K Class 9 TG Muscles of Arm

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Kinesiology



There is a closerelationship betweenthe shoulder girdlemuscles that movethe shoulder joint.The humerus hangsoff the scapula in avulnerable position

depends on themuscles, tendonsligaments to preventforce, momentum,direction fromdislocating the joint.



These muscles have to oppose each other tostop the action, add another action, &stabilize the joint all at the same time.Shoulder girdle muscles stabilize the scapula& share the pain and soreness of soft tissueproblems.Some sources suggest that therapists work

the shoulder girdle muscles first and thenwork out to the shoulder joint, workingopposing muscles to create a balance.



These musclesrespond better ifthe joint is treatedas a whole insteadof in pieces.The side-lyingposition is useful in

treating theshoulder joint as awhole.



Muscles of the Arm



Originates byattachments on theclavicle, sternum andcostal cartilage of ribpairs 1-7 insertson the bicepitalgroove of thehumerus.Anterior axillary foldis formed primarilyby this muscle.



Its fan-likestructurecompletely twists atthe insertion at thelateral lip of thebicepital groove.Its insertion is

superficial to thoseof latissimus dorsiand teres major.



Assists serratus anterior in drawing thescapula forward as it moves the humerus inflexion & medial rotation.

Even though the pectoralis major is notattached to the scapula , it is effective inshoulder protraction because of its anteriorpull on the humerus.

Pectoralis major also works as a synergist tolatissimus dorsi in extension & adduction ofthe humerus from a raised position.



A typical action isthrowing abaseball.

As the gleno-humeral joint isflexed, the humerusis medially rotated

the scapula isdrawn forward withan upward rotation.



The pectoralis majormuscles are alsobreast supporterssince the breasts siton top of them.These muscles areoften contracted,forming roundedshouldersexacerbated bybreast weight.



It is beneficial to stretch the pectoralis majorto help with postural problems & supportback muscles.Compression, myofascial stretches, & jostlingare all great to use on these muscles.





Originates on thecoracoid process of thescapula & inserts onthe humerus.

Mostly buried underthe pectoralis major &has a long tendon thatruns side by side withthe biceps brachiishort-head tendon.



This is not a powerful muscle but it doesassist in flexion & adduction.It is most functional in moving the armhorizontally toward & across the chest.Therapists need to be cautious in workingthis muscle since the brachial plexus entersthe arm in close proximity to this muscle.



This muscle can develop a painful pulsingreferred pain pattern that travels down thearm to the hand. This is usually acompensating pattern to adhesive capsulitisor to an injury that limits movement of theshoulder joint.When this muscle is shortened, the clientwon’t be ble to pl ce his h nd behind hisback due to the pain of that movement.



Originates on theclavicle scapula

all 3 sections

(anterior, middleposterior)

insert at deltoid

tuberosity of thehumerus.



Commonly used inactivities such asdriving a car, polingin cross-countryskiing, doing anylifting movements.The trapeziusstabilizes the

scapula as thedeltoid pulls on thehumerus.



The anterior fibers of deltoid flex & internallyrotate the humerus & oppose the posteriorfibers that extend & externally rotate thehumerus.The anterior fibers also horizontally adductthe humerus while the posterior fibershorizontally abduct it.

All 3 sections contribute to shoulderabduction.



Any movement of the humerus on thescapula will involve part or all of the deltoid.The posture of rounded shoulders willshorten the anterior deltoid while lengtheningthe posterior deltoid.Stretching the anterior deltoid &strengthening the posterior deltoid will help

to balance the deltoids & improve posture.



The subdeltoidbursa is locatedbelow the anteriordeltoid sotherapists need toavoid usingcompression

techniques thatcould irritate thebursa.







Abduction of the shoulder joint isaccompanied by an upward rotation ofthe scapula which latissimus dorsi

opposes.When latissimus dorsi adducts, it actuallypulls the entire pectoral girdle downwardwhich downwardly rotates the scapula.



