IJAR.2020.237

Type of Article:  Original Research

Volume 8; Issue 4.2 (December 2020)

Page No.: 7823-7828

DOI: https://dx.doi.org/10.16965/ijar.2020.237

SITE-SPECIFIC FASCIA TUNING PEGS AND PLACES OF PERILOUS PASSAGE MYOFASCIAL CONSIDERATIONS IN UPPER EXTREMITY ENTRAPMENT NEUROPATHIES: A CLINICAL ANATOMISTS VIEW

John Sharkey MSc.

Faculty of Medicine, Dentistry and Clinical Sciences, University of Chester/NTC, 15-16aSt Joseph’s Parade, Dorset St, DO7 FR6C, Dublin, Ireland.

Corresponding Author: John Sharkey MSc. Faculty of Medicine, Dentistry and Clinical Sciences, University of Chester/NTC, 15-16aSt Joseph’s Parade, Dorset St, DO7 FR6C, Dublin, Ireland. E-Mail:  john.sharkey@ntc.ie

ABSTRACT

The objective of this study was to identify common anatomical locations of densified fascia associated with axillary, musculocutaneous, median, ulnar and radial nerve entrapment. Additionally, a proposal concerning a tensegrity based expansive decompressive protective role of muscles and ligaments as ‘site-specific fascia tuning pegs’ is offered for consideration.  This observational report provides a means to stimulate research into the dynamics of force transfer via tensegral mechanotransductive pathways possibly decompressing neurovascular structures. Morphological changes to fascia profunda, septal tissues, epineurium, perineurium and endomysial tissue in continuity with neural structures were noted. Entrapment neuropathies involving the upper extremity are a growing and widespread phenomenon within modern society. Upper extremity neuropathies affect dentists, athletes (professional and recreational), pianists, grocery store employees, office workers, cab drivers and a host of other professional and non-professional individuals. Neurovascular insults can develop at multiple sites referred to by anatomists as the three P’s [i.e. Places of Perilous Passage]. The complexity of the inter-communicating nerve network, known as the brachial plexus, is well described as are the referred pain patterns of the contributing terminal branches. Sensory innervation to the upper extremity includes most of the axilla while excluding a specific region of the medial upper extremity and axilla which is supplied by the intercostobrachial nerve [i.e. T2]. This observational study identified specific anatomical locations where increased fascial densification lead to reduced gliding of the various facial laminae due to densified, fibrotic or adhered fascial tissues. A new hypothesis emerged concerning “site-specific fascia tuning pegs” described as biological instruments [i.e. muscle fibers and ligaments] that modify the length and width of the various specialist neural and vascular tubes [i.e. epineurium, tunica adventitia]. This author hopes that providing this information will assist in improving diagnosis, treatment and prognosis of upper extremity neurovascular insults that result in pain or unpleasant changes in sensation.

Key Words: Neuropathy, Fascia, Entrapment, Brachial Plexus, Tensegrity, Densification, Fibrotic, Site-Specific Fascia Tuning Pegs.

