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Distance Education -> Prevention of Medical Errors for the Massage Therapist -> Chapter: 09
Endangerment Sites
An endangerment site19, 20 is a region of the body in which nerves, arteries, or veins lay close to the body's surface. These areas are not well protected by muscle or connective tissue, and have the potentially to be damaged. Deep pressure either sustained or through friction, would be contraindicated for the vessels and nerves in these areas. These areas may contain bony projections that are fragile and may be broken. Massage therapists should exercise extreme caution when working in or close to these endangerment areas.
A medical error in execution may occur when a massage therapist or body worker does not exhibit extreme caution when working in one or more of these areas and injury results from treatment.
Endangerment Sites of the Face and Neck
- Anterior Triangle of the Neck . The anterior triangle of the neck consists of the medial border of the sternocleidomastoid (SCM) muscle, the inferior border of the mandible and the trachea. It contains the jugular vein, the carotid artery, and the vagus nerve, which are located deep to the SCM.
- Posterior Triangle of the Neck. The posterior triangle of the neck consists of the posterior border of the SCM, the superior border of the clavicle, and the anterior border of the upper trapezius muscle. This area contains the brachio-cephalic artery and vein superior the clavicle, the sub-cephalic vein, and the nerves of the brachial plexus.
- Posterior to the Mandible. The area posterior to the mandible contains the facial artery and nerve, and the styloid process of the temporal bone. The styloid process is a very delicate bone that can be broken from extreme pressure.
- Sternal Notch and Anterior Throat. The area of the sternal notch and anterior throat consists of the medial heads of the right and left clavicle, and their attachment at the superior edge of the sternum. This area contains the vagus nerve, and nerves and vessels to the thyroid gland.
Endangerment Sites of the Shoulder
- Axillary Triangle of the Under Arm. The axillary triangle of the under arm consists of the anterior edge of the pectoralis major, the posterior edge of the latissimus dorsi, the superior head and medial shaft of the humerus, the upper ribs and the medial aspect of the serratus anterior. This area contains the nerves of the distal brachial plexus, and the brachial artery, the axillary nerve, vein, and artery, and the cephalic vein.
- Deltoid-Pectoral Traingle. The deltoid-pectoral Triangle is a narrow area between the medial aspect of pectoralis major, the lateral aspect of the anterior deltoid, and the superior border of the clavicle. This area contains the cephalic vein.
Endangerment Sites of the Elbow
- Medial Elbow. The area between the medial epicondyle of the humerus and olecranon process of the ulna. This area contains the ulnar nerve.
- Lateral Elbow. The area between the lateral epicondyle of the humerus and the olecranon process of the ulna. This area contains the radial nerve.
Endangerment Sites of the Abdomen
- Umbilicus Area. The umbilicus area, to either side, contains the descending aorta and the abdominal aorta.
- Dorsal Body Area, 12 th Rib. The dorsal area in the region of the 12 th rib, is located over the kidneys, in the lower back.
Endangerment Sites of the Lower Extremity
- Femoral (Inguinal ) Triangle. The femoral or inguinal triangle consists of the lateral aspect of the sartorius muscle, the superior aspect of the inguinal ligament, and the medial aspect of adductor longus muscle. This area contains the femoral nerve, the femoral artery and vein, the great saphenous vein, external iliac artery, and the inguinal lymph nodes.
- Sciatic Notch. The sciatic notch is located in the area in which the sciatic nerve passes out of the pelvis through the greater sciatic foramen, under the pirformis muscle.
- Popliteal Fossa. The popliteal fossa is a diamond-shaped area at the posterior knee. The superior area consists of the lateral tendon of the biceps femoris, and the medial tendons of the semitendinosus, semimembranosus and the sartorius muscles. The inferior area consists of the two heads of the gastrocnemius muscle. This area contains the popliteal artery and vein and the tibial and common peroneal nerves.
- Deep Calf. The deep calf region of the lower extremity can be located between the two heads of the gastrocnemius muscle. This area contains the posterior tibial artery and vein.
- Tarsal Tunnel. The tarsal tunnel is located in a groove on the medial aspect of the calcaneus and inferior to and posterior to the medial malleolous. This area contains the posterior artery and vein, deep to the flexor retinaculum.
PRACTICE QUESTIONS FOR CHAPTERS 9.
Please complete the following questions:
1. A region of the body in which nerves, arteries, or veins lay close to the body's surface in known as:
a. Palpation site
b. Endangerment site
c. Connective tissue
2. This endangerment site consists of the medial border of the SCM muscle, the inferior border of the mandible, and the trachea.
a. Posterior Triangle of the Neck
b. Anterior Triangle of the Neck
c. Sternal Notch and Anterior Throat
3. A massage therapist or body worker may potentially cause injury if they work too aggressively in an endangerment area.
This injury is considered which medical error?
a. Error in execution
b. Error in planning
c. Error in indication
19 Newton, M.A., D.C., Don, Clinical Pathology for the Professional Bodyworker , Scappoose, Oregon, Simran Publications, 1998.
20 Fritz, Sandra, Mosby's Fundamentals of Therapeutic Massage, 2 nd Ed ., St. Louis, MI, Mosby's Inc. 2000, pg. 212.
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