The trapezius inserts via broad aponeurotic and tendinous fibres across three bony surfaces: the upper fibres insert on the posterior border of the lateral third of the clavicle; the middle fibres on the medial margin of the acromion and the superior lip of the scapular spine; and the lower fibres end in an aponeurosis that glides over the smooth triangular area at the medial end of the spine to attach to a tubercle at its apex. The acromial and scapular spine insertions of the middle and lower trapezius are the most clinically relevant.
| Muscle | |
|---|---|
| Attachment | Lateral third of the clavicle, acromion and spine of the scapula |
Elevates, retracts and upwardly rotates the scapula
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. Weakness or poor activation of the lower trapezius is associated with scapular dyskinesis and subacromial pain in overhead athletes, and progressive loading of the middle and lower fibres is a mainstay of rehabilitation. Upper trapezius pain at the clavicular insertion is common in neck-shoulder pain and after whiplash, and its trigger points classically refer to the lateral neck, temple and angle of the jaw. The middle trapezius aponeurosis is harvested for tendon transfer procedures in shoulder reconstruction.
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.
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