What is Trapezius Palsy

Trapezius palsy happens when a nerve (spinal accessory nerve) that connects the spinal cord to the trapezius muscle becomes damaged. The trapezius is a muscle in the upper back that helps to control the shoulder blade (scapula) and stabilize the spine.

This causes pain and weakness in the back of the shoulder and the upper back. This also limits the range of motion of the shoulder joint. Damage to the spinal accessory nerve usually happens because of an injury (trauma) to the back or shoulder.

Trapezius palsy is often associated with bones moving out of place (subluxation). This can happen to the joint between the collarbone (clavicle) and the scapula (acromioclavicular subluxation), or to the joint between the breastbone (sternum) and the clavicle (sternoclavicular subluxation). Trapezius palsy usually gets better on its own in 3–6 months. In some cases, symptoms can return (recur), and this condition can be long-lasting (chronic).

What are the causes?

This condition is caused by trauma that damages the spinal accessory nerve. Trauma may result from:

• A direct, forceful hit or injury to the shoulder or the neck.
• A fall.
• Complications from a previous surgery on the neck or upper back.

What increases the risk?

The following factors may make you more likely to develop this condition:

• Participating in contact sports.
• Past surgery on the neck or upper back.
• Having poor strength and flexibility.

What are the signs or symptoms?

Symptoms of this condition may include:

• Pain in the shoulder, upper back, or neck. Pain may feel like an ache or a burning sensation.
• A feeling that the arm of the injured shoulder is heavier or more tired than usual (fatigue).
• Shrinkage (atrophy) of the trapezius muscle. This may cause the neckline to look uneven.
• Shoulder drooping. This may cause one shoulder to look lower than the other shoulder.
• Decreased shoulder strength and range of motion.
• Instability of the scapula (scapular winging). This may result in:
  • The scapula noticeably sticking out from the back.
  • Pain when pressure is put on the scapula.
  • A visible bump on the scapula.
• Numbness, tingling, or weakness in the shoulder, arm, or back.

How is this diagnosed?

This condition is diagnosed based on your symptoms, your medical history, and a physical exam. You may have tests, including:

• X-rays.
• CT scan.
• Electromyogram (EMG). This test measures electrical signals sent by your nerves into the muscles.
• MRI.

How is this treated?

This condition is treated by resting and icing the injured area and doing physical therapy exercises. Depending on the severity of your condition, treatment may also include:

• Keeping your shoulder in place for periods of time (immobilization). This may be done using:
  • A shoulder sling to support the weight of your arm.
  • A shoulder brace.
• Medicines that help to relieve pain and inflammation.
• Ultrasound therapy. This is when sound waves are applied to the injured area.
• Transcutaneous electronic nerve stimulation (TENS). This uses an electric current to activate the nerves.
• Surgery (rare).

Follow these instructions at home:

If you have a brace or sling:

• Wear it as told by your health care provider. Remove it only as told by your health care provider.
• Loosen the brace or sling if your fingers tingle, become numb, or turn cold and blue.
• Do not let your brace or sling get wet if it is not waterproof.
• Keep the brace or sling clean.
• Do not take baths, swim, or use a hot tub until your health care provider approves.
  • Ask your health care provider if you can take showers. You may only be allowed to take sponge baths for bathing.
  • If you have a brace or a sling that is not waterproof, cover it with a watertight covering when you take a bath or a shower.

Managing pain, stiffness, and swelling

• If directed, apply ice to the injured area:
  • Put ice in a plastic bag.
  • Place a towel between your skin and the bag.
  • Leave the ice on for 20 minutes, 2–3 times a day.
• If directed, apply heat to the affected area before you exercise or as often as told by your health care provider. Use the heat source that your health care provider recommends, such as a moist heat pack or a heating pad.
  • Place a towel between your skin and the heat source.
  • Leave the heat on for 20–30 minutes.
  • Remove the heat if your skin turns bright red. This is especially important if you are unable to feel pain, heat, or cold. You may have a greater risk of getting burned.
• Move your fingers often to avoid stiffness and to lessen swelling.

Driving

• Do not drive or operate heavy machinery while taking prescription pain medicine.
• Ask your health care provider when it is safe to drive if you have a brace or a sling on your arm.

Activity

• Return to your normal activities as told by your health care provider. Ask your health care provider what activities are safe for you.
• Avoid activities that cause pain or make your condition worse.
• Do not lift anything that is heavier than 10 lb (4.5 kg) until your health care provider tells you that it is safe.
• Do exercises as told by your health care provider.

