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of proper joint mechanics can then produce various other pathologies. For example, the serratus anterior muscle plays a key role in scapular mechanics. Dysfunction in the serratus anterior muscle can lead to subacromial impingement and rotator cuff problems because of disturbed mechanics between the scapula and humerus. Physical characteristics ulnar nerve entering the cubital tunnel 3 can add to this cycle, making the problems more severe. Bone spurs and acromion process architecture can decrease the space between the acromion process and the supraspinatus tendon, and result in rotator cuff tears and degeneration. This is particularly true if the worker's activities require abduction of the shoulder, for example when a keyboard or mouse is too high and the arms must be raised to reach it. Even without bone spurs, long periods of increased abduction can produce The ulnar nerve is susceptible to compression in two key locations: in the elbow and the wrist. Mediclip image copyright (1998) Williams & Wilkins. All rights reserved. serious degenerative changes to the rotator cuff tissues. Even minor pressure from this adverse position can lead to shoulder impingement problems, such as rotator cuff compression or subacromial bursitis. Treatment strategies should pay attention to the tissues mentioned above, particularly those not usually treated. The supraspinatus should also be addressed, as it is regularly under perpetual contraction to hold the shoulders in slight abduction to reach the desk or keyboard. Specific treatment, such as static compression or deep stripping methods, should be applied to the remaining rotator cuff muscles, teres major, biceps brachii, and serratus anterior to help normalize shoulder mechanics. UPPER EXTREMITY Typical office tasks result in proximal upper-extremity stresses that are quite different from those in the distal upper extremity. The hands and fingers produce rapid and frequent tendon movement, while the upper arm is held rigid. This biomechanical pattern is problematic. Fascial fibers throughout the upper extremity envelop all of the tissues from the shoulder and neck down to the fingertips. Increased tightness with lack of mobility in the neck and upper arm can produce fascial adhesions and contribute to distal-extremity disorders such as tenosynovitis and upper- extremity nerve entrapment syndromes. Nerve tissue is especially susceptible to compression pathology when small loads are continually applied to a nerve for long periods. This is exactly what happens in most upper-extremity nerve compression pathologies. Because of the repetitive flexion motion of the fingers during typing, CTS is almost epidemic among office workers. It is the repetitive sliding of the flexor tendons through the tunnel that produces inflammatory reactions and decreases space within the tunnel, leading to median nerve compression. CTS is one of the most common conditions referred for surgery in office workers, yet it can often be successfully addressed with changes in ergonomics. Deep and specific stripping techniques applied to the forearm flexor muscles are highly valuable. Research also shows benefits of myofascial techniques applied directly to the carpal tunnel in gently increasing tunnel space and reducing compression on the nerve. It is important to make sure pressure is not applied directly to the irritated nerve during any massage technique, as this will aggravate the condition. Stretching of the palm is also useful for CTS, as long as none of the stretching motions further aggravate the nerve symptoms. 106 massage & bodywork july/august 2012