The Superficial Front Arm Line is one of several Fascial Lines proposed by Thomas Myers (SOURCE-1). This line is implicated in a wide range of movements at The Shoulder Girdle and The Wrist , including a coordinated effort with the Deep Front Arm Line during grip (SOURCE-1). The Superficial Front Arm Line is one of four Arm Lines that course the upper limb.
The following lists bony and muscular landmarks that are integrated into the Superficial Front Arm Line from most proximal to distal (SOURCE-1):
Medial 1/3rd of Clavicle
Costal Cartilages
Medial Edge of Shaft
Medial Epicondyle
Fingers (palmar surfaces)
Wrist Flexors:
As scientific understanding of Fascia l structures is still in its infancy, the sophisticated and interrelated Fascial Lines discussed by Thomas Myers are yet to gain full support of the literature. With this said, there is growing evidence of myofascial continuities that reflect some of the relations described by Fascial Lines :
Pectoral/ Axillary Fascia - envelops the Pectoralis Major and the lateral portion of the Latissimus Dorsi which arises from the Thoracolumbar Fascia and vertebrae of the Thoracic Spine and Lumbar Spine (SOURCE-2). Inferolaterally, the Pectoral Fascia follows the path of both muscles towards their Humeral attachments and on this course form the floor of the Axilla, known as theAxillary Fascia(SOURCE-2). The investing layer of Pectoralis Major Fascia is continuous with the Medial Intermuscular Septum (arm) (SOURCE-4)
Medial Intermuscular Septum (arm) to Common Flexor Tendon - the Medial Intermuscular Septum (arm) descends the anteromedial Humerus to make its attachment on the Medial Supracondylar Ridge (SOURCE-2). The sleeve-like deep Fascia of forearm is attached superiorly to the Medial Intermuscular Septum and distinguishes deep and superficial Muscle compartments (SOURCE-2). The superficial compartment contains the forearm flexors and the Common Flexor Tendon they arise from
The following observations may be indicative of Superficial Front Arm Line dysfunction:
Resting Posture
Excessive Anterior Humeral Head
Movement
Horizontal GH Joint - Extension - may be used to dermine the relative tone between the Superficial Front Arm Line and the Deep Front Arm Line . This movement when performed in GH Joint - External Rotation emphasises the superficial line, while the addition of GH Joint - Internal Rotation emphasises the deep line (SOURCE-1). A disparity in range may indicate restriction with the regions of the greatest stretch sensation suggesting which tissues require the most attention (SOURCE-1)
Symptoms of Pain may be greater with all involved joints locked rather than bent as the fascial line is pulled taut
Determining the direction and extent of Fascial restriction can be done with a light pressure over a desired segement and applying a superficial glide. The region and direction of greater soft-tissue resistance would suggest fascial restriction.
Treatment for Superficial Front Arm Line dysfunction emphasises restoring Fascial mobility and quality movement at The Shoulder Girdle and The Wrist. In some instances the release of a single structure contained within the Superficial Front Arm Line forms an effective treatment, while in others the entire Fascial line may require attention.
The folowing stretching techniques may be beneficial for dysfunction of the Superficial Front Arm Line:
Split Stance Biceps Stretch ( Thumb up variation) - self-guided anterior shoulder stretch with large GH Joint - Extension range
Door Frame Shoulder Stretch - self-guided anterior shoulder stretch with large Horizontal GH Joint - Abduction range
Banded Capsule Rolls - split stance biceps variation that emphasises shoulder rotation
Dowel External Rotation Stretch - self-guided GH Joint - External Rotation stretch with overpressure
Shoulder External Rotation Stretch - rudimentary active stretch with large GH Joint - External Rotation range and several variations
Myofascial Release of the following structures through Massage or self-guided means may be of benefit to those with Superficial Front Arm Line dysfunction, with specific techniques often discussed on their respective pages:
Practitioner-Guided
Pectoralis Major - with patient supine a superficial glide may be applied with a broad hand or forearm in the direction of restriction, typically towards its shoulder insertion. To create a “pin and stretch” effect, the patient can add GH Joint - Abduction and/or GH Joint - External Rotation to further elongate the muscle/ line
Latissimus Dorsi - with patient prone or supine, a superficial glide to the Muscle is applied along its length over the posterolateral Ribs in the direction of Fascia l restriction, typically from distal attachment towards the Axilla/Humeral attachment.The patient may move through GH Joint - Abduction and GH Joint - Adduction to elongate the Muscle under the gliding pressure
Common Flexor Tendon - the shared origin of the Wrist - Flexion muscles may be treated at the Medial Epicondyle of Humerus with sustained compression, transverse frictions or a “pin and stretch” with the addition of Wrist - Extension / Elbow - Supination
Wrist Flexors - superficial glides may be applied with a forearm, broad Thumb pad or knuckles in the direction of restriction, typically towards The Wrist
Self-Guided
Pectoralis Major Release - using either Foam Roll or Handle of a Kettlebell in a “pin and stretch” type fashion
The following Strength techniques can be used for the Superficial Front Arm Line:
Chest Fly (with GH Joint - External Rotation ) - large horizontal abduction range to emphasise lengthening of the Chest
Chest Press Machine - rudimentary horizontal push machine
Half DB Bench Press - unilateral isotonic horizontal pressing motion that emphasises the Anterior Sling
DB Pullover - moderate isotonic movement with large overhead and Thoracic - Extension range
Farmers Carry - upperbody/ Core isometric exercise with perturbation of walking
Kneeling Landmine Press - wholebody, explosive vertical pressing exercise with large overhead range
Medball Pullover Throw - plyometric Pullover variation
Suitcase Carry - unilateral farmers carry which emphasises crossbody functional patterns
Split Stance Landmine Press - crossbody, standing variation of the Kneeling Landmine Press
Rope Climb - pull-up variation with entire load bestowed on alternating arm
DB Snatch to Step-Up - wholebody DB Snatch variation that emphasises diagonal functional patterns
Myers, T. W. (2009). Anatomy trains: Myofascial meridians for manual and movement therapists (2nd ed.). Elsevier.
Standring, S. (Ed.). (2016). Gray’s anatomy: The anatomical basis of clinical practice (41st ed.). Elsevier.
Wilke, J., & Krause, F. (2019). Myofascial chains of the upper limb: A systematic review of anatomical studies. Clinical anatomy (New York, N.Y.), 32(7), 934–940. https://doi.org/10.1002/ca.23424
Butt, U., Mehta, S., Funk, L., & Monga, P. (2015). Pectoralis major ruptures: a review of current management. Journal of shoulder and elbow surgery, 24(4), 655–662. https://doi.org/10.1016/j.jse.2014.10.024