Trapezius

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A Moment in History

William S. Halsted, MD
(1852 – 1922)

American anatomist, teacher, and surgeon, William Stewart Halsted was born in New York City, USA to a wealthy family of English origin. His father was involved in charitable work and Governor and trustee to a city hospital. Not a brilliant student initially, Halsted took an undergraduate in Liberal Arts in Yale, CT., after which he entered the Medical College of Physicians at the Columbia College, where he excelled.

As a second-year medical student Halsted applied and obtained a position in surgery at a local hospital. In here he learned about Lister’s antiseptic technique and became an adamant proponent of it to reduce infection. In 1877 Halsted obtained his MD. After a short time as House Physician at the New York Hospital, Halsted traveled to Europe to further his education studying for two years at the Universities of Vienna, Leipzig, and W?rzburg.

Besides being at the forefront of surgical and antiseptic techniques (introducing the use of rubber gloves in surgery), Halsted was extremely concerned with the way medical students were taught in the US. He pioneered bedside clinical round discussions with the medical students after two years of basic sciences studies. Halsted developed the idea of a patient chart; he also developed the residency program for medical students in use today.

Halsted is probably the most influential researcher and surgeon at the turn of the century. He dedicated time to the study of intestinal anastomoses and the use of silk as a suture material. His experimental work in 1887 proved that the inclusion of the submucosa layer in an anastomosis was mandatory, as well that a single layered anastomosis was enough to attain closure. Perhaps Halsted’s most important contribution was the application and use of the scientific method to surgical questions. Halsted’s principles set the standards used today in surgical suturing and surgical stapling.

He also pioneered the development and surgical techniques for radical mastectomy as a treatment for breast cancer.

As a side effect of this studied in anesthesia and the use of cocaine for anesthesia, Halsted became addicted to this substance, a problem that followed him through the years. Without impairing his capacity as a researcher and a surgeon, Halsted eventually recovered. He died in Baltimore in 1922 as a complication to surgery.

Sources:
1. Dubay, A. D., & Franz, G. M. (2003). Acute Wound Healing: The Biology of Acute Wound Failure. Surg Clin NA, 83, 463-481.
2. Halsted, W. S. (1887). Circular Suture of the Intestine - An Experimental Study. Am J Med Sci, 436-461.
3. “William Stewart Halsted: his life and contributions to surgery” Osborne, P. Lancet Oncol 2007; 8: 256–65
4. “William Stewart Halsted: Surgical pioneer” Burress, P Endoc Today (2010), 8: (2) 22
5. “William Stewart Halsted (1852–1922) Neurological stamp” Haas, LF J Neurol Neurosurg Psych 2000;69:641
Original image courtesy of "Images from the History of Medicine" at www.nih.gov

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Details: Published: January 09, 2014

Posterior view of the superficial and
intermediate muscle layers of the back

The [trapezius] is a bilateral muscle belonging to the superficial muscles of the back. On each side it is a flat, thin triangular muscle that spans the neck, shoulders and the superior and middle aspect of the back. When seen together these two triangular muscles form a diamond-shaped quadrangle from which its name derives. The word originates in the Greek [τραπεζι] meaning "a four-legged table" (four sides). This word later evolved into the New Latin [trapezium].

In the midline the trapezius muscle attaches to the inion (external occipital protuberance), the ligamentum nuch?, the spinous processes of the seventh cervical vertebra (vertebra prominens), and the spinous processes of all the thoracic vertebr?.

The trapezius’ muscle fibers have three orientations. From the midline the superior fibers course inferolaterally to attach to the posterior border of the lateral third of the clavicle. The middle fibers course laterally to attach to the medial margin of the acromion, and posterior border of the spine of the scapula. The inferior fibers course superolaterally to attach to the spine of the scapula by way of an aponeurosis.

Because of their attachments, the superior and inferior fibers of the trapezius act coordinatedly to rotate the scapula, while the middle fibers act to retract the scapula. The superior fibers also act to slightly elevate the scapula. The trapezius muscle is sometimes described as an accessory respiratory muscle.

The trapezius muscle receives muscular innervation by way of the spinal accessory nerve (11^th Cranial Nerve) which courses on the deep aspect of the muscle along with the superficial branch of the transverse cervical artery and vein. The muscle also receives sensory innervation by way of nerves arising from the ventral rami of the 3^rd and 4^th spinal nerves.

The trapezius is one of the 17 muscles that attach to the scapula.

Sources:
1 "Tratado de Anatomia Humana" Testut et Latarjet 8 Ed. 1931 Salvat Editores, Spain
2. "Anatomy of the Human Body" Henry Gray 1918. Philadelphia: Lea & Febiger
Original images courtesy of bartleby.com

Trapezius

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