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Trapezius

The trapezius muscle is a large, superficial, kite-shaped (trapezoid) muscle located on the upper back and neck, extending from the base of the skull to the mid-thoracic spine and forming a paired structure that covers much of the posterior aspect of the neck and trunk.^[1] It serves as a key component of the shoulder girdle, enabling a wide range of movements involving the head, neck, and upper limbs while also playing a vital role in maintaining posture and stabilizing the scapula.^[2] Anatomically, the trapezius originates from the external occipital protuberance, the medial third of the superior nuchal line, the ligamentum nuchae, and the spinous processes of the seventh cervical vertebra (C7) through the twelfth thoracic vertebra (T12), along with their associated supraspinous ligaments.^[1] Its fibers converge into three distinct bands—superior (upper), middle, and inferior (lower)—which insert into the lateral third of the clavicle (upper fibers), the medial border of the acromion and the superior crest of the scapular spine (middle fibers), and the apex of the scapular spine (lower fibers).^[3] This broad attachment allows the muscle to influence scapular positioning and motion across multiple planes. The trapezius receives its primary motor innervation from the spinal accessory nerve (cranial nerve XI), with additional sensory input from the anterior rami of the C3 and C4 spinal nerves, making it unique among upper limb muscles as it does not derive innervation solely from the brachial plexus.^[1] Blood supply is provided mainly by the transverse cervical artery, with contributions from the dorsal scapular artery and branches of the posterior intercostal arteries.^[1] Functionally, the trapezius is essential for coordinated upper body movements, with its upper fibers elevating the scapula and extending or laterally flexing the neck, the middle fibers retracting and stabilizing the scapula, and the lower fibers depressing and aiding in the upward rotation of the scapula during arm elevation.^[3] Together, these actions support the scapulohumeral rhythm, facilitate shrugging, head turning, and torso twisting, and help counteract gravitational forces to uphold upright posture.^[2] Clinically, trapezius dysfunction—often from overuse, poor posture, or accessory nerve injury—can lead to pain, stiffness, weakness, or conditions like tension headaches and shoulder impingement, underscoring its importance in daily activities and its vulnerability in repetitive strain scenarios.^[4]

Etymology and history

Naming origin

The name trapezius originates from the Modern Latin trapezius (musculus), derived from the Greek trapezion, meaning a "small table" or irregular quadrilateral, reflecting the muscle's broad, trapezoid- or diamond-shaped contour when viewed posteriorly as a paired structure spanning the upper back and neck.^[5]^[6] This geometric resemblance, formed by the converging fibers from the occipital region to the thoracic spine and scapula, underscores the descriptive etymology common in classical anatomy.^[1] Similar to the trapezius, other muscles receive names based on their morphological features; for instance, the deltoid muscle is so called from the Greek deltoeidēs ("triangular"), due to its shape mimicking the uppercase delta (Δ), highlighting a shared tradition in nomenclature that prioritizes visual analogy over function.^[7]^[8]

Historical descriptions

The earliest descriptions of the trapezius muscle date back to the 2nd century AD in the anatomical writings of the Greek physician Galen of Pergamon. In his treatise Anatomical Procedures, Galen provided one of the first detailed accounts of upper back muscles based on dissections of human and animal cadavers, noting the trapezius as a broad, flat muscle extending across the posterior neck and upper thorax. He likened its shape to a trapezium—a geometric figure with four sides and no parallel lines—describing it as "a little short of a triangle, what the geometers call the trapezoid," which highlighted its irregular, diamond-like form when viewed bilaterally. This observation underscored Galen's emphasis on functional anatomy, as he explained the muscle's role in elevating and retracting the scapula during shoulder movements, drawing from limited human dissections supplemented by ape and other animal studies due to restrictions on human cadaver use in antiquity.^[9] During the Renaissance, significant advancements in the study of the trapezius occurred with the publication of Andreas Vesalius's De Humani Corporis Fabrica Libri Septem in 1543, marking a pivotal shift toward human-based anatomy. Vesalius, through systematic dissections of human cadavers, corrected and expanded upon Galen's descriptions, identifying the trapezius as muscle "No. 2 moving the scapula" in his muscle tables. He detailed its origins from the external occipital protuberance and spinous processes of the vertebrae down to the eighth thoracic level, and its insertions along the scapular spine, acromion, and clavicle, emphasizing its composite structure with upper, middle, and lower fibers. Vesalius illustrated the trapezius prominently in the second table (Tabula II) of his work's muscle section, depicting it as label "K" in the famous "muscle men" engravings, which showcased layered dissections to reveal its superficial position over the back. These illustrations and texts revolutionized anatomical accuracy, portraying the trapezius's functions in scapular elevation, depression, retraction, and stabilization, while critiquing Galen's reliance on non-human models for certain musculoskeletal details.^[10]