It is one of the mostimportant extensormuscles of thehumerus & it

contracts powerfullyin doing chin-ups.It works with teresmajor in all itsfunctions.



It is sometimes calledthe swimmer’smuscle because of itsfunction in pulling

the body forward inthe water duringmedial rotation,adduction &

extension.



The muscle is designed for powerfulmovements like rowing & pulling.Its fibers at the ribs intersect with theexternal oblique which can make it hard totake a deep breath when torn tissues arepresent.The latissimus dorsi is not designed to pick

up weights in a flexed-trunk position & as aresult, its aponeurosis can be injured.





Originates on theinferior angle of theposterior scapulainserts on the

bicepital groove ofthe humerus.Effective only whenthe rhomboidsstabilize the scapulaor move the scapulain downwardrotation.



Teres major works as a synergist withlatissimus dorsi in adducting, mediallyrotating & extending the humerus. This muscle is less frequently injured thanlatissimus dorsi. It can become fatigued withuse.Teres major will try to compensate for

latissimus dorsi when latissimus dorsi isinjured.



Rotator Cuff Muscles





The group is important for keeping the head ofthe humerus in its proper location within theglenoid fossa.While smaller than the deltoid & pectoralis major,

the group must have adequate strength &muscular endurance to ensure proper functioningespecially in repetitive overhead movementssuch throwing, swimming, & pitching.

They have to prevent abnormal & excessivemovements of the humeral head in the glenoidfossa.



The group (especially supraspinatus), if weakor if fatigued or not properly warmed up, willfail to dynamically stabilize the head of thehumerus in the glenoid fossa which can leadto problems such as tendonitis, tendonosis,or rotator cuff impingement within thesubacrominal space.Tendonosis is a breakdown of the collagenfibers within the tendon, while tendonitis (FESp. 403) is an inflammation of a tendon.



Originates on the subscapularis fossa of theanterior scapula and inserts on the lessertubercle of the humerus. Its main concentricaction is medial rotation of the humerus.Works with latissimus dorsi & teres major &all 3 form the posterior axillary fold.Most effective when the rhomboids stabilize

the scapula.It is the least powerful of the 3 muscles dueto its close proximity to the joint.





Originates on the supraspinatus fossa ofthe posterior scapula & its insertion lines upnext to the infraspinatus & teres minor onthe greater tubercle of the humerus.Its major concentric action is abduction ofthe shoulder.When the body is engaged in a throwing

movement, the supraspinatus provides animportant dynamic stability for the head ofthe humerus in the glenoid fossa.



The supraspinatus is the most often injuredmember of the group.Mild to moderate strains or tears oftenoccur with athletic activity with repetitiveoverhead movements such as swimming &throwing.If weak, the athlete tends to use scapula

elevators & upward rotators to obtainhumeral abduction.





Its agonists include teres minor & theposterior deltoid.Clients who have difficulty fastening a seatbelt or placing an arm in a sleeve may have a

problem with infraspinatus.Sports injury or other trauma such as haulinga wheeled suitcase or excessive poling incross-country skiing, could also contribute to

infraspinatus tendonitis or tendonosis.The infraspinatus tendon is often tender at itsattachment site.







Pectoralis Major is a synergist with Latissimusdorsi in shoulder adduction.Teres major is a synergist with Latissimusdorsi in all its functions.Subscapularis is a synergist with Latissimusdorsi & Teres major in medial rotation.Teres minor is a synergist with Infraspinatus

in all its functions.





This is the mostcommonlydislocated joint inthe body.Dislocations canoccur in anterior,posterior, inferior

directions.



The strong coracohumeral ligament usuallyprevents dislocation in the superiordirection.Dislocations typically occur when thehumerus is abducted & externally rotated,with anterior-inferior displacement beingmore common.





The dislocation can also happen in anaccident in cycling & participation inwrestling or football.Unfortunately once the joint has beendislocated, the stretching of the collagen inthe surrounding ligaments predisposes it toadditional dislocations.

Some people also genetically have a weaker joint capsule.



Dislocations orseparations canhappen withwrestlers footballplayers.

