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Viscerosomatic Reflex

Dr. Jimenez DC presents clinical implications of the viscerosomatic reflex.

In today’s big data informational era, there are many disorders, diseases, and clinical presentations that demonstrate concomitant associations, coincidences, correlations, causations, overlapping profiles, overlapping risk profiles, co-morbidities, and risks of associated disorders that clinically intermingle in presentations and outcomes.

To this point, assessing the viscerosomatic dysfunction and somatovisceral disorders is of paramount importance in order to get a full clinical picture affecting patients.

The clinician is mandated by the depth of our present clinical understandings and our oath to our patients to see the complete clinical picture within these integrated clinical paradigms and to treat accordingly.

Somatic dysfunction is defined as the “impaired or altered function of related components of the somatic (body framework) system: skeletal, arthrodial, and myofascial structures, and related vascular, lymphatic, and neural elements.”

A viscerosomatic reflex is the resultant of the effect of afferent stimuli arising from a visceral disorder on the somatic tissues. The reflex is initiated by afferent impulses from visceral receptors; these impulses are transmitted to the dorsal horn of the spinal cord, where they synapse with interconnecting neurons. These, in turn, convey the stimulus to sympathetic and peripheral motor efferents, thus resulting in sensory and motor changes in somatic tissues of skeletal muscle, viscera, blood vessels, and skin.

As an example only, visceral afferents play an important part in the maintenance of internal equilibrium and the related mutual adjustments of visceral function. They are also responsible for the conduction of pain impulses that may be caused by distention of a viscus, anoxia (particularly of muscle), irritating metabolites, stretching or crushing of blood vessels, irritation of the peritoneum, contraction of muscular walls, and distention of the capsule of a solid organ.” Because pain-sensitive nerve end- ings are not numerous in viscera, pain sensation or a visceral reflex response may result from the combined input of several different types of receptors rather than as a specific response to a particular receptor. A variety of visceral receptors have been mucosal and epithelial receptors, which respond to mechanical and epithelial stimuli; tension receptors in the visceral muscle layers, which respond to mechanical distention, such as the degree of filling; serosal receptors, which are slow adapting mechanoreceptors in mesentery or
serosa and which monitor visceral fullness; Pacinian corpuscles in mesentery and pain receptors; and free nerve endings in viscera and blood vessels.

https://pubmed.ncbi.nlm.nih.gov/?term=Viscerosomatic+pathophysiology

https://pubmed.ncbi.nlm.nih.gov/?linkname=pubmed_pubmed&from_uid=32644644

General Disclaimer *

The information herein is not intended to replace a one-on-one relationship with a qualified healthcare professional or licensed physician and is not medical advice. We encourage you to make your own healthcare decisions based on your research and partnership with a qualified healthcare professional.

Blog Information & Scope Discussions

Our information scope is limited to Chiropractic, musculoskeletal, physical medicines, wellness, contributing etiological viscerosomatic disturbances within clinical presentations, associated somatovisceral reflex clinical dynamics, subluxation complexes, sensitive health issues, and/or functional medicine articles, topics, and discussions.

We provide and present clinical collaboration with specialists from a wide array of disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the injuries or disorders of the musculoskeletal system.

Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate to and support, directly or indirectly, our clinical scope of practice.*

Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We provide copies of supporting research studies available to regulatory boards and the public upon request.

We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez DC or contact us at 915-850-0900.

We are here to help you and your family.

Blessings

Dr. Alex Jimenez DC, MSACP, CCST, IFMCP*, CIFM*, ATN*

email: coach@elpasofunctionalmedicine.com

Licensed in: Texas & New Mexico*

Dr. Alex Jimenez DC, MSACP, CIFM*, IFMCP*, ATN*, CCST
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Trigger Points Affecting The Fingers

Trigger Points Affecting The Fingers

Introduction

The fingers are in a close relationship with the hands and the body. Each finger digit is controlled by various muscles encompassing the wrist and forearms. The fingers allow the host to be expressive and point and manipulate objects while protecting the joints in each digit. When chronic conditions or injuries begin to affect each finger digit, it can lead to referred pain along the hand muscles, the wrists, and the forearms, causing the development of trigger points to overlap the affected muscles in the fingers. Today’s article looks at how the finger extensor muscles work, how trigger points affect the finger extensor muscles, and how to manage pain associated with trigger points along the fingers. We refer patients to certified providers who specialize in hand pain treatments to aid individuals suffering from trigger points related to pain affecting the finger extensor muscles along the hands. We also guide and inform our patients by referring them to our associated medical providers based on their examination when appropriate. We established that education is a great solution to asking our providers profound questions the patient requests. Dr. Jimenez DC takes note of this information as an educational service only. Disclaimer

How Do The Finger Extensor Muscles Work?

 

Are you experiencing pain in your fingers? Does it seem difficult to hold onto items even for a short period? Or are you experiencing muscle pain from your thumb to your wrist? Numerous individuals experiencing pain in their fingers and hands risk developing trigger points or myofascial pain syndrome in their fingers and hands. The hand muscles have many intricated muscles and insert themselves as the origin points for the bones, ligaments, and fascia of the hands. The finger extensor muscles begin at the forearms as the point of origin and stretch past the wrist to each finger digit which includes:

  • Thumb
  • Index finger
  • Middle finger
  • Ring finger
  • Pinky finger

The three main fingers that provide motion for the hands are the index, ring, and middle finger, which allow the muscles to be held in flexion and extension while giving extra support for hand actions for gripping items. Studies reveal that even though the structural and functional complexities of the human fingers have been recognized, each finger recognized an effective function of precise coordination of multiple muscles. To that point, this results in constrained finger motion by exerted forces from the joint capsules, ligaments, and joint articular surfaces. However, the tendons and the extensor muscles of the fingers suffer from injuries and conditions that can affect the functionality of each finger’s grip strength.

 

How Trigger Points Affect The Finger Extensor Muscles?

When the hands, wrists, and forearms are injured from traumatic forces or through ordinary factors like pulling a muscle or feeling unexplainable pain in the forearms, it can lead to referred pain along the affected muscles. This then leads to the development of trigger points along the affected muscles affecting mobility function with the fingers. According to Dr. Travell, M.D., when patients complain about pain in their hands, they often identify it with arthritis on the fingers when it is caused by trigger points affecting the extensor muscles in the fingers. Studies reveal that trigger points along the finger extensor muscles could refer to mechanical impingement of the tendon being narrowed through repetitive movements. When this happens, it can lead to inflammation and resistance of the tendon, causing the finger digit to lock up in a flex pose. Sometimes trigger points can even inhibit muscular contraction without pain, causing symptoms of grip weakness on the fingers. When trigger points affect the extensor muscles of the fingers and hands, it can make many individuals feel frustrated that they cannot hold onto items while doing their daily activities.

