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A B M P m e m b e r s e a r n F R E E C E a t w w w. a b m p . c o m / c e b y r e a d i n g M a s s a g e & B o d y w o r k m a g a z i n e 69 TABLE 3 Muscle Innervations of the Preterminal Branches Author's note: The abbreviation listed after each name corresponds to the abbreviation used in Image 2. Long Thoracic Ner ve Serratus Anterior ( SA) Dorsal Scapular Ner ve Rhomboid Major ( RMaj) Rhomboid Minor ( RMin) Levator Scapulae ( LevSc) Subclavian Ner ve Subclavius ( Subcl) Suprascapular Ner ve Infraspinatus ( Infra) Supraspinatus ( Supra) Medial Pectoral Ner ve Pectoralis Minor ( PMin) Pectoralis Major ( PMaj) Lateral Pectoral Ner ve Pectoralis Minor ( PMin) Pectoralis Major ( PMaj) Upper Subscapular Ner ve Teres Major ( TMaj) Subscapularis ( Subsc) Lower Subscapular Ner ve Subscapularis ( Subsc) Thoracodorsal Ner ve Latissimus Dorsi ( Lat) Medial Antebrachial Cutaneous Ner ve Sensor y only Medial Brachial Cutaneous Ner ve Sensor y only nerve branch is being compressed and, therefore, direct our manual therapy assessment and treatment. Image 4 illustrates the sensory innervation pattern of the peripheral nerves of the brachial plexus. BRACHIAL PLEXUS AND ITS RELATIONSHIP TO THORACIC OUTLET SYNDROME Although knowing anatomy for anatomy's sake is wonderful, ultimately, its importance lies in our ability to marry together the underlying science of anatomy with our hands-on manual therapy assessment and treatment techniques. By first learning anatomy (structure), physiology (function) can be figured out. By then understanding function, altered function (pathophysiology) can be figured out. Armed with an understanding of the mechanics of pathophysiology, our hands- on assessment and treatment tools can then be determined. In essence, a deeper knowledge of anatomy allows for the critical reasoning skills that then allow for creative application of our hands-on manual and movement therapy techniques. Joseph E. Muscolino, DC, has been a manual and movement therapy educator for more than 30 years. He is the author of multiple textbooks, including The Muscular System Manual: The Skeletal Muscles of the Human Body (Elsevier, 2017); The Muscle and Bone Palpation Manual with Trigger Points, Referral Patterns, and Stretching (Elsevier, 2016); and Kinesiology: The Skeletal System and Muscle Function (Elsevier, 2017). He is also the author of 12 DVDs on manual and movement therapy and teaches continuing education workshops around the world, including a certification in Clinical Orthopedic Manual Therapy (COMT), and has created Digital COMT, a video streaming subscription service for manual and movement therapists, with new content added each and every week. Visit www.learnmuscles. com for more information or reach him directly at joseph.e.muscolino@gmail.com. see Image 4). Thus Image 2 gives us the full expression of the structure and innervation patterns of the brachial plexus of nerves. Importance of Motor Innervation The specific muscles innervated by the terminal and preterminal branches of the brachial plexus have been described in Images 2 and 9, and listed in Tables 2 and 3. Knowing these motor innervations of the brachial plexus nerves can help us understand how TOS nerve compression can affect muscular function and assist us in finding and treating our clients' dysfunctional patterns. Most commonly, TOS will result in compression of median, radial, or ulnar nerves. Assessing the presence of TOS can then be correlated with motor dysfunction in the innervation patterns of these nerves. The following motor innervation generalizations can be made: • The musculocutaneous nerve innervates the muscles of the anterior arm. • The median nerve innervates the muscles of the anterior forearm and the intrinsic muscles of the thenar eminence of the hand. • The ulnar nerve innervates the intrinsic muscles of the hypothenar eminence and central compartment of the hand. • And the radial nerve innervates the posterior muscles of the arm and forearm. Author's note: slight exceptions to these rules exist (see Image 2 for the detailed muscle innervations), but they are a good starting point to learning motor innervation patterns of the upper extremity. Importance of Sensory Innervation Knowledge of the sensory innervation patterns of the branches of the brachial plexus is also extremely important. If a client presents with any type of paresthesia (e.g., pain, tingling, numbness) in the upper extremity, the location of the paresthesia can direct us toward which brachial plexus