ulnar nerve impingement/cubital tunnel syndrome

[k2snoboarding4life]

I've searched and read other posts here regarding this, but aside from working the scalenes, pecs, and upper arm - if the impingement is at the elbow, how would you work this?
I am planning on ordering the DVD highly recommended in another thread about this - from realbodywork.com on nerve mobilization. just thought I would see if anyone had any other thoughts, suggestions, etc. in the meantime before the dvd gets here 8)
thanks in advance for any tips!

a little more detailed info for you:
client is having numbness and pins & needles in left pinky and ring finger. She sleeps with her arm bent and under her, spends time during the day with elbow bent and on the table, is having difficulty doing pinching motions with that hand.
I worked scalenes, pec minor, along with entire upper body really... and showed her some pec stretches, forearm stretches, and self massage techniques to do at home along with ice and anti-inflammatory like ibuprofen. she is trying to stop sleeping with her elbow bent, and has been very good at doing her other homework and she is working on correcting the habits that are contributing to this. she definately felt a connection to the work we have done and her finger pain/ numbness.

how would you proceed?

 

[ying ting]

Massage to the Pronator & Supinator is helpful for relieving nerve impingements at the elbow. Here are links to pictures of muscle locations:

Pronator Teres:
http://www.waynesburg.edu/depts/ccink/armpics/pronatorteres.jpg

Supinator:
http://www.waynesburg.edu/depts/ccink/armpics/supinator.jpg

Use the picture to locate the general area of thee Pronator Teres. Hold your fingers on where you think the muscle is, and then pronate/supinate your client's hand back and forth. You'll feel the muscle contract, so you'll know you're in the right place. Press a little stronger on the muscle, and continue that motion, creating a massage effect on the muscle. Move your fingers to different locations on the muscle, so you're sure to massage the whole thing. Experiment with pronating/supinating your client's hand slowly vs. quickly, for different effects. You can also experiment between using your fingers or thumb to apply pressure. Do this treatment on yourself, to get the feel of it, before trying on clients.

Do the same technique for the supinator, placing your fingers on the opposide side of the arm. Again pronate/supinate your client's hand back & forth, to feel for the contraction (locating the muscle). Massage accordingly.

I incorporate this work in many massages. Clients love it!

 

[Mama77]

oh yes yes - I LOVE that stuff - I forgot to mention that I did do that work also on the forearms. but when I did the tingling pins/needles feeling intensified... so I backed off. And actually, I was surprised to not find as much tension there as I expected. (but maybe I'm just too used to MY forearms!!)
those pics are great and really help illustrate those muscles, thanks! 8)

 

[Your Gorgeousness]

Where you able to help the client. I think I have Cubital Tunnel Syndrome and need help without going to a neuro., in between insurance comp. What did you work to get relief? I would like to pass it on to the therapist I share space with who will be working on me. THX

 

[Teh]

The nerve DVD from real body work is very good.

if you can find someone who has the Active Release Techniques (ART) upper extremity text and DVD, that has some excellent stuff for this problem and other nerve entrapments.

Remeber the the ulnar nerve runs down the ulnar side of the forearm along side the Flexor Carpi Ulnaris...you can work that muscle all the way down if you assess it and find that it is affecting the issue.

Anything coming from that medial epicondyle needs to be assessed (all the flexor tendons/muscles, pronator teres and palmaris longus) as they can be impinging the nerve.

Working the triceps can help as well as the intermuscular septum of the humerus.

scales, pec minor, etc....as you stated also need to be checked.


What sort of things re-create her symptoms? Also, make sure you have good postural assessment to determine where movement faults and postural deviations are taking place. This is a big one! Most people want to get in there and jsut work everything! Be specific with your treatment and determine what things are affeting this problem. Remeber that symptoms are just a presentation of the problem. They are just letting you know that something is wrong, however they are not letting you know WHAT is wrong. you need to determine that! I mean, sometimes we will see people with medial epicondyle or lateral epicondyle problems (usually throwing athletes or tennis players) and it will be because they have a weak core musculature and instead of having good transfer of power from the lower extremity to the upper extremity, they have all these energy leaks and are forced to develop greater torque at the shoulder or elbow. All of these things....static posture, active movement, passive ROM, active ROM, resisted muscle strength testing, muscle length testing, should be addressed!

Good luck!

Patrick

 

[RaTz]

It's me. Bending my arm increases tingle and numbing feeling and also increasing the number of fingers. All of pinky and ring then increases to the tips of mid and index.

 

[element_ice5]

Hey Amyisms -

I did all of the above, including purchasing the dvd from realbodywork, lol. (I'm not so good with learning from a video though, I need to feel the work on myself to really get it, but that's just me!)
the client did get some relief, but I'm not really sure how she's doing now as she lives an hour away and I don't see her often. I didn't get to work with her as much as I had hoped on this issue.
I think Patrick's suggestion of ART would be really beneficial. Please let us know what you try and how it works for you!