 


Trigger Points On The Extensor Digitorum-Video

Are you noticing that your grip strength has weakened? Do you feel pain starting from your forearm and ending at your fingertips? Or do your fingers lock up from time to time? Many of these symptoms affecting the fingers could develop signs of trigger points affecting the finger extensor muscles, causing hand pain. Trigger points usually form when the muscle from each section of the body has been through trauma, injuries, or overuse. To that point, the affected muscle has small knots along the muscle fibers, thus causing referred pain in the affected area. The video above explains where the extensor muscles are located in the forearm and how they branch out to each finger digit. When trigger points affect the muscle fibers of the extensor muscles, it can lead to hyperirritability of the muscle fibers and invoke referred pain in the surrounding tendons. Studies reveal that factors that pertain to overusing the fingers may be due to work-related musculoskeletal disorders, which lead to the association with intracellular compartmentation during non-invasive activities. This shows that latent trigger points may potentially occur on the affected muscle with or without pain.


Managing Pain Associated With Trigger Points On The Fingers

 

When it comes to managing trigger points along the extensor fingers, there are various techniques that many people can use to relieve pain in their hands, strengthen their grip strength, and prevent future trigger points from forming along the forearms. When many people go to their primary physicians and complain about losing their grip strength or feeling symptoms of inflammation associated with arthritis, their doctors begin to do a full examination. They communicate with them about what they have been doing with their hands. Once the doctors have a full diagnosis, they will begin to advise their patients on various techniques to relieve pain in their hands and strengthen their fingers. Some of the ways to manage trigger points along the fingers include:

  • Hand stretches to relieve stress on the finger joints
  • Finger extension extends with a rubber band
  • Avoid gripping items tightly
  • Sleep with fingers in a flex position
  • Use an ice pack to reduce inflammation in the forearm muscles

Incorporating these various techniques can reduce pain-like symptoms along the forearms, wrists, and hands and help manage trigger points from causing more issues on the hands. These techniques allow the finger extensor muscles to regain their strength and enable the individual to restore grip strength.

Conclusion

The fingers provide a close working relationship with the hands and body. The fingers allow motions expressively with the host and provide flexion and extension to each digit through extensor muscles that are located in the forearms. When injuries or hyperextension issues affect the extensor muscle, it can develop trigger points that can affect grip strength on the hands and cause pain along the finger digits and wrist. This can cause misery to the individual. Fortunately, various techniques reduce the pain in the hands and increase grip strength on the fingers while managing trigger points associated with the extensor muscles. When individuals begin to utilize stretches for their hands and wrists, it allows them to have finger mobility back to their hands and reduces the effects of pain along their forearms.

 

References

Ali, Stephen R, and Hussein Mohamedbahi. “Acute Trigger Finger Presenting as an Extensor Lag.” Eplasty, Open Science Company, LLC, 5 Jan. 2018, www.ncbi.nlm.nih.gov/pmc/articles/PMC5765627/.

Hu, Dan, et al. “Biomechanical Analysis of the Human Finger Extensor Mechanism during Isometric Pressing.” PloS One, Public Library of Science, 14 Apr. 2014, www.ncbi.nlm.nih.gov/pmc/articles/PMC3986208/.

Moreno-Torres, Angel, et al. “Work-Related Pain in Extrinsic Finger Extensor Musculature of Instrumentalists Is Associated with Intracellular Ph Compartmentation during Exercise.” PloS One, Public Library of Science, 9 Feb. 2010, www.ncbi.nlm.nih.gov/pmc/articles/PMC2817730/.

Okwumabua, Ebubechi, et al. “Anatomy, Shoulder and Upper Limb, Hand Muscles.” In: StatPearls [Internet]. Treasure Island (FL), StatPearls Publishing, 31 July 2021, www.ncbi.nlm.nih.gov/books/NBK537229/.

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Trigger Point Affecting The Hands & Wrist

Trigger Point Affecting The Hands & Wrist

Introduction

The forearms have a casual relationship with the hands and the wrist as they are below the elbow and have very important motor functions. The hands and wrists help many individuals hold onto items, while the forearms provide support by carrying items without pain. The various muscles surrounding the forearms, hands, and wrist joints help provide mobility and flexibility to the arms. Injuries like muscle sprain, strains, or stiffness in the forearms, hands, or wrist can be due to trigger points along the brachioradialis muscles affecting the hands and wrist. Today’s article looks at the brachioradialis muscle functions on the hands and wrist, how trigger points affect the hands and wrist, and how to manage trigger points associated with the hands and wrist. We refer patients to certified providers who specialize in arm pain treatments to aid individuals suffering from trigger points associated with the brachioradialis muscles along the wrist and hands of the body. We also guide and inform our patients by referring them to our associated medical providers based on their examination when appropriate. We established that education is a great solution to asking our providers profound questions the patient requests. Dr. Jimenez DC takes note of this information as an educational service only. Disclaimer

The Brachioradialis Function On The Hands & Wrist

 

Have you been experiencing stiffness in your wrist or forearms? Do you have trouble gripping items in your hands? Or do you experience radiating pain from your forearms to your wrist? Many people experiencing these pain-like symptoms are associated with trigger points along the brachioradialis muscle that affect the forearms, hands, and wrist. The brachioradialis is a superficial muscle that is located in the lateral forearm. The brachioradialis muscle works with different muscles attached to the upper arms to provide flexion to the elbow joints while working with various muscle tendons along the wrist and hands. Research studies reveal that the brachioradialis muscle works with the central nervous system by sending signals to the forearm and provides reflexes to the wrist and fingers by lightly tapping the muscle tendon of the brachioradialis. This light tapping motion sends the signal back to the brain and shows which muscle is activated. However, injuries along the brachioradialis muscle can invoke referred pain to the wrist and hands.