When a rigidlyoutstretched armsustains the full forceof a full-body fall,either the AC jointseparates or there isa fracture of theclavicle.



A common injury among workers or athletes whoengage in forceful overhead movements thatinvolve abduction or flexion along with medialrotation.

Is caused by progressive pressure on the rotatorcuff tendons by the bone & soft tissues.Symptoms include hypermobility of the anteriorshoulder capsule, hypomobility of the posterior

capsule, excessive external rotation plus limitedinternal rotation of the humerus, & lax ligamentsof the shoulder joint.



Can result ininflammation of thetendons or bursa or, insevere cases, ruptureof one of the tendonsof the rotator cuff.The most commonlyaffected muscle issupraspinatus possiblybecause its bloodsupply is the mostsusceptible topressure.



Can cause pain and tenderness in the anterior& superior shoulder regions & sometimesshoulder weakness.Activities that can cause this conditioninclude throwing (especially something like a

javelin), serving in tennis, & swimming(especially free style, backstroke & butterfly).It is so common among swimmer’s it is alsoknown as swimmer’s shoulder.



Tears of the labrum (ring of connective tissuearound the glenoid fossa), the rotator cuffmuscles, & the biceps tendon are among theinjuries that may result from repeated,

forceful rotation of the shoulder.Examples of this type of movement isthrowing, serving in tennis & spiking avolleyball.

Most tears happen in the anterior-superioraspect of the labrum & in the supraspinatusmuscle.



Normal Labral Tear



Tears of the biceps tendon occur at itsattachment site on the glenoid fossa.Other injuries that can occur are calcificationsof the soft tissues of the joint & degenerationof the articular surface.Bursitis can also affect one or more bursa ofthe shoulder joint.





This conditionsometimes occurs withcompetitive volleyballplayers.It is a loss of nervesupply to infraspinatuswith loss of strength inexternal rotation of thehumerus.Associated withrepeated stretching ofthe nerve duringserving.



A pain response duringa part of an active orpassive jointmovement.In the shoulder, paincan occur when theclient abducts thehumerusHe does not feel painuntil the arm is about90 degrees abductedthen the pain subsidesas the arm continuesto move in abduction.



Cause is the humerus interacting too closelywith the acromion process.The rotator cuff lines up with the greatertubercle of the humerus. If there is notenough room for the humerus to slide underthe acromion process in abduction, it mightimpinge on parts of the rotator cuff muscles.Additionally the subacrominal bursa could beirritated by the close proximity of thehumerus.



This is a progressive, painful conditionthat starts with limited ROM &progresses to a frozen stage.

Small adhesions form in the jointcapsule, creating an extremelydebilitating condition.





Elbow Radioulnar Joint Muscles



The elbow isformed by theulna articulating

with the humerusthe radiuspivots around theulna to form theradioulnar joints.



As the radioulnar joint goes through its ROM,the glenohumeral muscles & elbow musclescontract to stabilize or assist in theeffectiveness of the radioulnar joints.

When we hold a screwdriver in the right hand& work to fully tighten a screw , themovement consists of radioulnar supination,which usually involves laterally rotation &flexing the glenohumeral & elbow joints.



When we try to loosen a screw , the movementconsists of pronation, which usually involvesmedially rotating & extending the elbow &glenohumeral joints.

In both cases, the body depends on the boththe agonists & the antagonists in thesurrounding joints to assist with anappropriate amount of stabilization.We need to keep in mind that all movement isconnected up the kinetic chain of the arm tothe shoulder girdle & neck.





A two-headed musclethat originates on thesupraglenoid tubercle

coracoid process ofthe scapula insertson the tuberosity ofthe radius.There is no attachmentto the humerus.



The coracoid process of the scapula is also anattachment site for coracobrachialispectoralis minor.Some sources consider the biceps as a 3-

joint muscle: shoulder, elbow & radioulnar.It is weak in shoulder joint actions but it doesassist in providing dynamic stabilization tokeep the humerus in the glenoid fossa.



