Sunday, July 29, 2018

Trapezius and pericarditis.

Suppose a patient of 40 years of age male comes to you with complaints of  chest pain which is often heavy, squeezing and crushing.

You make up the diagnosis of MI based upon the symptoms in your mind. Proceeding for proper history of case you ask patient if the pain is radiating type.
Patient explains you that the pain is radiating and he is eventually experiencing pain in to the back of this some muscle. You find out that he is pointing towards the "Trapezius muscle" .

Now, this should raise an alarm in your mind. You should stop thinking about MI.

Reason?

Both NSTEMI and STEMI shows pain which is radiating in nature. Pain involves the central portion of the chest, sometimes epigastrium and occasionally it radiates to the arms. Less common involves back, neck, lower jaw. Pain can radiate as high as occipital area but never below umbilicus.
but it never radiates to trapezius.

Depicting exact lines of Harrison textbook of medicine.

"Radiation of discomfort to the trapezius is not seen in patients with STEMI and is  useful in correct diagnosis of pericarditis"

Now, why pain radiates to trapezius?

Pericarditis, as name suggests inflames the pericardial sac of the heart. This causes irritation of the vagus nerve supplying heart. Vagus nerve is affected because it is closely related to pericardial sac. Vagus nerve acts as the afferent nerve fibers. These fibers reaches nucleus tractus solitarius in the medulla oblongata. From there it comes downwards reaches cervical plexus C2, C3 and C4. From there, the nerve fibers formed supplies lower part of trapezius.

Trapezius nerve supply:
Upper part is supplied by the spinal accessory nerve.
Lower part is supplied by the nerves from C3 and C4 only.

Hence pain radiates to trapezius in pericarditis.

-Vipul and Ojas.

1 comment:

  1. It's wrong to say that the pain of MI "never" radiates to the trapezius (which is in the back) because occasionally, pain of MI can radiate to the back.

    Also, pain radiating to the back should alarm you to a more serious diagnosis - aortic dissection.

    Maybe you should clarify this in the post.

    ReplyDelete

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