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News in Brief
National Chiropractic Health Month: Be Proactive; Collegiate Roundup: Academic Appointments at Parker, Logan.
Why Young People Need Chiropractic Now More Than Ever
According to a recent study published in BMC Musculoskeletal Disorders, "It is now widely acknowledged that neck pain (NP), mid back pain (MBP), and low back pain (LBP) (spinal pain) start early in life and that the lifetime prevalence increases rapidly during adolescence to reach adult levels at the age of 18."
New Medical Technologies You Need to Know
We're all familiar with how fast computers become obsolete, as well as the rapid pace of development in the field of cell phone technology. The latest smart phones are far more powerful than desktop computers were only a few years ago.
Finders Keepers: The Secret to Relationship-Based Marketing
Becoming a successful practitioner has less to do with what you learned in school, and more to do with your ability to find new patients and keep them!
Chiropractic Research in Review
Chiropractic Treatment of Lateral Epicondylitis; Cost / Benefit Analysis: Different Doses of SMT for Low Back Pain; Imaging for Occult Rib and Costal Cartilage Fractures; Treating Neck Pain: Thoracic Thrust Manipulation vs. Non-Thrust Mobilization.
Peer Points: Always Seeking To Grow
Ellen "Kiki" Geary has spent the last decade honing her craft. As a specialist in integrative holistic care, she went straight from completing her master's degree in acupuncture and chinese herbal medicine from Bastyr University to building a successful and thriving practice in the small community of Anacortes, Washington.
CCE Finally Takes a "Baby Step" Toward Reform
During a 16-month period from October 2010 to February 2012, I devoted four separate columns to the heavy-handed attempt by the Council on Chiropractic Education to radically change the chiropractic profession through the accreditation process.
A Vibrating Capsule for Constipation? Relevance to Your Chiropractic Practice
The relationship between gastrointestinal (GI) complaints and back pain is not typically written about or discussed.
Don't Turn a 2 Into a 10
The Wong-Baker FACES Pain Rating Scale1 is so useful because it can be used by almost anyone. Patients can use the numbers associated with the faces depicted on the scale or select the face that demonstrates their current level of pain from 0-10.
Pain Underfoot: Metatarsalgia
Foot pain can interfere significantly with normal activities and severely limit participation in sports. Metatarsalgia is foot pain involving the metatarsal bones in the forefoot – the complaint of pain on the bottom of the ball of the foot.
9 Common Causes of Thyroid Imbalance and How You Can Help
How you sleep, how easily you wake up, and how much energy and stamina you have during the day are directly related to levels of the thyroid hormones.
Building From the Bottom Up
I caught up with my dear friend Honora Wolfe, in her Colorado painting studio where, if she is not praying in Bhutan or doing charitable work in a Nepali free clinic, she spends most of her time now.
Medical Qigong for the Heart: Part III
Part 1 and Part II of this series focused on the physical aspect of the Heart and mental emotional aspects of the Heart respectively. Now, I would like to focus on the spiritual aspect of the Heart.
A History Worth Telling
The popularity and the use of acupuncture for the treatment of animals in the United States is at its peak.
A Guide for Talking to Doctors about Acupuncture and Brain Chemistry
Before I begin any discussion of how to talk about the effects of acupuncture on brain chemistry, nervous and endocrine function, it is essential to understand just what physicians most need help with.
A Chinese Medicine Story: An Interview with Mazin Al-Khafaji
Mazin Al-Khafaji's work has interested me for years. In February 2014, we invited him for the second time to speak at the Southwest Symposium in Austin, Texas.
MPA Media Wins 7 Publishing Awards
MPA Media, publisher of Dynamic Chiropractic and DC Practice Insights, among other titles, has been recognized for editorial and design excellence with an unprecedented seven publishing awards by the American Society of Business Publication Editors (ASBPE), the nation's largest organization for business-to-business publications.