It is most powerful in flexing the elbow whenthe radioulnar joint is supinated.It is also a strong supinator, especially if theelbow is flexed. Palms away from the face(pronation) decrease the effectiveness of thebiceps.It works with brachialis & brachioradialis toflex the elbow.



The biceps weakly abducts the arm at theshoulder when it is laterally rotated with themiddle deltoid and supraspinatus.It also assists coracobrachialis and the

clavicular head of pectoralis major inhorizontal adduction.Triceps brachii is the main antagonist.Synergists for biceps brachii include

brachialis, brachioradialis and pronator teresfor elbow flexion and the supinator forsupination of the forearm.



The biceps is used so frequently for commonactivities that everyone at some time hasexperienced fatigued anterior arm muscles.Shoveling snow, performing a hard tennis

serve, playing the violin, engaging in heavylifting – all stress the biceps repeatedly.Usually the ache is felt superficially & canrefer down the arm or laterally.



The long head of the biceps is like a ropestretched over a pulley (the humerus). Thewear & tear on the long-head tendon causesattachment tenderness at its origin.

Injury to the long-head tendon can result inbicepital tendonitis , which may involve thetendon in slipping out of the bicepital groovewhich can irritate the tendon.A tell-tale snap may indicate rubbing over thelesser tubercle.





Originates on thehumerus insertson the ulna.Works with theother elbow flexormuscles, regardlessof supination orpronation.



It pulls on the ulna, which does not rotate;making this muscle is the only true flexor ofthe elbow.Synergists include biceps & brachioradialis.

Heavy lifting can lead to discomfort in thebrachialis.This muscle is easily strained in elbowflexion, especially if the biceps is weak.

When injured, the brachialis is extremelypainful.



Massage, along with moist heat, relieves themuscle soreness.Clients can passively shorten the brachialis byplacing a pillow in the flexed elbow.Stretching the muscle by gentle extension ofthe elbow can help increase blood flow.



Originates on thelateral supra-condylar ridge ofthe humerusinserts on thestyloid process ofthe radius.





Since brachioradialis is used a great deal in theneutral position, carpenters, roofers & grocerycashiers all can experience muscle exhaustion.Massage & stretching can resolve the situation.

It may also be involved in tendonitis ortendonosis of the lateral epicondyle region dueto its close proximity to the overused wristextensors.

Some sources recommend working it beforethe other smaller forearm muscles.



Originates on themedial epicondyleof the humerus andulna inserts onthe radius.It is located on theopposite side of theforearm from thesupinator.



Typical movement of the pronator teresmuscle occurs with the forearm pronating asthe elbow flexes. Movement is weaker inflexion with supination.

Repetitive actions in the supine to proneposition tend to promote stress on pronatorteres & fatigue to the forearm muscles.



It is helpful toremember that themedian nerve travelsthrough the pronatorteres. Continual

repetitive pronationcan fatigue the muscleenough to annoy themedian nerve.Symptoms may reflectcarpal tunnelsyndrome.



It is locatedanteriorly, distallydeeply close to thewrist.Originates on theulna inserts onthe radius.



It works to pronate the forearm incombination with triceps in extending theelbow.It is commonly used in turning a screwdriveror in movements requiring extension &pronation such as throwing a curve ball.Because of the deep location of pronatorquadratus, it is difficult to work.



It can be stretchedalong with theother pronatormuscles.All the wrist flexortendons pass overthis muscle.



A 3-headed musclethat has the origin forthe long head on theinfraglenoid tubercle ofthe scapula.

The lateral & medialheads originate on thehumerus & theinsertion of all 3 headsis on the olecranonprocess of the ulna.



Typical action oftriceps is shown inpush-ups whenthere is a powerfulextension of theelbow.It is used in handbalancing in anypushing movementinvolving the arm.



The long head is animportant extensorof the shoulder

joint. It works withanconeus.The golf & tennisswing would beimpossible withoutthe use of thetriceps.



