Abstract
This chapter covers the topic of trapezius strain and reviews current definitions and symptom presentation. It also discusses myofascial pain, since this is the most common reason for pain in this area. Pertinent clinic findings on examination, functional limitations, differential diagnoses, and workup are reviewed. The latest treatment options and the associated risks are discussed.
Keywords
Injury, Muscle, Myofascial, Neck, Pain, Shoulder, Strain, Trapezius
| Synonyms | |
| |
| ICD-10 Codes | |
| M79.1 | Myalgia |
| M60.9 | Myositis, unspecified |
| S13.9 | Neck sprain, unspecified parts of the neck |
| S16.1 | Neck strain (add additional character for type of encounter) |
| S13.4 | Whiplash injury (cervical spine) |
| S23.3 | Thoracic sprain |
| S39.012 | Back strain |
Definition
Trapezius strain is often considered a part of the myofascial pain syndrome (MPS). This is a common diagnosis of patients who present to outpatient clinics for musculoskeletal pain disorders. There is no standard definition of trapezius strain or MPS; however, MPS is described as a disorder characterized by nonspecific pain in single or multiple muscles with the presence of trigger points that can be defined as a hyperirritable area within a taut band of skeletal muscle. The pain in this area must not be mistaken for cervical radicular pain that involves the shoulder girdle and the upper limb. The etiology of trigger point formation is not known. There have been numerous attempts to identify the etiology of trigger points and taut muscle bands, but none have reached a level of a criterion standard.
Trapezius strain is thought to be due to common repetitive strain or stress injury associated with carrying light loads and certain postures, such as working on a computer for long periods of time. Myofascial trigger points can be the main cause of neck and upper back pain and the trapezius muscle is the most commonly studied. The condition can also result from acute causes, such as a whiplash injury.
Symptoms
Typically, patients complain of a sore or aching sensation in the region of the upper trapezius muscle. Patients may also complain of posterior neck and shoulder pain. Some may have associated posterior headaches, difficulty with sleeping due to shoulder pain, and interscapular area pain. The symptoms can be constant and relieved by rest and worsened with activity. There can be increased pain with cervical movement and, hence, limitation in neck range of motion. The pain is regional and does not follow spinal segmental or peripheral nerve distribution. Patients may often report that the symptoms are partly relieved with the use of heat or cold modalities and focal pressure.
Physical Examination
The importance of the physical examination is to rule out other conditions that may be causing the patient’s symptoms, such as a radiculopathy, peripheral nerve injury, cervical dystonia, or some other conditions that may be suspected based on the history. A neurological and musculoskeletal examination focusing on the neck and upper body should be done in addition to a general examination. Cranial nerve function, especially checking the spinal accessory nerve function; sensation to light touch and pin prick about the face, upper limbs, and torso with attention to dermatomes and cutaneous nerve distribution; muscle stretch reflexes; and strength testing. The neurological examination is typically normal in primary trapezius strain. The patient may present with a forward head posture, scapular protraction, and compensatory cervical hyperextension. Muscle palpation about the neck and shoulder girdle may reveal tender areas and trigger points, especially in the trapezius muscle. A shoulder examination should be carried out to assess for shoulder pathology.
Functional Limitations
Trapezius muscle strain can limit activities requiring the arm to be outstretched in front or the side. There can be pain with rotation of the head and, hence, limit function such as turning the head for an over-shoulder check when driving. Pain in certain positions may interfere with restful sleep, and, hence, impact overall function.
Diagnostic Studies
There is no specific test to diagnose trapezius strain. It is a clinical diagnosis based on the history and physical examination. Radiological studies, electrodiagnostic testing, and laboratory testing can be helpful in ruling out other potential conditions, such as cervical radiculopathy, cervical degenerative disease, shoulder pathology, or an inflammatory process. Newer musculoskeletal imaging techniques show promise for future application as diagnostic tools to objectively measure the presence or absence of myofascial trigger points. Magnetic resonance elastography is a research tool that is used to measure the stiffness of biological tissues and has been reported to successfully identify and quantify myofascial taut bands. Musculoskeletal ultrasound is another tool that is changing the approach to the diagnosis of musculoskeletal conditions, including muscle strains.
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