Anatomy

Origin, insertion, and relations

The trapezius muscle originates from several key structures in the posterior neck and upper trunk, with its fibers divided into superior, middle, and inferior portions based on their attachments and orientations. The superior fibers arise from the medial third of the superior nuchal line of the occipital bone, the external occipital protuberance, and the ligamentum nuchae extending from approximately C1 to C6.^[3] The middle fibers originate from the spinous processes and supraspinous ligaments of the T1 to T4 vertebrae (sometimes including C7 to T3).^[3] The inferior fibers attach proximally to the spinous processes and supraspinous ligaments of the T4 to T12 vertebrae.^[3] These origins provide a broad base spanning from the skull to the mid-thoracic spine, allowing the muscle to influence movements across the neck, shoulder girdle, and upper back.^[1] The insertions of the trapezius reflect its functional divisions and connect it to the pectoral girdle. The superior fibers insert along the posterior surface of the lateral third of the clavicle.^[3] The middle fibers attach to the medial margin of the acromion and the superior crest of the scapular spine.^[3] The inferior fibers converge to insert at the apex of the medial end of the scapular spine via an aponeurosis.^[3] Collectively, these insertion points on the clavicle, acromion, and scapular spine enable the trapezius to stabilize and mobilize the scapula relative to the axial skeleton.^[1] Anatomically, the trapezius is positioned superficially on the upper back and neck, overlying several deeper muscles and contributing to regional boundaries. It lies superficial to the rhomboid major and minor, as well as the levator scapulae, forming a protective layer over these scapular stabilizers.^[3] The trapezius also covers the supraspinatus and infraspinatus muscles in the shoulder region, with its fibers draping over the supraspinous and infraspinous fossae of the scapula.^[4] Additionally, its lateral aspect forms the posterior boundary of the posterior triangle of the neck, alongside the sternocleidomastoid anteriorly and the clavicle inferiorly.^[1] These relations position the trapezius as a key superficial landmark in the posterior cervical and thoracic regions.^[3]

Structure and composition

The trapezius muscle exhibits a complex internal architecture characterized by its division into three distinct functional parts based on fiber orientation: the upper (descending) fibers, middle (transverse) fibers, and lower (ascending) fibers. These divisions allow for specialized roles within the muscle's overall structure.^[3] The upper fibers course in a descending manner from their superior attachments, the middle fibers extend horizontally in a transverse direction, and the lower fibers run in an ascending pattern toward their superior-lateral insertions, reflecting the muscle's trapezoidal shape and fiber alignment.^[3] This orientation is influenced by the muscle's attachments along the occipital region, cervical and thoracic spinous processes, and scapular structures.^[1] In terms of muscle fiber types, the trapezius shows a predominance of type I slow-twitch fibers, especially in the lower third of the descending portion, transverse portion, and ascending portion, which support sustained postural endurance. Type II fast-twitch fibers are more frequent in the superior aspects of the descending portion, enabling phasic contractions for dynamic activities.^[11] These fiber type distributions vary across the muscle's regions, aligning with differing mechanical demands.^[12] Regarding size and thickness, the trapezius in adults typically spans approximately 34 cm in length and 18 cm in width, forming a broad, flat sheet across the upper back and neck. Thickness varies by region, averaging 1-1.5 cm in the upper portion based on ultrasonographic measurements, with the muscle exhibiting bilateral symmetry in both dimensions and composition.^[13]^[14]^[15]

