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Integrated functional anatomy of the coracobrachialis. Attachments, nerves, palpation, joint actions, arthrokinematics, fascia, triggerpoints, and behavior in postural dysfunction. Common exercises, foam rolling, and stretches for the coracobrachialis. 

Coracobrachialis

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This course describes the anatomy and integrated function of the coracobrachialis. As the name suggests, the coracobrachialis has an origin on the coracoid process of the scapula (a.k.a. shoulder blade) and an insertion on the "brachii" or anterior side of the humerus (a.k.a. upper arm bone). When this course was published, research could not be located that reported the relative mass and proportion of muscle fiber types of this muscle.

The coracobrachialis crosses the shoulder joint and acts as a synergist during shoulder flexion, horizontal adduction, and adduction. This course also discusses the coracobrachialis and shoulder (glenohumeral) joint arthrokinematics, fascial integration, subsystem integration, and postural dysfunction. For example, the coracobrachialis may act synergistically with the pectoralis major, latissimus dorsi, and teres major, contributing to adduction of the humerus and inferior glide of the humeral head in the glenoid fossa. These actions may be a component of the sign "

postural dysfunction (e.g. movement impairment) of the upper body.

Sports medicine professionals (personal trainers, fitness instructors, physical therapists, massage therapists, chiropractors, occupational therapists, athletic trainers, etc.) must be aware of the 

 function of the coracobrachialis for the detailed analysis of human movement, and the development of sophisticated exercise programs and therapeutic (rehabilitation) interventions. For example, altered activity and length of the coracobrachialis may contribute to shoulder impingement syndrome (SIS), anterior shoulder pain, bursitis, trigger points, and musculocutaneous nerve impingement. Altered coracobrachialis activity may also result in a reduction in posterior rotator cuff (infraspinatus and teres minor) activity, resulting in a significant decrease in upper body speed, agility, and strength, and a reduction in the effectiveness of resistance training routines intended to improve upper body strength and hypertrophy (bodybuilding). Deeper knowledge of coracobrachialis anatomy is essential for optimal assessment, intervention selection, and building a repertoire of coracobrachialis specific techniques.

 (<180°): Coracobrachialis Short and Over-active

Latissimus Dorsi Self-administered Active Release

Brookbush Institute’s most recommended techniques for Coracobrachialis (see videos below):

Anterior view of the coracobrachialis

 Course Summary: Coracobrachialis

Coracobrachialis Course Study Guide

Study Guide: Coracobrachialis

Webinar: Functional Anatomy of the Coracobrachialis

Introduction

 before a vowel, brachi-, word-forming element meaning “arm,” from Greek brakhion “arm,” perhaps originally “upper arm,” literally “shorter,” and from brakhys “short” (see 

 (adj.)), in contrast to the longer forearm. (

From shorter segment of arm to raven's beak-shaped protrusion of the scapula

The origin and insertion of the coracobrachialis muscle

Created from Gray's Anatomy plate 411 using Gimp, Public Domain, https://commons.wikimedia.org/w/index.php?curid=1595008

Attachment and Innervation

Attachments on the coracoid process of the scapula

Attachments & Innervation: Coracobrachialis 

Relative Location

A cadaver view of the anterior shoulder muscles

Where is the Coracobrachialis Located?

Palpation

Palpating the Coracobrachialis

Etymology of Terms Related to Coracobrachialis

Actions

This muscle will contribute to adduction, horizontal adduction, and flexion of the shoulder (1, 5).

Note: This muscle is lengthened by both internal and external rotation of the humerus and may play a role in returning the humerus to a neutral position (5).

Front raise exercise demonstrating shoulder flexion

The coracobrachialis will contribute to the stabilization of the shoulder (glenohumeral) joint.

The coracobrachialis eccentrically decelerates shoulder extension, abduction, horizontal abduction, internal rotation, and external rotation.

 is the prime mover, and the coracobrachialis is a synergist along with the 

 During shoulder horizontal adduction the 

 is the prime mover, and the coracobrachialis is a synergist along with the 

The anatomy of the shoulder including the pectoralis major and coracobrachialis

https://s-media-cache-ak0.pinimg.com/736x/16/dd/88/16dd8851669e36e5a4369f3e3d65645b.jpg

