Week 5

Arm lines ppt

4 arm lines per arm, 8 total

  • Deep Front Arm Lines (DFAL)

  • Deep Back Arm Lines (DBAL)

  • Superficial Front Arm Lines (SFAL)

  • Superficial Back Arm Lines (SBAL)

4 distinct Myofascial meridians (layers):

  • From axial shoulder through:

    • 4 layers of the shoulder to 4 quadrants of the arm and 4 sides of the hand (thumb, little finger, palm, and back of the hand)

Functions:

  • ADLs

  • Supporting body

  • Pushing and pulling

  • Connecting to other lines

Common issues:

  • compensation patterns

    • Protracted, retracted, rounded shoulders

    • Take help from other lines

  • Carpal tunnel syndrome

  • Elbow and shoulder impingement

  • Trigger point pain

Position arm out to he side with palm facing floor and olé ran on of elbow points back

  • DFAL: Thenar muscles, radius, biceps and pectoralis minor

  • DBAL: hypothecated muscles, ulnar, triceps, rotator cuff, rhomboids, levator Scap.

Position arm to side with palm forward and elbow down

  • SBAL: Trap, deltoid, lateral intermuscular septum, extensors

  • SFAL: Palmar muscles, lower arm flexors, intermuscular septum, pectorialis minor

DFAL: Functions

  • stabilizing line

  • In table top- Restricts or allows side to side movement

  • In open chain controls angle of the hand a the thin

    • -thumb’s grip

  • Anterior 3,4, & 5 ribs - pec minor-subclavius-clavipectoral fascia - coracoid process

    • Pectoralis minor and subclavius are embedded in clavipectoral fascia

    • Clavipectoral fascia runs from armpit to clavicle

  • Coracoid process-SH biceps- CCB-Brachialis

    • There is direct fascia continuity between pec minor and these distal muscles

    • May not seem like it when our arms are stationary at our sides, but they all align when arm is outstretched or we are in a chin-up type position

  • Pec Minor one unit with clavipectoral fascia

    • excessive shortness of this unit negatively affects:

      • Breathing

      • Neck and head posture

      • Function of shoulder/arm (specially reaching upwards)

      • Restriction of upper rib movement

      • Anterior tilt of scapular or rounded shoulders

      • Pin and stretch techniques work well here

  • SH biceps-CCB, brachialis - radial tuberosity

    • SH biceps affect 3 joints:

      • Glenohumeral joint

      • Humerus-ulnar joint

      • Radio-ulnar joint

  • Radial tub- pronation, supination, radial periosteum-radial styloid process

    • Pronator teres is also in the SBAL

      • Included because along with supinator, it controls rotation of the radius

  • RCL-scaphoid and Trap - thenar muscle - outside of thumb

    • Ext pollicis brev. & Abd pollicis long accompany these tissues They are part of the DBAL

SFAL: functions:

  • lies over DFAL

  • Broad set of origin attachments

  • Allows for shoulder abduction & extension

  • Participates with DFAL in hand grip

  • Broad origin points - pec major & latissumus Dorsi - medial humeral line

    • Latissmus Dorsi picks up teres major (lat’s little helper)

    • Lat, Pec major, teres major tendons all twist together and insert on the humerus

  • Medial humeral line - med. intermuscular septum - med. humeral epicondyle -common flexor tendons-carpal tunnel-palmar surface of hand and fingers

Stretch Assessment:

  • SFAL:

    • lie on back, drop arm, palm up, shoulder abducted

      • Extend the wrist & fingers for a greater stretch

      • Note stretch of pec major

  • DFAL:

    • Lie on back, drop arm, THUMB up

    • Stretch thumb away from shoulder

    • Note stretch up to pec minor

DBAL:

  • SPs lower Cervical & upper Thoracic - Rhomboids & lev. Scap. - med border of scap.

    • Rhomboids also part of spiral line

      • Spiral Line continues with Serratus

  • continues its rotator cuff

    • Infraspinatus

    • Then picking up teres minor

  • Greater tubercle on head of Humerus

  • Branch line: occiput - rectus capitis lat. - superior angle of Scap. - Supraspinatus - greater tubercle

  • Subscap - lesser tubercle

    • Subscap. Is connected with rhomboid fascia

  • Head of humerus-triceps- & anconeus - olecranon

  • Olecranon - ulna periosteum fascia - styloid process - UCL logs at wrist - triquetrum- hamate - outer 5th finger - hypothenar muscles

    • Roughly equivalent to lateral line in lower leg

    • Works with DFAL to:

      • Adjust angle of elbow

      • Limit or allow for side to side movement when in quadruped (table top)

      • Provide stability from outside of hand to back of the shoulder

SBAL:

  • wide sweep of axial attachments-trap-spine of Scap, acromiom, Thoracic SPs-deltoid

    • Thoracic fibers of trap link with post fibers of deltoid

    • Cervical fibers of trap link with mid deltoid

    • Occipital fibers of trap link with ant deltoid

  • Deltoid-deltoid tubercle-lat intermuscular septum-lat epicondyle humerus- common ext tendon-dorsal surface of fingers

    • Controls movement that occurs behind later midline

    • Counterbalances strong flexion tendency of SFAL

    • Controls abduction of shoulder

      • Tend to get overused when ribcage/spine slumps out from shoulder girdle

  • Stretch Assessment:

    • SBAL: Hold wrist of client and have them lean back (like water skiing), palms up

      • Note stretch through trapezius down through extensors

    • DBAL: Hold wrists of client and have them lean back (like water skiing), thumbs down

      • Note stretch through rhomboids and rotator cuff

Considerations of Scapula

  • our shoulder has the widest range of any joint in our body

    • Plenty of room for imbalances and instability do develop

    • Glenoid fossa is very shallow makes the muscles surrounding important in stabilization

  • Achieving a neutral positioned scapula is a great goal to have when evaluating patients (and uninjured athletes- especially overhead throwers)

  • Like the ASIS that Dr previously discussed the scapula is a roundhouse with multiple lines of pull

  • Of all these directions, 4 stand out for stability making an X pattern

    • Rhombo-serratus muscles unit

      • Serratus protracts scap inferiorly & Laterally

      • Rhomboids retract superiorly & medially

    • Lower trapezius & pec minor

      • Trap pulls spine of scap. Inferiorly & medially

      • Pecminor pulls down and in from anterior side

  • Lateral Scapula (scap pulling laterally): conditions

    • Long (weakened and stretched) Rhomboid, short serratus

    • Often Kyphotic thoracic curve

  • Medial Scapula (scap pulling medially): condition

    • Short rhomboid, long serratus

    • Often flat thoracic spine

  • Anterior tilt of scap on ribs (scap pasted on ribs)

    • Short pec minor and long lower trap

  • Treatment considerations:

    • Muscles locked short

      • Lengthening procedures (stretch, Myofascial release, etc.)

    • Muscles locked long:

      • Strengthen/tone muscles