Coracobrachialis
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Trigger point pain.
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The Coracobrachialis is a muscle of the arm.
Anatomical Attachments:
- Origin: Attaches to the coracoid process of the scapula.
- Insertion: Attaches approximately half way down the medial aspect of the humerus.
Action: Flexes and adducts the arm.
Synergist: Biceps brachii, Pectoralis major, anterior deltoid.
Antagonist: Posterior Deltoid, Latissimus dorsi, Teres major, and the long head of the Triceps brachii.
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Nerve Supply: Musculocutaneous nerve (C5, C6, C7).
Nerve Entrapment: While leading authors currently have not identified any entrapment syndrome associated with this muscle, it’s difficult, after studying anatomy, to disassociate it from that eventuality due to its attachment to the coracoid process and the numerous nerves and blood vessels passing in close approximation of this muscle and the frequently encountered fascial restriction associated with this region. However, if there should be a soft tissue component associated with neurovascular entrapment, it should be easily identified through muscle testing, palpation, and decreased function.
Vascular supply: Muscular branches of brachial artery.
Travell and Simons Trigger Point Pain Referral:
- Primary: The pain refers over the anterior deltoid area, down the back of the arm and over the dorsum of the hand to the middle finger, bypassing the elbow and the wrist.
- Satellite or associated triggers: Anterior and posterior deltoid, Biceps brachii, Supraspinatus and Triceps brachii.
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Trigger Point Signs and Symptoms: Anterior shoulder and posterior arm pain which is exacerbated when an individual attempts to extend and medially rotate their arm and forearm, as in placing the dorsum of the hand in the middle of their back. David Simons states, that in a shortened position the coracobrachialis also can elicit pain such as attempting to reach behind one’s head and touch one’s face or mouth also known as the hand wrap around maneuver.
Trigger Point Activating and Perpetuating Factors: According to Travell and Simons, the perpetuating factors are usually due to active TrPs in the surrounding muscles. However, any activity which would result in hypertonicity of this muscle potentially could activate the TrPs, such as, an activity that would result in mechanical overloading of the arm flexion or adduction.
Differential Diagnosis: (Segmental, Subluxation, Somatic dysfunction) C5 C6 or C7 radiculopathy, Thoracic outlet syndrome, Angina Pectoris, Myocardial infarction, Pericarditis, Pneumothorax, Adhesive capsulitis (Frozen Shoulder), Shoulder pointer, Cubital tunnel syndrome, Carpal tunnel syndrome, Bicipital tendinitis, Subacromial bursitis, Supraspinatus Tendinitis, Acromioclavicular joint dysfunction, Subluxation/Dislocation of glenohumeral joint, Charcot’s arthropathy, Complex regional pain syndrome (Reflex sympathetic dystrophy), Fibromyalgia, Tension myalgia, Polymyositis, Tenosynovitis, Rotator cuff injury, Sprain/strain injury, Polymyalgia rheumatica, Bone fracture, Bone cancer, Gallstones, Osteomyelitis, Osteoarthritis, Rheumatoid arthritis, Eosinophilic fasciitis, Tetanus, Systemic infections or inflammation, Nutritional inadequacy, Metabolic imbalance, Toxicity, Side effects of medication.
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