Trapezius Tendinous Insertion

tendo partis descendentis musculi trapezii

The trapezius inserts via broad aponeurotic and tendinous fibres across three bony surfaces: the upper fibres insert on the posterior surface of the lateral clavicle; the middle fibres on the medial acromion and the superior lip of the scapular spine; and the lower fibres taper to a tendinous insertion at the deltoid tubercle of the scapular spine. The acromial and scapular spine insertions of the middle and lower trapezius are the most clinically relevant.

Region: Shoulder

Clinical Relevance

Clinical Notes

Trapezius tendinopathy at the scapular spine and acromial insertion is a recognised cause of posterior shoulder and interscapular pain in desk workers, overhead athletes, and following accessory nerve palsy. The lower trapezius insertion at the scapular spine root is the specific palpation target for posterior shoulder pain from trapezius tendinopathy. Dry needling and progressive loading of the middle and lower trapezius fibres is the mainstay of physiotherapy for trapezius tendinopathy and scapular dyskinesis. The middle trapezius aponeurosis is harvested for tendon transfer procedures in shoulder reconstruction.

Pathology

Common Injuries & Conditions

Trapezius Insertional Tendinopathy

Overuse or postural loading causes insertional tendinopathy at the middle and lower trapezius attachment on the scapular spine, producing posterior shoulder and periscapular pain with tenderness at the scapular spine, managed with scapular stabilisation exercises, manual therapy, and dry needling.