The long head will often have tenderness at theorigin on the scapula.Stretching the long head is necessary to maintainforward elevation of the shoulder.Because one of its main actions is the forcefulextension of the forearm, fatigue can develop inoveruse activities.A therapist can passively shorten the triceps byworking on the muscle in an overhead position.

Roll the triceps & biceps around the humerus forreleasing tension.



Originates on thelateral epicondyleof the humerusinserts on theolecranon processof the ulna.



The chief function is to pull the synovialmembrane of the elbow joint out of the wayof the olecranon process during elbowextension.

It contracts along with triceps & is more of astabilizer for the elbow.Some sources consider the anconeus anextension of the triceps.When it is fatigued, it tends to haveattachment tenderness at the lateralepicondyle area.



Due to its size & its attachment to the lateralcondyle, it can also be involved in tennis elbow.It is important to remember the radial nervetravels through this muscle & has a fibrous arch

of tissue over the nerve. Should the radial nervebecome entrapped, it is a medical conditionrequiring surgery to release the tissue to free upthe nerve.

Otherwise the supinator stabilizes pronation &can be involved in tendonosis or tendonitis of thelateral epicondyle area.



Originates on thehumerus ulnainserts on the

radius.



Produces supination when extension isrequired, as in turning a screwdriver orthrowing a curve ball.The supinator acts as the elbow is extended

just before the ball release.It is most isolated in actions that requiresupination with extension since biceps assistwith supination when the elbow is flexed.



Injuries and Overuse Syndromes



Fracture Dislocations



This type offracture prohibitsthe use of a cast.If the joint wasimmobilized, thejoint would likely‘fuse’ or severely

limit motion asthe joint heals.





A painful conditionwhich requires medicalcare.A dislocation couldconstrict circulation ornerve function locallyas well as distally.Ligaments can also betorn or sprained in adislocation.



Massage should be avoided on affected areauntil bruising is minimal or gone, swellingis significantly reduced, circulation isnormal, and it is safe to apply pressure to

the soft tissue.Therapists need to remember that whenone joint suffers trauma, the rest of thebody compensates for the injury andmassage can help with the compensationpattern.





This condition is frequently associated withgripping & lifting activities as well as manyrepetitive actions of the hand & wrist.Tennis elbow produces painful movement &discomfort in the hand & wrist.Golfer’s elbow is a somewhat less commonproblem & is associated with the wristflexors & pronators near their origin on themedial epicondyle.





Both of these conditions involve musclesthat cross the elbow & shoulder but actprimarily on the wrist & hand.Rehabilitation of epicondyle dysfunctionshould include exercises that target wrist &finger flexion & extension.Ulnar & radial rotation (supination &pronation) against resistance is alsoimportant.



Chronic, painful repetitive injuries often havespells of subacute flare-ups which are a responseto a chronic injury that is not allowed to rest.Using the forearm & arm muscles repeatedly can

cause sore, fatigued & hypertonic muscles.The origins & insertions of tendons are oftentender at the attachment sites.If the muscles continue to be used, the tendons

can start to tear which can be the beginning oftendonitis or tendonosis.





Bursitis can occurwith medialepicondylitis.Swelling of thebursa can getbigger than a golfball.Often requiresmedical treatment

draining.



The cubital tunnel is between the medialcondyle & the olecranon process.The ulnar nerve resides in the cubital tunnel& compression of this nerve can occur whenthe nerve doesn’t have enough room in thetunnel, usually from the placement of theelbow joint.One solution is to surgically move the ulnarnerve to avoid compression.





The radial nerveruns through anumber of armforearm muscles

before it endsdistally in the hand.Entrapment of thenerve can occur inthe triceps orsupinator.



This disorder can include carpal tunnelsyndrome, pronator teres syndrome &double-crush syndrome.Median nerve disorders are all vulnerable tomedian nerve entrapment form the brachialplexus to the wrist.◦ Pectoralis minor can entrap the brachial

plexus in thoracic outlet syndrome.◦ Pronator teres can entrap the median

nerve & cause pronator teres syndrome.



