Understanding the Role of the Brachial Plexus in Shoulder Mobility

Written by Lavonne Ayoub 6/25/2024

Today, we're exploring the intricate role of the brachial plexus in shoulder mobility! So much fun! Understanding this crucial network of nerves is essential for effectively addressing shoulder issues and enhancing your massage therapy practice. Let's explore how this knowledge can empower us to deliver substantial pain relief and improve the well-being of our massage clients.

Today, let's marvel at the intricate beauty of the brachial plexus and its crucial role in shoulder mobility. Understanding this network of nerves is critical to addressing the myriad shoulder issues clients often present with, including pain radiating into the arm and hand. Understanding this complex system will empower us to deliver substantial pain relief and enhance our clients' overall well-being.

What is the Brachial Plexus?

The brachial plexus is a marvelous network of nerves that begins in the neck and travels through the armpit to innervate the shoulder, arm, and hand. Imagine it as a highway system for nerve signals, ensuring every muscle and sensory receptor in the upper limb gets the right message from the brain. Let's focus on the nerves and their interactions with muscles without delving into the complete anatomy of the nerve roots (C5-T1).

Here we go! If you are a massage therapy nerd like me, you are going to love this :)

Key Nerves and Their Functions:

• Musculocutaneous Nerve:
  • Nerve Roots: C5, C6, and C7.
  • Functions: Powers the biceps and other arm flexors and provides sensation to the lateral forearm.
• Axillary Nerve:
  • Nerve Roots: C5 and C6.
  • Functions: Activates the deltoid and teres minor muscles, essential for shoulder movements.
• Radial Nerve:
  • Nerve Roots: C5, C6, C7, C8, and T1.
  • Functions: Controls the triceps and extends muscles in the arm and forearm, provides sensation to the posterior arm and hand.
• Median Nerve:
  • Nerve Roots: C5, C6, C7, C8, and T1.
  • Functions: Innervates most forearm flexors and some hand muscles, critical for fine motor skills.
• Ulnar Nerve:
  • Nerve Roots: C8 and T1.
  • Functions: Powers the hand's intrinsic muscles and some forearm muscles, vital for grip and dexterity. 

The Role of the Brachial Plexus in Shoulder Mobility

The shoulder joint relies heavily on the brachial plexus for mobility and stability. A healthy nerve supply ensures effective muscle contraction and coordination, essential for smooth, pain-free movement. When clients present with symptoms of pain and discomfort in the shoulder, arm, and hand, we can use the "midline out" principle of the Total Body Flow Massage® Method. Using this principle, we would work from the lamina groove (midline) at the cervical spine around the muscles near the C5, C6, and C7 nerve roots outward into the scalene, shoulder, arm, and back again.

Why?

Remember, a Total Body Flow massage is a holistic full-body experience. So, we want to address any discomfort as a full-functioning unit. In this case, the nerve roots C 5, 6, and 7 innervate and affect an entire quadrant, including the neck, shoulder, arm, and hand, so it makes sense to address not just the pain point but the entire function unit. We want to decompress and relax the entire unit.   

Looking at the Compressed Nerve Roots will help us visualize:

• • C5 Root: Travels through the anterior and middle scalene muscles. Compression can cause pain, referring to the deltoid muscle area, with numbness and tingling in the upper arm laterally.
  • C6 Root: Also passes between the anterior and middle scalene muscles. Compression can cause pain radiating down the forearm's lateral aspect, affecting the thumb and index finger, with muscle weakness in the biceps and wrist extensor muscles.
  • C7 Root: Generally less compressed but can cause pain to refer down the back of the arm into the middle finger, with weakness affecting the triceps and wrist flexors.

Symptoms of Brachial Plexus Compression:

• Tingling, numbness, or burning sensations in the arm and hand.
• Weakness in the affected muscles.
• Reduced range of motion and strength in the shoulder, arm, or hand.
• Symptoms may worsen with certain positions or movements, such as lifting the arm overhead or turning the head to the side.

How to address Brachial Plexus Compression as a massage therapist:

1. Relax the muscles around the cervical vertebra, like the multifidus and rotatores in the lamina groove, as well as the upper trapezius and splenius cervicis, to help decompress the cervical vertebra joints.  
2. Address the scalene muscle directly because the scalene muscles may be compressing the brachial plexus roots, leading to conditions like thoracic outlet syndrome (TOS).
3. Extend massage therapy techniques into the shoulder, arm, and hands to palpate muscles directly affected by the results of brachial compression pain in the limb.

