The human trapezius muscle has an origin that is more extensive than that of any other body muscle; it has a complex macroscopic structure with fibers running in different directions. Histochemical analysis of multiple samples, obtained from different parts of the trapezius muscle from five males, showed marked differences in the distribution and the cross-sectional fiber area of the fiber types among different parts of the muscle as well as among individuals. As revealed by the mATPase activity, after different levels of alkaline and acidic preincubations, the lower third of the descending portion, the transverse, and the ascending portions of the muscle had a predominance of type I fibers (low mATPase activity at pH 9.4), whereas the most superior parts of pars descendens had a higher frequency of type II fibers (high mATPase activity at pH 9.4). The fibers of the most superior parts of the muscle were considerably smaller compared with those in all the other parts. In sections stained for NADH-TR, moth-eaten fibers were observed within parts of the descending portion. Their location and their larger fiber area, compared with that of ordinary type I fibers, may be related to frequent and/or continuous use of these fibers. In conclusion, the differences in fiber type composition between the different parts of the muscle probably reflect different functional demands on the trapezius muscle in various head, neck, and shoulder movements. We suggest that the interindividual differences in muscle fiber composition are due, at least in part, to genetic factors.

The association of cytochrome c oxidase negative fibres (COX-negative) and ragged-red fibres (RR-fibres) with work related trapezius myalgia has been proposed. Hitherto studies have been small or without control groups. The aim of the present study was to investigate the prevalences of RR-fibres and COX-negative fibres in female cleaners with (n=25) and without (n=23) trapezius myalgia and in clinically healthy female teachers (n=21). The cleaners did mainly floor cleaning requiring monotonous loading on the trapezius muscle. A questionnaire covering background data and aspects of pain (prevalence, duration, intensity and influence on daily living) was answered. Biopsies were obtained from the trapezius muscle by an open surgical technique. The three groups did not differ in prevalence of COX-negative or COX-superpositive (i.e. type-I fibres with extremely strong brownish reaction in both the COX and SDH/COX stainings) fibres. The prevalence of COX-negative fibres was age dependent. Two subgroups of RR-fibres were present when stained for COX; COX-negative (73%) and COX-superpositive (26%) fibres. Forty-two percent of the COX-negative fibres were RR-fibres and 79% of the COX-superpositive were RR-fibres. A significantly (P=0.002) higher proportion of the COX-superpositive fibres in the cleaners were RR-fibres compared to the teachers. Multivariate regression analysis revealed that age, occupation as cleaner and a tender point in the trapezius were significantly associated with increased prevalences of RR-fibres; a cleaner with a tender point had a 4.35 higher prevalence of RR-fibres compared to a teacher without a tender point. No correlations between other pain related variables and prevalence of RR-fibres were noted. In conclusion, RR-fibres but not COX-negative or COX-superpositive fibres were correlated with cleaning work tasks and with a tender point in the trapezius.

The aim of the investigation was to evaluate the status and function of the temporomandibular joint (TMJ) and masticatory system in patients with habitual snoring and obstructive apnoea after 2 years nocturnal treatment with a mandibular advancement splint. Thirty-two patients participated in the study, ranging from 43.0 to 79.8 years of age (mean 54.4 years, SD 8.78) at the start of treatment. All patients had been referred from the ENT department for treatment with a mandibular advancement splint. The acrylic splint advanced the mandible 50-70 per cent of maximal protrusion, opened 5 mm vertically, and was used 6-8 hours per night and 5-7 nights per week. Overjet, overbite, and molar relationship were measured on dental casts. The patients were asked to answer a questionnaire concerning symptoms of craniomandibular dysfunction (CMD). They were also clinically examined in a standardized manner, including registration of range of mandibular movements, TMJ sounds, pain on movement, and palpatory tenderness of the TMJ and the masticatory muscles. None of the patients showed more than five symptoms of dysfunction either at the start of or after 2 years of treatment. A decrease in the frequency of headache was found for nine of those 18 patients that reported headache (P = 0.004). A minor, but significant decrease in overjet and overbite was found and the molar relationship was also changed. It was concluded that 2 years' treatment with a mandibular advancement splint had no adverse effects on the craniomandibular status and function, but the observed occlusal changes requires further evaluation.

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Tne anatomy of the human trapezius muscle is complex, with an extensive origin and fibers running in different directions. The muscle is commonly divided into three different muscle portions according to the fiber direction: the descending, transverse, and ascending portions. In a previous study in males, the structure of the muscle differed between different portions with respect to the enzyme-histochemical fiber-type profile. The lower regions of the descending portion and the transverse and the ascending portions had a predominance of type I fibers. The type II fibers were more frequent in the upper regions of the descending portion, and the cross-sectional fiber area in this region of the muscle was smaller. In this study, we have investigated the trapezius muscle in females and compared the results with those from males. The different portions of the female muscle had a relatively even fiber-type composition. However, there tended to be fewer type I fibers and more type IIB fibers in the descending portion of the muscle, and the fibers of the lower regions of the descending portion were somewhat larger. The fiber-type distribution pattern was similar to that of the male trapezius muscle, but the mean cross-sectional area of the fibers in the female muscle was considerably smaller. Thus, our conclusion is that the trapezius muscle of females has a similar activity pattern as that of males. The significantly smaller cross-sectional fiber area, however, may indicate a lower functional capacity which may be of importance in the development of neck and shoulder dysfunction in females.