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Anatomy

Upper Limb

Question 123 of 239

You are examining the shoulder of a 43 year old woman who complains of progressive weakness in her left arm. You note wasting of the left trapezius muscle in comparison with the right. The trapezius muscle is innervated by which of the following nerves:

Answer:

The trapezius is innervated by the spinal part of the accessory nerve (motor supply) and the anterior rami of C3 and C4 (sensory supply). These nerves pass vertically along the deep surface of the muscle. The accessory nerve can be evaluated by testing the function of the trapezius muscle, most easily done by asking the patient to shrug their shoulders against resistance.

Trapezius Muscle

Anatomy / Upper Limb / Pectoral Region

Last Updated: 8th April 2019

The trapezius muscle is responsible for the smooth contour of the lateral side of the neck and over the superior aspect of the shoulder.

Table: Function and Innervation of the Trapezius Muscle

Muscle Trapezius
Origin Superior nuchal line, external occipital protuberance, medial margin of ligamentum nuchae, spinous processes of C7 – T12 and the related supraspinous ligaments
Insertion Superior edge of crest of the spine of the scapula, acromion and posterior border of lateral one-third of clavicle
Function Elevation of scapula, rotation of scapula during abduction of humerus above horizontal, retraction and depression of scapula
Innervation Spinal accessory nerve

Origin

The trapezius muscle has an extensive origin from the axial skeleton, originating from the superior nuchal line, the external occipital protuberance, the medial margin of the ligamentum nuchae, the spinous processes of C7 - T12 and the related supraspinous ligaments.

Insertion

The muscle inserts onto the skeletal framework of the shoulder (to the superior edge of the crest of the spine of the scapula, the acromion and the posterior border of the lateral one-third of the clavicle) along the inner margins of a continuous U-shaped line of attachment orientated in the horizontal plane, with the bottom of the U directed laterally.

Function

The trapezius is a powerful elevator of the shoulder and also rotates the scapula to extend the reach superiorly (during abduction of the humerus above horizontal). The middle fibres retract the scapula and the lower fibres depress the scapula.

Innervation

The trapezius is innervated by the spinal part of the accessory nerve (motor supply) and the anterior rami of C3 and C4 (sensory supply). These nerves pass vertically along the deep surface of the muscle. The accessory nerve can be evaluated by testing the function of the trapezius muscle, most easily done by asking the patient to shrug their shoulders against resistance.

By Mikael Häggström, used with permission. (Image:Gray409.png) [Public domain or Public domain], via Wikimedia Commons

Trapezius Muscle. (Image by Mikael Häggström, used with permission. (Image:Gray409.png) [Public domain or Public domain], via Wikimedia Commons)

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  • Biochemistry
  • Blood Gases
  • Haematology
Biochemistry Normal Value
Sodium 135 – 145 mmol/l
Potassium 3.0 – 4.5 mmol/l
Urea 2.5 – 7.5 mmol/l
Glucose 3.5 – 5.0 mmol/l
Creatinine 35 – 135 μmol/l
Alanine Aminotransferase (ALT) 5 – 35 U/l
Gamma-glutamyl Transferase (GGT) < 65 U/l
Alkaline Phosphatase (ALP) 30 – 135 U/l
Aspartate Aminotransferase (AST) < 40 U/l
Total Protein 60 – 80 g/l
Albumin 35 – 50 g/l
Globulin 2.4 – 3.5 g/dl
Amylase < 70 U/l
Total Bilirubin 3 – 17 μmol/l
Calcium 2.1 – 2.5 mmol/l
Chloride 95 – 105 mmol/l
Phosphate 0.8 – 1.4 mmol/l
Haematology Normal Value
Haemoglobin 11.5 – 16.6 g/dl
White Blood Cells 4.0 – 11.0 x 109/l
Platelets 150 – 450 x 109/l
MCV 80 – 96 fl
MCHC 32 – 36 g/dl
Neutrophils 2.0 – 7.5 x 109/l
Lymphocytes 1.5 – 4.0 x 109/l
Monocytes 0.3 – 1.0 x 109/l
Eosinophils 0.1 – 0.5 x 109/l
Basophils < 0.2 x 109/l
Reticulocytes < 2%
Haematocrit 0.35 – 0.49
Red Cell Distribution Width 11 – 15%
Blood Gases Normal Value
pH 7.35 – 7.45
pO2 11 – 14 kPa
pCO2 4.5 – 6.0 kPa
Base Excess -2 – +2 mmol/l
Bicarbonate 24 – 30 mmol/l
Lactate < 2 mmol/l

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