Positive Health Online

Two arms. Two hands. An armful of pathologies: tennis elbow (lateral epicondylitis), the so-called repetitive strain injury, writer's cramp (should be called typist's cramp, really), Dupuytren's contracture, knitters' little finger, carpal tunnel syndrome, de Quervain's disease, trigger digit, peritendinitis crepitans, ganglions of the hand and wrist.... Although these problems are increasingly common, specialists rarely agree on their exact cause and are often at a loss when it comes to explain why these symptoms appear. So, let's roll up our sleeves and take a closer look at the upper limb so that we may get the upper hand on these various disabilities.

When anatomists describe the body, they do so in reference to what is known as the anatomical position. John Napier tells us that: "The concept of an anatomical position is derived from the posture in which human cadavers were in Hunter's time suspended for dissection, either for reasons of space or verisimilitude."[1],[2] In this position, the person is standing up with the arms by the sides and the palms of the hands facing forwards (supination). Note that it's not a position of rest but one that requires externally rotated arms and supinated hands. I agree with FM Alexander that an individual whose hands fall in this position when they are at rest would be badly co-ordinated. But we can say that these cases are a rare occurrence.

In fact, for most of us, it is rather difficult to adopt this position correctly. Judge for yourself. Stand up with your back against a wall, making sure that your skull, shoulder-blade area, sacrum and heels are touching it. Your arms by the sides, bring the bony bits at the back of your elbows in contact with the wall. Now, without losing this elbow/wall contact, twist your forearms and hands so that your palms are facing forwards. Spread out your fingers and try to make your wrists and the tips of your fingers, including your thumbs, touch the wall. Watch out! If you concentrate too hard on your hands, you will overlook your elbows. Are they still in contact with the wall? What about your shoulders? Are they turning inwards (round shoulders) or are they going up towards your ears? And your spine? Aren't you arching it – how much of your back is still touching the wall? And, a vital question, are you still breathing? Maybe the idiom 'to have one's back to the wall' has never fitted the context so well. I hope this little exercise will have convinced you of the supremacy of the internal rotator and pronator muscles of the upper limb over the external and supinator ones; of the flexor muscles over the extensor ones.

On the other hand, this position is naturally adopted when we come back from a shopping spree and have to carry heavy bags. In this case the elbow joints usually form an angle that 'looks' laterally. It is called a cubitus valgus, also known as the 'carrying angle', and is said to be normal when it measures roughly 5 degrees in males and between 10 and 15 degrees in females. It is doubtful, however, that such angles are normal. Most of the time it should rather be interpreted as a deviation from the norm – the result of a lack of co-ordination between the respective rotations of the arm and forearm where the former rotates outwards too much. The opposite distortion is called cubitus varus or 'gunstock deformity'. These angles only show up when the arms are in full extension.

While certain people have some difficulty in fully extending their elbows, others go too far and end up in a position of hyperextension or recurvatum of the elbow – the elbow bends backwards. The latter are 'double-jointed'; the former, 'jointless'. It is generally believed that double-jointedness is a sign of great laxity and flexibility. It is unfortunately not true. In most subjects, hyperextension of the elbow is the result of an excessive outward rotation of the arm and shoulder-blade, accompanied by an upper back lordosis, caused by the shortening of some of the back muscles. It just goes to show that the arms, like any other part of the body, are part of a closely-knitted whole and that any form of analytical work is unacceptable and inefficient.

Our arms are rarely allowed to be at rest. They behave as if they were trying to uphold our human frame or were constantly carrying heavy suitcases. No wonder, then, that the arms are usually stiff. To rest your arms you must first 'rest your case', i.e., put down your imaginary bulky suitcases. But people are rarely aware of the harmful amount of stiffness that their arms harbour. My pupils, however, are quickly made to realize it. All I have to do is to raise their arms at a right angle to their body and then gently pull them towards a correct alignment. This manoeuvre, although gentle, is sufficient to make most of them beg for mercy. The shortening of the brachial (arm) muscular chain has thus been exposed. The existence of such a muscular chain running along the length of the whole arm and hand and the muscular chain concerning the upper body are sufficient to explain most, if not all, of the pathologies listed at the beginning of this article.

It is hopeless, however, to tell people that their arms are stiff. It is better to make them aware of this fact by lengthening their brachial muscular chain. But even that is not enough. What is essential is to give them the new and correct sensory experience of arms in a state of repose, and this requires that the whole person be properly co-ordinated.

References

1. Napier John. Hands. Princeton Science Library. 1993.
2. John Hunter (1728-1793), great anatomist, medical man, physiologist....