Upper Limb Neuropathy: Assessment and Management Upper limb neuropathy arises from the entrapment of any of the 3 main nerves: Median, Radial or Ulnar. A clinician often suspects which nerve is entrapped based on the cutaneous distribution or muscular impairment. Our Doctors:
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Dr. Robert LaBelle D.C., B.Sc., Owner Dr. Lynda Chen D.C., B.Sc., Acupuncture Provider Dr. Edward Wong D.C., B.Sc., Acupuncture Provider
Nerve:
Exam:
Symptom:
Diagnosis:
Sustained passive wrist extension
Paresthesia, weakness in thumb opposition and digit flexion may be present
Median nerve entrapment at carpal tunnel
Resisted Pronation
Weakness and tightness in anterior forearm
Median nerve entrapment at pronator teres/ flexor digitorum
Resisted wrist extension/ supination
Paresthesia and wrist drop or tenderness around lateral
Radial nerve entrapment along supinator
Median Nerve Paresthesia along the palmer first 3 digits of the hand and thenar eminence
Radial Nerve Treatment Methods:
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Active Release Technique; Acupuncture; Ball Release; Low Level Laser Therapy; Manual Therapy; Myofascial Release Therapy; Registered Massage Therapy; Stretching and Strengthening.
Paresthesia along the dorsal first 3 digits of the hand and lateral thumb
Trauma: Fracture of humerus or extended use of crutches
Radial nerve damage along humerus spiral groove or entrapment within axilla
Ulnar Nerve Paresthesia 4th and 5th digits and hypothenar
Passive elbow flexion with tapping of cubital tunnel
Paresthesia and weakness in hand
Ulnar nerve entrapment along medial elbow (Tunnel of Guyon)
Clinical Pearl: The median, ulnar and radial nerves are all branches of the brachial plexus. Upon exiting the cervical spine, the brachial plexus can be entrapped proximally beneath the anterior scalene muscle or underneath the pectoralis minor muscles. This entrapment can then cause paresthesia in any or all of the cutaneous distribution. In our experience there is rarely a structural problem such as an extra rib causing the compression. Treatment: With thorough examination we can determine where the nerve is being entrapped along its pathway. We use a combination of nerve gliding techniques and manual release of the surrounding soft tissues to repair the affected soft tissues. Patients respond well and report reduced paresthesia of their hands. Studies of manual therapy indicate the necessity of 10-20 treatments in order to reduce mechanical pressure around nerves. Our patients are provided individual-based, in-home rehabilitation programs in order to help them reduce or even discontinue treatment and self-manage their conditions. Suite 303, 1640-16th Avenue NW Calgary, AB T2M 0L6
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