Arthrokinematics

Cross-sectional view of the arm including the coracobrachialis

Arthrokinematics and the Coracobrachialis

Joint Actions and Integrated Function of the Coracobrachialis

Fascial Integration

Our understanding of fascia has benefited from an exponential increase in research over the past two decades. This includes more research on its traditional functions as a passive medium that supports, protects, and encapsulates tissues (7), and its capacity to store elastic energy for explosive activity (8, 9). This also includes exciting new research that implicates fascia as a medium of communication. Levangin hypothesized that this may occur via electrical, cellular, and/or mechanical signals (10). Histological studies have shown this tissue to be densely innervated by free 

 endings, as well as by Pacinian corpuscles and Ruffini endings (8, 9). This inspires consideration of fascia as a sensory organ with a strong link to motion and neuromuscular reflex. Further, Stecco et al. have demonstrated that deep fascia is arranged in layers that may 

 over one another (9). This finding is likely more responsible for inspiring various fascia-specific interventions and is most often referred to when describing fascia’s role in “interrupting” 

Fascia as a Passive Tissue (Traditional Functions):

Fascia as an Active Medium of Communication

 endings, Pacinian corpuscles, and Ruffini endings

May transmit the force of multiple muscles to aid in joint stabilization

Fibroblasts may play a role in increasing 

Image of the fascial system of the body connecting muscles

 The coracobrachialis and biceps brachii share a tendon (originating on the coracoid process) which may imply a synergistic relationship. Both muscles contribute to shoulder flexion (e.g. shoulder front raise exercise), and potentially shoulder adduction when starting from an arm elevated position (e.g. lat pull down exercise). Further, both muscles may contribute to similar arthrokinematic motions and shoulder (glenohumeral) joint stability by resisting the inferior pull of gravity during relaxed standing (6), and contributing to compression during abduction.

The shared tendon may also share fascial continuity with the tendon of the 

. This is noted by Tom Myers as the proximal portion of the Deep Front Arm Line (DFAL) (11). These muscles work synergistically during shoulder extension and/or adduction from an arm-elevated position (as mentioned above) when combined with scapula downward rotation and/or anterior tipping. This combination of actions is common during activities like a pull-over, 

The coracobrachialis, biceps brachii, and pectoralis minor exhibit a propensity toward over-activity and trigger point development; however, the pectoralis minor exhibits a significantly higher prevalence of trigger point development (12).

Last, further research is needed to determine if the shared tendon of the coracobrachialis, biceps brachii, and fascial continuity with the tendon of the pectoralis minor may have additional fascial continuity with the coracoacromial ligament or coracohumeral ligament. This could imply that an increase in tension of these muscles may increase the tension of these ligaments and contribute to acromioclavicular (AC) joint and glenohumeral joint stability, or that increased tension of these ligaments during glenohumeral and AC joint motion may affect the activity of these muscles. This relationship may be analogous to the relationship between the biceps femoris, the sacrotuberous ligament, and the sacroiliac joint.

Attachments on the Coracoid Process - http://clinicalgate.com/wp-content/uploads/2015/03/B9780323039895000079_f005-006-9780323039895.jpg

The insertion of the coracobrachialis lies between and abuts the attachments of the brachialis and medial head of the triceps brachii on the medial aspect of the humerus. A synergistic relationship between the coracobrachialis and these muscles is puzzling because neither muscle crosses the shoulder, and the coracobrachialis does not cross the elbow. If there is a synergistic relationship it is unlikely to be related to osteokinematic motions. The fascial continuity from the coracobrachialis tendon, the medial intermuscular septum, the medial condyle of the humerus, and the flexor mass of the forearm, may imply that the synergistic relationship with the medial head of the triceps brachii and brachialis is related to elbow stabilization, particularly the medial aspect of the humeroulnar joint. This myofascial synergy may aid in resisting forces when an external load is carried in the hand (flexion of fingers, elbow stabilization, and resisting inferior glide of the humerus).

Attachments on anterior humerus

Fascial Integration and the Coracobrachialis

 The coracobrachialis (and short head of the biceps brachii) may contribute to superior glide of the humeral head, increased stiffness of the glenohumeral joint, increased stiffness during internal and external rotation without reducing ROM when the shoulder is abducted, and restriction of shoulder extension ROM.

The coracobrachialis may play a larger role in the acceleration of a maximal upper extremity effort, and potentially is more active during horizontal adduction (pitching), when compared to a routine functional task that involves primarily shoulder flexion (lifting a box to eye level).

