Massage & Bodywork

MAY | JUNE 2016

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SCIENCE OF NERVES detrimental effects of nerve compression is to get pressure off the nerve and allow that tissue time to heal appropriately. Consequently, any alterations in activity or aggravating factors that can be reduced outside of the treatment room will be a key component of successful resolution. It is helpful to treat the entire path of the ulnar nerve—from the cervical region all the way through the distal end of the upper extremity. Treatment in other areas that may reduce nerve irritation can play a very important role in resolving symptoms. Decreasing pain and neural excitability with massage should be encouraged. Nerve compression disorders can become more problematic and spread to other areas because of the constant bombardment of noxious irritation signals from the problem region. Massage works powerfully in producing positive and pleasurable neurological sensations, and these can interrupt the cycle of perpetual noxious impulses that lead to pain. Breaking this cycle is an important part of resolving many nerve pathologies. Conservative treatment approaches are ideally tried first, and in most cases they will be successful. If conservative treatment is not successful, surgical approaches are sometimes used to address this problem. However, many of the surgeries used to treat cubital tunnel syndrome also create biomechanical challenges that can lead to further injury down the road. One of the more common surgical approaches is to move the ulnar nerve so it is not sitting in the tunnel but is actually to the (medial) side of the humeral epicondyle. Repositioning the nerve does decrease the tensile pull on the nerve during elbow flexion. However, it also brings the nerve more superficial and exposes it to increased external compressive forces on the medial side of the elbow. A study evaluating the results of nerve transposition reported a very interesting finding. They noted that in a large percentage of the patients who had undergone nerve transposition surgery, the nerve had actually increased in diameter once it was moved. 4 The increased size of the nerve makes it more susceptible to pressure against adjacent structures. CONCLUSION Numerous occupations and recreational activities involve repetitive or prolonged upper extremity positions that may lead to ulnar nerve compression. Notably, this condition is an occupational injury that can affect the massage professional. To avoid surgery, clients are likely to seek out massage as a potential solution. Massage can either aggravate the problem if excessive pressure is applied in the wrong location, or can help reduce symptoms and contribute to resolution. How you handle 6 Schematic representation of motor and sensory nerve distribution in a cross section of the ulnar nerve at the elbow. Sensory (blue) fibers are more concentrated around the periphery, and motor (red) fibers are more concentrated in the center. 7 Upper limb neurodynamic test #4 puts tensile stress on the ulnar nerve and may reproduce symptoms. this challenging situation is based on your proper understanding of the condition and your ability to construct an effective and results-oriented treatment plan. Notes 1. H. Assmus, G. Antoniadis, and C. Bischoff, "Carpal and Cubital Tunnel and Other, Rarer Nerve Compression Syndromes," Deutsches Ärzteblatt International 112, no. 1–2 (January 2015): 14–25, quiz 26, doi:10.3238/arztebl.2015.0014. 2. J. Bozentka, "Cubital Tunnel Syndrome Pathophysiology," Clinical Orthopaedics and Related Research 351 (1998): 90–94. 3. David D. Dawson, Mark Hallett, and Asa J. Wilbourn, Entrapment Neuropathies 3rd ed. (Philadelphia: Lippincott Williams & Wilkins, 1999). 4. M. M. Vosbikian et al.,"Does the Ulnar Nerve Enlarge After Surgical Transposition?," Journal of Ultrasound in Medicine 33, no. 9 (September 2014): 1647–52, doi:10.7863/ultra.33.9.1647. Whitney Lowe is the developer and instructor of one of the profession's most popular orthopedic massage training programs. His texts and programs have been used by professionals and schools for almost 30 years. Learn more at www.academyofclinicalmassage.com. C h e c k o u t A B M P 's l a t e s t n e w s a n d b l o g p o s t s . Av a i l a b l e a t w w w. a b m p . c o m . 101

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