Upper Extremity Myofascial Chains

Original Editor - Carin Hunter based on the course by Rina Pandya
Top Contributors - Jess Bell and Carin Hunter

Introduction[edit | edit source]

Historically, skeletal muscles have been viewed as independent structures. However, recent research increasingly suggests that skeletal muscles work together as part of interconnected anatomical chains - i.e. myofascial chains.[1][2][3]

A myofascial chain is essentially a line of connective tissue that runs through the body. These chains enable movement and force transmission[3] and help the body to move as a unit.  They can, however, also cause pain and structural weakness.[4] Thus, by understanding myofascial chains, you may be better able to understand injuries and movement limitations.

A number of theories about myofascial chains have been proposed. In 2013, Meyers suggested that there are 12 myofascial meridians in the body.[5] A systematic review by Wilke and Krause[6] found strong evidence to support the existence of three myofascial chains. This page focuses on four myofascial chains of the upper limb,[4] which are described in more detail below:

  1. Superficial front arm line (Figure 1)
  2. Deep front arm line (Figure 2)
  3. Superficial back arm line (Figure 3)
  4. Deep back arm line (Figure 4)

Superficial Front Arm Line[edit | edit source]

This line travels down the anterior and medial side of the arm.[4]

  1. Figure 1. Superficial front arm line.
    Medial third of the clavicle, coastal cartilage
  2. Pectoralis major, latissimus dorsi
  3. Medial humeral line
  4. Medial intermuscular septum
  5. Medial humeral epicondyle
  6. Flexor group
  7. Carpal tunnel
  8. Palmar surface of the fingers

Deep Front Arm Line[edit | edit source]

This line travels down the radial side of the arm. Clinical symptoms associated with this chain might include tingling / numbness on the lateral side of the thumb, which could be associated with golfer's elbow.[4]

  1. Figure 2. Deep front arm line.
    3rd, 4th and 5th ribs
  2. Pectoralis minor
  3. Coracoid process
  4. Biceps brachii
  5. Radial tuberosity
  6. Anterior border of radial periosteum
  7. Styloid process of radius
  8. Radial collateral ligaments and thenar muscles
  9. Scaphoid and trapezuim
  10. Outside of the thumb

Superficial Back Arm Line[edit | edit source]

This line travels along the radial side of the arm. Clinical symptoms associated with dysfunction in this line include: rounded shoulders / kyphotic spine (i.e. office workers) with hypomobility, neck pain and headaches. Trigger points may be present in the periscapular area and along the extensor aspect of the arm. There may also be signs of carpal tunnel syndrome.[4]

  1. Figure 3. Superficial back arm line.
    Occipital ridge
  2. Nuchal ligament
  3. Thoracic spinous process
  4. Trapezius
  5. Spine of scapula, acromion, lateral third of clavicle
  6. Deltoid
  7. Deltoid tubercle of humerus
  8. Lateral intramuscular septum
  9. Lateral epicondyle of humerus
  10. Extensor group
  11. Dorsal surface of fingers

Deep Back Arm Line[edit | edit source]

This line travels along the ulnar border of the arm. Patients might complain of "bone" pain on the medial border of the scapula. They may also have a forward head position with a hypomobile ridge along the cervicothoracic junction.[4]

  1. Figure 4. Deep back arm line.
    Spinous process of lower cervicals and upper thoracic spine, C1-4 transverse processes
  2. Rhomboids and levator scapula
  3. Medial border of scapula
  4. Rotator cuff muscles
  5. Head of humerus
  6. Triceps brachii
  7. Olecranon of ulna
  8. Fascia along ulnar periosteum
  9. Styloid process of ulna
  10. Ulnar collateral ligaments
  11. Triquetrum, hamate
  12. Hypothenar muscles
  13. Outside of little finger

Stabilisation Tracts[edit | edit source]

1. Back arm line[edit | edit source]

  1. Latissimus dorsi
  2. Thoracolumbar fascia
  3. Sacral fascia contralateral to thoracolumbar fascia
  4. Gluteus maximus contralateral to thoracolumbar fascia
  5. Vastus lateralis

2. Front arm line[edit | edit source]

  1. Pectoralis major
  2. External oblique
  3. Adductor longus contralateral to external oblique
  4. Gracilis contralateral to external oblique
  5. Pes anserine contralateral to external oblique
  6. Tibial periosteum contralateral to external oblique

References[edit | edit source]

  1. Burk C, Perry J, Lis S, Dischiavi S, Bleakley C. Can myofascial interventions have a remote effect on ROM? A systematic review and meta-analysis. Journal of sport rehabilitation. 2019 Oct 18;29(5):650-6.
  2. Dischiavi SL, Wright AA, Hegedus EJ, Bleakley CM. Biotensegrity and myofascial chains: A global approach to an integrated kinetic chain. Medical hypotheses. 2018 Jan 1;110:90-6.
  3. 3.0 3.1 Bordoni B, Myers T. A review of the theoretical fascial models: biotensegrity, fascintegrity, and myofascial chains. Cureus. 2020 Feb;12(2).
  4. 4.0 4.1 4.2 4.3 4.4 4.5 Pandya R. Upper Extremity Myofascial Chains Course. Physioplus, 2021.
  5. Kazakos D, Liapis A, Mylonas K, Angelopoulos P, Koubetsos A, Tsepis E, Fousekis K. Treatment of scalene muscles with the Ergon technique can lead to greater improvement in hip abduction range of motion than local hip adductor treatment: a study on deep front line connectivity. Journal of Physical Therapy Science. 2020;32(11):706-9.
  6. Wilke J, Krause F. Myofascial chains of the upper limb: a systematic review of anatomical studies. Clinical Anatomy. 2019 Oct;32(7):934-40.