Anatomy of the Elbow, Part 2
Before we get into the ligaments and muscles of the elbow, I want to relate an experience I had yesterday. Recently I began to work with a fellow massage therapist. She has been booking 2-hour sessions, which is fabulous for me. The index finger on her right hand has developed some arthritis. It is swollen, stiff, and the range of motion is fairly limited. She has had these symptoms for two years! I said something to her about how she should have had it worked on before now (because massage therapists chronically do not get enough bodywork!), and she responded that she had tried a few times, but she couldn’t find a therapist that knew what to do with her arm and hand.
This began a conversation. I have had the same experience multiple times. I go to get work done, my forearm is killing me, I ask the therapist to focus there, and, as my client said, that means he or she spends three minutes there. In a couple of weeks I am going to Seattle to teach two classes – Head & Neck, and Arm & Hand. And in May I am going to the Orlando area to teach the same two classes. We, of course, have substantially more enrollment for Head & Neck.
I spent an hour and 45 minutes working on my client’s right hand, forearm, upper arm, and shoulder. It was fantastic to be able to spend that much time in one area and really clear the issues. After the session I was a little jealous, though, my arms wishing someone could do that to me! Now, to our anatomy.
First, muscles that connect the scapula and humerus: Deltoid, coracobrachialis, supraspinatus, infraspinatus, teres minor, subscapularis, latissimus dorsi, and teres major. Additionally, connecting the scapula and humerus are the glenohumeral joint capsule, the coracohumeral ligament, and the transverse humeral ligament. These muscles and ligaments make sure that the humerus and scapula never get too far apart. This means that if the scapula is pulled out of a neutral position so is the humerus, but it also means that if the humerus is pulled out of a neutral position so is the scapula.
Next, muscles that connect the scapula to the radius and ulna: Biceps brachii and triceps brachii. And muscles that connect the humerus to the radius and ulna: Brachialis, anconeus, triceps brachii (both the lateral head and the medial head originate on the posterior humerus), pronator teres, supinator, and brachioradialis. Additionally, the joint capsule for the elbow, the ulnar collateral ligament, the radial collateral ligament, and the anular ligament of the radius connect the humerus to the radius and ulna. These muscles and ligaments never let the radius and ulna get too far away from the humerus. This means that if the humerus is pulled out of a neutral position, it will pull the radius and ulna out of neutral. And if the radius and/or ulna are shifted out of a neutral postion, the humerus will be also.
Let’s stop here for a moment. I’m sure some of you are beginning to see the point I am making. As bodyworkers we spend quite a bit of time on the shoulders. Most clients shoulders are pulled into an anterior position. We spend time trying to move the shoulder back, release the tissue around the shoulder, and create more space and mobility. We understand the shoulder and the tissue that operates at the shoulder. But there is a direct correlation, through muscle tissue and bony articulation, between the humeral position, the elbow, and the forearm. So, why are we so versed in the shoulder, but avoid the elbow and forearm?
Finally, let’s look at muscles that connect the humerus to the hand: Flexor carpi radialis, flexor carpi ulnaris, palmaris longus, flexor digitorum superficialis, extensor carpi radialis longus, extensor carpi radialis brevis, extensor carpi ulnaris, extensor digitorum communis, and extensor digiti minimi. These muscles create a direct link between the position of the humerus and alignment of the hand. This means the shoulder position is connected to what is happening in the hand.
Is it possible to fully unlock the tissue of the shoulder without working on the tissue of the upper arm, the forearm, and the hand? My answer to this would be no. Releasing the hand, the forearm, and the upper arm can fully shift the position of the shoulder. This can effect muscles like serratus anterior, which in turn can loosen its grip on the ribcage (and the fascia from serratus anterior blends into the fascia of external obliques, so this may even have an effect on the abdominal muscles and overall posture). The ribcage having more space can open up the back, which will already be feeling better because of the more neutral position of the scapula. This could go on and on……and all from a little arm and hand work.