Integrative Works

Active people complain of pain on the top of their shoulder when lifting their arm. When I ask them to lift their arm, it doesn’t really hurt until their elbow gets level with their shoulder and the tip of the shoulder begins to rotate upward. This is the point that the middle trapezius strongly engages. Sometimes they will produce the pain by wiggling around their shoulder until they lift it up and back. They also complain of pain during exercises that lift their arm above their head as that also rotates the scapula upward.

People who carry something with a strap over the shoulder have tenderness on that spot where the bag presses into the shoulder. They will shift their purse, baby bag, travel bag, or yoga bag to the other shoulder and smile as they tell me that the bag is probably causing the problem. This combination doubly aggravates this spot as it presses into the trigger point while the trapezius is rotating the shoulder up to keep the bag in place. People with a backpack may carry it by the strap or just put it on the other shoulder.

People may also complain of a heavy coat that rides their sore shoulder, leaving them irritated. Children with sensory processing disorders may complain that they “just don’t like” their coat or backpack.

A few different motions aggravate this.

• First, lifting the shoulder toward the ear. It usually happens because people lift their elbow above the shoulder. This extended side pose is a good example of that movement. It lifts the elbow above the head while opening the chest by retracting the scapula.
• Second, people have something that presses into the top of the shoulder. Backpack. Shoulder bag. Squat bar. Kid on your shoulders. The pressure into the muscle activates the trigger point as it lengthens.
• Third, and less common, people raise their shoulders to type, eat, work on their laptops, etc. This is less likely to aggravate this muscle as it often acts as an assistant in this motion. But it happens. Sometimes.

This pain comes out of the middle trapezius, which lifts the clavicle by pulling the shoulder blade toward the spine. It pivots the clavicle on the sternum and the shoulder blade tips upward.

Musculoskeletal Anatomy

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This post on anatomy contains standard information about the origin, insertion, function, and innervation of muscles. It also includes information on functional considerations and anomalies.

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