REFERENCES

[1]. Sanger, JM., Sanger, JW. Recent advances in muscle research. Anat Rec (Hoboken). 2014 Sep;297(9):1539-42.
https://doi.org/10.1002/ar.22986
PMid:25125167 PMCid:PMC4351654
[2]. Mukund K, Subramaniam S. Skeletal muscle: A review of molecular structure and function, in health and disease. Wiley Interdiscip Rev Syst Biol Med. 2020 Jan;12(1):e1462. doi: 10.1002/wsbm.1462. Epub 2019 Aug 13.
https://doi.org/10.1002/wsbm.1462
PMid:31407867 PMCid:PMC6916202
[3]. Tran, K., Han, J.-C., Crampin, E. J., Taberner, A. J., and Loiselle, D. S. (2017). Experimental and modelling evidence of shortening heat in cardiac muscle. J. Physiol. 595, 6313-6326.
https://doi.org/10.1113/JP274680
PMid:28771742 PMCid:PMC5621496
[4]. Hack GD, Koritzer RT, Robinson WL, et al. Anatomic relation between the rectus capitis posterior minor muscle and the dura mater. Spine 1995;20:2484-6.
https://doi.org/10.1097/00007632-199512000-00003
PMid:8610241
[5]. Zheng N, Yuan XY, Li YF, Chi YY, Gao HB, Zhao X, Yu SB, Sui HJ, Sharkey J. Definition of the to be named ligament and vertebrodural ligament and their possible effects on the circulation of CSF. PLoS One. 2014 Aug 1;9(8):e103451.
https://doi.org/10.1371/journal.pone.0103451
PMid:25084162 PMCid:PMC4118883
[6]. Hallgren RC, Hack GD, Lipton JA. Clinical implications of a cervical myodural bridge. AAO J 1997; 7:30-4.
[7]. Scali F, Marsili ES, Pontell ME. Anatomical connection between the rectus capitis posterior major and the dura mater. Spine 2011;36: E1612-4.
https://doi.org/10.1097/BRS.0b013e31821129df
PMid:21278628
[8]. Polcaro L., Charlick M., Daly DT. Anatomy, Head and Neck, Brachial Plexus. [Updated 2020 Aug 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan.
[9]. Bayot ML, Nassereddin A, Varacallo M. Anatomy, Shoulder and Upper Limb, Brachial Plexus. In: StatPearls. Treasure Island (FL): StatPearls Publishing; July 27, 2020.
[10]. Sharkey, J. Biotensegrity focused full-body Thiel soft-fixed dissections. 2015-2019. University of Dundee, Scotland.
[11]. Gurushantappa PK, Kuppasad S. Anatomy of axillary nerve and its clinical importance: a cadaveric study. J Clin Diagn Res. 2015 Mar;9(3):AC13-7.
https://doi.org/10.7860/JCDR/2015/12349.5680
PMid:25954611 PMCid:PMC4413059
[12]. Maruvada S, Madrazo-Ibarra A, Varacallo M. Anatomy, Rotator Cuff. [Updated 2020 Mar 29]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan.
[13]. Mark A. Mahan., Jaime Gasco., David B. Mokhtee., Justin M. Brown. Anatomical considerations of fascial release in ulnar nerve transposition: a concept revisited. 2015. J Neurosurg 123:1216-1222.
https://doi.org/10.3171/2014.10.JNS141379
PMid:25909576
[14]. Agarwal P, Gupta S, Yadav P, Sharma D. Cadaveric study of anatomical variations of the median nerve and persistent median artery at wrist. Indian J Plast Surg. 2014 Jan;47(1):95-101.
https://doi.org/10.4103/0970-0358.129632
PMid:24987212 PMCid:PMC4075226
[15]. Tubbs, Shane, R., Tyler, M., Marios, L., Mohammadali, Shoja, M., Aaron, A and Cohen-Gadol. The sublime bridge: anatomy and implications in median nerve entrapment. Laboratory investigation. J Neurosurg 2010;110-112.
https://doi.org/10.3171/2009.10.JNS091251
PMid:19895198
[16]. Guru A, Kumar N, Ravindra Shanthakumar S, Patil J, Nayak Badagabettu S, Aithal Padur A, Nelluri VM. Anatomical Study of the Ulnar Nerve Variations at High Humeral Level and Their Possible Clinical and Diagnostic Implications. Anat Res Int. 2015;378063.
https://doi.org/10.1155/2015/378063
PMid:26246909 PMCid:PMC4515264
[17]. Reckelhoff K, Li J, Kaeser M, Haun D, Kettner N. Ultrasound evaluation of the normal ulnar nerve in guyon’s tunnel: cross-sectional area and anthropometric measurements. J Med Ultrasound. (2015) 23:171-6.
https://doi.org/10.1016/j.jmu.2015.09.002
[18]. Clain JB, Vitale MA, Ahmad CS, Ruchelsman DE. Ulnar Nerve Complications After Ulnar Collateral Ligament Reconstruction of the Elbow: A Systematic Review. Am J Sports Med. 2019 Apr;47(5):1263-1269.
https://doi.org/10.1177/0363546518765139
PMid:29683338
[19]. Dy CJ, Mackinnon SE. Ulnar neuropathy: evaluation and management. Curr Rev Musculoskelet Med. 2016 Jun;9(2):178-84.
https://doi.org/10.1007/s12178-016-9327-x
PMid:27080868 PMCid:PMC4896870

Cite this article: John Sharkey MSc. SITE-SPECIFIC FASCIA TUNING PEGS AND PLACES OF PERILOUS PASSAGE MYOFASCIAL CONSIDERATIONS IN UPPER EXTREMITY ENTRAPMENT NEUROPATHIES: A CLINICAL ANATOMISTS VIEW. Int J Anat Res 2020;8(4.2):7823-7828. DOI: 10.16965/ijar.2020.237