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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_5521_Библиотеки_им_академика_М_И_Перельмана.pdf
Chapter 4 / Kinesiology and Biomechanics 171
Figure 4-15. Asymmetric stance. (A) Asymmetric lean. (B) Asymmetric pull.
Symmetric Stance
The symmetric stance , also called the parallel stance, has
both feet facing forward about shoulder-width apart, hips facing forward, knees bent. In this position, your body is symmetrical (the same on both sides) while facing your work
(Fig.4-14). This stance is good for performing light strokes
that travel only a few inches along the client’s body and when
the stroke travels directly transversely, across the client’s body.
Asymmetric Stance
The asymmetric stance , also called the one-foot- forward
stance, has one foot in front of the other, the front foot facing the work, the back foot laterally rotated. The hips face the
work, the feet are about shoulder-width apart, the front knee
is flexed, and the back knee is extended. Your weight is primarily supported by your back foot and the client’s body at
the contact point, and the front foot is used more for balance
than support (Fig. 4-15A). This asymmetric stance is most
often used in massage therapy because it provides the best
leverage for strokes that require a lot of pressure and makes
it easier to move around the table throughout the massage.
The asymmetric stance can also be used for pulling. If
you maintain structural alignment, your own weight does
the pulling rather than your muscles. Simply grasp your client’s arm or hand, relax your elbows and shoulders, and lean
backward (Fig. 4-15B).
symmetric stance. In terms of body mechanics, you can
apply more pressure with the same amount of exertion if
you lean from your back foot than if you flex at the hips and
lean from your waist. Try to keep your ears, shoulders, hips,
and back heel in a straight line. It minimizes unnecessary
stress on your body and maximizes the pressure you can
apply. You can use the steps in Box 4-2 to take an asymmetric position next to a client on the massage table.
head-to-heel line as long as you are an appropriate distance
away from the table. Typically, therapists keep their front
foot less than 10 inches away from the table, but this is a
general distance that is adjusted for different strokes and different applications. Standing too close to or too far from the
table compromises the head-to-heel line.
ing guidelines can help you establish an efficient asymmetric
alignment for applying most massage strokes (Fig. 4-16):
The asymmetric stance offers more leverage than the
An open, asymmetric stance allows you to maintain the
Once you get comfortable with the stances, the follow-
• Use the back foot to support your weight.
• Use the front foot for balance.
172 INTRODUCTION TO MASSAGE THERAPY
Taking an Asymmetric Stance Next to a Client on a Massage Table
1. Stand about 6 inches away from the middle of the massage
table, with your head, hips, and toes all facing the center of
the table.
2. Spread your feet shoulder-width apart.
3. Turn toward the client’s head by pivoting on your toes. Your
toes, hips, and face will all be facing your client’s head, at an
angle to the massage table, with one foot in front of the other.
4. Take a half step backward with your back foot to spread
your feet apart. You may want to laterally rotate your back
leg for stability.
5. Place the hand that is contralateral to (on the opposite side
of) your back foot on the client’s shoulder.
6. Lean on the client’s shoulder and lift your weight off your
front foot to rest your weight on the client’s body and the
floor under your back foot.
7. Place your other hand on the client for balance.
Figure 4-16. Ideal asymmetric alignment.
Chapter 4 / Kinesiology and Biomechanics
173
• Use the hand that is contralateral to the back foot to
apply the stroke (use the right hand if the left foot is
in back) to avoid twisting at the waist.
• Keep your ears, shoulders, hips, and the heel of your
back foot in a line as much as possible.
• Point your front foot and hips toward your work
instead of twisting at the waist.
• The wrist angle, between the posterior surface of the
hand and the forearm, should be no less than 110°.
• The axillary angle, or the angle between your
humerus and the side of your body, should not
exceed 90°.
• Position yourself behind your work instead of on
top of it.
Try to keep the axillary angle of about 90°, keeping your arm about perpendicular to your body, to help
you achieve efficient alignment. When the angle is less
than 90° or your arm is too close to your body, you may
be applying pressure from an angle that puts undue and
unsafe stresses on your glenohumeral joint. When the
angle exceeds 90° or your arm is too far away from your
body, you have to use your muscles to hold your body up,
creating additional muscle strain and increasing the possibility of pain or injury. To maintain this angle while performing a long stroke that travels some distance along the
client’s body, you have to walk slowly and smoothly with
the stroke (Fig. 4-17).