General instructions

• Take over-the-counter and prescription medicines only as told by your health care provider.
• Do not use any tobacco products, such as cigarettes, chewing tobacco, or e-cigarettes. Tobacco can delay bone healing. If you need help quitting, ask your health care provider.
• Keep all follow-up visits as told by your health care provider. This is important.

How is this prevented?

• Warm up and stretch before being active.
• Cool down and stretch after being active.
• Give your body time to rest between periods of activity.
• Make sure to use equipment that fits you.
• Be safe and responsible while being active to avoid falls.
• Do at least 150 minutes of moderate-intensity exercise each week, such as brisk walking or water aerobics.
• Maintain physical fitness, including:
  • Strength.
  • Flexibility.
  • Cardiovascular fitness.
  • Endurance.

Contact a health care provider if:

• You have symptoms that get worse or do not get better after 6 weeks of treatment.
• You have pain that gets worse or does not get better with medicine.
• You develop new, unexplained symptoms.

Get help right away if:

• You have severe pain.
• You have numbness, tingling, or weakness in any part of your body.
• You cannot move a part of your body (you have paralysis).

Trapezius Palsy Rehabilitation

Ask your health care provider which exercises are safe for you. Do exercises exactly as told by your health care provider and adjust them as directed. It is normal to feel mild stretching, pulling, tightness, or discomfort as you do these exercises, but you should stop right away if you feel sudden pain or your pain gets worse. Do not begin these exercises until told by your health care provider.

Stretching and range of motion exercises

These exercises warm up your muscles and joints and improve the movement and flexibility of your shoulder. These exercises can also help to relieve pain, numbness, and tingling.

Exercise A: Flexion, standing

1. Stand and hold a broomstick, a cane, or a similar object. Place your hands a little more than shoulder-width apart on the object. Your left / right hand should be palm-up, and your other hand should be palm-down.
2. Push the stick to raise your left / right arm out to your side and then over your head. Use your other hand to help move the stick. Stop when you feel a stretch in your shoulder, or when you reach the angle that is recommended by your health care provider.
   1. Avoid shrugging your shoulder while you raise your arm. Keep your shoulder blade tucked down toward your spine.
3. Hold for __________ seconds.
4. Slowly return to the starting position.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise B: Abduction, supine

1. Lie on your back and hold a broomstick, a cane, or a similar object. Place your hands a little more than shoulder-width apart on the object. Your left / right hand should be palm-up, and your other hand should be palm-down.
2. Push the stick to raise your left / right arm out to your side and then over your head. Use your other hand to help move the stick. Stop when you feel a stretch in your shoulder, or when you reach the angle that is recommended by your health care provider.
   1. Avoid shrugging your shoulder while you raise your arm. Keep your shoulder blade tucked down toward your spine.
3. Hold for __________ seconds.
4. Slowly return to the starting position.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise C: Flexion, active-assisted

1. Lie on your back. You may bend your knees for comfort.
2. Hold a broomstick, a cane, or a similar object. Place your hands about shoulder-width apart on the object. Your palms should face toward your feet.
3. Raise the stick and move your arms over your head and behind your head, toward the floor. Use your healthy arm to help your left / right arm move farther. Stop when you feel a gentle stretch in your shoulder, or when you reach the angle where your health care provider tells you to stop.
4. Hold for __________ seconds.
5. Slowly return to the starting position.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise D: External rotation and abduction

1. Stand in a door frame with one of your feet slightly in front of the other. This is called a staggered stance.
2. Choose one of the following positions as told by your health care provider:
   1. Place your hands and forearms on the door frame above your head.
   1. Place your hands and forearms on the door frame at the height of your head.
   1. Place your hands on the door frame at the height of your elbows.
3. Slowly move your weight onto your front foot until you feel a stretch across your chest and in the front of your shoulders. Keep your head and chest upright and keep your abdominal muscles tight.
4. Hold for __________ seconds.
5. To release the stretch, shift your weight to your back foot.

Repeat __________ times. Complete this stretch __________ times a day.

Strengthening exercises

These exercises build strength and endurance in your shoulder. Endurance is the ability to use your muscles for a long time, even after your muscles get tired.