Common Conditions Involving the Brachial Plexus

While massage therapists do not prescribe or diagnose, understanding the brachial plexus is critical in addressing these conditions in their massage therapy practice when a massage client has been diagnosed by a physician or a massage therapy client presents with symptoms that we have learned through experience mimics the pain patterns of conditions like:

• Thoracic Outlet Syndrome (TOS): Caused by compression of the brachial plexus, leading to pain, numbness, and weakness.
• Brachial Plexopathy: Damage to the brachial plexus, often due to trauma, tumors, or radiation therapy.
• Neuralgic Amyotrophy: Parsonage-Turner syndrome is characterized by sudden onset of severe shoulder pain followed by muscle weakness.
• Rotator Cuff Impingement Syndrome: Inflammation and irritation of the rotator cuff tendons, causing shoulder pain, weakness, and restricted range of motion, often exacerbated by overhead activities or repetitive stress. 

Can my massage therapy practice really help with these conditions?

Certainly, we each have anecdotal evidence in our practices of how beneficial massage therapy is for almost every disease a person can have, from cancer to diabetes to anxiety and everything in between, especially muscular and nerve-related illnesses.

However, a case study on Thoracic Outlet Syndrome, which is directly influenced by brachial plexus compression, shows how massage and an interdisciplinary approach can help clients holistically with these conditions.

A Clinical Case Study for Neurogenic Thoracic Outlet Syndrome and Massage Therapy

Case Study: Neurogenic Thoracic Outlet Syndrome

A client presented with long-standing pins and needles down their arms and into both hands, particularly affecting the fourth and fifth fingers. Symptoms increased during strength training. Initial assessments, including nerve length testing and the ROOS stress test, confirmed the presence of neurogenic thoracic outlet syndrome. Treatment involved massage targeting the anterior scalene and pectoralis minor, providing short-term relief. Complementary strengthening exercises for the upper back and neck, along with nerve mobility exercises, were implemented to maintain benefits and improve nerve capacity and mobility. Over several sessions, the client experienced significant symptom reduction and improved strength during training.

Source: Primal Physiotherapy.

Integrating Knowledge into Your Massage Therapy Practice

Understanding the brachial plexus in your massage therapy practice opens new dimensions for treating shoulder issues. Here are some tips to incorporate this knowledge into your massage therapy practice:

1. Assessment: Evaluate your massage therapy client's shoulder mobility and look for signs of nerve impingement, such as numbness or tingling. (A good intake form for new massage therapy clients will help tremendously with this discovery.)
2. Targeted Techniques: Alleviate compression for your massage therapy recipient by releasing tension in the scalene muscles, which can compress the brachial plexus roots. Include stretches and mobilizations to enhance joint function.
3. Nerve Gliding Exercises: Provide information to promote healthy nerve movement within the brachial plexus. Learn more about nerve gliding exercises here.
4. Advanced Treatment Techniques: Advanced techniques for addressing brachial plexus issues include:
   • Myofascial Release: Focus on the scalene muscles to relieve nerve compression.
   • Trigger Point Therapy: Identify and release trigger points in the neck and shoulder region.
   • Stretching and Mobilization: Enhance joint function and muscle flexibility.
5. Interdisciplinary Collaboration: Massage therapists who collaborate with other healthcare professionals in their massage therapy practice enhance their treatment outcomes. Physical therapists can provide complementary exercises, while chiropractors can address spinal alignment issues. Regular communication and coordinated care plans can help with optimal client outcomes. You can never have too much information; partnerships only increase your value.
6. Continuing Education and Research: Massage therapists must continue learning and improving. Stay current with the latest research and continuing education. Consider joining professional organizations such as the American Massage Therapy Association (AMTA) or the National Certification Board for Therapeutic Massage and Bodywork (NCBTMB). Participate in other workshops, webinars, and courses to deepen your knowledge.

Conclusion

By understanding the brachial plexus and its role in shoulder mobility, massage therapists can provide more effective treatments in their massage therapy practice and improve their clients' quality of life. This knowledge empowers us to address both neural and muscular components within our scope of practice, leading to comprehensive and holistic care.

I don't know about you, but I loved this deep dive into the brachial plexus and its impact on shoulder mobility and pain relief for massage therapy clients and recipients!

Come back often for more insights and practical tips as we continue to explore the fascinating world of massage therapy together.

Keep learning, stay curious, and continue to elevate your practice!

With gratitude,
Lavonne Ayoub

Total Body Flow Massage Method
OnlineMassageAcademy.com