. ISBN   978-1416034278.
  2. "Tufts". Archived from the original on April 22, 2003. Retrieved December 11, 2007.
  3. Dalley, Arthur F.; Moore, Keith L.; Agur, Anne M.R. (2010). Clinically oriented anatomy (6th [International] ed.). Philadelphia [etc.]: Lippincott Williams & Wilkins, Wolters Kluwer. p. 700. ISBN   978-1-60547-652-0.
  4. Lajtai, Georg; Applegate, Gregory; Snyder, Stephen J.; Aitzetmüller, Gernot; Gerber, Christian (March 11, 2003). "trapezoid"&pg=PA89 Shoulder Arthroscopy and MRI Techniques: 20 Tables. ISBN   9783540431121.
  5. 1 2 3 4 5 Bakkum, Barclay W.; Cramer, Gregory D. (January 1, 2014), Cramer, Gregory D.; Darby, Susan A. (eds.), "Chapter 4 - Muscles That Influence the Spine", Clinical Anatomy of the Spine, Spinal Cord, and Ans (Third Edition), Saint Louis: Mosby, pp. 98–134, ISBN   978-0-323-07954-9 , retrieved January 8, 2021
  6. Martin, RM; Fish, DE (March 2008). "Scapular winging: anatomical review, diagnosis, and treatments". Current Reviews in Musculoskeletal Medicine. 1 (1): 1–11. doi: 10.1007/s12178-007-9000-5 . PMC   2684151 . PMID   19468892.
  7. Panagiotopoulos AC, Crowther IM (2019). "Scapular Dyskinesia, the forgotten culprit of shoulder pain and how to rehabilitate". SICOT-J. 5: 29. doi: 10.1051/sicotj/2019029 . PMC   6701878 . PMID   31430250.
  8. Wiater JM, Bigliani LU (1999). "Spinal accessory nerve injury". Clinical Orthopaedics & Related Research. 368 (1): 5–16. doi : 10.1097/00003086-199911000-00003.
  9. Parada, Stephen; Girden, Alex; Warner, Jon JP (January 17, 2019). "Evaluation and Management of Scapular Winging due to Facioscapulohumeral dystrophy (FSH)". Cancer Therapy Advisor. Archived from the original on November 4, 2023.
  10. Bergin, Michael; Elliott, James; Jull, Gwendolen (2011). "The Case of the Missing Lower Trapezius Muscle". Journal of Orthopaedic & Sports Physical Therapy. 41 (8): 614. doi: 10.2519/jospt.2011.0416 . PMID   21808102. Archived from the original on December 2, 2023.
  11. Yiyit, N; Işıtmangil, T; Oztürker, C (November 2014). "The abnormalities of trapezius muscle might be a component of Poland's syndrome". Medical Hypotheses. 83 (5): 533–6. doi:10.1016/j.mehy.2014.09.007. PMID   25257706.

PD-icon.svgThis article incorporates text in the public domain from page 432 of the 20th edition of Gray's Anatomy (1918)