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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."
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.
News in Brief
National Chiropractic Health Month: Be Proactive; Collegiate Roundup: Academic Appointments at Parker, Logan.
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.
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.
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.
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.
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.
Waking Up the Gluteus Maximus
In previous articles in this series, we expounded on the importance of the gluteus maximus (GM) in athletic performance and protecting the knee from injury. We also know there is a link between iliotibial band syndrome and GM weakness.
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.
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.
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.
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.
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.
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.
A History Worth Telling
The popularity and the use of acupuncture for the treatment of animals in the United States is at its peak.
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.
May, 2007, Vol. 07, Issue 05
Pronator Teres Syndrome
By Whitney Lowe, LMT
Upper extremity nerve entrapments are a common cause of pain and disability. The increase in repetitive motions associated with occupational and recreational environments usually is singled out as the primary cause of these problems.Many individuals with nerve entrapment symptoms will seek the care of a massage practitioner.
If a client comes to you with an upper extremity pain condition, you want to accurately identify that problem so you can determine if it warrants massage treatment or referral to another health professional. In some cases, a condition might have symptoms that very closely mimic a different pathology. If you don't identify the condition correctly, your treatment is not going to be as effective.
The symptoms of pronator teres syndrome (PTS) can be identical to those of carpal tunnel syndrome because they both involve compression of the median nerve. PTS may be underdiagnosed by medical professionals because its symptoms are so closely related to carpal tunnel syndrome, which is a much more well-known condition.1
PTS develops from compression of the median nerve by the pronator teres muscle, and is sometimes referred to as pronator syndrome. The term pronator syndrome also can include median nerve compression by other structures in the elbow, such as the ligament of Struthers or the bicipital aponeurosis (lacertus fibrosus).2
As the median nerve passes the elbow, it runs between the two heads of the pronator teres muscle, where the nerve may be compressed (Figure 1). Compression can be due to muscle hypertonicity or fibrous bands within the muscle pressing on the nerve.3 In some cases, pressure is placed on the nerve by anatomical anomalies, such as the nerve traveling deep to both heads of the pronator teres.4 In this situation, the nerve might be compressed against the ulna by the pronator teres muscle itself.
PTS results from repetitive motions that cause hypertonicity in the pronator teres. Occupational activities such as hammering, cleaning fish, or performing any activity that requires continual manipulation of tools can cause overuse of the pronator teres. The hypertonicity then causes nerve compression, and the symptoms are felt in the anterior forearm and the median nerve distribution in the hand (Figure 2). Women are affected more than men, although the reason for this is not clear.
Most symptoms of nerve compression radiate distal to the site of compression. Aching forearm pain and paresthesia, along with pain in the median nerve distribution in the hand, are likely to be PTS and should not be assumed to indicate carpal tunnel syndrome.
While PTS and carpal tunnel syndrome both affect the median nerve and have similar symptoms, there are distinct differences. PTS pain is exacerbated by repetitive elbow flexion, and symptoms arise in the forearm as well as the hand. Carpal tunnel syndrome is aggravated by wrist movements, and pain is not experienced as much in the forearm. In both cases, atrophy is possible in the thenar muscles of the hand, which are innervated by branches from the median nerve.
There are several other ways to identify PTS and distinguish it from carpal tunnel syndrome. Clients with carpal tunnel syndrome frequently report night pain, while individuals with PTS generally do not.1 Prolonged wrist flexion during sleep aggravates carpal tunnel syndrome because it decreases the space in the carpal tunnel and presses on the median nerve. Because wrist flexion does not affect the pronator teres muscle, this wrist position does not increase nerve compression symptoms in PTS.
An evaluation procedure called the pronator teres test also is helpful in identifying the condition. The client stands with the elbow in 90 degrees of flexion. The practitioner then places one hand on the client's elbow for stabilization and the other hand grasps the client's hand in a handshake position. The client holds this position as the practitioner attempts to supinate the client's forearm (forcing the client to contract the pronator muscles). While holding the resistance against pronation, the practitioner extends the client's elbow (Figure 3). If the client's pain or discomfort is reproduced, there is a good chance of median nerve compression by the pronator teres. The client should keep the elbow relaxed during the test, because holding the elbow firmly in flexion will not allow elbow extension.
Pronator teres syndrome is most commonly caused by muscular compression of the median nerve. Therefore, it is a condition that is effectively treated with massage. However, it is important that the practitioner accurately identify the problem so treatment can be directed to the proper region of the upper extremity.
Author's note: The content of this article is excerpted from: Lowe W. Orthopedic Assessment in Massage Therapy. Sisters, OR: Daviau-Scott; 2006.
Click here for more information about Whitney Lowe, LMT.
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