Effectiveness of trigger point release and ultrasound therapy on Trapezitis

Yuvaraj. M

Physiotherapist, Kauvery Hospital, Salem

Anatomy and physiology of Trapezius Muscle

Trapezius is the large superficial back muscle made up of particularly long muscle fibres. Trapezius is the one of the postural muscles of the neck and it is highly affectable to overuse. The main function of the trapezius muscle is to stabilize and move the shoulder blade (scapula).

The trapezius was subdivided into three fibres:

The upper trapezius muscle arises from occipital protuberance, the medial third of the superior nuchal line, nuchal ligament and inserts to the outer one third of the clavicle or collar bone
The middle fibres arise from the spinous processes and supraspinous ligaments of vertebrae (T1-T4) and it inserts on the acromion process of the scapula
The lower fibres arise from the spinous process and supraspinous ligament of vertebrae(T4-T12) and insert on spine of the scapula (lower fibre)

Background

What is Trapezitis?

Trapezitis is the inflammation of the trapezius muscle and it is one of the common inflammatory conditions occurs mainly in people who are working at computers for the long time.

It caused due to repetitive movements, forward head posture, sitting without back support, working without arm support, prolong typing keyboard etc.,

Trapezitis leads to the stress pain, which is known as neck pain or stiffness around neck or shoulder, the pain around the neck, present even at the rest and it is aggravated by activity. The range of motion are usually restricted due to pain and spasm. The overloading and injury of the muscle tissue leading to involuntary shortening of localized fibres.

Trigger Points

The area of the stressed soft tissue receives less oxygen, glucose and nutrients supply, it leads to the accumulation of the high level of metabolic wastes, it results in pain and development of the trigger points. Trigger points has potential to create pain, limits range of the motion and restrict functional ability.

The trigger points are the hyperirritable site, usually within a taut band of the skeletal muscle or in the muscle by fascia, which is painful on the compression and give rise to referred pain and motor dysfunction. Trigger point develop usually in muscles that help in maintaining posture.

Case Presentation

A 35 years aged male patient who works in IT came to assessment on 7^th May 2024

Chief Complaints

Difficulty in reading books
Difficulty in doing desktop works
Difficulty in performing ADL

History of present illness

Patient complains of severe neck pain while using mobile phones, deskwork and reading. Patient was normal, On April 5 while using a mobile phone the pain started mildly. Patient have taken volini and applied some oil to relieve pain, but it did not reduce. On April 29^th, patient visited Orthopaedician at kauvery hospital for treatment. He took tablets for a week. Pain not decreased. Then doctor refered Physiotherapy for further management.

Past medical history – Nil

Past Surgical History – Nil

Personal history – Nil

On Observation

Body built – Mesomorphic

Posture – Forward neck posture

Gait – Normal

Swelling – Present over neck

Redness – Nil

On Palpation

Warmth – Nil

Tenderness – Present over upper fibres of Trapezius

Crepitus – Nil

On Examination

Respiratory rate: 14 – 16

Pulse rate: 96 bpm

Blood pressure – 125/86mmHg

Temperature – 97.5°C

Pain Assessment

Onset – Gradual

Location – Around the Right Neck

Type – Dull aching

Duration of pain – 1 month

Aggravating Factor – Performing desk works

Relieving factor – Rest

Intensity of pain – According to Numeric Pain Rating Scale (NPRS): 70/100

Motor assessment

Muscle tone – Normal

Muscle power – Normal

Range of motion – Restricted

Jump sign – Positive

	Flexion	Extension	Lateral Flexion		Rotation
			Right	Left	Right	Left
AROM	35	40	25	27	38	45
PROM	40	45	30	30	45	50

Diagnosis

Trapezitis

Overall Complaints

Difficulty in performing ADL
Difficulty in neck ROM
Pain over right Neck

Physiotherapy Management

Goals

To reduce pain
To improve neck ROM
Make the patient back to performing ADL comfortably.

Ultrasound Therapy

The ultrasound therapy has been given for 7 days with Trigger point release with the following parameters

Technique of application – Direct contact method
Mode – Continuous mode
Frequency – 0.75 to 1MHZ (Penetrate deeply)
Intensity – 0.1–0.8 W/cm²
Duration – 8 min

Post Test

ROM has improved after the treatment

NPRS after treatment – 30/100

	Flexion	Extension	Lateral Flexion		Rotation
			Right	Left	Right	Left
AROM	40	45	36	38	50	55
PROM	45	50	40	45	56	60

Home Programme

Exercises (3 Repetition 10 Sets) 2 times per day
Shoulder blade squeeze
Shrug
Trapezius Stretching
Isometric neck Strengthening
Advised rest
Advised the application of ice pack frequently while working
Advised to take break atleast in between an hour during working.

Ergnomic postural correction during deskwork

Good posture will help to take some of the strain off from trapezius muscle.
Sit upright with shoulder relaxed
Sit with back support and arm support
Thighs horizontal and Feet flat on the floor
Adjust screen or laptop to bring it up to eye level.

Conclusion

On comparing pre and post-test values of NPRS and Neck ROM, this study concludes that trigger point release with ultrasound therapy found to be effective in reducing pain, improve Neck range of motion and ADL activities in-patient with Trapezitis.

Mr. Yuvaraj. M
Physiotherapist

Effectiveness of trigger point release and ultrasound therapy on Trapezitis

Effectiveness of trigger point release and ultrasound therapy on Trapezitis

Yuvaraj. M

Nightingale Journals