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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 13 THE BRACHIAL PLEXUS Thank you for your brachial plexus article (November/December 2017, page 60). This is terrifi c! This is one of the best descriptions and most helpful illustrations I've ever seen about the brachial plexus. I have just started seeing a client with a bewildering pain in his lateral upper arm, and if this article doesn't help me parse it out, at the very least it will help me navigate the waters, as it were, a little better. Joseph, I hope to look into your educational materials, as this is exactly the kind of thing I've been feeling I need to move forward after nearly 20 years of being a licensed MT. Many thanks, ABMP. You continue to make my membership worthwhile. KRISTEN BURKHOLDER BELFAST, MAINE DIABETES Thank you for the excellent article on diabetes in the September/October 2017 issue of Massage & Bodywork ["Hey Sugar! A Diabetes Review," page 40]. Having been a long-time member, I wish to congratulate all those who work to create a truly spectacular magazine. Each year the publication improves and we greatly benefi t from the information (and videos) offered! Ruth Werner's article was very helpful. She did an excellent job explaining a complex disease—one that our family lives with. I would like to offer a suggestion to our population of health-care professionals that would build on her article. Anyone who has this disease (or is in a family or friendship with someone who does) should know about a conference that is offered multiple times per year across the country. Doctors, nurses, massage therapists, and supportive family members attend with those who have diabetes to hear information that directly pertains to the disease. It is called TCOYD, which stands for Take Care of Your Diabetes, and directly relates to Werner's statements about taking charge of one's health. Stephen Edelman, MD, (who lives successfully with Type 1 diabetes) is the founder and main presenter. Attendees hear updates about medications, products to support monitoring their blood sugar, and ideas for diet—all of which is presented in an upbeat, positive fashion. Spirits are lifted! The enthusiasm is contagious and people leave the day-long conference realizing there is hope—based on their actions. Our family attends every year (seven years and counting) and has found that the repeat attendance rekindles our sense of how this disease can be controlled successfully through diet and exercise. Anyone who has heard the numbers of people who have developed type 2 (as well as those born with type 1) know how important it is to take charge. I hope this additional information is helpful. The website is JUDY "SHANTI" GARLOCK ST. HELENA, CALIFORNIA A Correction In Til Luchau's article in the November/ December 2017 issue ["Working with the Vagus Nerve," page 94], there was an error with the image captions. The caption for Image 3 should go under Image 2, and the full caption for Image 3 should be: "Green: vagus nerve (X): auricular branch. Violet: mandibular nerve (V3): auriculotemporal branch. Orange: lesser occipital nerve (C2) and greater auricular nerve (C2, C3). White dots: facial nerve (VII): cutaneous fi bers. Courtesy" READER FORUM The brachial plexus of nerves and the subclavian/axillary artery and vein comprise a neurovascular bundle that is often compressed in the lower neck/upper thoracic region, causing a condition known as thoracic outlet syndrome (TOS). There are actually four different forms of TOS, each named for the region where the compression occurs (Image 1). One is called anterior scalene syndrome because the neurovascular contents are entrapped and compressed between the anterior and middle scalene muscles. The second is called costoclavicular syndrome because the entrapment/compression occurs between the first rib (cost is Latin for "rib") and the clavicle. The third is called pectoralis minor syndrome because the entrapment/ compression occurs between the pectoralis minor and the rib cage. The fourth type of TOS occurs due to the presence of a genetic anomaly that creates what is called a cervical rib, which is a formation of bone off the seventh cervical vertebra (C7). The first three types of TOS—anterior scalene, costoclavicular, and pectoralis minor syndromes—are caused by soft- tissue postural dysfunction and will respond well to manual and movement therapy care. Therefore, the emphasis for anyone in the field of bodywork should be placed on these forms of TOS. The fourth type—cervical rib TOS—being due to a relatively rare bony anomaly (which occurs in approximately 1–2 percent of the population) is not readily treatable with manual and movement therapy and is therefore of less importance to bodyworkers. The Brachial Plexus and Thoracic Outlet Syndrome Understanding Signs and Symptoms By Joseph E. Muscolino, DC Middle scalene Anterior scalene Brachial plexus trunks Musculocutaneous nerve Median nerve Ulnar nerve Axillary nerve Radial nerve Pectoralis minor Brachial plexus cords Subclavius Subclavian artery Cervical rib T1 C8 C7 C6 C5 C3 C6 1st rib Axillary artery and vein Thoracic outlet syndrome is the name given to a set of neurovascular compression syndromes that affect the brachial plexus of nerves and/or the subclavian/axillary artery and vein where they outlet from the thorax into the upper extremity. Note the presence of a cervical rib on the model's left side. Images courtesy Joseph E. Muscolino. Illustrations by Giovanni Rimasti. Photography by Yanik Chauvin and Joseph E. Muscolino. 60 m a s s a g e & b o d y w o r k n o v e m b e r / d e c e m b e r 2 0 1 7 1 This image is an anatomically correct, yet artistic, rendering of the brachial plexus of nerves, providing a visual touchstone for learning the structures. Leaves represent the muscles innervated by the branches of the brachial plexus; "½" indicates that muscle is innervated by two different nerve branches. Please see Tables 2 and 3 for a listing of the muscles corresponding to the abbreviations used in this image. 2 Brachial Plexus Tree

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