 

Trigger Points Affecting The Hands & Wrist

As stated in many research studies, trigger points or myofascial pain syndrome is a chronic musculoskeletal disorder that causes hard, discrete, tiny nodules along the taut muscle fiber bands of the affected muscle, causing pain. When the brachioradialis muscle has succumbed to pain-like symptoms from common factors or injuries, it can lead to the development of referred pain associated with trigger points affecting the hands and wrist of the body. So how would trigger points affect the hands and wrist? Well, trigger points can mimic other chronic conditions and cause pain to the affected muscles. So when trigger points affect the brachioradialis muscle, it also affects the hands and wrists. 

Studies reveal that when trigger points affect the hands and the wrist, it can lead to symptoms of pain, stiffness, burning, or tingling sensations in the hands and wrist. To that point, a person can experience these pain symptoms even if they are not injured. Trigger points can form when the individual has made repetitive motions to the muscle that causes it to be overused and cause strain on the muscle, thus leading to trigger points associated with joint and muscle pain. Other studies reveal that non-specific shoulder pain associated with trigger points can increase pain intensity to the brachioradialis and affect hand grip strength. This can make many individuals unable to hold onto the items they carry.

 


Wrist & Hand Trigger Points- Video

Are you having trouble making a fist in your hands? Do you experience a burning sensation on your forearm down to your wrist? What about feeling pain radiating down from your elbows to your hands? Many people experiencing these pain symptoms might risk developing trigger points along the brachioradialis muscle affecting the hands and wrist. The video above explains what happens when trigger points affect the wrist and hand extensors muscles that work together with the brachioradialis muscles. Trigger points along the brachioradialis can cause referred pain to the forearms and lead to chronic symptoms that affect the functionality of the wrist and hands. This can lead to a decrease in grip strength and cause hand mobility issues for many people. At last, all is not lost, as various treatments are available to manage trigger points associated with the hands and wrist.


Managing Trigger Points Associated With The Hands and Wrist

 

Various treatments can help many individuals dealing with trigger points associated with the hands and wrist. Many people would go to pain specialists like chiropractors, massage therapists, or physiotherapists to manage trigger points affecting the brachioradialis muscles along the hands and wrist. These pain specialists will incorporate various techniques to reduce the pain and address the trigger points along the affected muscle. Studies reveal that acupuncture on the hands and wrist can reduce pain intensity caused by trigger points and bring back mobility function to the hands and wrist. This can regain the grip strength of the individual and improve hand and wrist functionality without pain. Other studies also reveal that trigger point therapy can also be utilized to reduce pain-like symptoms affecting the hands and wrist. Combined with gentle massages can prevent trigger points from forming in the future and reduce pain symptoms affecting grip mobility on the hands.

 

Conclusion

The forearms have a casual relationship with the hands and wrist as the brachioradialis muscles help provide mobility functions. The hands and wrist help grip items a person carries, while the forearms offer support. When injuries or ordinary factors are causing pain-like symptoms on the forearm, it can lead to the development of trigger points affecting the mobility function of the hands and wrist. To that point, it can lead to a burning sensation or decreased grip strength on the hands. This can affect a person as they won’t be able to hold onto items and are dealing with a numbing sensation along the wrist and hands. Luckily there are pain specialists available that can utilize various techniques to help manage trigger points along the affected muscle and help bring back grip function and mobility to the hands and wrist. People who incorporate these treatments as part of their daily life schedule can begin to get their sense of belonging back without pain in their wrists and hands.

 

References

Calvo Lobo, Cesar, et al. “Comparison of Hand Grip Strength and Upper Limb Pressure Pain Threshold between Older Adults with or without Non-Specific Shoulder Pain.” PeerJ, PeerJ Inc., 9 Feb. 2017, www.ncbi.nlm.nih.gov/pmc/articles/PMC5345821/.

Cao, Talia, and Prasanna Tadi. “Brachioradialis Reflex.” In: StatPearls [Internet]. Treasure Island (FL), StatPearls Publishing, 26 Mar. 2022, www.ncbi.nlm.nih.gov/books/NBK554537/.

Hong, C Z. “Specific Sequential Myofascial Trigger Point Therapy in the Treatment of a Patient with Myofascial Pain Syndrome Associated with Reflex Sympathetic Dystrophy.” Australasian Chiropractic & Osteopathy : Journal of the Chiropractic & Osteopathic College of Australasia, BioMed Central, Mar. 2000, www.ncbi.nlm.nih.gov/pmc/articles/PMC2050812/.

Lung, Brandon E, et al. “Anatomy, Shoulder and Upper Limb, Forearm Brachioradialis Muscle.” In: StatPearls [Internet]. Treasure Island (FL), StatPearls Publishing, 31 July 2021, www.ncbi.nlm.nih.gov/books/NBK526110/.

Oh, Sein, et al. “Causes of Hand Tingling in Visual Display Terminal Workers.” Annals of Rehabilitation Medicine, Korean Academy of Rehabilitation Medicine, Apr. 2013, www.ncbi.nlm.nih.gov/pmc/articles/PMC3660483/.

Trinh, Kien, et al. “The Effect of Acupuncture on Hand and Wrist Pain Intensity, Functional Status, and Quality of Life in Adults: A Systematic Review.” Medical Acupuncture, U.S. National Library of Medicine, 1 Feb. 2022, pubmed.ncbi.nlm.nih.gov/35251436/.

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It Could Be More Than Triceps Muscle Pain

It Could Be More Than Triceps Muscle Pain

Introduction

One of the many muscles that help stabilize the shoulders and provide movement when the arms are in motion. The tricep muscles are one of the most underrated muscles that many people don’t seem to take care of when working out. The other muscles in the upper arms and shoulders are more likely to be worked on when it comes to being physically active. The deltoidsbiceps, and brachialis muscles are some of the muscles that get much more attention when working on shoulder mobility. Still, the triceps provide the functionality to the shoulders as well. When the shoulders or the upper arms are injured and develop pain-like symptoms in the muscle groups, it can develop trigger points along the affected muscle. Today’s article looks at the tricep muscles, how trigger points affect them, and ways to manage trigger points along the tricep muscles. We refer patients to certified providers who specialize in arm pain treatments to aid individuals suffering from trigger points associated with the tricep muscles along the upper arms and elbows. We also guide and inform our patients by referring them to our associated medical providers based on their examination when appropriate. We established that education is a great solution to asking our providers profound questions the patient requests. Dr. Jimenez DC takes note of this information as an educational service only. Disclaimer

What Do The Tricep Muscles Do?