Your wrist should remain relaxed, and the angle
between the posterior surface of the hand and the forearm should not be less than about 110° (see Fig. 4-16). Try
this: actively extend your wrist and notice the limit of the
extension. That position is as far as you want to push your
wrist when applying strokes. When the angle is less than
that, the structures running through the carpal tunnel are
compressed.
It is safer for clients if the pressure of your stroke is delivered at an oblique angle or from a somewhat sideways direction instead of directly perpendicular to the client’s tissues.
When pressure comes from an angle, clients can roll away
from pressure that is painful or uncomfortable, giving them
a sense of control over the session. When the pressure comes
from directly behind the contact point where the massage
stroke is applied to their skin, clients cannot roll away. Besides,
in order to apply pressure directly into the client’s tissues rather than at an angle, you would need to be standing on top of
the client in order to maintain good body mechanics.
Ergonomics
Ergonomics adapts the workspace to maximize a person’s
productivity, well-being, and safety. The components of
ergonomics in a massage practice include equipment and
workspace design.
Equipment
Massage equipment is not standard. There are different
sizes and shapes of massage tables, some of them at a fixed
height and others that are manually or electrically adjustable. Stools may or may not have wheels or adjustable
heights. In order to maintain good body mechanics, the
height of the table or, more importantly, the height of the
client’s body on the table is critical. The general rule is to
make sure that the top of the table is about at the middle
of your index finger or the middle of your thigh, but that
is only a general starting point (Fig. 4-18). It is important
Figure 4-17. Walking with stroke.
174 INTRODUCTION TO MASSAGE THERAPY
Figure 4-18. Proper table height.
to take your own body type into consideration with the
table height. If you have a long torso and short legs or you
have a short torso and long legs, you will need to adjust
the table to ensure your body remains in alignment as you
perform massage. If your table is too high, you may feel
neck and shoulder tension, discomfort, or pain, symptoms
that suggest you are elevating your shoulders while giving
massages. Conversely, if your table is too low, you may feel
tension or pain in your low back, suggesting that you are
bending at the waist while treating clients.
You may need to adjust the height of your table for different clients. The body of a very thin client can be a foot
lower than the body of a very thick client, and these differences will affect your body mechanics significantly. When the
client’s body is at the right height, you can use your body
with ease, and the massage can flow smoothly. If your massage table is not adjustable, you will have to adjust your
stance in an effort to maintain good body mechanics.
Sitting on a chair or stool uses less energy than standing, and there are times during the massage that you can
sit in a chair and still maintain good body mechanics. Any
time you work on a client’s head, hands, or feet, it may be
better to sit down (Fig. 4-19). Chairs and stools with wheels
are especially easy to use, because you can easily move them
around with your feet while your hands maintain contact
with your client’s body.
anything, or getting hurt. There should be enough floor
space around your massage table so you can use an asymmetric stance and lean into your client without stepping on
anything or running into a wall. If you do not have enough
room around the table, your tendency will be to stand too
Workspace Design
The arrangement of the equipment in your massage workspace should take efficiency as well as safety into consideration. You will need adequate space around the table to
maintain good body mechanics, to move easily around
the table, and to make sure your clients can maneuver in
the room without bumping into anything, tripping over
Figure 4-19. Sitting on a chair to conserve energy.
Chapter 4 / Kinesiology and Biomechanics 175
AB
Figure 4-20. (A) Adequate workspace allows for efficient structural alignment. (B) Inadequate workspace results in compromised body
mechanics. (Reprinted with permission from Frye B. Body Mechanics for Manual Therapists: A Functional Approach to Self-Care. Philadelphia:
Lippincott Williams & Wilkins, 2010.)
keep breathing while doing massage. The muscles need oxymuscular work or lose the proper alignment of your body
and endanger your joints. You should also take the size and
shape of your own body into account. For example, if you
are very tall you may need more space around the table than
if you are shorter. In general, you should have at least 3 feet
of space around your table to be able to move freely during the session. Figure 4-20 illustrates the difference between
adequate and inadequate workspace.
gen to generate energy. You may occasionally want to utilize
deep breathing to increase circulation and decrease muscle
tension. There is more information about breathing and an
exercise for learning how to breathe from the diaphragm in
Chapter 9, Massage Strokes and Flow.
You may want to incorporate a body mechanics “check”
at opportune points throughout the massage, perhaps when
you hold up the sheet to allow clients to turn over or when
you redrape a particular area of the body. You can practice
body awareness by periodically asking yourself questions
while you give a massage:
Body Awareness
• Am I using my whole body?
