What are the treatment options for trapezius muscle pain?

Treatment Options for Trapezius Muscle Pain

For trapezius muscle pain, a combination of physical therapy, muscle relaxants, trigger point interventions, and pain management techniques should be implemented, with conservative approaches prioritized before considering more invasive options.

Conservative Management Approaches

Physical Therapy and Exercise

• Reciprocal inhibition techniques of muscle energy technique (MET) significantly improve neck pain, cervical range of motion, and functional activities in patients with upper trapezitis 1
• Lower trapezius strengthening exercises effectively reduce neck dysfunction, improve posture alignment, and increase muscle thickness and contraction rate 2
• Optimal postural alignment should be encouraged at rest and during functional activities to normalize movement patterns and muscle activity 3
• Even distribution of weight in sitting, transfers, standing, and walking helps normalize movement patterns 3

Manual Therapy Techniques

• Myofascial release therapy can be effective for treating trapezius trigger points and improving pain and function 4
• Positional release techniques may help alleviate pain from active trigger points in the trapezius muscle 5
• Avoid postures that promote prolonged positioning of joints at end range to prevent muscle strain 3
• Strategies to reduce muscle overactivity include muscle relaxation techniques and properly supporting the affected area when at rest 3

Pharmacological Management

• Cyclobenzaprine is indicated as an adjunct to rest and physical therapy for relief of muscle spasm associated with acute, painful musculoskeletal conditions 6
• Cyclobenzaprine should be used only for short periods (up to two or three weeks) as evidence for longer use is not available 6
• For elderly patients or those with hepatic impairment, cyclobenzaprine therapy should be initiated at a lower dose (5 mg) and titrated slowly upward due to higher plasma concentrations in these populations 6
• Aspirin is recommended for treatment of pain associated with pericarditis, which may be extrapolated to musculoskeletal pain management 3

Interventional Approaches

Trigger Point Injections

• Trigger point injections (TPIs) appear to have some value in treating muscle pain, with various studies showing effectiveness 3
• TPIs with anesthetic were more effective for pain relief than control injections of saline in several studies 3
• Dry needling of trigger points showed a 63% decrease in pain compared to 42% with drug injections, suggesting that needle placement alone may provide benefit 3
• Injection of methylprednisolone with lidocaine showed significant decreases in pain scores compared to saline injections 3

Intra-articular Injections

• Intra-articular corticosteroid injections may provide short-term relief for painful flares, especially in trapeziometacarpal joint pain 3
• One uncontrolled trial demonstrated that intra-articular corticosteroid significantly reduced pain at one month but not at 3,6, or 12 months after injection 3
• The evidence for intra-articular hyaluronan suggests it may be useful in treating trapeziometacarpal pain 3

Considerations for Refractory Cases

Surgical Options

• Surgery should be considered only in patients with marked pain and/or disability when conservative treatments have failed 3
• For severe cases involving the trapezius due to spinal accessory nerve injury, surgical reconstruction such as the Eden-Lange procedure may be considered if conservative treatment fails after 1 year 7
• Single surgical procedures appear to have fewer complications than combined approaches 3

Common Pitfalls and Caveats

• Avoid splinting as it may prevent restoration of normal movement and function by increasing attention to the area, promoting accessory muscle use, and leading to muscle deconditioning 3
• Discourage cocontraction or tensing of muscles as a method to suppress symptoms, as this is unlikely to be a helpful long-term strategy 3
• Cyclobenzaprine may cause drowsiness and dry mouth; monitor for side effects, especially in elderly patients 6
• The combination of cyclobenzaprine with naproxen was associated with more side effects than therapy with naproxen alone, primarily drowsiness 6
• Glucocorticoids and nonsteroidal anti-inflammatory drugs are potentially harmful for treatment of certain pain conditions and should be used cautiously 3