Innervation

The trapezius muscle receives its primary motor innervation from the spinal accessory nerve (cranial nerve XI), which originates from the upper cervical spinal cord segments (C1–C5) and enters the muscle through the posterior triangle of the neck, traveling superficially beneath the muscle's fascia to distribute branches throughout its fibers.^[1] This nerve provides the dominant somatic motor supply, enabling coordinated contractions for scapular stabilization and movement.^[16] In addition to motor input from cranial nerve XI, the trapezius receives sensory and proprioceptive innervation from the cervical spinal nerves C3 and C4, conveyed via branches of the cervical plexus that pierce the muscle's deep surface.^[1] These cervical contributions transmit afferent signals for pain, touch, and muscle position sense, integrating with central pathways for reflexive adjustments and postural control.^[16] Segmental innervation varies across the trapezius's three functional divisions: the upper (descending) fibers are innervated solely by a fine branch of the spinal accessory nerve for primary motor control, while the middle (transverse) and lower (ascending) fibers receive dual innervation from both the spinal accessory nerve and trapezius branches of the cervical plexus (primarily C3–C4), supporting additional motor input and reflex arcs in the caudal regions.^[17] This dual supply in the lower trapezius enhances resilience to isolated cranial nerve XI disruption, as cervical motor fibers can partially compensate for function.^[18]

Blood supply

The trapezius muscle receives its primary arterial blood supply from the transverse cervical artery, a branch of the thyrocervical trunk arising from the subclavian artery, which predominantly nourishes the upper and middle portions of the muscle.^[1] The lower part of the trapezius is mainly supplied by the dorsal scapular artery, which typically originates either from the transverse cervical artery or directly from the subclavian artery, with anatomical variations reported across studies.^[19]^[20] Accessory arterial branches contribute to the vascular network, including the occipital artery providing supply to the superior aspect of the muscle and the superficial cervical artery (an ascending branch of the transverse cervical artery) delivering blood laterally to the middle and lateral regions.^[21]^[3] Venous drainage of the trapezius parallels its arterial supply, with veins accompanying the transverse cervical and dorsal scapular arteries to form the primary outflow pathways.^[1] These veins converge into the transverse cervical vein, which empties into tributaries of the external jugular vein and ultimately drains into the subclavian vein.^[22]

Function

Scapular movements

The trapezius muscle plays a critical role in scapular positioning and motion, primarily through its three distinct fiber segments: upper, middle, and lower. These fibers work synergistically to enable precise control of the scapula during upper limb activities, such as arm abduction and adduction. The upper fibers originate from the occipital bone and cervical vertebrae, inserting on the clavicle and acromion, and are responsible for elevating the scapula and contributing to its upward rotation, particularly during the initial phases of arm abduction. This action helps position the glenoid fossa optimally for humeral head movement.^[1] The middle fibers of the trapezius, spanning from the thoracic vertebrae to the scapular spine, primarily facilitate retraction (adduction) of the scapula, drawing it medially toward the spine. This retraction stabilizes the scapula against protraction forces generated by anterior shoulder muscles, maintaining alignment during activities like rowing or pushing. Meanwhile, the lower fibers, arising from the lower thoracic vertebrae and inserting on the spine of the scapula, depress the scapula and contribute to its upward rotation, counterbalancing the elevating effect of the upper fibers while synergizing on upward rotation to ensure balanced scapular motion. Together, these actions prevent excessive tilting or winging of the scapula.^[1] In the context of scapulohumeral rhythm—the coordinated movement between the glenohumeral joint and scapulothoracic articulation—the trapezius integrates with other muscles like the serratus anterior to produce smooth arm elevation. During glenohumeral abduction beyond the initial approximately 30 degrees, the trapezius, particularly its upper and lower fibers, activates to produce scapular upward rotation, contributing to the overall 2:1 ratio of glenohumeral to scapulothoracic motion and optimizing shoulder mechanics to prevent impingement.^[23]^[24]