It will be helpful to incorporate body awareness as you learn
massage, paying attention to your body’s positions, movements, and sensations during a massage session. Make sure
that you establish good body movement habits and that you
keep your body relaxed and comfortable. For example, massage therapists tend to shrug their shoulders when they are
first learning massage as well as when they are fatigued. The
result is usually tight and sore shoulders by the end of the day.
If you pay attention to your body, you will notice the improper position of your shoulders and can relax and drop your
shoulders before pain and tension set in.
Breathing is an important component of body awareness you might not have considered. Curiously enough,
massage students tend to hold their breath when they are
first learning. It may seem obvious, but it is important to
• Is there a straight line formed by my head, hips, and
back foot?
• Are my hips and front foot facing my work?
• Are my wrists, hands, and shoulders relaxed?
• Are any of my joints hyperextended?
• Am I breathing?
• Does my body hurt anywhere?
There is no doubt that at some point in your career
you will experience some pain and discomfort, either in a
massage session or as the result of performing several massages over time; increased body awareness will help you
make the necessary adjustments to minimize your chance
of injury.
176 INTRODUCTION TO MASSAGE THERAPY
Improper Body Mechanics
Your ability to deliver strength, pressure, and control are
compromised by poor structural alignment. Worse yet,
inefficient alignment can lead to injury. Massage involves
a lot of repetitive movements and compression, both of
which are stressful on the joints. A vicious circle of bad
body mechanics begins as bad body mechanics lead to
fatigue, fatigue often exacerbates bad body mechanics,
and so on.
The hands, fingers, thumbs, and wrists are used
extensively in massage. Although the hands are the first
things that come to mind when you think about giving
a massage, the rest of your body supports your hands in
the application of a stroke or technique. One massage
performed with poor body mechanics may not cause
much harm, but after several massages a day over months
and years, bad body mechanics will undoubtedly cause
trouble. You can develop chronic pain, injuries, and other
uncomfortable symptoms in your hands, fingers, thumbs,
wrists, shoulders, neck, back, and low back. In severe
cases, these conditions can end your career. This section
points out how improper body mechanics can develop
into pain patterns, and how you can minimize the risk of
injury.
Injury
Massage puts undue stress on the muscles and joints even
when you do use good body mechanics. Essentially, the
body is not designed to perform repetitive motions for an
extended period, which is what occurs in massage therapy.
RSIs result when specific body movements are repeated
enough to stress the involved structures to the point of damage. Several areas of the body are prone to pain patterns,
possible reasons for which are described below:
• Neck and shoulders
• The table may be too high.
• You may be pushing instead of leaning.
• Wrist and hands
• You may be applying pressure directly into the
client’s tissues rather than leaning at an angle.
• You may be using your fingers and thumbs to
squeeze and knead more than necessary.
• You may not be stacking the joints of your fingers
and thumb when applying strokes.
• Back
• You may be bending and/or overreaching.
• You may be lifting with improper alignment.
• Knees
• You may be hyperextending (locking) your knees.
• You may be twisting, leaving toes pointed in one
direction while the hips point in another direction.
• Ankles and feet
• You may be standing too much.
• You may need shoes that are more supportive.
A sudden increase in your workload or decrease in the
amount of rest you take between massage sessions can also
develop pain patterns. For example, your massage practice
suddenly jumps from 3 to 5 clients a week to 10 clients per
week. This large influx of clients is financially appealing, but
you will do yourself a long-term favor by pacing yourself
and scheduling these clients over a 2-week period.
Repetitive motions impact the musculotendinous unit as
muscles repeatedly exert strain on their tendons. Symptoms
of inflammation, mild-to-severe discomfort or pain, decreased
strength, and decreased ROM can result. Examples of specific
musculotendinous injuries include muscle strain, tendinitis,
or tenosynovitis (inflammation of the tendon sheath) in the
shoulder, forearm, hands, fingers, or thumbs.
Nerve compression impairs nerve function and results
in symptoms such as burning, tingling, pins and needles
(paresthesia), and radiating pain. A couple of nerve compression injuries are carpal tunnel syndrome and thoracic
outlet syndrome. Briefly, the carpal tunnel is created by the
carpals of the wrist forming a passageway for blood vessels,
tendons, and the median nerve, which serves the thumb and
first two fingers. Excessive, sustained pressure on the carpal
tunnel can negatively affect the structures running through
it, eventually becoming a nerve compression injury called
carpal tunnel syndrome. Thoracic outlet syndrome is a similar nerve compression injury resulting from restricted and
tight soft tissues that compress the brachial plexus, which
serves the shoulder, forearm, and hand.