 

Do you experience pain underneath your forearm? How about feeling a dull ache on your elbows? Or do you feel a numbing sensation on your ring and pinky fingers? Individuals experiencing these symptoms in their arms could potentially develop trigger points along their tricep muscles. The tricep muscles are located under the upper arm and are a large, thick horseshoe-shaped muscle at the end of the arm. As stated earlier, the tricep muscles are one of the most underrated muscles in the arm that no one tends to work on during a workout, so they can be easily overlooked. However, the tricep muscles help in providing stability to the shoulders and help strengthen the arms. One of the main functions the triceps offer is that they allow the extension of the elbow joints. Studies reveal that the three head tendons that make up the triceps can influence elbow extension torque. The three heads of the triceps have different patterns of force when it comes to various activities during different shoulder evaluations. To that point, multiple combinations of the shoulder and elbows at different angles can affect the tricep’s shoulder extensions. Since many individuals don’t work on their triceps often, it can potentially develop issues that can make this underrated muscle weak.

 

How Trigger Points Affect The Tricep Muscles?

 

When the triceps don’t get worked on during a workout, it can lead to muscle weakness when doing pushups or when someone suffers from an injury with direct trauma in the elbows. When the tricep muscles become affected, it can lead to chronic conditions that are associated with myofascial pain or trigger points. Trigger points in the triceps can be formed when there are restrictions in extending the elbow joints. Studies reveal that when the triceps become overloaded from overusing the forearms from normal activities, it could potentially lead to tricep tendon rupture. To that point, which leads to the development of trigger points to invoke pain in the triceps and elbow joint. According to  Dr. Janet Travell, M.D., trigger points associated with the tricep muscles could potentially involve referred pain in the vicinity of the elbow joints. What this refers to is that trigger points can mimic other chronic conditions so in this case, referred pain caused by trigger points associated with the tricep muscles can be mistakenly attributed to arthritis on the elbow joints. All is not lost, as there are ways to manage trigger points affecting the tricep muscles.

 


Treating Trigger Points On The Triceps- Video

Have you been experiencing pain in your shoulders, elbows, and hands? Do you have limited mobility when extending your elbows? Or do you notice that your triceps are weaker than normal? If you have been dealing with any of these symptoms, it could be due to trigger points associated with the tricep muscles that are causing referred pain to the upper arms and elbows. The triceps in the upper arms is one of the most underrated muscles people tend to overlook. When individuals begin to succumb to injuries that affect their triceps, it can lead to the development of trigger points along the muscle fibers in the tricep muscles. Trigger points can occur in the tricep muscles due to overusing the forearm muscles, causing stress in the elbow joint and the muscle itself. When the trigger points become active, it can lead to limited mobility to the elbow joint, causing the individual thinks they are developing arthritis when it is the trigger points causing the referred pain. There are ways that many people can manage trigger points associated with the elbows along the triceps to relieve the pain from the muscle. The video above shows where the active trigger points are located and how to release them through palpations and massage. Treating the trigger points along the tricep muscles allows many individuals to regain mobility in their elbows and upper arms.


Managing Trigger Points Along The Triceps

 

As stated earlier, the triceps are the underrated muscle that people tend to forget. When the tricep muscles succumb to trigger points, it can lead to referred pain along the elbow joints, causing pain-like symptoms affecting the elbow’s mobility function. When this happens to the upper arms, there are various ways to strengthen the tricep muscles and manage trigger points from developing in the future. Incorporating exercises targeting the tricep muscles can help improve mobility to the elbows and shoulders. If a person is playing sports like tennis, they can opt for a lighter racket and have a more lightweight grip on the handle. Suppose a person is in pain from their triceps. In that case, however, studies reveal that upper limb rehabilitation can help reduce the pain along the triceps and improve the mobility range caused by pain associated with trigger points. People can continue their daily activities without pain when they utilize these various ways to enhance their triceps’ functionality. 

 

Conclusion

As the most underrated muscle that people tend to forget to work out, the tricep muscle can be overlooked. This large, thick horseshoe-shaped muscle has a job that provides stability to the shoulders and allows an extension to the elbow joints. When individuals don’t work on their tricep muscles, it can lead to muscle weakness and pain-like symptoms that lead to the development of trigger points. Trigger points associated with the tricep muscles can cause referred pain to the elbow joint, making many individuals believe they have arthritis. However, many individuals can regain mobility to their elbows by incorporating exercises targeting the triceps and utilizing treatments to manage trigger points along the muscle fibers. They can do daily activities that require the triceps without pain.

 

References

Landin, Dennis, et al. “Functions of the Triceps Brachii in Humans: A Review.” Journal of Clinical Medicine Research, Elmer Press, Apr. 2018, www.ncbi.nlm.nih.gov/pmc/articles/PMC5827912/.

Lennon, Olive, et al. “Effect of the Triceps Brachii Facilitation Technique on Scapulohumeral Muscle Activation during Reach and Point in a Healthy Population.” Physiotherapy Canada. Physiotherapie Canada, University of Toronto Press, 2019, www.ncbi.nlm.nih.gov/pmc/articles/PMC6855346/.

Mangano, Tony, et al. “Chronic Tendonopathy as a Unique Cause of Non Traumatic Triceps Tendon Rupture in a (Risk Factors Free) Bodybuilder: A Case Report.” Journal of Orthopaedic Case Reports, Indian Orthopaedic Research Group, 2015, www.ncbi.nlm.nih.gov/pmc/articles/PMC4719357/.

Tiwana, Manpreet S, et al. “Anatomy, Shoulder and Upper Limb, Triceps Muscle.” In: StatPearls [Internet]. Treasure Island (FL), StatPearls Publishing, 6 Aug. 2021, www.ncbi.nlm.nih.gov/books/NBK536996/.

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Trigger Points Affecting The Brachialis Muscles

Trigger Points Affecting The Brachialis Muscles

Introduction

When it comes to the human body in motion, the arms can carry, lift, and move items from one place to another without pain. The arms have different muscles that work together to protect the arm and shoulder joints while providing mobility and movement. One of the muscles that help the arms carry items is the brachialis muscles, which work together with the bicep and tricep muscles. As part of the forearm, it can succumb to various injuries affecting the muscle, tendons, and ligaments. When this happens, referred pain can affect the arm and develop trigger points to overlap chronic conditions that can potentially cause more pain. Today’s article looks at the brachialis muscle’s function, how trigger points affect the muscle, and various ways to manage brachialis trigger points. We refer patients to certified providers who specialize in arm pain treatments to aid individuals suffering from trigger points associated with the brachialis muscles along the upper arms. We also guide and inform our patients by referring them to our associated medical providers based on their examination when appropriate. We established that education is a great solution to asking our providers profound questions the patient requests. Dr. Jimenez DC takes note of this information as an educational service only. Disclaimer

What Is The Brachialis Muscle Function?