Cadaver Studies Including the Coracobrachialis

Two cadaveric studies investigated the forces imparted by the coracobrachialis (and various shoulder muscles) on the shoulder joint. Halder et al. compared 10 cadaveric shoulders mounted on a testing device with cables connected to the tendons of the investigated shoulder muscles. The shoulder was pneumatically positioned at 30°, 60°, and 90° of glenohumeral abduction, and a constant inferiorly directed force was applied to the humeral head to ensure an identical starting position. Outcome measures included mean translation (in millimeters) of the humeral head by the anterior, middle, and posterior deltoid, supraspinatus, short head of biceps brachii, and coracobrachialis. The findings demonstrated that these muscles had a larger capacity for superior glide at 30° and 60° of glenohumeral abduction when compared to 90°. When comparing the ability of these muscles to superiorly glide the humeral head, the supraspinatus had the least capacity, the anterior deltoid exhibited the least capacity of the deltoid muscles, the middle deltoid exhibited the largest capacity of all of the muscles tested, and the posterior deltoid, biceps brachii, and coracobrachialis exhibited significant capacity between the least and most capable (16). Giles et al. compared 6 cadaveric shoulders (average age: 76.7 years) sectioned at the mid-humerus and mounted on a testing device. Loads were applied by pneumatic actuators via cables from the musculotendinous junctions of the coracobrachialis and short head of the biceps brachii through the conjoined tendon at the coracoid process. Four loads were tested (0, 5, 10, and 15 N), and 4 positions were tested (neutral abduction and neutral rotation, neutral abduction with end range external rotation, 90° of abduction with neutral rotation, and 90° of abduction with end range external rotation). Outcome measures included shoulder extension, internal rotation, and external rotation range of motion (ROM), and glenohumeral stiffness. The findings demonstrated that increasing tension increased glenohumeral stiffness in all configurations, and there was a trend toward a decrease in shoulder extension ROM with increased load. There was also a trend toward increased stiffness during internal rotation and external rotation in the abducted position starting from neutral rotation; however, ROM was not significantly affected. There was no significant change in ROM for the other positions and ranges tested (17). These studies suggest that the coracobrachialis (and short head of the biceps brachii) may contribute to superior glide of the humeral head, increased stiffness of the glenohumeral joint, increased stiffness during internal and external rotation without reducing ROM when the shoulder is abducted, and restriction of shoulder extension ROM.

One case study and one experimental study investigated EMG activity of the caracobrachialis during functional tasks. Saito et al. compared two university baseball pitchers with 8+ years of baseball experience during the pitching motion of 20 maximal effort pitches (fastballs). The findings demonstrated that the coracobrachialis and triceps brachii exhibited increased EMG activity during the cocking phase (acceleration). The biceps brachii exhibited increased EMG activity during the cocking phase (acceleration) and follow-through (deceleration). The latissimus dorsi and the pectoralis major exhibited increased EMG activity during the cocking phase (acceleration) but the duration of activity was significantly less when compared to other muscles. The deltoid muscles exhibited increased EMG activity in a sequential pattern starting with the anterior deltoid during the cocking phase, then the middle deltoid, then the posterior deltoid exhibiting the most activity during the release phase. Finally, the 2 participants exhibited significantly different EMG activation patterns for the trapezius and serratus anterior muscles (18). Martinez et al. compared 20 women (age: 21.4 + 1.9 years) and 20 men (age: 24.9 + 3.2 years) with no history of musculoskeletal disorders, upper extremity pain, or back pain. All participants moved a 6 kg and 12 kg box from a shelf at hip height to a shelf at eye height, for 3 trials/load, with 30 sec rest between trials (additional recovery time was given when needed). Outcome measures included glenohumeral joint reaction forces and EMG activity of the upper trapezius, infraspinatus, anterior deltoid, middle deltoid, posterior deltoid, teres major, triceps brachii, pectoralis major, pectoralis minor, subclavius, coracobrachialis, and lower trapezius. The findings demonstrated that during these lifting tasks "higher EMG activity" was exhibited by the trapezius, infraspinatus, anterior deltoid, and middle deltoid, and "lower EMG activity" was exhibited by the teres major, triceps brachii, pectoralis major, subclavius, coracobrachialis, lower trapezius, pectoralis minor, and posterior deltoid. The findings demonstrated that women exhibited a larger percentage of muscle force and muscle activation when compared to men, especially during the initial pull of the 12 kg box and lifting either load to the shelf at eye height (19). These studies may imply that the coracobrachialis plays a larger role in the acceleration of a maximal upper extremity effort, and potentially is more active during horizontal adduction (pitching), when compared to a routine functional task that involves primarily shoulder flexion (lifting a box to eye level).

