Trapezius Myalgia: Symptoms, Causes, and Evidence-Based Treatment Options

Trapezius myalgia is characterized by persistent pain and discomfort in the trapezius muscle region, primarily affecting the superior division that extends along the neck between the occiput (base of the skull) and the scapular spine. This common musculoskeletal condition significantly impacts daily activities and workplace productivity, particularly among office workers and those who perform repetitive upper body movements.

This comprehensive guide explores trapezius myalgia’s causes, symptoms, diagnostic approaches, and evidence-based treatment options to help you understand and manage this condition effectively.

Trapezius Muscle Anatomy and Function

Understanding the trapezius muscle’s structure is essential for recognizing how trapezius myalgia develops and affects movement.

The trapezius muscle originates from:

• The medial third of the superior nuchal line
• The external occipital protuberance
• The ligamentum nuchae
• The apices of the seventh cervical vertebra
• All thoracic spinous processes
• The supraspinous ligaments of cervical and thoracic vertebrae

The muscle fibers then insert at different locations:

• Upper fibers: Descend to attach to the lateral third of the posterior border of the clavicle
• Middle fibers: Run horizontally to the medial acromial margin and superior lip of the scapular spine
• Lower fibers: Ascend to attach to an aponeurosis at the medial end of the scapular spine, ending at a tubercle at the scapular lateral apex

Research indicates that while the trapezius receives nerve supply from both the spinal accessory nerve and C2-C4 branches of the cervical plexus, the spinal accessory nerve provides the most important motor supply to all portions of the muscle.

The trapezius plays a critical role in:

• Shoulder girdle elevation
• Scapular stabilization
• Neck and head positioning
• Upper limb movement coordination

For optimal function, the trapezius requires proper stabilization of the cervical spine by the anterior neck flexors. Without this stabilization, the head may translate anteriorly, decreasing trapezius efficiency and increasing cervical lordosis.

See Also: Scapula Anatomy

See Also: Trapezius Muscle Anatomy

Trapezius Myalgia Causes and Risk Factors

Several factors contribute to the development of trapezius myalgia:

Postural Factors

• Poor sitting posture during prolonged desk work
• Forward head positioning
• Increased cervical flexion angles
• Hyperkyphotic sitting position

Muscular Imbalances

• Derangements in upper trapezius firing patterns
• Increased muscle activity during rest
• Decreased maximum contraction strength
• Reduced muscle endurance
• Involvement of both fast-twitch and slow-twitch muscle fibers

Workplace Factors

• Extended computer use
• Non-ergonomic workstations
• Repetitive overhead activities
• Lack of movement variation
• Psychological stress

Associated Conditions

Trapezius myalgia frequently coexists with:

• Scapular dyskinesis
• Rotator cuff impingement syndrome
• Cervical spine disorders

See Also: Subacromial Impingement Syndrome

Symptoms and Clinical Signs of Trapezius Myalgia

Patients with trapezius myalgia typically present with:

• A persistent dull ache in the upper trapezius region
• Tenderness to palpation along the muscle
• Subjective “tightness” along the lateral side of the neck
• Pain that worsens with prolonged static postures
• Referred pain patterns to the head, neck and shoulders
• Decreased range of motion in the neck and shoulders
• Clinically significant scapular malposition (decreased posterior tilt and increased protraction)
• Increased capacity for passive glenohumeral internal rotation

Research by Juul-Kristensen et al. confirmed these findings, noting that patients with severe work-related disability showed approximately 20° increase in passive glenohumeral internal rotation compared to others with the condition.

Diagnostic Approaches for Trapezius Myalgia

Proper diagnosis involves:

1. Clinical examination
   • Thorough history taking
   • Palpation of the trapezius muscle
   • Assessment of scapular position and movement
   • Evaluation of neck and shoulder range of motion
2. Differential diagnosis to rule out:
   • Cervical spine disorders
   • Rotator cuff pathology
   • Thoracic outlet syndrome
   • Fibromyalgia
   • Myofascial pain syndrome
3. Advanced assessment when needed:
   • Electromyography (EMG) to evaluate muscle activation patterns
   • Diagnostic imaging to exclude structural pathologies

Evidence-Based Trapezius Myalgia Treatment Options

Treatment for trapezius myalgia typically includes a combination of approaches:

Conservative Management

• Heat therapy to increase blood flow and reduce muscle tension
• Rest from aggravating activities
• Pain management with acetaminophen or non-steroidal anti-inflammatory drugs (NSAIDs)
• Short-term use of muscle relaxants for severe cases

Physical Therapy Interventions

Physical therapy should focus on:

• Correcting muscular imbalances
• Improving scapular position and movement
• Addressing hyperkyphotic posture
• Re-establishing normal scapular motion
• Preventing secondary complications like rotator cuff disease

Ergonomic Modifications

• Workstation adjustments
• Proper monitor height and positioning
• Supportive chair with appropriate height
• Regular movement breaks
• Ergonomic keyboard and mouse

Long-Term Management Strategies

• Regular stretching routines
• Strength training focused on scapular stabilizers
• Postural awareness exercises
• Stress management techniques

Prevention of Trapezius Myalgia

Preventive strategies include:

• Maintaining proper posture during desk work
• Taking frequent breaks from static positions
• Performing regular neck and shoulder exercises
• Using ergonomic office equipment
• Practicing stress reduction techniques
• Addressing early symptoms before they worsen

Why Proper Diagnosis is Critical

The high prevalence of neck pain associated with desk work suggests trapezius myalgia is likely more common than documented. Misdiagnosis can lead to:

• Incorrect attribution of symptoms to cervical spine pathology
• Ineffective treatment approaches
• Unnecessary procedures (cervical spine manipulation, injections, acupuncture)
• Prolonged suffering and disability

Healthcare providers must recognize primary and secondary risk factors for trapezius myalgia to ensure appropriate treatment and avoid misguided interventions.

Frequently Asked Questions About Trapezius Myalgia

What’s the difference between trapezius myalgia and neck strain?

Trapezius myalgia is a chronic condition involving muscular imbalances and altered firing patterns in the trapezius muscle, while neck strain typically refers to an acute injury caused by overstretching or tearing of the muscle or tendon fibers.

Can trapezius myalgia cause headaches?

Yes, trapezius myalgia can refer pain to the head and contribute to tension-type headaches due to the connection between the upper trapezius and the base of the skull.

How long does it take to recover from trapezius myalgia?

Recovery time varies depending on severity, duration of symptoms, and adherence to treatment. With appropriate management, symptoms may improve within 2-4 weeks, though complete resolution of chronic cases may take several months of consistent therapy.

Is surgery ever needed for trapezius myalgia?

Surgery is rarely indicated for trapezius myalgia. Most cases respond well to conservative management including physical therapy, ergonomic modifications, and medication.

Can trapezius myalgia come back after treatment?

Yes, recurrence is possible, especially if underlying contributing factors like poor posture, ergonomic issues, or stress are not adequately addressed. Long-term management strategies are essential for preventing recurrence.

References

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• Ayub E: Posture and the upper quarter. In: Donatelli RA, ed. Physical Therapy of the Shoulder, 2nd ed. New York: Churchill Livingstone, 1991:81–90.
• Juul-Kristensen B, Kadefors R, Hansen K, Byström P, Sandsjö L, Sjøgaard G. Clinical signs and physical function in neck and upper extremities among elderly female computer users: the NEW study. Eur J Appl Physiol. 2006;96(2):136–45.
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