From the Guidelines
A trapezius muscle tear should be managed with conservative treatment, including rest, ice, heat therapy, NSAIDs, and physical therapy, unless it's a complete tear or avulsion, in which case surgical repair may be necessary, as recommended by the most recent and highest quality study 1. The clinical presentation of a trapezius muscle tear typically includes pain, tenderness, and weakness in the upper back, neck, and shoulder region, with patients often reporting acute pain following trauma or overuse, difficulty with shoulder elevation, and visible deformity in severe cases.
- Key symptoms:
- Pain and tenderness in the upper back, neck, and shoulder region
- Weakness in the affected area
- Difficulty with shoulder elevation
- Visible deformity in severe cases The best imaging modality to confirm a trapezius tear is MRI, as it provides detailed visualization of soft tissue injuries, showing the extent of muscle fiber disruption, associated edema, and any retraction of the torn muscle, as supported by the American College of Radiology Appropriateness Criteria 1.
- Imaging modalities:
- MRI: best for visualizing soft tissue injuries and confirming the diagnosis
- Radiography: may be useful for evaluating bony pathology, but not for diagnosing muscle tears Treatment depends on the severity of the tear, with conservative management preferred for mild to moderate tears, and surgical repair considered for complete tears or avulsions, particularly in athletes or those with significant functional impairment, as recommended by the American College of Radiology Appropriateness Criteria 1.
- Treatment options:
- Conservative management: rest, ice, heat therapy, NSAIDs, and physical therapy
- Surgical repair: considered for complete tears or avulsions, particularly in athletes or those with significant functional impairment Recovery typically takes 6-12 weeks for conservative management, while surgical recovery may extend to 3-6 months with a gradual return to activities, as supported by the American Family Physician study 1.
- Recovery timeline:
- Conservative management: 6-12 weeks
- Surgical repair: 3-6 months
From the Research
Clinical Presentations
- Trapezius muscle tears can result in muscle weakness and dysfunction, leading to shoulder pain and limited range of motion 2, 3, 4
- Scapular dyskinesis and shoulder soft-tissue tightness can also be associated with trapezius muscle tears 5
- Patients may experience pain, limitation of motion, muscle weakness, and referral pain due to myofascial pain syndrome in the upper trapezius muscle 6
Best Imaging Modalities
- No specific imaging modalities are mentioned in the provided studies for diagnosing trapezius muscle tears
- However, studies have used various assessment tools such as electromyography, rehabilitative ultrasound imaging (RUSI), and magnetic resonance imaging to evaluate muscle function and rule out other conditions 5
Treatment Options
- Neuromuscular electrical stimulation (NMES) combined with bilateral exercise may be an effective component of a comprehensive shoulder rehabilitation program for patients with persistent trapezius muscle dysfunction 2
- Arthroscopically assisted lower trapezius transfer may be a viable treatment option for patients with massive irreparable posterior-superior rotator cuff tears, including those with pseudoparalysis 3
- Dry needling treatment may be effective in improving shoulder symptoms and sleep quality in patients with myofascial pain syndrome in the upper trapezius muscle 6
- Serratus anterior training and neuromuscular electrical stimulation of the lower trapezius may be beneficial for patients with scapular dyskinesis and lower trapezius dysplasia 5