Injury Prevention
Now that you recognize the possibility of developing your
own pain patterns by practicing massage, you can appreciate
how important it is to take care of your body. If you do not
keep your muscles healthy with sufficient exercise, water
consumption, stretching, and massage, your body will be
more susceptible to injury and fatigue. Massage is a physically demanding career that requires strength and flexibility.
Strength will help you perform massage strokes, lift clients,
and assist clients who need help getting on and off the table.
Since massage involves a lot of muscular activity on your
part, it is wise to stretch before and between massage sessions to keep your soft tissues flexible. Remember to:
• Breathe deeply.
• Relax.
Chapter 4 / Kinesiology and Biomechanics 177
• Stretch slowly to avoid the stretch reflex.
• Hold the stretch for at least 10 seconds to trigger the
tendon reflex, which comfortably enhances the stretch.
If massage is going to be your career, you may want to
consider strength training, yoga, tai chi, or stretching on a
regular basis as part of your self-care regimen. Self-care for
the massage therapist, including examples of stretches, is
covered in more detail in Chapter 13, Professional Massage
Practice.
Along with developing strength and flexibility, it is
also a good idea to develop your cardiovascular system to
increase your endurance, which you can incorporate into
your self-care regimen. Endurance is not necessary to perform one massage, but as you increase your practice to multiple massages each day and more than 10 a week, you will
need endurance to sustain your practice. If your endurance
is low, you may get tired easily, your body mechanics may
suffer, and you may be more likely to suffer an injury.
The following are guidelines to help you with injury
prevention:
• Consistently use all the components of good body
mechanics.
• Rest your body and your hands by scheduling clients
a minimum of 15 minutes apart.
• Stretch before and after massage sessions.
• Use the proper table height.
• Make sure you have plenty of room to move around
the table.
• Use a variety of techniques in your massage sessions.
• Be cautious with applications of sustained pressure.
• Increase your own physical fitness and endurance.
• Get plenty of sleep and rest.
If you notice any soreness, aches, fatigue, pain, burning, numbness, tingling or loss of function, or signs of inflammation including
redness, heat, or swelling, you must try to figure out what is causing
the symptoms and make the appropriate changes to your structural
alignment, techniques, equipment, or schedule. You may want to
visit a healthcare professional for evaluation and treatment. Do not
risk your career by tolerating pain and injury.
Body mechanics are best learned in a classroom with an instructor
to help you, but the concepts outlined in this chapter can serve as
reminders outside the classroom. There are differing thoughts and
opinions about which stances are best for minimizing stress on your
body and maximizing your energy to practice massage. As you learn
and practice massage, your body awareness can guide you to the
stances and positions that are most comfortable and do not create
discomfort or pain in your body. To start, just choose a stance, relax
your body, and begin to work. If you feel muscle tension developing
or you start feeling fatigued at any point during a massage, change
your position or change your technique. You must raise your body
awareness and develop good body mechanics as you learn the strokes
and flow of massage so you can build a successful practice without
damaging your body.