 

Have you been experiencing muscle strain in your forearms? What about stiffness in your wrist? Or do your arm muscles begin to spasm out of nowhere? Many people who have experienced these pain symptoms might be caused by trigger points associated with the brachialis muscle. The brachialis is an important muscle that flexes the forearm at the elbow. This muscle works with the biceps as it can carry heavy items, like the deltoid, and is the opposite of the tricep muscles. However, it can become overused and succumb to injuries that can invoke pain in the arm muscles, thus leading to the development of trigger points along the brachialis muscle.

 

How Does Trigger Points Affect The Brachialis Muscle?

 

When the brachialis muscle becomes injured, many people will experience pain when flexing their elbows inward or outward. According to Dr. Travell, M.D., these pain symptoms may be due to referred pain and tenderness from brachialis trigger points or radial nerve entrapment. During heaving lifting, the forearm flexion stress overload activates trigger points along the brachialis. Studies reveal that excessive sudden physical stress or repetitive activities may result from a muscle sprain or tear in the brachialis muscle. To that point, these symptoms associated with trigger points can cause overlapping risk profiles that can mask the condition. Some of the conditions that can overlap and activate trigger points include: 

  • Carrying heavy groceries
  • Holding power tools
  • Tennis elbow
  • Playing a string instrument

Studies also reveal that active trigger points along the affected muscle can increase weight coefficients and alter motor control without co-contraction patterns. This is due to trigger points becoming tricky to diagnose and mimic other conditions affecting the arms’ muscle group. Many people with pain-like symptoms associated with trigger points often complain about numbness or deep pain in their arms and hands. To that point, trigger points can also be involved with nerve entrapment in the brachialis muscles.

 


The Brachialis Trigger Points Release-Video

Have you been experiencing stiffness in your hands and arms? What about muscle spasms near your elbow? Or does constant pain affect your forearm muscles when you bend your arm? Many of these symptoms are associated with trigger points affecting the brachialis muscle that is causing pain in the forearms. Trigger points or myofascial pain syndrome can affect a person’s well-being by impairing their mobility in the affected areas, causing pain, and even reducing their overall sense of life. Trigger points affecting the brachialis muscles can mimic chronic conditions like nerve entrapment that can affect the motor function of the forearm. Luckily, trigger points are treatable, and there are ways to reduce the pain-like symptoms from the affected brachialis muscles. The video above shows how to treat trigger points along the forearm. Incorporating non-invasive treatments to reduce future trigger points to form can reduce the pain symptoms and release the trapped nerves that are causing motor function problems in the arms.


Ways To Manage Brachialis Trigger Points

 

As stated earlier, trigger points are tricky to diagnose since they can mimic other chronic conditions along the affected muscles. When the affected muscle succumbs to injuries and is not treated, it can develop tiny knots along the taut muscle band fibers known as trigger points over time. To that point, it can cause referred pain-like symptoms along the muscle group. Luckily, treatments can help reduce pain-like symptoms and prevent trigger points from forming along the muscle fibers. Studies reveal that trigger point injections are one of the various treatments that can help reduce pain in the brachialis muscle. With gentle stretching and physical therapy, allow mobility back to the arm. One way to manage brachialis trigger points that many people can use is to place a pillow at the angle of the elbow to prevent the arms from tightening or use a hot pack to relax the forearm muscles to relieve muscle strain and aches. Another way is not to overuse their forearms when playing an instrument or carrying items on their forearms. This can prevent trigger points from forming in the future and reduce pain-like symptoms from affecting the forearms.

 

Conclusion

The brachialis is the main muscle that is important to the forearms. This large muscle works with the bicep and tricep muscles to help the host carry heavy objects while bending at the elbows. However, like all the muscles in the body, the brachialis muscles can succumb to injuries and develop trigger points along the brachialis muscle fiber bands. Trigger points along the brachialis muscle are associated with pain-like symptoms that can mimic conditions like tennis elbow or nerve entrapment in the forearms. Fortunately, various treatments are utilized by doctors to help many patients dealing with trigger points along the brachialis muscle and can help reduce pain in the forearms. This allows mobility back to the arms and prevents future trigger points from forming.

 

References

Geri, Tommaso, et al. “Myofascial Trigger Points Alter the Modular Control during the Execution of a Reaching Task: A Pilot Study.” Scientific Reports, Nature Publishing Group UK, 5 Nov. 2019, www.ncbi.nlm.nih.gov/pmc/articles/PMC6831581/.

Plantz, Mark A, and Bruno Bordoni. “Anatomy, Shoulder and Upper Limb, Brachialis Muscle.” In: StatPearls [Internet]. Treasure Island (FL), StatPearls Publishing, 22 Feb. 2022, www.ncbi.nlm.nih.gov/books/NBK551630/.

Sharma, Pankaj, et al. “Isolated Traumatic Brachialis Muscle Tear: A Case Report and Review of Literature.” Bulletin of Emergency and Trauma, Shiraz University of Medical Sciences, Oct. 2017, www.ncbi.nlm.nih.gov/pmc/articles/PMC5694606/.

Suh, Mi Ri, et al. “Ultrasound-Guided Myofascial Trigger Point Injection into Brachialis Muscle for Rotator Cuff Disease Patients with Upper Arm Pain: A Pilot Study.” Annals of Rehabilitation Medicine, Korean Academy of Rehabilitation Medicine, Oct. 2014, www.ncbi.nlm.nih.gov/pmc/articles/PMC4221396/.

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The Biceps Being Affected By Trigger Points

The Biceps Being Affected By Trigger Points

Introduction

The upper arms allow the individual to move the arms, hands, and fingers, enabling them to do everyday activities without feeling pain or injuries. Different muscles in the upper arms allow precise movements, from threading a needle to throwing a ball across the field. These muscles also work with the shoulders, allowing a full range of motion and flexion. One of the muscles that help the upper arms is the bicep brachii, which provide flexion to the arm. However, like all the muscles in the body, they can succumb to pain caused by trigger points. Today’s article looks at the bicep muscles’ function, how trigger points affect the muscles, and how to manage trigger points associated with the bicep muscles. We refer patients to certified providers who specialize in arm pain treatments to aid individuals suffering from trigger points associated with the bicep brachii muscles along the upper arms. We also guide and inform our patients by referring them to our associated medical providers based on their examination when appropriate. We established that education is a great solution to asking our providers profound questions the patient requests. Dr. Jimenez DC takes note of this information as an educational service only. Disclaimer

What Are The Bicep Muscles Function?

