The objective of this study was to identify common anatomical locations of densified fascia associated with axillary, musculocutaneous, median, ulnar and radial nerve entrapment. Additionally, a proposal concerning a tensegrity based expansive decompressive protective role of muscles and ligaments as ‘site-specific fascia tuning pegs’ is offered for consideration. This observational report provides a means to stimulate research into the dynamics of force transfer via tensegral mechanotransductive pathways possibly decompressing neurovascular structures. Morphological changes to fascia profunda, septal tissues, epineurium, perineurium and endomysial tissue in continuity with neural structures were noted. Entrapment neuropathies involving the upper extremity are a growing and widespread phenomenon within modern society. Upper extremity neuropathies affect dentists, athletes (professional and recreational), pianists, grocery store employees, office workers, cab drivers and a host of other professional and non-professional individuals. Neurovascular insults can develop at multiple sites referred to by anatomists as the three P’s [i.e. Places of Perilous Passage]. The complexity of the inter-communicating nerve network, known as the brachial plexus, is well described as are the referred pain patterns of the contributing terminal branches. Sensory innervation to the upper extremity includes most of the axilla while excluding a specific region of the medial upper extremity and axilla which is supplied by the intercostobrachial nerve [i.e. T2]. This observational study identified specific anatomical locations where increased fascial densification lead to reduced gliding of the various facial laminae due to densified, fibrotic or adhered fascial tissues. A new hypothesis emerged concerning “site-specific fascia tuning pegs” described as biological instruments [i.e. muscle fibers and ligaments] that modify the length and width of the various specialist neural and vascular tubes [i.e. epineurium, tunica adventitia]. This author hopes that providing this information will assist in improving diagnosis, treatment and prognosis of upper extremity neurovascular insults that result in pain or unpleasant changes in sensation.

John Sharkey – MSc

John Sharkey is an international educator, author and authority in the areas of clinical anatomy, exercise science, human movement and the manual treatment of chronic pain. He is a graduate of the University of Dundee, University of Liverpool and University of Chester. He completed undergraduate and post-graduate studies in the areas of exercise physiology, clinical anatomy and holds a post-graduate certificate in education. He is currently a senior lecturer within the Faculty of Medicine, Dentistry and Life Sciences, University of Chester/NTC, Dublin and is the programme leader of the Biotensegrity focused Thiel soft fix cadaver dissection courses department of anatomy and human identification, Dundee University, Scotland.

John has been delivering human anatomy dissection courses for many years teaching the geometry of anatomy and movement from the unique Biotensegrity-Anatomy for the 21st Century perspective. His presentations are respectful, dynamic, entertaining, educational and insightful.

John promotes his model of “Biotensegrity-anatomy for the 21st century” integrating the pioneering work of his mentor Dr. Stephen Levin MD. John has been teaching European Neuromuscular Therapy using living anatomy and specialising in chronic pain conditions. He is recognised as one of the worlds leading authorities on fascia and Biotensegrity. He is a member of the editorial board of the Journal of Bodywork and Movement Therapies (JBMT), International Journal of Osteopathic Medicine and other professional journals.

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