178 INTRODUCTION TO MASSAGE THERAPY
SPECIAL MUSCLE SECTION
Action Movement Muscle Origin
Insertion (bone that is
moved is CAPITALIZED)
SHOULDER
Elevation Levator scapula Transverse
processes of C1–C4
Rhomboid major C7, T1–5 Medial border of
Trapezius (upper) Occiput,
ligamentum nuchae
Depression Serratus anterior Outer surfaces of ribs
8–10
Subclavius Junction of first rib and
costal cartilage
Trapezius (lower) T4–12 Root of spine of SCAPULA Accessory (C3,4) Plate 4-1
Protraction Serratus anterior Outer surfaces of ribs
8–10
Retraction Rhomboid major C7, T1–5 Medial border of
Trapezius
(middle)
Upward Rotation Serratus anterior Outer surfaces of ribs
Trapezius (lower) T4–12 Root of spine of
Trapezius
(upper)
Downward
Rotation
Forward Rotation Pectoralis minor Anterior surface of ribs
Flexion Coracobrachialis Coracoid process of
Accessory
Muscles/Assist
Flexion
Levator scapula Transverse processes of
Pectoralis minor Anterior surface of ribs
Rhomboid major C7, T1–5 Medial border of
Deltoid (anterior) Lateral third of clavicle Deltoid tuberosity of
Pectoralis major Medial clavicle, sternum,
Biceps brachii Long head: supraglenoid
Subscapularis Subscapular fossa on
Ligamentum nuchae,
C7-T4
8–10
Occiput, ligamentum
nuchae
C1–C4
3,4,5
3,4,5
scapula
costal cartilages of
ribs2–6
tubercle of scapula Short
head: coracoid process of
scapula
anterior scapula
Medial border of
SCAPULA
SCAPULA
Lateral end of clavicle,
lateral spine of SCAPULA
Anterior surface of medial
border of SCAPULA
Inferior surface of
CLAVICLE
Anterior surface of medial
border of SCAPULA
SCAPULA
Spine of SCAPULA Accessory (C3,4) Plate 4-1
Anterior surface of medial
border of SCAPULA
SCAPULA
Lateral end of clavicle,
lateral spine of SCAPULA
Medial border of
SCAPULA
Coracoid process of
SCAPULA
SCAPULA
Coracoid process of
SCAPULA
Medial side of middle of
HUMERUS
HUMERUS
Greater tubercle of
HUMERUS
Tuberosity of RADIUS Musculocutaneous
Lesser tubercle of
HUMERUS
Nerve (spinal segment
nerve numbers) Plate(s)
Cervical & dorsal
scapular (C3,4,5)
Dorsal scapular (C4,5) Plate 4-1
Accessory (C2,3,4) Plate 4-1
Long thoracic (C5,6,7) Plate 4-2
Branch of brachial
plexus (C5,6)
Long thoracic (C5,6,7) Plate 4-2
Dorsal scapular (C4,5) Plate 4-1
Long thoracic (C5,6,7) Plate 4-2
Accessory (C3,4) Plate 4-1
Accessory (C2,3,4) Plate 4-1
Cervical & dorsal
scapular (C3,4,5)
Lateral pectoral
(C5,6,7)
Dorsal scapular(C4,5) Plate 4-1
Lateral pectoral
(C5,6,7)
Musculocutaneous
(C5,6,7)
Axillary (C5,6) Plate 4-3
Lateral and medial
pectoral (C7,C8,T1)
(C5,6)
Subscapular (C5,6,7) Plate 4-2
Plate 4-1
Plate 4-3
Plate 4-1
Plate 4-3
Plate 4-3
Plate 4-4
Plate 4-3
Plate 4-4
(continued)
Chapter 4 / Kinesiology and Biomechanics 179
SPECIAL MUSCLE SECTION (Continued)
Action Movement Muscle Origin
SHOULDER (continued)
Extension Deltoid
(posterior)
Latissimus dorsi Thoracolumbar fascia,
Teres major Lower third of scapula Bicipital groove of
Accessory
Muscles/Assist
Flexion
Abduction Deltoid Anterior: lateral third of
Accessory
Muscles/Assist
Abduction
Adduction Latissimus dorsi Thoracolumbar fascia,
Accessory
Muscles/Assist
Adduction
Lateral Rotation Deltoid
Triceps brachii Long head: infraglenoid
Supraspinatus Supraspinous fossa of
Biceps brachii
(long head)
Infraspinatus Infraspinous fossa of
Pectoralis major Medial clavicle, sternum,
Teres major Lower third of scapula Bicipital groove of
Biceps brachii
(short head)
Coracobrachialis Coracoid process of
Teres minor Upper axillary border of
( posterior)
Infraspinatus Infraspinous fossa of
Teres minor Upper axillary border of
Spine of scapula Deltoid tuberosity of
iliac crest, inferior angle
of scapula, spinous
processes of T7-S3)
tubercle of scapula
lateral head: upper third
of posterior humerus
medial head: distal half of
