It is hard to imagine performing daily activities without the use of our arms and hands, which together complete the kinetic chain of the upper extremity. The upper extremity assists with tasks such as lifting and carrying; however, it also functions to protect the body during collisions, falls, and injuries.

The elbow functions as the link between the powerful movement of the shoulder and the fine motor control of the hand. The shoulder positions the hand in space, while the elbow adjusts the height and length of the arm and rotates the hand into position.

Because the wrist and the hand are the most active and intricate parts of the upper extremity, they are also vulnerable to injury and do not respond well to trauma. And, in addition to performing numerous functional tasks, the hand is an important sensory organ that provides information about our surroundings such as temperature, texture, shape, and motion. Under certain circumstances, the hands and the upper extremities also assist in communication when used for things such as sign language.

Assessing and treating the elbow, forearm, wrist, and hand can be challenging because of the complexity of the joints; moreover, the sources of dysfunction in these areas can arise from myriad causes. Each component of the upper extremity must work in harmony with related components for the entire structure to function properly.

Any disruption of balance, regardless of cause, can lead to dysfunction and disability. In addition, this region is susceptible to both chronic and traumatic injuries. The elbow is second only to the shoulder as the most dislocated joint in the body, and it is second to the knee in overuse injuries. The wrist can sustain acute injuries through falls or blunt force on a hyperextended joint, and it is also subject to injuries from chronic overuse conditions.

As with the other regions of the body, it is essential for massage practitioners to have a thorough knowledge and understanding of the anatomy and physiology of the region. By taking an extensive history and conducting a thorough assessment, the therapist will be able to properly identify and treat most conditions. While this chapter is not a comprehensive study of the elbow, forearm, wrist, and hand, it does provide a general understanding of the region, its functions, and how to recognize, assess, and treat some common pathologies. In addition to reviewing the structures, this chapter discusses:

• Specific bony landmarks for palpation

• Soft tissue structures, including the muscles of the region

• The movements of the region, and basic biomechanics of the elbow, forearm, and wrist

• Manual muscle tests for the region

• Dermatome and trigger-point referral patterns for the involved muscles

• Some common causes of dysfunction and how to assess and treat them using soft tissue therapy