Spinal and head movements

The upper fibers of the trapezius muscle are primarily responsible for movements of the head and neck. When contracting bilaterally, these fibers extend the head and neck by drawing the occiput and cervical vertebrae posteriorly.^[1] Unilaterally, the upper fibers facilitate lateral flexion of the neck toward the same side while simultaneously rotating the head to the contralateral side, aiding in precise head orientation during daily activities.^[25]^[26] The middle and lower fibers of the trapezius contribute to thoracic spinal movements by assisting in extension, which helps maintain the natural curvature of the upper back.^[1] These fibers also provide stabilization to the thoracic spine, particularly during upper limb activities that involve dynamic loading, ensuring spinal integrity without compromising mobility.^[1] In coordinated action, the trapezius integrates with other posterior neck muscles, such as the splenius capitis for extension support and the sternocleidomastoid for balanced flexion and rotation, to achieve stable head posture and prevent undue strain on the cervical spine.^[27] This synergy is essential for maintaining upright alignment and facilitating controlled head movements in various postures.^[26]

Role in posture and respiration

The trapezius muscle plays a primary role in maintaining static posture by supporting an erect spinal column and aligning the head and shoulders in an upright position.^[1] Its upper fibers provide tonic extension of the head and neck, counteracting forward head posture, while the lower fibers contribute tonic depression of the scapula to prevent slouching and promote balanced shoulder girdle positioning.^[1] Together with the middle fibers' retraction of the scapulae, these actions enable a stable, "ramrod straight" posture during standing.^[1] The trapezius also contributes to scapular stabilization during dynamic postural adjustments.^[28] In respiration, the trapezius serves as an accessory muscle, particularly during forced inspiration, where its upper fibers elevate the clavicle to expand the thoracic cavity and assist primary inspiratory muscles like the scalenes.^[29] This elevation increases the superior-inferior dimension of the thorax, facilitating greater airflow when demand exceeds diaphragmatic capacity, such as during exercise or respiratory distress. Chronic tonic activation of the trapezius, often due to poor ergonomics like prolonged sitting or suboptimal workstation setup, can lead to muscle fatigue and the development of myofascial trigger points.^[30] These trigger points arise from sustained low-level contractions and repetitive strain, compromising the muscle's postural endurance over time.^[31]

Clinical significance

Injuries and pain syndromes

The trapezius muscle is susceptible to acute strains, which often result from sudden or excessive loading during overhead activities such as throwing in sports or lifting heavy objects, leading to overstretching or tearing of muscle fibers.^[32] These strains can also occur in whiplash injuries, typically from motor vehicle accidents, where rapid hyperextension and flexion of the neck impose abrupt tension on the upper trapezius.^[33] Acute trapezius strains are classified into three grades based on severity: grade I involves mild damage with minimal fiber tearing and no loss of function; grade II features moderate partial tears with noticeable weakness and pain; and grade III represents a complete rupture, often accompanied by a popping sensation and significant functional impairment.^[34] Myofascial pain syndrome in the trapezius commonly arises from trigger points, particularly in the upper fibers, which are hypersensitive nodules that produce local tenderness and referred pain to the head, temples, or shoulders, mimicking tension headaches or cervical discomfort.^[35] These trigger points develop due to sustained muscle contraction from repetitive tasks, such as prolonged desk work involving forward head posture and shoulder elevation.^[36] The syndrome is characterized by chronic aching, restricted range of motion, and exacerbation with palpation, often requiring targeted therapies like dry needling or manual release for relief.^[37] Severe tenderness in the upper trapezius affects 13-19% of female office workers with nonspecific neck/shoulder pain, primarily due to poor ergonomics that promote static loading and repetitive strain on the upper trapezius during computer use.^[38] A 2025 review emphasizes trapezius myalgia as an underdiagnosed condition in office workers, highlighting the role of psychosocial stress and the effectiveness of dry needling, manual therapy, and ergonomic adjustments in management.^[30] Rehabilitation for these injuries typically involves rest, ice, and progressive mobilization to restore function, though specifics depend on severity.^[34]