humerus
clavicle middle: lateral
acromion posterior: spine
of scapula
scapula
Supraglenoid tubercle of
scapula
scapula
iliac crest, inferior angle
of scapula, spinous
processes of T7-S3)
costal cartilages of
ribs2–6
Coracoid process of
scapula
scapula
scapula
Spine of scapula Deltoid tuberosity of
scapula
scapula
Insertion (bone that is
moved is CAPITALIZED)
HUMERUS
Bicipital groove of
HUMERUS
HUMERUS
Olecranon process of
ULNA
Deltoid tuberosity of
HUMERUS
Greater tubercle of
HUMERUS
Tuberosity of RADIUS Musculocutaneous
Greater tubercle of
HUMERUS
Bicipital groove of
HUMERUS
Greater tubercle of
HUMERUS
HUMERUS
Tuberosity of RADIUS Musculocutaneous
Middle of medial
HUMERUS
Greater tubercle of
HUMERUS
HUMERUS
Greater tubercle of
HUMERUS
Greater tubercle of
HUMERUS
Nerve (spinal segment
nerve numbers) Plate(s)
Axillary (C5,6) Plate 4-3
Thoracodorsal, brachial plexus (C6,7,8)
Upper and lower
scapular(C5,6)
Radial (C6,7,8) Plate 4-4,
Axillary (C5,6) Plate 4-3
Suprascapular (C5,6) Plate 4-5
(C5,6)
Suprascapular (C5,6) Plate 4-5
Thoracodorsal, brachial plexus (C6,7,8)
Lateral and medial
pectoral (C7,C8,T1)
Upper and lower
scapular (C5,6)
(C5,6)
Musculocutaneous
(C5,6,7)
Axillary (C5,6) Plate 4-5
Axillary (C5,6) Plate 4-3
Suprascapular (C5,6) Plate 4-5
Axillary (C5,6) Plate 4-5
Plate 4-1
Plate 4-1
Plate 4-8
Plate 4-4
Plate 4-1
Plate 4-3
Plate 4-1
Plate 4-4
Plate 4-4
(continued)
180 INTRODUCTION TO MASSAGE THERAPY
SPECIAL MUSCLE SECTION (Continued)
Action Movement Muscle Origin
Insertion (bone that is
moved is CAPITALIZED)
SHOULDER (continued)
Medial Rotation Anterior deltoid Lateral third of clavicle Deltoid tuberosity of
HUMERUS
Latissimus dorsi Thoracolumbar fascia,
iliac crest, inferior angle
of scapula, spinous
processes of T7-S3)
Pectoralis major Medial clavicle, sternum,
costal cartilages of
ribs2–6
Subscapularis Subscapular fossa (ante-
rior surface of scapula)
Teres major Lower third of scapula Bicipital groove of
Bicipital groove of
HUMERUS
Greater tubercle of
HUMERUS
Lesser tubercle of
HUMERUS
HUMERUS
ELBOW
Flexion Biceps brachii Long head: supraglenoid
tubercle of scapula Short
head: coracoid process of
scapula
Brachialis Distal half of anterior
humerus
Brachioradialis Lateral, distal humerus Styloid process, distal
Extension Triceps brachii Long head: infraglenoid
tubercle of scapula
lateral head: upper third
of posterior humerus
medial head: distal half of
humerus
Assist Extension/
Accessory
Muscles
Pronation Pronator
Assist pronation/
Accessory
muscles
Supination Biceps brachii Long head: supraglenoid
Anconeus Lateral epicondyle of
humerus
Anterior, distal ulna Anterior, distal RADIUS Median (C6,7) Plate 4-6
quadratus
Pronator teres Medial epicondyle of
humerus, coronoid
process of ulna
Anconeus Lateral epicondyle of
humerus
Brachioradialis Lateral, distal humerus Styloid process, distal
tubercle of scapula Short
head: coracoid process of
scapula
Supinator Lateral epicondyle of
humerus; proximal,
posterior end of ulna
Tuberosity of RADIUS Musculocutaneous
Proximal tuberosity of
ULNA
end of RADIUS
Olecranon process of
ULNA
Olecranon process of
ULNA
Middle of lateral RADIUS Median (C6,7) Plate 4-6
Olecranon process of
ULNA
end of RADIUS
Tuberosity of RADIUS Musculocutaneous
Anterior, proximal third of
RADIUS
Nerve (spinal segment
nerve numbers) Plate(s)
Axillary (C5,6) Plate 4-3
Thoracodorsal,
brachial plexus
(C6,7,8)
Lateral and medial
pectoral (C7,C8,T1)
Subscapular (C5,6,7) Plate 4-5
Upper and lower
scapular(C5,6)
(C5,6)
Musculocutaneous
(C5,6,7)
Radial (C5,6) Plate 4-7
Radial (C6,7,8) Plate 4-8
Radial (C7,8) Plate 4-7
Radial (C7,8) Plate 4-7
Radial (C5,6) Plate 4-7
(C5,6)
Radial (C6) Plate 4-6
Plate 4-1
Plate 4-3
Plate 4-1
Plate 4-6
Plate 4-7
Plate 4-6
(continued)