National Associaltion of Myofascial Trigger Point Therapists - Symptom Checker

This is the technical name of the muscle being described.  This name may be used to find additional information in any medical resource. Trapezius
A group of muscles generally denotes muscles of the same function and may share a common attachment point.  
Muscle function, in this definition, is what the muscle could do if it was to contract by itself with the body in anatomical position.  This is a general definition of muscle function.  For more information on how muscles work together on the body please refer to a physiology or functional anatomy text.

There are three divisions of the trapezius muscle – upper, middle, and lower. 

The upper trapezius extends (allows a person to tilt the head back to look up) and laterally flexes (ear to the shoulder) to the same side.

The middle trapezius fibers work primarily on the scapula to adduct (move closer to the midline) and upwardly rotate to allow for arm movement.

The lower trapezius fibers work to assist in adducting and upwardly rotating the scapula, as well as to stabilize the scapulas during certain movement.

A description of where a Myofascial Trigger Point may produce pain in the body.  This area is generally located away from the trigger point.

The pain patterns for the three different fiber directions of the trapezius are very distinct and varying.

The upper trapezius refers pain into the head along the posterolateral aspect of the neck and into the head.  When the referral is more intense it will also extend through the side of the head and concentrate in the temple and behind the eye.  The pain may also travel to the angle of the jaw.

The middle trapezius fibers can harbor TrPs that refer a superficial, burning pain that is concentrated between the the TrP and the spinous processes (part of the vertebrae) of C7-T3.  Pain is also referred to the acromion (top of the shoulder).  There is an area in the middle trapezius that can produce a sensation described as “the chills”.  This area, when stimulated, can cause goose bumps to appear on the lateral arm of the same side, and may be felt in the thigh as well.

The lower trapezius fibers harbor TrPs that go overlooked with regards to upper cervical pain.  The pain may be referred as far up as the high cervical region around the suboccipital area at base of the skull.  Pain from the lower trapezius may also be referred to the suprascapular region and acromion (top of the

A description of the symptoms a person may experience with trigger points in the muscle being described.

A person with TrPs in the trapezius muscle may complain of headaches that go up the side of the neck and center in the  temporal area.  A person may also complain of a stiff neck as  well as being uncomfortable in heavy clothing because the weight of the clothes rest on the trapezius and cause irritation. 

Burning sensations may be felt as a result of the middle trapezius as well as making the shoulder intolerant of a heavy overcoat or heavy purse carried by a shoulder strap. 

The lower trapezius then refers pain into the upper neck, but does not restrict the neck motion.


 A list of possible diseases that fit the information derived from examination of a patient.

  1. Temporomandibular disorder (TMJD).
  2. Tension headache.
  3. Occipital neuralgia
  4. Cervicogenic headache.
  5. Chronic intractable benin pain of the neck and/or back.
  6. Bursitis.
  7. Articular dysfunction of C2, C3, or C4.
  8. C6, C7, T1, and sometimes T2 dysfunction.
  9. T6 or T7 dysfunction.

A list of activities or positions that may either CAUSE a trigger point to manifest or PROLONG a pain condition respectively.

  1. TrPs may be activated by sudden trauma including falls and whiplash injuries.
  2. A walking cane that is at an improper length.
  3. Use of a telephone (when holding up to the shoulder).
  4. High keyboard on a computer workstation or keyboard that is set on a table top with the monitor.
  5. Prolonged use of a computer mouse.
  6. Short upper arms.*
  7. Lower limb length inequality (one leg shorter).
  8. Cold drafts on the neck.
  9. Sewing with the arms unsupported.
  10. Bra that is too tight.
  11. Heavy purse, backpack, or coat.
  12.  Sleeping on the back with the head rotated to one side.
  13.  Emotional distress.
  14.  Arm rests that are too high.
  15.  Driving a vehicle with the hands high on the steering wheel.
  16.  ANY position in which the shoulders are held up for periods of time may perpetuate TrPs in this muscle.

*Short upper arms occur when the elbows of a person are not long enough to reach their iliac crests (the upper aspect of the hip bone) when standing.  Short upper arms are characteristic of Native American body structure, but not limited to that race.  This condition perpetuates TrPs in the shoulder girdle by placing undue stress on shoulder elevator muscles.

A corrective action is usually a modification of daily routine which will reduce stress on the affected muscle(s) in a person with myofascial trigger points.

  1. Correction of arm rests if short upper arms are evident.
  2. Correction of lower limb length inequality.
  3. Use of a headset or speaker phone for phone conversation will release tension on the trapezius and other neck muscles and will free the hands to complete other tasks.
  4. Have workstation ergonomics set up properly.
  5. Invest in a trackball style mouse, in which the cursor is controlled by the thumb, thus allowing the shoulder to relax into the arm rest and relieving tension.
  6. While working on a computer or desk in which posture may influence pain a person can set a timer across the room that will go off every 20-30 minutes and allow the person to get up, stretch, and reset the timer.
  7. Use a scarf to keep the neck warm in cold climates or in places prone to drafts, including airplanes.
  8. Carry purses and bags with strap across the body with the strap resting on the acromion (bone on the top of the shoulder), which is the bone on the top of the shoulder.
  9. Avoid sleeping on the stomach.
  10.  A walking cane should be fitted properly.
  11.  Tight bras should be replaced or loosened.
  12.  When driving a vehicle the hands should rest on the bottom of the wheel with the palm down verses being high on the wheel.
  13. Close attention should be paid to the position in which the shoulders are held.  Some individuals “carry stress” in the form of unconscious sustained elevation of their shoulders or immediately elevate their shoulders under certain stress and activate their headaches or pain complaint.  Activities that should be monitored are at the workstation, driving, and even relaxing.

References : 
Simons DG, Travell JG, Simons LS, Myofascial Pain and Dysfunction: The Trigger Point Manual, vol 1, 2nd Ed. Baltimore: Williams and Wilkins, 1999.

Travell JG, Simons DG, Myofascial Pain and Dysfunction, vol 2. Baltimore: Williams & Wilkins, 1992.

This information is not intended to diagnose, treat, or cure any disease.  A proper diagnosis should be sought from a licensed health care provider.