 

[iamcrazyy]

It's me. Bending my arm increases tingle and numbing feeling and also increasing the number of fingers. All of pinky and ring then increases to the tips of mid and index.

start by palpating the area where the cubital tunnel is and see if that recreates symptoms. The ulnar nerve may be pressed between the Flexor Carpi Unlaris and the Cubital Tunnel there. Look for hyperonicity in the flexor carpi ulnaris and work that muscle. Get it soft and then stretch the wrist flexors. Try some ART too....the techniques are pretty much pin-and-stretch techniques and you can use them over the flexor carpi ulnaris and the other flexors originating at the medial epicondyle. Use short but more frequent massage sessions through the week (every other day or once every two days) instead of just going for one long full body massage once a week. Get on a specific treatment plan.

look at your activities of daily living and limit the movement that creates pain for awhile as you try and rehab.

patrick

 

[Steve the Fob]

Being a massage therapist with a full sched, it's kind of hard to stop what I'm doing. I could always just do a one handed massage

 

[Skidoo]

Being a massage therapist with a full sched, it's kind of hard to stop what I'm doing. I could always just do a one handed massage

I realize that, but you have to take care of yourself! Like people who work at a desk all day and have a kyphotic posture or carpal tunnel syndrome...they can't just stop working....but they must do something that allows them to break that poor activity of daily living which is contributing to the problem. Some ideas would be:

- schedule less people during the work day
- leave more time between clients to allow yourself to stretch, rest and recover.
- work less, and take a day off inbetween massage work days.
- take a vacation


The problems don't go away on their own unless you fix them.

Most of the time, those in the 'healing' field (massage therapists, physical therapists, doctors) are the worst patients because they know what is wrong, they know what to do to fix it, and they end up not doing a darn thing.

Patrick

 

[Bert Sullivan]

Being a massage therapist with a full sched, it's kind of hard to stop what I'm doing. I could always just do a one handed massage

This is absolutely possible! When my hand was injured and I had a full schedule that I couldn't take time off from, I did one handed massage. I used the elbow and forearm of the "broken" hand, and the hand and elbow and forearm of the other hand. I had to change a lot of my strokes and the way I worked, but I still gave a great massage. I think with enough motivation (ie pain! lol) and creativity you can do this.

 

[nefertiti_1018]

Being a massage therapist with a full sched, it's kind of hard to stop what I'm doing. I could always just do a one handed massage

I realize that, but you have to take care of yourself! Like people who work at a desk all day and have a kyphotic posture or carpal tunnel syndrome...they can't just stop working....but they must do something that allows them to break that poor activity of daily living which is contributing to the problem. Some ideas would be:

- schedule less people during the work day
- leave more time between clients to allow yourself to stretch, rest and recover.
- work less, and take a day off inbetween massage work days.
- take a vacation


The problems don't go away on their own unless you fix them.

Most of the time, those in the 'healing' field (massage therapists, physical therapists, doctors) are the worst patients because they know what is wrong, they know what to do to fix it, and they end up not doing a darn thing.

Patrick

I just wanted to quote this because it is so important. Patrick says it best, if we don't take care of ourselves, we will break down. I am currently one more time learning this, needing to take time off, listen to my body/mind and what it wants/needs.

For your issue, though remember random fascial restrictions can alter the articulation of the ulna and radius.

Also elbow issues sometimes indicate a liver issue. If you cannot find someone who does Visceral Manipulation, pay particular attention to your diaphragm/ ribcage especially over the right side. Alter your diet for a time if necessary to detox the liver a bit. Google Liver Detox and you can get lots of information on this.

For the fascial restrictions, a good friend can do an arm pull that is amazing for the whole quadrant.

hope this helps, even if I came into this discussion a bit late.

 

[Frank the tank]

I took the week off, the numbness isn't constant any more, some pain in the elbow. Worse after a nights sleep. I'm not the best sleeper. We'll see how it goes come Monday after a day of work.

Unfortunatly I can not decrease my sched. any more than it is. In the last 3 years I have gone from 32hrs. a week to 16 hrs. a week. I'm at bare min. financially.

I spent the week revising my resume and have sent it out. Maybe it's time for a complete change and back to school to finish some loose ends.

Thanks for all of your help.

 

[Indumukhi]

Amyisms, Do I detect a sound of regret?
hard to 'hear' through text.

Who is treating you?
Are you happy with the idea of changing channels as it were?
I would hate you to change professions if your heart isn't in it.

But I am sure you have thought all this through.

Just wanted to acknowledge what sounds a bit like regret.

 

[Aundrea]

After 8 yrs. it's time to make this my part-part-time gig. I love what I do and I'm a damn great therapist, but my heart isn't in it like it use to be.

 

[Nicnac]

ah I so understand.
I have been at this over 25. LOVE IT.
the last 5 years full time. It makes a huge difference in the work to be sure.
and the toll on the body.

It isn't easy.

Best of luck to you!