Have you been dealing with radiating pain down to your elbow? Do your upper arm muscle ache when carrying items from place to place? Or have you experienced muscle spasms in your arms and hands? Many people experiencing these symptoms might risk developing trigger points along their bicep muscles. The bicep brachii is a large, thick muscle that covers the joints and is located in the upper arms. The bicep muscle consists of two attachments: the short head (caput breve) and the ling head (caput longum). It works together with the coracobrachialis muscle to support stability to the shoulders.

 

Studies reveal that these two muscle bands work together to provide multiple actions between the shoulder and elbow joints by being in conjunction with the other muscles. The main function of the bicep muscles is that it is one of the three muscles that can flex the elbow and shoulders. The biceps also allow flexion and supination or outward rotation of the forearms at 90 degrees. This muscle is very important for athletes that require lifting, carrying, or throwing and can make the individual stronger. To that point, the bicep muscle can also succumb to injuries that can cause pain to the upper arms and shoulders.

 

How Does Trigger Points Affect The Bicep Muscles?

 

When the bicep muscles succumb to injuries, it can be due to overusing the long head of the bicep muscles and can lead to bicep tendon rupture. When the bicep muscle succumbs to a tendon rupture, it is due to excessive eccentric force that brings the arms to an extension rather than flexion. Other issues affecting the biceps can correlate to rotator cuff pathology and can be associated with being a common source of shoulder pain. Studies reveal that since the bicep is closely associated with the rotator cuff, tendinopathy can form due to repetitive traction, friction, and rotation of the shoulder joints. To that point, it can lead to the development of trigger points along the bicep muscles. Trigger point pain can be complicated to diagnose since it can mimic other chronic conditions. For trigger points to occur along the bicep muscles, pain-like symptoms are caused when the arm is above the shoulder. To that point, it causes symptoms of aches, stiffness, and muscle weakness in the bicep muscles.

 


Trigger Points Affecting The Bicep Brachii- Video

Have you experienced muscle aches and stiffness when lifting your arms above your shoulders? Do you find difficulty to bend your elbows? Or have you been experiencing radiating pain along the shoulders, arms, and hands? These pain-like symptoms are associated with trigger points along the bicep muscles and can evoke motor dysfunction in the upper arms. The video above gives an overview how trigger points affect the bicep brachii and cause symptoms like “frozen shoulder” to affect the entire arm. Studies reveal that trigger points are the most frequent causes of chronic musculoskeletal pain that causes the muscle tissue to become hyperirritable. Trigger points can also cause referred pain to the affected muscles, causing limited range of motion to the joints. When the bicep muscles are being affected by trigger points, it can cause stress on the muscle and cause hyper-extension to the arm. According to Dr. Travell, M.D., when trigger points affect the bicep brachii muscles and cause referred pain and tenderness on the ball-and-socket joint, the symptoms associated with trigger points are mistaken as a rheumatic joint disease unless the affected bicep is examined for trigger points. Thankfully, there are ways to manage trigger points associated with the bicep muscles to reduce pain in the upper arms.


Managing Trigger Points Associated With The Bicep Muscles

 

 

When individuals are suffering from pain along their bicep muscles, it can cause them to be miserable as they cannot participate in various activities that require their arms; when trigger points are formed along the taut muscle band of the bicep muscles, the radiating pain from the shoulder to the elbow, causing stiffness and muscle aches. Fortunately, various techniques can help manage trigger points associated with the bicep muscles. Studies reveal that many people can manage trigger points related to the bicep muscles to reduce shoulder pain by resting, modifying their activities, and seeking more non-invasive treatments to reduce the pain associated with the bicep muscles. Many people can do various arm and shoulder stretches to reduce the stiffness of the bicep muscles. This allows gentle stretching along the upper arm muscles and releases tension through slow, even breathing and prolonged shortening of the bicep muscles.

 

Conclusion

The bicep has two attachments that provide mobility and are a large thick muscle that covers the upper arm joints. The bicep muscles also work together with the coracobrachialis muscle to help support the shoulders by making them stable. When the bicep muscles become overused and succumb to injuries, they can develop trigger points along the bicep muscles, causing referred pain to the arms and shoulders. When this happens, the muscles become stiff and can become painful when doing simple actions like lifting their arms or playing a sport. When this happens, many individuals become miserable since they can’t participate. Fortunately, various techniques can help reduce the pain symptoms in the arms and prevent future injuries. Gentle stretching and muscle massages can release the trigger points from the bicep muscles and improve arm mobility to the biceps.

 

References

Akamatsu, Flávia Emi, et al. “Trigger Points: An Anatomical Substratum.” BioMed Research International, Hindawi Publishing Corporation, 2015, www.ncbi.nlm.nih.gov/pmc/articles/PMC4355109/.

Landin, Dennis, et al. “Actions of the Biceps Brachii at the Shoulder: A Review.” Journal of Clinical Medicine Research, Elmer Press, Aug. 2017, www.ncbi.nlm.nih.gov/pmc/articles/PMC5505302/.

McDevitt, Amy W, et al. “Physical Therapy Interventions for the Management of Biceps Tendinopathy: An International Delphi Study.” International Journal of Sports Physical Therapy, NASMI, 1 June 2022, www.ncbi.nlm.nih.gov/pmc/articles/PMC9159730/.

Raney, Elise B, et al. “Pain and the Pathogenesis of Biceps Tendinopathy.” American Journal of Translational Research, e-Century Publishing Corporation, 15 June 2017, www.ncbi.nlm.nih.gov/pmc/articles/PMC5489872/.

Tiwana, Manpreet S, et al. “Anatomy, Shoulder and Upper Limb, Biceps Muscle.” In: StatPearls [Internet]. Treasure Island (FL), StatPearls Publishing, 11 Aug. 2021, www.ncbi.nlm.nih.gov/books/NBK519538/.

