Lower fibers: spinous processes of fourth through twelfth thoracic vertebrae. Middle fibers: spinous processes of seventh cervical vertebra and upper three thoracic vertebrae. Origin: Upper fibers: base of skull at occipital protuberance and the nuchal ligaments (ligamentum nuchae) of neck. Trapezius Synergists and Antagonists Muscles by Shoulder Girdle Action Elevation
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8: Masseter Muscle.” Travell & Simons’ Myofascial Pain and Dysfunction: the Trigger Point Manual. The closely related levator scapulae were also found to be the top runner in some studies and this would make sense because the same perpetuating circumstances that affect the trapezius would also affect the levator scapulae.
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The upper trapezius was found by Travell and Simons to be the muscle most often affected by trigger points, which has been confirmed by other authors. Other trapezius muscle relationships are shown in the table below. The action of the trapezius is closely linked with the levator scapulae in shoulder elevation and its other synergists in this role are the rhomboids major and minor. The trapezius is sometimes considered an “upper back” muscle or a “shoulder” muscle but it is more correctly considered a muscle of the scapulothoracic joint of the shoulder girdle (The two other shoulder girdle joints are the sternoclavicular (SC) and the acromioclavicular joint ). More specific functions of the upper, lower, and middle fibers will be discussed below under “actions”. The trapezius is most well-known as the “shrug” muscle and it is worked heavily with the traditional bodybuilding shrug exercise as well as during the Olympic lifts and anything that elevates the shoulders. The trapezius fixes the scapula for movement of the shoulder joint and continuously rotates the scapula upward to permit the arm to be raised over the head. Adduction of the scapula is the same thing as “retraction” of the scapula and means to move the scapula medially toward the spinal column. The trapezius also extends the head and when all the fibers work together they tend to pull the shoulder upward and adduct the scapula. In general, the action of the trapezius is to elevate and depress the scapula and to rotate the shoulder girdle upward and downwards. Some experts divide the middle section into two parts, the upper middle and lower middle but for the purposes of this article, which is to serve as an introduction for the trapezius trigger point explanation, we will consider only three divisions. These different groups of fibers are usually referred to as the upper, middle, and lower trapezius. Together the two trapezii form a diamond or kite-shaped trapezoid from which the muscle derives its name.Īlthough usually discussed as one muscle, it is separated into distinct groups of fibers which run in different directions and thus can have slightly different movement roles. Williams & Wilkins, Baltimore, 1983).The trapezius is a three-part (tripartite) muscle of the upper back extending from the base of the skull all the way to the lower thoracic spine and laterally from the clavicle to the entire length of the spine of the scapula.
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The physical findings for diagnosis of a myofascial trigger point are (1) palpation of a tender nodule in a taut band, (2) a referred pain pattern specific for the muscle, (3) a local twitch response (LTR) with snapping palpation or triggering with needle, and (4) restricted ROM (Travell J, Simons DG, Myofascial pain and dysfunction: the trigger point manual, vol 1. Active TrP produce a referred pain pattern specific to that muscle spontaneously and when the TrP is palpated. Latent TrP are associated with stiffness and restricted ROM but no pain unless palpated. Trigger points (TrP) can be latent or active (Simons DG, Travell JG, Postgrad Med 73:66–108, 1983). The diagnosis of MPS is based on the presence of 1 or more trigger points.
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Myofascial pain syndrome (MPS) as defined by Travell and Simons is characterized by trigger points (TrP), limited ROM of the affected muscle(s), and neurologic symptoms (autonomic, proprioceptive) (Simons DG, Travell JG, Postgrad Med 73:66–108, 1983).