The trapezius is a large paired

trapezoid A quadrilateral with at least one pair of parallel sides is called a trapezoid () in American and Canadian English. In British and other forms of English, it is called a trapezium (). A trapezoid is necessarily a convex quadrilateral in Eu ...

-shaped surface muscle that extends longitudinally from the occipital bone to the lower

thoracic vertebrae In vertebrates, thoracic vertebrae compose the middle segment of the vertebral column, between the cervical vertebrae and the lumbar vertebrae. In humans, there are twelve thoracic vertebrae and they are intermediate in size between the cervical ...

of the spine and laterally to the spine of the

scapula The scapula (plural scapulae or scapulas), also known as the shoulder blade, is the bone that connects the humerus (upper arm bone) with the clavicle (collar bone). Like their connected bones, the scapulae are paired, with each scapula on eith ...

. It moves the scapula and supports the

arm In human anatomy, the arm refers to the upper limb in common usage, although academically the term specifically means the upper arm between the glenohumeral joint (shoulder joint) and the elbow joint. The distal part of the upper limb between th ...

. 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 In geometry a quadrilateral is a four-sided polygon, having four edges (sides) and four corners (vertices). The word is derived from the Latin words ''quadri'', a variant of four, and ''latus'', meaning "side". It is also called a tetragon, ...

. 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. Similarly, the term "tri-axle back plate" was historically used to describe the trapezius muscle.

Structure

The ''superior'' or ''upper'' (or descending) fibers of the trapezius originate from the

spinous process The spinal column, a defining synapomorphy shared by nearly all vertebrates, Hagfish are believed to have secondarily lost their spinal column is a moderately flexible series of vertebrae (singular vertebra), each constituting a characteristic ...

of C7, the

external occipital protuberance Near the middle of the squamous part of occipital bone is the external occipital protuberance, the highest point of which is referred to as the inion. The inion is the most prominent projection of the protuberance which is located at the posterioin ...

, the medial third of the

superior nuchal line The nuchal lines are four curved lines on the external surface of the occipital bone: * The upper, often faintly marked, is named the highest nuchal line, but is sometimes referred to as the Mempin line or linea suprema, and it attaches to the epi ...

of the occipital bone (both in the back of the head), and the

ligamentum nuchae The nuchal ligament is a ligament at the back of the neck that is continuous with the supraspinous ligament. Structure The nuchal ligament extends from the external occipital protuberance on the skull and median nuchal line to the spinous proc ...

. From this origin they proceed downward and laterally to be inserted into the posterior border of the lateral third of the

clavicle The clavicle, or collarbone, is a slender, S-shaped long bone approximately 6 inches (15 cm) long that serves as a strut between the shoulder blade and the sternum (breastbone). There are two clavicles, one on the left and one on the r ...

. The middle fibers, or transverse of the trapezius arise from the

of the seventh cervical (both in the back of the neck), and the spinous processes of the first, second, and third

. They are inserted into the medial margin of the

acromion In human anatomy, the acromion (from Greek: ''akros'', "highest", ''ōmos'', "shoulder", plural: acromia) is a bony process on the scapula (shoulder blade). Together with the coracoid process it extends laterally over the shoulder joint. The ac ...

, and into the superior lip of the posterior border of the

spine of 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. Structure It begins at the vertical ...

. 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 Epimysium (plural ''epimysia'') (Greek ''epi-'' for on, upon, or above + Greek ''mys'' for muscle) is the fibrous tissue envelope that surrounds skeletal muscle. It is a layer of dense irregular connective tissue which ensheaths the entire muscle ...

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. File:Muscle trapèze.png, Trapezius muscle. File:Gray129.png, Occipital bone. File:Gray200.png, Left

. Superior surface. File:Gray203.png, Left

. Posterior surface.

Innervation

Motor function is supplied by the

accessory nerve The accessory nerve, also known as the eleventh cranial nerve, cranial nerve XI, or simply CN XI, is a cranial nerve that supplies the sternocleidomastoid and trapezius muscles. It is classified as the eleventh of twelve pairs of cranial nerv ...