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Trigger Points Affecting The Upper Arm Muscles

Trigger Points Affecting The Upper Arm Muscles

Introduction

The upper extremities of the body, which include the head, neck, shoulders, chest, and arms, all have a specific job of keeping the body functioning and helping move from place to place. The head and neck work together to allow the host to have the mobility to turn, rotate from side to side, and lean from one side. The shoulders work with the arms to let the muscles have a full range of motion and even help stabilize the upper body. The shoulders have various muscles, tendons, and ligaments to protect the skeletal joints and even work to do everyday activities like carrying or lifting items. When injuries begin to affect the muscle groups of the upper body, it can lead to pain-like symptoms that can lead to chronic conditions developing over time if not treated right away. One of the muscles in the upper body is called the coracobrachialis muscle, which can be affected by injuries. Today’s article observes the coracobrachialis muscle, how trigger points affect the upper arm muscles, and how to manage trigger points associated with the coracobrachialis muscle. We refer patients to certified providers who specialize in shoulder pain treatments to aid individuals suffering from trigger points associated with the coracobrachialis muscles along the upper arms. We also guide and inform our patients by referring them to our associated medical providers based on their examination when appropriate. We established that education is a great solution to asking our providers profound questions the patient requests. Dr. Jimenez DC takes note of this information as an educational service only. Disclaimer

What Is The Coracobrachialis Muscle?

 

Have you been dealing with pain from the upper arms to the hands? Do simple arm and shoulder stretches seem to be difficult to do? Or have you been dealing with symptoms of pain, stiffness, or tenderness in your upper arms? Experiencing these pain-like symptoms could overlap other conditions affecting the upper arms and develop trigger points along the muscles, including the coracobrachialis. The coracobrachialis is the smallest muscle located in the front of the upper arm’s anterior that originated in the shoulder coracoid process. This small muscle is connected to the tendon located at the short head of the bicep brachii, and according to Dr. Janet Travell, M.D., the coracobrachialis muscle function helps flex and adduct the arms at the shoulders while working together with the surrounding muscles of the upper arm and shoulders. This allows the arms to move forward slightly and inward. This means that the coracobrachialis muscle will enable individuals to place their arms behind their back without pain. However, like any muscle in the body, injuries can occur in the upper arms and lead to the development of trigger points along the upper arm muscles affecting the coracobrachialis muscle.

 

How Trigger Points Affect The Upper Arm Muscles?

When the upper arm and the coracobrachialis muscle suffer from pain, tiny nodules along the muscle fiber bands known as trigger points can cause referred pain to the upper arms. Now trigger points are tricky to diagnose due to mimicking overlapping conditions affecting the upper arms. Studies reveal that non-specific arm pain could potentially be one of the causes that trigger points mimic due to strenuous physical activities or work-related activities that can overuse the upper arm muscles.

 

Studies reveal that individuals with idiopathic arm pain deal with high variable upper-extremity dysfunction, which could play a factor in pain-like symptoms along the surrounding muscles of the arms and shoulders. Many people often experience pain when reaching behind their back for the coracobrachialis affected by trigger points. Since the coracobrachialis works with the surrounding muscles in the shoulders and upper arms, trigger points associated with the coracobrachialis correspond to those muscles causing overlapping risk profiles. Trigger points affecting the coracobrachialis muscle can also mimic nerve entrapment since the coracobrachialis helps the bicep muscles when flexing. Pain associated with trigger points could potentially irritate the surrounding nerves in the muscle fibers, which causes radiating pain along the arms.

 


Treating The Coracobrachialis Muscle-Video

Does your arm feel stiff when trying to reach behind your back? Do your shoulders ache for no apparent reason? Or have you experienced sharp, shooting pain down your arm? Many people experience pain along their shoulders and arms, affecting their mobility to hold and carry items. They deal with overlapping symptoms associated with trigger points along the coracobrachialis muscle. Trigger points along the coracobrachialis muscle are developed when the upper arm muscles have been overused and irritate the surrounding nerves. This causes radiating referred pain down the arms and can affect a person’s ability to hold items. Thankfully there are ways to manage trigger points along the coracobrachialis and its surrounding muscles. The video above demonstrates a massage technique that works along the coracobrachialis muscle to release nerve entrapment and manage trigger points along the surrounding muscles.


Ways To Manage Trigger Points Affecting The Coracobrachialis

 

There are various techniques that many specialists, like chiropractors, massage therapists, and physiotherapists, can use to identify and manage trigger points in the body. Since trigger points are tricky to diagnose due to causing referred pain along the surrounding muscles, treatments like stretching, massages, acupuncture, and chiropractic adjustments can help alleviate the pain and reduce future trigger points from forming. Studies reveal that pain specialists could manage trigger points associated with shoulder pain along the coracobrachialis through treatments of manual compression and other various techniques. Once treatments have been incorporated to relieve trigger point pain along the affected muscle, many people can further prevent the symptoms from returning by not lifting or carrying heavy objects and not forcing their coracobrachialis to be a substitute for their bicep muscles.

 

Conclusion

The coracobrachialis is a short muscle that works with the bicep muscle and helps with mobility and motor functions for the arms and shoulders. This muscle allows the arms to move forward and can be placed in the back without pain. When muscle injuries affect the surrounding muscles that work with the coracobrachialis, it can develop trigger points associated with pain along the upper arms. When this happens, it can lead to symptoms of stiffness, pain, and tenderness in the upper arms, causing mobility issues. Pain specialists for trigger points can utilize various treatments to relieve the pain and reduce the effects that trigger points cause on the affected muscle. This allows the upper arms to gain mobility back and the host to do various activities without feeling pain.

 

References

Bron, Carel, et al. “Treatment of Myofascial Trigger Points in Patients with Chronic Shoulder Pain: A Randomized, Controlled Trial.” BMC Medicine, BioMed Central, 24 Jan. 2011, www.ncbi.nlm.nih.gov/pmc/articles/PMC3039607/.

Georgiev, Georgi P, et al. “Coracobrachialis Longus Muscle: Humeroepitrochlearis.” Cureus, Cureus, 13 May 2018, www.ncbi.nlm.nih.gov/pmc/articles/PMC6044495/.

Moradi, Ali, et al. “Nonspecific Arm Pain.” The Archives of Bone and Joint Surgery, Archives of Bone and Joint Surgery Co., Dec. 2013, www.ncbi.nlm.nih.gov/pmc/articles/PMC4151410/.