Research Investigating the Coracobrachialis

 Unfortunately, there are few studies investigating the activity and function of the coracobrachialis. Based on current publications and research on other muscles with similar/synergistic functions, the coracobrachialis should likely be categorized as over-active and short(12). This change in activity and length may result in shoulder pain near end of range (e.g. shoulder impingement syndrome), and in rare cases may result in irritation of the musculocutaneous nerve (12).

 Over-activity is addressed with release techniques (self-administered, manual, vibration, IASTM, or a combination), and a decrease in length is addressed with lengthening techniques (self-administered or manual static lengthening). Although coracobrachialis specific techniques are rarely necessary, manual release may be performed in the same position as pectoralis minor manual release, self-administered release may be performed in the same position as lastissimus dorsi and teres major self-administered release, the coracobrachialis may be affected when performing upper extremity instrument assisted soft tissue mobilization (IASTM) over the medial aspect of the arm, and lengthening of the coracobrachilis would occur during lengthening techniques for the pectoralis major and/or latissimus dorsi.

Pectoralis Minor Self-administered Release

Latissimus Dorsi and Teres Major Static Stretch (Child's Pose)

Movement Impairment and Postural Dysfunction:

: Signs correlated with UBD include "arms fall" and "shoulder girdle elevation" during an 

, and excessive humeral internal rotation and scapula anterior tipping (rounded shoulder posture) during static posture. The coracobrachialis may contribute to "arms fall" during an 

 by restricting end-range shoulder flexion, and may contribute to "shoulder girdle elevation" by contributing to scapula anterior tipping (decrease in length between coracoid process and humerus) during static posture. Identification of these signs may imply that the coracobrachialis should be specifically addressed with 

 techniques and potentially additional lengthening (e.g. stretching) techniques.

Lumbo Pelvic Hip Complex Dysfunction (LPHCD)

: The coracobrachialis does not play a significant role.

Sacroiliac Joint Dysfunction (SIJD): The coracobrachialis does not play a significant role.

 The coracobrachialis does not play a significant role.

Pain at end range, or during combined motions

: Coracobrachialis over-active and short.

 (<180°): Coracobrachialis over-active and short.

Top Arm: Inability to reach T7 or the opposite superior angle of the scapula may indicate coracobrachialis over-activity.

Bottom Arm: Inability to reach T7 or the opposite inferior angle of the scapula may indicate coracobrachialis over-activity.

Movement Impairment and the Coracobrachialis

Behavior in Postural Dysfunction

This section describes the locations of coracobrachialis trigger points. Although trigger points may be 

 without knowledge of common locations, learning these locations may improve practice by further increasing reliability and the efficiency of implementing self-administered and manual release techniques. Practitioners will often memorize dozens or 100s of common trigger point locations with relatively little concerted study. This may be accomplished via reading descriptions of trigger point locations, motor point maps, and referral pain patterns like the content below. Followed by practicing the self-administered and/or manual techniques discussed in the next session, and reinforcing that knowledge with repeated use in practice.

Active trigger points generally develop secondary to trigger points in synergistic muscles (

Palpation results in tenderness (trigger points or tender points) or radiating pain in a broken pattern over the anterior deltoid, triceps brachii, dorsum of the forearm, back of the hand, and may extend down the middle finger; skipping the elbow and wrist (12).

The common trigger points of the anterior and posterior arm

Figure 29.1 vol 1, pg 639 Janet G. Travell & David G. Simons & Lois S. Simons, Myofascial Pain And Dysfunction, The Trigger Point Manual, Volume 1- Upper Half Of Body, Lippincott Williams & Wilkins, Philadelphia, 1999

Common Trigger Point Locations and Referral Pain Patterns for the Coracobrachialis

Techniques and Ending Info

Upper Extremity (Arm) Vibration Release Technique

Brachial Forearm Fascia IASTM

Crucifixion/Cross Stretch

Manual Pectoralis Major Stretch

Exercises and Techniques for the Coracobrachialis

Sample Intervention

Holzbaur KR, Murray WM, Gold GE, Delp SL. Upper limb muscle volumes in adult subjects. J Biomech. 2007;40(4):742-9. doi: 10.1016/j.jbiomech.2006.11.011. Epub 2007 Jan 22. PMID: 17241636.

Florence Peterson Kendall, Elizabeth Kendall McCreary, Patricia Geise Provance, Mary McIntyre Rodgers, William Anthony Romani

Ilayperuma I, Nanayakkara BG, Hasan R, et al. (2015). Coracobrachialis muscle: morphology, morphometry and gender differences.

