Faculty Bibliography

Fifteen unembalmed cadavers were dissected in order to study the "anatomical continuity" between the various muscles involved in the movement of flexion of the upper limb. This study demonstrated the existence of specific myofascial expansions, with a nearly constant pattern, which originate from the flexor muscles and extend to the overlying fascia. The clavicular part of the pectoralis major sends a myofascial expansion, with a mean length of 3.6cm, to the anterior region of the brachial fascia, and the costal part sends one to the medial region of the brachial fascia (mean length: 6.8cm). The biceps brachii presents two expansions: the lacertus fibrosus, oriented medially, with a mean height of 4.7cm and a base of 1.9cm, and a second, less evident, longitudinal expansion (mean length: 4.5cm, mean width: 0.7cm). Lastly, the palmaris longus sends an expansion to the fascia overlying the thenar muscles (mean length: 1.6cm, mean width: 0.5cm). During flexion, as these muscles contract, the anterior portion of the brachial and antebrachial fascia is subject to tension. As the fascia is rich in proprioceptive nerve endings, it is hypothesized that this tension activates a specific pattern of receptors, contributing to perception of motor direction. If the muscular fascia is in a non-physiological state, these mechanisms are altered, and the proprioceptors in the fascia may be incorrectly activated, thus giving rise to many types of extra-articular pain.

Classical anatomy still relegates muscular fascia to a role of contention. Nonetheless, different hypotheses concerning the function of this resilient tissue have led to the formulation of numerous soft tissue techniques for the treatment of musculoskeletal pain. This paper presents a pilot study concerning the application of one such manual technique, Fascial Manipulation, in 28 subjects suffering from chronic posterior brachial pain. This method involves a deep kneading of muscular fascia at specific points, termed centres of coordination (cc) and centres of fusion (cf), along myofascial sequences, diagonals, and spirals. Visual Analogue Scale (VAS) measurement of pain administered prior to the first session, and after the third session was compared with a follow-up evaluation at 3 months. Results suggest that the application of Fascial Manipulation technique may be effective in reducing pain in chronic shoulder dysfunctions. The anatomical substratum of the myofascial continuity has been documented by dissections and the biomechanical model is discussed.

The aim of this study is to analyse the deep fasciae of limbs in order to evaluate the collagen and elastic fibre arrangement and the types of innervation. Histological and immunohistochemical stains were performed in 72 specimens. The deep fascia of the limbs is a sheath presenting a mean thickness of 1mm, formed by two to three layers of parallel collagen fibre bundles. In the adjacent layers, they show different orientations. Each layer is separated from the adjacent one by loose connective tissue, permitting the sliding of the collagen layers. Nerve fibres were found in all specimens, while muscular fibres were evidenced only in one specimen. The described structure permits the fasciae of the limbs to have a strong resistance to traction, even when exercised in different directions. The capacity of the different collagen layers to glide one on the other could be altered in cases of overuse syndrome, trauma, or surgery.

BACKGROUND/AIMS: The aim of this study was to analyse the relationships between the expansions of the pectoral girdle muscles, i.e. pectoralis major, latissimus dorsi and deltoid, and the brachial fascia. METHODS: Thirty shoulder specimens from 15 unembalmed adult cadavers were studied by dissection and in vivo radiological studies were performed in 20 patients using magnetic resonance (MR) imaging. RESULTS: The clavicular part of the pectoralis major muscle sent a fibrous expansion onto the anterior portion of the brachial fascia, its costal part onto the medial portion and medial intermuscular septum. The latissimus dorsi muscle showed a triangular fibrous expansion onto the posterior portion of the brachial fascia. The posterior part of the deltoid muscle inserted muscular fibres directly onto the posterior portion of the brachial fascia, its lateral part onto the lateral portion and the lateral intermuscular septum. In MR images, the brachial fascia appeared as a low-signal-intensity sinuous line of connective tissue, sharply delineated in T(1)-weighted sequences. CONCLUSION: The expansions of the pectoral girdle muscles onto the brachial fascia were present in all the subjects and showed a quite constant course with a specific spatial organization. During the various movements of the arm, these expansions stretch selective portions of the brachial fascia, with possible activation of specific patterns of fascial proprioceptors.