Ring, David, et al. “Idiopathic Arm Pain.” The Journal of Bone and Joint Surgery. American Volume, U.S. National Library of Medicine, July 2004, pubmed.ncbi.nlm.nih.gov/15252084/.

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Deltoid Muscles Being Affected By Trigger Points

Deltoid Muscles Being Affected By Trigger Points

Introduction

The shoulders help stabilize the upper extremities of the body and provide a wide range of movements for the arms. The shoulders have many muscles, ligaments, and tendons that help support the joints from injuries and utilize the motor function to do everyday actions like throwing a ball or stretching for long distances. Even though the shoulders help stabilize the upper extremities, they are still prone to injuries since the shoulder muscles are constantly used throughout the day. One of the shoulder muscles that are continuously utilized is the deltoid muscle, which can lead to the development of trigger points when it becomes injured. Today’s article examines the deltoid muscles, how trigger points affect the deltoids and shoulders, and managing trigger points associated with the deltoid muscles. We refer patients to certified providers specializing in shoulder pain treatments to aid individuals suffering from trigger points associated with the deltoid muscles along the shoulders. We also guide and inform our patients by referring them to our associated medical providers based on their examination when appropriate. We ensure that education is a great solution to asking our providers insightful questions the patient requests. Dr. Jimenez DC observes this information as an educational service only. Disclaimer

What Is The Deltoid Muscle?

 

Have you been feeling pain on the top of your shoulders? Do your shoulders feel stiff when rotating them? Or do you feel radiating pain along your upper arms? Individuals with shoulder pain may be experiencing trigger points affecting their deltoid muscles. The deltoids are large triangular-shaped muscles that are associated with the shoulder girdle. The deltoids sit on top of the shoulder girdle and have anterior and posterior sections that work together with the rotator cuff muscles that provide a full range of motion to the arms. Studies reveal that the deltoid muscles have a more complex structure since the intramuscular tendons from the deltoids help provide different functions when it comes to the shoulders and arms’ motor function. According to Dr. Janet G. Travell, M.D., the anterior sections of the deltoid muscles are used in sports activities. In contrast, the posterior section works with the rotator cuff muscles for mobility. Injuring the deltoid muscles can lead to the development of trigger points associated with shoulder pain. 

 

How Do Trigger Points Affect The Deltoids & Shoulders?

 

Regarding the shoulders, they can succumb to various injuries that can become an issue over time, lead to the development of trigger points in the shoulder muscles, and cause referred pain to the upper arms. Trigger points or myofascial pain syndrome along the deltoid muscles may invoke referred pain to the shoulders. Studies reveal that myofascial pain syndrome is often described as the sensory, motor, and autonomic symptoms caused by trigger points that cause tender spots on the hardened muscle to produce pain. Trigger points are a bit tricky to diagnose since they mimic other chronic conditions in the body. The deltoid muscles are superficial, and trigger points can cause referred pain to the muscles that mimic arthritis in the shoulder joints. Some of the other symptoms associated with trigger points along the shoulders and deltoids include:

  • Limited range of mobility
  • Tenderness in the shoulder muscles
  • Muscle spasms
  • Muscle pain
  • Stiffness in the deltoid muscles

Pain in the shoulders can cause the body to become unstable and cause many individuals to develop a hunched position over time to reduce the pain they are feeling; fortunately, there are various ways to manage the pain associated with trigger points along the shoulders and deltoid muscles.

 


Trigger Point Release On The Deltoid Muscle- Video

Have you been feeling stiffness along the shoulders or the deltoid muscles? Have you experienced muscle tenderness in your upper arms? Or do you feel like being hunched over reduces the pain in your shoulders? If you have been experiencing any of these symptoms, it could be the development of trigger points associated with shoulder pain along the deltoid muscles. Trigger points cause referred pain to the affected muscle area and are developed when the muscles are overused. For the deltoid muscles, when active trigger points affect the deltoids’ anterior or posterior sections, it can cause the muscles to twitch and later cause moderate tension. The video above explains where the trigger points are located on the deltoid muscles and how to release them through palpations and massages. This is one of the techniques that can help manage trigger points from affecting the shoulders and deltoid muscles.


Managing Trigger Points Associated With The Deltoid Muscles

 

When dealing with trigger points associated with the deltoid muscles can be managed through various techniques that many people can utilize to reduce the pain symptoms along the upper arms and shoulders. Studies reveal that dry needling is one of the techniques that can relieve trigger points to ease the pain intensity and irritability to the shoulders. Other techniques that many people can utilize are to correct how they carry heavy objects to reduce the load on their shoulders, stretch the arms and shoulders to minimize soreness and alleviate tight muscles, and even take a hot shower to relax the shoulder muscles, can reduce the chances of trigger points from forming in the future. 

 

Conclusion

The deltoid is located on top of the shoulder girdle and is a large triangular-shaped muscle that works together with the rest of the shoulder and the rotator cuff muscles. The shoulders have many muscles, ligaments, and tendons that provide stability and perform everyday functionality to the body. When the shoulders become injured, the affected muscles could potentially develop trigger points to cause referred pain to the shoulders and upper arms. When trigger points affect the deltoid muscles, it can cause them to have symptoms of stiffness, tenderness, and pain that mimic other chronic conditions affecting the shoulders and arms. Thankfully, various techniques relieve referred pain from the arms and help manage trigger points along the deltoid muscle. This allows the deltoid muscle to relax and reduce trigger points from developing further on the shoulders.

 

References

Bron, Carel, and Jan D Dommerholt. “Etiology of Myofascial Trigger Points.” Current Pain and Headache Reports, Current Science Inc., Oct. 2012, www.ncbi.nlm.nih.gov/pmc/articles/PMC3440564/.

Calvo-Lobo, César, et al. “Dry Needling on the Infraspinatus Latent and Active Myofascial Trigger Points in Older Adults with Nonspecific Shoulder Pain: A Randomized Clinical Trial.” Journal of Geriatric Physical Therapy (2001), Wolters Kluwer Health, Inc., 2018, www.ncbi.nlm.nih.gov/pmc/articles/PMC5728593/.

Elzanie, Adel, and Matthew Varacallo. “Anatomy, Shoulder and Upper Limb, Deltoid Muscle.” In: StatPearls [Internet]. Treasure Island (FL), StatPearls Publishing, 15 May 2022, www.ncbi.nlm.nih.gov/books/NBK537056/.

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