. Sensation, including pain and the sense of joint position (

proprioception Proprioception ( ), also referred to as kinaesthesia (or kinesthesia), is the sense of self-movement, force, and body position. It is sometimes described as the "sixth sense". Proprioception is mediated by proprioceptors, mechanosensory neurons ...

), travel via the ventral rami of the third (C3) and fourth (C4) cervical

spinal nerves 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 ...

. Since it is a muscle of the upper limb, the trapezius is not innervated by

dorsal rami The dorsal ramus of spinal nerve (or posterior ramus of spinal nerve, or posterior primary division) is the posterior division of a spinal nerve. The dorsal ramus (Latin for branch, plural ''rami'' ) is the dorsal branch of a spinal nerve that form ...

, 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. Its main function is to stabilize and move the scapula.

Scapular movements

The upper fibers elevate the scapulae, the middle fibers retract the scapulae, and the lower fibers depress the scapulae. In addition to scapular translation, the trapezius induces scapular rotation. The upper and lower fibers tend to rotate the scapula around the

sternoclavicular articulation The sternoclavicular joint or sternoclavicular articulation is a synovial saddle joint between the manubrium of the sternum, and the clavicle, as well as the first rib. The joint possesses a joint capsule, and an articular disk, and is reinfo ...

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 The serratus anterior is a muscle that originates on the surface of the 1st to 8th ribs at the side of the chest and inserts along the entire anterior length of the medial border of the scapula. The serratus anterior acts to pull the scapula fo ...

to upwardly rotate the scapulae, and work in opposition to the

levator scapulae The levator scapulae is a slender skeletal muscle situated at the back and side of the neck. As the Latin name suggests, its main function is to lift the scapula. Anatomy Attachments The muscle descends diagonally from its origin to its inserti ...

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 A winged scapula (scapula alata) is a skeletal medical condition in which the shoulder blade protrudes from a person's back in an abnormal position. In rare conditions it has the potential to lead to limited functional activity in the upper ex ...

, sometimes further specified as "lateral winging" and in an abnormal mobility or function of the scapula (scapular dyskinesia). 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 Motion, the process of movement, is described using specific anatomical terms. Motion includes movement of organs, joints, limbs, and specific sections of the body. The terminology used describes this motion according to its direction relativ ...

and abduction, and associated with a drooping shoulder, and shoulder and neck pain. 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 Facioscapulohumeral muscular dystrophy (FSHD) is a type of muscular dystrophy, a group of heritable diseases that cause degeneration of muscle and progressive weakness. Per the name, FSHD tends to sequentially weaken the muscles of the face, ...

(FSHD). The lower and middle fibers are affected initially, and the upper fibers are commonly spared until late in the disease.

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. Absence of the trapezius has been reported in association with

Poland syndrome Poland syndrome is a birth defect characterized by an underdeveloped chest muscle and short webbed fingers on one side of the body. There may also be short ribs, less fat, and breast and nipple abnormalities on the same side of the body. Typical ...

Society and culture

Exercises

* The upper portion of the trapezius can be developed by elevating the shoulders. Common exercises for this movement are any version of the clean, particularly the hang clean, and the

shoulder shrug The shoulder shrug (usually called simply the shrug) is an exercise in weight training used to develop the upper trapezius muscle. Form and execution The lifter stands erect, hands about shoulder width apart, and slowly raises the shoulders as ...

. The uppermost area can be trained through neck extension. * Middle fibers are developed by pulling shoulder blades together. This adduction also uses the upper/lower fibers. * The lower part can be developed by drawing the shoulder blades downward while keeping the arms almost straight and stiff. It is mainly used in throwing, with the

deltoid muscle The deltoid muscle is the muscle forming the rounded contour of the human shoulder. It is also known as the 'common shoulder muscle', particularly in other animals such as the domestic cat. Anatomically, the deltoid muscle appears to be made up o ...

and

rotator cuff The rotator cuff is a group of muscles and their tendons that act to stabilize the human shoulder and allow for its extensive range of motion. Of the seven scapulohumeral muscles, four make up the rotator cuff. The four muscles are the supraspi ...

References

External links

Superficial Back Dissection Video showing trapezius
{{Authority control Back anatomy Muscles of the upper limb