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Corresponding Author: John Sharkey MSc. Faculty of Medicine, Dentistry and Clinical Sciences, University of Chester/NTC, 15-16aSt Joseph’s Parade, Dorset St, DO7 FR6C, Dublin, Ireland. E-Mail: john.sharkey@ntc.ie 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.

international journal of anatomy and research

SITE-SPECIFIC FASCIA TUNING PEGS AND PLACES OF PERILOUS PASSAGE MYOFASCIAL CONSIDERATIONS IN UPPER EXTREMITY ENTRAPMENT NEUROPATHIES: A CLINICAL ANATOMISTS VIEW