Exercise E: Scapular depression and adduction

1. Sit on a stable chair. Support your arms in front of you with pillows, armrests, or a tabletop. Keep your elbows in line with the sides of your body.
2. Gently move your shoulder blades down toward your middle back. Relax the muscles on the tops of your shoulders and in the back of your neck.
3. Hold for __________ seconds.
4. Slowly release the tension and relax your muscles completely before doing this exercise again.
5. After you have practiced this exercise, try doing the exercise without the arm support. Then, try the exercise while standing instead of sitting.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise F: Shoulder abduction, isometric

1. Stand or sit about 4–6 inches (10–15 cm) from a wall with your left / right side facing the wall.
2. Bend your left / right elbow and gently press your elbow against the wall.
3. Increase the pressure slowly until you are pressing as hard as you can without shrugging your shoulder.
4. Hold for __________ seconds.
5. Slowly release the tension and relax your muscles completely.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise G: Shoulder flexion, isometric

1. Stand or sit about 4–6 inches (10–15 cm) away from a wall with your left / right side facing the wall.
2. Keep your left / right elbow straight and gently press the top of your fist against the wall. Increase the pressure slowly until you are pressing as hard as you can without shrugging your shoulder.
3. Hold for __________ seconds.
4. Slowly release the tension and relax your muscles completely.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise H: Internal rotation

1. Sit in a stable chair without armrests, or stand. Secure an exercise band at your left / right side, at elbow height.
2. Place a soft object, such as a folded towel or a small pillow, under your left / right upper arm so your elbow is a few inches (about 8 cm) away from your side.
3. Hold the end of the exercise band so the band stretches.
4. Keeping your elbow pressed against the soft object under your arm, move your forearm across your body toward your abdomen. Keep your body steady so the movement is only coming from your shoulder.
5. Hold for __________ seconds.
6. Slowly return to the starting position.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise I: External rotation

1. Sit in a stable chair without armrests, or stand.
2. Secure an exercise band at your left / right side, at elbow height.
3. Place a soft object, such as a folded towel or a small pillow, under your left / right upper arm so your elbow is a few inches (about 8 cm) away from your side.
4. Hold the end of the exercise band so the band stretches.
5. Keeping your elbow pressed against the soft object under your arm, move your forearm out, away from your abdomen. Keep your body steady so the movement is only coming from your shoulder.
6. Hold for __________ seconds.
7. Slowly return to the starting position.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise J: Shoulder extension

1. Sit in a stable chair without armrests, or stand. Secure an exercise band to a stable object in front of you so the band is at shoulder height.
2. Hold one end of the exercise band in each hand. Your palms should face each other.
3. Straighten your elbows and lift your hands up to shoulder height.
4. Step back, away from the secured end of the exercise band, until the band stretches.
5. Squeeze your shoulder blades together and pull your hands down to the sides of your thighs. Stop when your hands are straight down by your sides. Do not let your hands go behind your body.
6. Hold for __________ seconds.
7. Slowly return to the starting position.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise K: Shoulder extension, prone

1. Lie on your abdomen on a firm surface so your left / right arm hangs over the edge.
2. Hold a __________ weight in your hand so your palm faces in toward your body. Your arm should be straight.
3. Squeeze your shoulder blade down toward the middle of your back.
4. Slowly raise your arm behind you, up to the height of the surface that you are lying on. Keep your arm straight.
5. Hold for __________ seconds.
6. Slowly return to the starting position and relax your muscles.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise L: Horizontal abduction, prone

1. Lie on your abdomen on a firm surface so your left / right arm hangs over the edge.
2. Hold a __________ weight in your hand so your palm faces toward your feet. Your arm should be straight.
3. Squeeze your shoulder blade down toward the middle of your back.
4. Bend your elbow so your hand moves up, until your elbow is bent to an “L” shape (90 degrees). With your elbow bent, slowly move your forearm forward and up. Raise your hand up to the height of the surface that you are lying on.
   1. Your upper arm should not move, and your elbow should stay bent.
   1. At the top of the movement, your palm should face the floor.
5. Hold for __________ seconds.
6. Slowly return to the starting position and relax your muscles.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise M: Horizontal abduction, standing

1. Sit on a stable chair, or stand.
2. Secure an exercise band to a stable object in front of you so the band is at shoulder height.
3. Hold one end of the exercise band in each hand.
4. Straighten your elbows and lift your hands straight in front of you, up to shoulder height. Your palms should face down, toward the floor.
5. Step back, away from the secured end of the exercise band, until the band stretches.
6. Move your arms out to your sides, and keep your arms straight.
7. Hold for __________ seconds.
8. Slowly return to the starting position.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise N: Scapular retraction and elevation

1. Sit on a stable chair, or stand.
2. Secure an exercise band to a stable object in front of you so the band is at shoulder height.
3. Hold one end of the exercise band in each hand. Your palms should face each other.
4. Sit in a stable chair without armrests, or stand.
5. Step back, away from the secured end of the exercise band, until the band stretches.
6. Squeeze your shoulder blades together and lift your hands over your head. Keep your elbows straight.
7. Hold for __________ seconds.
8. Slowly return to the starting position.

Repeat __________ times. Complete this exercise __________ times a day.