Pectoralis Minor Thoracic OutletSyndrome



Repetitive pronationwith the arm in frontof the body with thescapula abducted can

set up an entrapmentenvironment bypectoralis minor andpronator teres known

as the double-crushsyndrome.



The carpal tunnelhas very little roomthe median nerve

sits on top of thetendons just belowthe flexorretinaculum.Inflammation of thenerve results incarpal tunnelsyndrome.





Wrist and Hand Muscles





Originates on themedial epicondyleof the humerusinserts on the radial

side of the wrist atthe base of the 2 nd

3 rd metacarpals.





Originates on themedial epicondyleof the humerusruns down the ulnarside of the forearmwhere it inserts atthe base of the 5 th metacarpal.Its tendon does notgo through thecarpal tunnel.



This muscle is important in wrist flexion.It is also one of only 2 muscles involved inwrist adduction or ulnar flexion.It can be strained by repetitive wrist actions.

Besides massage therapists working withhyperextended wrists, other overusemovements are using a trowel on cement,painting with a brush, or scrubbing a floor.Tenderness can appear at its attachments orat the extensor insertions at the wrist.



Originates on themedial epicondyleof the humerusinserts into the

palm of the hand.



This muscle is weak helper with wrist flexion due to its central location on the anteriorforearm and wrist.This muscle is often used for tendon repair in

surgery because it is superficial.It does not travel through the carpal tunnel &is not crucial to wrist flexion.It may also be absent in one or both forearmsin some people.



Superficial Wrist Extensors





Originates on thelateral epicondyleof the humerusinserts at the base

of the 2 nd metacarpal on thedorsal side of thehand.



This muscle is important in any sports activitythat requires powerful extensions. It is alsoinvolved in wrist abduction.Because its origin is so close to

brachioradialis & other lateral epicondyletendons, extensor carpi radialis longus isinvolved in tennis elbow.Carpenters, musicians, massage therapists, &keyboard operators can also develop it.



Originates on thelateral epicondyleof the humerusinserts at the base

of the 3 rd metacarpal on thedorsal side of thehand.



This muscle is important in any sports activitythat requires powerful wrist extensions suchas golf and tennis.It often is a part of the repetitive misuse of

the lateral epicondyle.As part of the common extensor tendon, itcontributes to tendonosis, tendonitis, strains,& other soft tissue problems.



Originates on thelateral epicondyleof the humerusruns down the ulnar

side of the forearmto the base of the5 th metacarpal onthe dorsal side ofthe hand.



This muscle along with extensor carpi radialisbrevis & longus are the most powerful of thewrist extensors.Any action requiring wrist extension dependson the strength of these muscles.They are involved with the backhand ofracquet sports & can be involved in lateralepicondyle soft tissue conditions.This muscle, along with flexor carpi ulnaris,can be strained in repetitive sidewaysmovements





Originates on thelateral epicondyle ofthe humerusinserts at the distalphalanges of the 4fingers on the dorsalside of the hand.Only muscle involved

in extension of all 4fingers.



It divides into 4 tendons on the back of thehand that insert on each of the 4 fingers. Italso assists with wrist extension.Massage students can strain these tendons

when they extend their fingers instead ofrelaxing the fingers & following the shape ofthe body part.Constant repetitive action takes a toll on the

entire muscle & at the lateral epicondyle area.If it is not able to function properly, it cannotcontribute to a strong grip.





Can also offer slight assistance in wristextension.For computer programmers & pianists,stretching the little finger to its maximumlength can be a repetitive action that resultsin hand pain & discomfort.A combination of little finger extension &abduction contributes to an overusecondition for massage therapists.It can be involved in lateral epicondylitis dueits origin at the lateral epicondyle.



How is area positioned where isresistance applied to test function ofwrist flexors?