Neurological palsies

Neurological palsies affecting the trapezius muscle arise from disruptions to its primary motor innervation via the spinal accessory nerve (cranial nerve XI) or secondary contributions from cervical nerve roots, leading to weakness, atrophy, and impaired function. The spinal accessory nerve provides the main motor supply to all portions of the trapezius, while C3 and C4 roots contribute sensory fibers and minor proprioceptive input, making isolated neural injuries a key cause of localized dysfunction. Accessory nerve palsy is the most common neurological impairment of the trapezius, frequently resulting from iatrogenic trauma during surgical interventions in the posterior cervical triangle, such as lymph node biopsies for malignancy staging. This injury denervates the trapezius, causing ipsilateral shoulder droop due to unopposed pull from antagonist muscles, lateral scapular winging during arm abduction, chronic shoulder pain, and weakness in elevation and retraction of the scapula.^[39]^[40] Patients often exhibit visible atrophy of the trapezius, creating neckline asymmetry, and reduced ability to perform overhead activities, with symptoms typically appearing within weeks of the procedure.^[41] Cervical radiculopathy at the C3-C4 levels, commonly caused by intervertebral disc herniation or foraminal stenosis, can produce sensory loss and pain radiating to the trapezius muscle, particularly affecting the lower fibers through compression of sensory and minor motor contributions from these roots. This may manifest as vague neck and upper back discomfort, paresthesia over the trapezius region, and subtle weakness in scapular depression, exacerbating postural instability.^[42]^[43] Diagnosis of accessory nerve palsy relies on clinical tests like the shoulder shrug test, in which the patient elevates both shoulders against downward resistance applied by the examiner; asymmetry in strength or failure to fully elevate the affected side confirms CN XI dysfunction and trapezius involvement.^[44] Electromyography can further delineate denervation patterns, distinguishing neural from other etiologies.^[39] Trapezius dysfunction may occasionally associate with broader neuromuscular conditions, such as facioscapulohumeral muscular dystrophy, where selective weakness in the lower trapezius contributes to scapular winging.^[45]

Associated disorders

Facioscapulohumeral muscular dystrophy (FSHD) is a genetic disorder characterized by progressive muscle weakness, often beginning in the facial and scapulohumeral regions, including the trapezius muscle, which serves as a key stabilizer of the scapula.^[46] The condition is primarily linked to a contraction in the D4Z4 microsatellite repeat array on chromosome 4q35 in FSHD1 (about 95% of cases), leading to inappropriate expression of the DUX4 gene and subsequent muscle degeneration.^[46] In FSHD, the trapezius is among the earliest and most consistently affected muscles, with imaging studies showing involvement in 100% of patients, manifesting as atrophy and fatty replacement, particularly in the upper and middle portions.^[47] FSHD has an estimated prevalence of 1 in 20,000 individuals worldwide.^[48] Fibromyalgia, a chronic pain syndrome involving widespread musculoskeletal pain and tenderness, features the trapezius as one of the 18 predefined tender points used in the 1990 American College of Rheumatology (ACR) diagnostic criteria.^[49] Specifically, tenderness at the midpoint of the upper trapezius border bilaterally is assessed by applying approximately 4 kg of pressure; pain in at least 11 of these points, combined with widespread pain lasting at least three months, supports the diagnosis.^[49] Although updated ACR criteria from 2010 and 2016 emphasize symptom severity and pain distribution over tender point counts, trapezius tenderness remains a common clinical finding in fibromyalgia patients.^[49]

Developmental variations

The trapezius muscle originates embryologically from the branchial (occipital) somites and upper cervical myotomes, initially appearing as a mesenchymal condensation ventral to the caudal occipital and anterior cervical myotomes in embryos of approximately 7 mm crown-rump length, corresponding to around the 6th week of gestation. By the 8th week, distinct muscle fibers begin to differentiate, with the trapezius separating from the adjacent sternocleidomastoid muscle to form its characteristic broad, triangular shape spanning the occipital bone, cervical and thoracic spine, and scapula. This dual origin from somitic mesoderm contributes to its role in both head and shoulder movements, with development completing through innervation by the accessory nerve and vascular supply in subsequent fetal stages.^[50]^[51] Congenital underdevelopment, or hypoplasia, of the trapezius is a rare anomaly, most notably associated with Klippel-Feil syndrome, a condition characterized by congenital fusion of two or more cervical vertebrae due to segmentation defects during somitogenesis. In such cases, the reduced number of cervical segments limits the proximal attachment sites of the trapezius, resulting in a shortened muscle span and diminished upper fibers, which may manifest as bilateral or unilateral weakness. Reports indicate that bilateral trapezius hypoplasia or agenesis is extremely uncommon outside this context, with only isolated cases documented in the literature linked to this syndrome.^[52]^[53] Mild asymmetry variations in trapezius morphology, such as unilateral differences in muscle thickness or fiber arrangement, occur in the general population without associated pathology, representing normal developmental heterogeneity rather than dysfunction. These variations typically involve subtle discrepancies in the upper or middle portions, often undetectable clinically, and do not impair function. Such asymmetries may arise from minor fluctuations in somite migration or myotome differentiation during embryogenesis. In cases of significant hypoplasia, like in Klippel-Feil syndrome, these developmental anomalies can contribute to postural imbalances, such as scapular elevation or drooping on the affected side.