October, 2004, Vol. 04, Issue 10
Median Nerve Compression Pathologies
By Whitney Lowe, LMT
The most researched and well-defined upper extremity nerve-entrapment problem is carpal tunnel syndrome (CTS). CTS involves compression of the median nerve at the base of the hand in a region called the carpal tunnel.Because this condition is studied so often, we have a very good understanding of how it occurs; however, because it has become such a "popular" condition, clinical practitioners may be too eager to assume the presence of CTS simply because their patient/client experiences median nerve compression symptoms.
This article will look at the entire length of the median nerve where there are numerous locations that median nerve entrapment may occur. We will follow the nerve's course from the spinal cord to its termination in the hand and describe common locations of compression pathology. It is essential to thoroughly evaluate the problem before coming to a conclusion about the presence of the ever-popular CTS.
The median nerve carries both motor and sensory fibers. Therefore, compression of the nerve may create both sensory and motor deficit. The sensory symptoms are located primarily in the palm (See Figure 1). They include pain (often described as sharp, shooting, or electrical in nature), paresthesia ("pins and needles"sensations), and numbness. The median nerve and its branches innervate primarily the flexors of the wrist and fingers, as well as several muscles of the thumb. Motor problems from median nerve compression usually show up as weakness in grip strength or atrophy of the thenar eminence (fleshy part of the palm near the base of the thumb).
The first location where median nerve compression may occur is at the cervical nerve roots. The median nerve is derived from the C5-T1 nerve roots. Intervertebral discs, bone spurs, small tumors, or other obstructions may press on these nerve roots and produce symptoms that affect the median nerve. Since the nerve roots also contain fibers for other peripheral nerves, symptoms of compression at the nerve root level may extend outside the commonly mapped area for median nerve sensory involvement illustrated in Figure 1.
Thoracic outlet syndrome is not consistently defined in the medical literature, so there is a great deal of confusion about it. Fibers of the median nerve can get compressed against a pathological bony extension of the C7 transverse process, called a cervical rib. This is called true neurological thoracic outlet syndrome. Other thoracic outlet syndrome variations that may compress the median nerve include the region between the anterior and middle scalene muscles, between the clavicle and first rib, and underneath the pectoralis minor muscle.
Moving distally after leaving the axillary region, the next location where median nerve entrapment is likely, is just proximal to the elbow. This location is only a possible source of nerve entrapment in a small percentage of the population. A ligament called the ligament of Struthers is present in 1 percent to 3 percent of the population. It runs between the medial epicondyle and the shaft of the humerus, and has no function. The median nerve passes underneath it and can get compressed here although it is not very common.
While the biceps brachii attaches primarily to the radius, there is a fibrous attachment to the ulna through a slip of fascia called the lacertus fibrosus, which is also called the bicipital aponeurosis. The median nerve runs underneath the lacertus fibrosus at the elbow and can get compressed by it here. If symptoms are aggravated during strong elbow flexion movements (when the biceps brachii is contracting strongly) there is a good likelihood that compression exists here.
After leaving the elbow, the median nerve runs between the two heads of the pronator teres muscle. This is a common region of median nerve compression and is commonly mistaken for CTS. The sensory and motor signals are almost identical, making it difficult to distinguish these two regions of entrapment without more specific physical examination, such as orthopedic special tests and nerve conduction studies.
The last common location of median nerve entrapment is within the carpal tunnel. While this region is the most common site of median nerve entrapment, it is not the only one. There are a large percentage of failed carpal tunnel treatments; this could very well be due to improper identification of the precise location of median nerve entrapment.
Keep in mind that compression may occur at several sites simultaneously. Therefore, you may have a problem that is not in just one of these locations, but in two or more.
One of the great benefits for using massage to treat nerve compression problems is that massage treatments are frequently applied to the whole length of the nerve and can easily work on multiple sites of compression at the same time.
A summary of the locations for median nerve entrapment are:
Click here for more information about Whitney Lowe, LMT.
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