Szewczyk, B., Polguj, M., Paulsen, F., Podgórski, M., Duparc, F., Karauda, P., & Olewnik, Ł. (2021). A proposal for a new classification of coracobrachialis muscle morphology. 

Benjamin, M. (2009). The fascia of the limbs and back–a review. 

Stecco, C., Porzionato, A., Lancerotto, L., Stecco, A., Macchi, V., Day, J. A., & De Caro, R. (2008). Histological study of the deep fasciae of the limbs. 

Journal of bodywork and movement therapies

Stecco, C., Pavan, P. G., Porzionato, A., Macchi, V., Lancerotto, L., Carniel, E. L., … & De Caro, R. (2009). Mechanics of crural fascia: from anatomy to constitutive modelling. 

: a body-wide signaling network? Med. Hypoththeses 66, 1074-1077

Donnelly, J. M., Fernández-de-Las-Peñas, Finnegan M., Freeman, J. (2022). 

Travell, Simons & Simons' Myofascial Pain and Dysfunction: The Trigger Point Manual 3rd Edition

Phillip Page, Clare Frank, Robert Lardner, 

Assessment and Treatment of Muscle Imbalance: The Janda Approach

Lawrence, R.L., Braman, J.P., Staker, J.L., Laprade, R.F., Ludewig, P.M. (2014) Comparison of 3-dimensional shoulder complex kinematics in individuals with and without shoulder pain, Part 2: Glenohumeral joint. 

Journal of Orthopaedic & Sports Physical Therapy

Wong CK, Coleman D, diPersia V, Song J, Wright D. (2010). The effects of manual treatment on rounded-shoulder posture, and associated muscle strength. 

Halder AM, Halder CG, Zhao KD, O'Driscoll SW, Morrey BF, An KN. Dynamic inferior stabilizers of the shoulder joint. Clin Biomech (Bristol, Avon). 2001 Feb;16(2):138-43. doi: 10.1016/s0268-0033(00)00077-2. PMID: 11222932.

Giles, JW, Boons HW, Ferreira LM, Johnson JA, Athwal GS. The effect of the conjoined tendon of the short head of the biceps and coracobrachialis on shoulder stability and kinematics during in-vitro simulation. J Biomech. 2011 Apr 7;44(6):1192-5. doi: 10.1016/j.jbiomech.2011.02.012. Epub 2011 Mar 5. PMID: 21377681.

Saito, Matsuo, & Miyazaki. (2006). Analysis of surface electromyogram of muscle activity in the upper limb and shoulder girdle during overhand baseball pitching. Sports Science Research, 51, 351-365

Martinez, R., Assila, N., Goubault, E., & Begon, M. (2020). Sex differences in upper limb musculoskeletal biomechanics during a lifting task. 

Coracobrachialis

Related Courses:

Course Summary: Coracobrachialis

Study Guide: Coracobrachialis

Webinar: Functional Anatomy of the Coracobrachialis

Etymology of Terms Related to Coracobrachialis
3 Sub Sections

Joint Actions and Integrated Function of the Coracobrachialis
1 Sub Section

Fascial Integration and the Coracobrachialis

Research Investigating the Coracobrachialis

Movement Impairment and the Coracobrachialis

Common Trigger Point Locations and Referral Pain Patterns for the Coracobrachialis

Exercises and Techniques for the Coracobrachialis
5 Sub Sections

Sample Intervention

Bibliography
1 Sub Section

Related Courses:

Comments

Guest

Coracobrachialis

Related Courses:

Course Summary: Coracobrachialis

Study Guide: Coracobrachialis

Webinar: Functional Anatomy of the Coracobrachialis

Etymology of Terms Related to Coracobrachialis3 Sub Sections

Joint Actions and Integrated Function of the Coracobrachialis1 Sub Section

Fascial Integration and the Coracobrachialis

Research Investigating the Coracobrachialis

Movement Impairment and the Coracobrachialis

Common Trigger Point Locations and Referral Pain Patterns for the Coracobrachialis

Exercises and Techniques for the Coracobrachialis5 Sub Sections

Sample Intervention

Bibliography1 Sub Section

Related Courses:

Comments

Guest

Etymology of Terms Related to Coracobrachialis
3 Sub Sections

Joint Actions and Integrated Function of the Coracobrachialis
1 Sub Section

Exercises and Techniques for the Coracobrachialis
5 Sub Sections

Bibliography
1 Sub Section