Training and exercises

Strengthening techniques

Strengthening the trapezius muscle is essential for enhancing shoulder stability, posture, and upper body performance in both fitness and rehabilitation contexts. Techniques target the upper, middle, and lower portions to promote balanced development and prevent overuse injuries. Exercises typically emphasize controlled movements with progressive overload to build hypertrophy and strength. For the upper trapezius, which facilitates scapular elevation, barbell or dumbbell shrugs are highly effective. In this exercise, an individual stands with feet shoulder-width apart, holds the weights at thigh level, and elevates the shoulders toward the ears while keeping the arms straight, then lowers slowly. Performing 3 sets of 10-15 repetitions allows for sufficient volume to stimulate muscle growth, as supported by electromyographic studies showing high activation in the upper fibers during shrug variations.^[54] The middle trapezius, responsible for scapular retraction, benefits from prone Y-raises or cable face pulls. Prone Y-raises involve lying face down on a bench or floor, extending the arms overhead in a "Y" position with thumbs up, and lifting them while squeezing the shoulder blades together. Face pulls, performed using a cable machine at face height, entail pulling the rope toward the face with elbows high and externally rotated to emphasize retraction. These movements elicit optimal muscle ratios for the middle trapezius, minimizing upper trapezius dominance, according to systematic reviews of periscapular exercises.^[55]^[56] To strengthen the lower trapezius for scapular depression, prone T-raises with external rotation are recommended. This exercise requires lying prone, extending the arms out to the sides in a "T" formation with thumbs pointing up, and lifting while incorporating slight external rotation at the shoulders to isolate the lower fibers. Progressive resistance can begin with bodyweight and advance to resistance bands or light dumbbells, fostering gradual strength gains as evidenced by EMG data favoring prone positions for lower trapezius activation over other stabilizers.^[55]^[57] Incorporating complementary stretching routines alongside these techniques can help maintain flexibility and prevent muscular imbalances.

Stretching and rehabilitation

Stretching the trapezius muscle focuses on improving flexibility, particularly for the upper fibers, which often become tight due to poor posture or repetitive strain. One effective static stretch involves a neck tilt combined with a chin tuck: sit or stand upright, gently tuck the chin toward the neck to align the ears over the shoulders, then tilt the head to one side, bringing the ear toward the shoulder without shrugging, to target the upper trapezius. Hold this position for 20-30 seconds per side, repeating 2-3 times daily to enhance range of motion and reduce tension.^[58] For dynamic rehabilitation following trapezius injury, scapular wall slides are commonly prescribed to restore mobility and scapular alignment. To perform, stand facing a wall with forearms placed against it at shoulder height, elbows bent at 90 degrees; slide the arms upward into a "Y" position while keeping contact with the wall, then lower slowly, emphasizing controlled scapular upward rotation—this exercise helps activate the trapezius and surrounding stabilizers post-injury. As recovery progresses, incorporate resisted scapular depression for the lower fibers: sit or stand holding a resistance band or light weight, depress the shoulder blades downward against resistance while keeping the arms at the sides, holding for 5-10 seconds per repetition to rebuild endurance.^[57] Rehabilitation protocols for trapezius strains typically begin with the RICE method—rest, ice, compression, and elevation—for the initial 48-72 hours to manage acute inflammation and pain. Following this, a progressive therapy program spanning 4-6 weeks incorporates the above stretches and dynamic exercises, gradually increasing intensity under physical therapy guidance to promote healing and prevent re-injury in mild to moderate cases. Strengthening exercises may complement these efforts to support overall recovery.^[59]^[60]

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To start this Evidence-Based Strength Training Series, well take a look ... Exercise for Lower TrapeziusProne Horizontal Abduction with External Rotation.
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rest, ice, compression, elevation: Rest. Avoid activities that cause ...
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