How is area positioned and where isresistance applied to test function of wristflexors

When testing for normal function of thewrist flexors, the wrist is flexed resistanceis applied to the palm of the hand





A variety of soft-tissue and bony injuries canhappen to the hand and wrist.Carpenters, manual laborers, fishermen,cooks and chefs can all injure their hands &

wrists in multiple ways including tendonlacerations or repetitive use conditions.Lacerations require surgical repair.Athletic injuries, falls, car accidents are otherways injuries can occur.



A person’s natural reaction to falling is touse the hands to break the fall.Landing on the hand with the full weight ofthe body can cause:◦ Fractures of the radius & ulna at the wrist◦ Dislocations & fractures fingers,

metacarpals & carpals◦ Tears or avulsions of ligaments◦ Strains & sprains







Tendonosis

Breakdown ofcollagen fibers inthe tissue andtendons can beginto ‘fray’ whichcauses the tendonto lose strengthresulting in chronicpain and soreness.



There can also betears in tendonsdue to overuseconditions. In the

healing processthere can be thedevelopment ofscar tissue andadhesions.



This is theinflammation of atendon and in theworst cases can

include a tearingthe periosteumaway from thebone.



This is inflammationof the tendon sheath,plastic wrap-likeconnective tissuestructures that

surround groups offlexor and extensortendons.The sheaths can

become inflamed dueto overuseconditions.



A cyst (lump) on the dorsal side of the wristIt sometimes comes from the tendon sheathor the joint capsule.Are annoying and sometimes painful

growths that sometimes impair normalROM.Treatment is draining the fluid contained inthe cyst.

Ganglions should not be massaged directlyand the area around the growth can beworked if there is no inflammation.





This is a debilitating hand condition that can inhibitnormal hand and finger function.This condition involves the Palmaris longus muscle,the palmar aponeurosis or fasciaNodules develop in the fibrous tissue & cause a

permanent flexion mostly the 4th

& 5th

fingers inone or both hands.Thought is that the condition is hereditaryAlso common in clam diggers & lobster fishermenwhose hands are submerged in cold water in flexedpositions doing repetitive actions & in carpenterswho use tools that press into the palm.





Swelling oftendons infingers due tooveruse







There can be severalreasons why the spacein the carpal tunnel isreduced: small tumors,a ganglion cyst, fluid

retention duringpregnancy, depressedcarpal bones, andtenosynovitis of flexor

digitorum superficialisand profundus.



Hands in a flexedposition Elevation of upper arm

This position can

compress median nerve.Sleepers can on wakingexperience numbness,tingling or pins-and-needles sensations in thehands.Propping a pillow underthe hand & forearm canhelp prevent abductionof the scapula & helpprevent hyperflexionduring sleep.

This position helpspectoralis minor entrapbrachial plexus &possibly impede bloodsupply to the hand &wrist.Sleepers tend to wakewith a numb arm & haveto use the other arm tomove the arm back to

anatomical position.



Fetal sleepingpositioncontributes toroundedshoulders andentrappingbrachial plexus

Rounded shoulders:this posture withthe repetitivepronated forearm

which engages thepronator teres canlead to entrapmentof the median nerve



Compression ofnerves at thecervical level canlead to these

conditions.Arthritis: FES p. 241An inflammation ofjoints is commonin the agingprocess.



This is more common in the cervical and lumbar spine.It is a degenerative joint disease that can add bonygrowths (bone spurs) to individual vertebra and fray theedges in a jagged manner.Bone spurs can occur on the side of the vertebra and

result in linking vertebra together in what is called‘kissing spurs’.The additional growth inhibits neck movements andinnervation. The inhibited nerves can result in muscleatrophy and twitching.Osteoarthritis has no cure and can also occur in bonesand joints that have had previous injuries.



Common joints affectedby osteoarthritis



Often present in persons

with osteoarthritis.Results in the loss of diskspace between vertebra &the disk itselfdegenerates & reduces insize.Disks are needed toseparate the vertebra &to allow space for nervesto travel safely out of thearea.

Gilding joints of thecervical region that areslightly ajar.Pain, numbness andtingling with passive

movement can helpidentify problems inthe cervical region.If present, refer clientto their physician.

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K Class 9 TG Muscles of Arm