Postaxial Innervation

Dorn Spinal Therapy

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The radial nerve branches into two nerves, the deep and superficial radial nerves on the forearm. At the branching location of each of these two nerves is a primary homeostatic ARP.

Two primary homeostatic ARPs on the posterior shoulder muscles are supplied by the posterior branches of the superior trunk from the brachial nerve plexus: the dorsal scapular nerve, and the suprascapular nerve.

H13 Dorsal Scapular (Muscular)

The dorsal scapular nerve branches from the ventral ramus of C5 and descends from the cervical region down to the medial border of the scapula. It innervates three muscles: the levator scapulae, the rhomboid major, and the rhomboid minor. This nerve enters the levator scapulae muscle approximately 1 cm superior to the base of the spine of the scapula (Fig. 8-18). The H13 dorsal scapular ARP is formed at this neuromuscular attachment.

The H13 dorsal scapular ARP is needled for all symptoms related to the head, neck, shoulder, arm, and upper back. All of the three muscles— the levator scapulae, rhomboid major, and rhomboid minor—are innervated by the dorsal scapular nerve and are sore or sensitive in most patients with these symptoms. These muscles should be treated in most patients. However, the needling is very tricky because the lung is directly under this ARP and under both the rhomboid muscles. The author suggests the following needling methods, but the practitioner should ensure that the needle is always outside the rib cage:

1. In a thinner patient, a 2.5-cm-long needle is directed horizontally and either inferiorly or laterally, to ensure entrance into the muscle but remaining outside the rib cage. If this is difficult, the alternative method is to needle this point perpendicularly with four or five 1.5-cm-long

Brachialis

Musculocutaneous nerve

Coracobrachial -

Biceps brachii

Lateral cutaneous nerve of forearm

Figure 8-17 The musculocutaneous nerve and its branch, the lateral antebrachial cutaneous nerve.

Brachialis

Greater occipital i Semispinalis capitis \ Occipital artery; vein Occipital artery Posterior auricular vein Occipital artery, mastoid branch Lesser occipitalis nerve Longissimus capitis Accessory nerve [XI] Splenius capitis Levator scapulae Dorsal scapular nerve Deep branch (transverse cervical artery) Levator scapulae

Transverse cervical vein Rhomboid minor Trapezius

Rhomboid major

Latissimus dorsi

Trapezius

Figure 8-18 The dorsal scapular nerve branches from the ventral ramus of C5 and descends from cervical region down to the medial border of the scapula. It innervates three muscles: the levator scapulae, the rhomboid major, and the rhomboid minor. This nerve enters the levator scapulae muscle approximately 1 cm superior to the base of the spine of the scapula. The H13 dorsal scapular point is formed at this neuromuscular attachment. The muscle levator scapulae is cut away in this illustration to show the dorsal scapular nerve.

Occipital artery, occipital branches Occipital artery Greater occipital nerve Occipital vein

Lesser occipital nerve Great auricular nerve Posterior auricular artery, occipital branch Splenius capitis Sternocleidomastoid External jugular vein

Posterior cutaneous branches (cervical and thoracic nerves, posterior branches)

Trapezius

Posterior cutaneous branches (thoracic nerves, posterior branches)

Lateral pectoral cutaneous branches (thoracic nerves, intercostal nerves)

Figure 8-18 The dorsal scapular nerve branches from the ventral ramus of C5 and descends from cervical region down to the medial border of the scapula. It innervates three muscles: the levator scapulae, the rhomboid major, and the rhomboid minor. This nerve enters the levator scapulae muscle approximately 1 cm superior to the base of the spine of the scapula. The H13 dorsal scapular point is formed at this neuromuscular attachment. The muscle levator scapulae is cut away in this illustration to show the dorsal scapular nerve.

needles. This alternative method is less effective but safer in dealing with thin patients.

2. In patients with average musculature, a 2.5-cm-long needle is directed perpendicularly at this point.

3. For more effective treatment, the forearm of a patient is laid under the back with a 90-degree flexion in order to raise the scapula, and a 4-cm-long needle is directed laterally at this point. The same method can be used to needle both the rhomboid muscles and the subscapularis muscle, which lies on the costal surface of the scapula.

H8 Infraspinatus (Muscular)

The infraspinatus ARP (Fig. 8-19) is so named because it is located right on the infraspinatus muscle. However, the infraspinatus and the supraspina-

tus muscles are all innervated by the same nerve: the suprascapular nerve.

The suprascapular nerve receives fibers from C5 and C6 and arises from the posterior division of the superior trunk of the brachial plexus. It supplies the suprascapular and infrascapular muscles and the shoulder joint. This nerve descends down from the neck, sends a branch to the supraspina-tus muscle, and curves around the scapular notch to reach the infraspinatus muscle. The nerve enters the infraspinatus muscle from underneath at the center of the infraspinatus fossa, and the ARP is formed at this neuromuscular attachment. It is easy to palpate this sensitive point, inasmuch as it is right in the center of the infrascapular fossa.

Although it is easy to find this point and safe to needle it because it is right on the scapular bone, caution is still needed. If a patient positions his or

Suprascapular nerve

Inferior transverse scapular ligament

Superior transverse scapular ligament

Suprascapular artery

Circumflex scapular artery

Suprascapular nerve

Inferior transverse scapular ligament

Circumflex scapular artery

Acromial anastomosis

Profunda brachii artery

Radial collateral artery,posterior branch

Figure 8-19 The infraspinatus acu-reflex point is so named because it is located right on the infraspinatus muscle. The infraspinatus and the supraspinatus muscles are all innervated by the suprascapular nerve.

Acromial anastomosis

Profunda brachii artery

Radial collateral artery,posterior branch

Inferior ulnar collateral artery Ulnar nerve Ulnar recurrent artery Cubital anastomosis

Figure 8-19 The infraspinatus acu-reflex point is so named because it is located right on the infraspinatus muscle. The infraspinatus and the supraspinatus muscles are all innervated by the suprascapular nerve.

Axillary nerve

Posterior circumflex humeral artery

Posterior cutaneous nerve of arm (radial nerve)

Inferior lateral cutaneous nerve of arm (radial nerve)

Radial collateral artery, anterior branch Posterior cutaneous nerve of forearm (radial nerve)

Lateral cutaneous nerve of forearm (musculocutaneous nerve)

her arms in a particular way, the scapula moves laterally, and the lung is exposed. For the sake of safety, practitioners must always make sure that the ARP is on the infraspinatus fossa of the bone.

Some patients have thick infraspinatus muscle, and so the needle can be directed perpendicular to the ARP and inserted all the way to the bone. For patients with a thin infraspinatus muscle, the needle can be tilted at a proper angle according to the thickness of the muscle.

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