Massage & Bodywork

January/February 2012

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BEST PRACTICES TABLE LESSONS for this seminar, Seth Will, asked Ms. L. to describe her symptoms to help us better grasp the problem. "I have pain and numbness on my right arm and hand. There was no specific incident that started it—just something I increasingly noticed as time went on. The numbness isn't quite the same as friends who have carpal tunnel; it feels more like a glove that dulls my whole hand. I often feel it all the way up my arm and sometimes even into my middle back. The pain is often worse upon arising in the morning, but gets better during the day. Sometimes my hand feels cold and the whole arm just feels heavier than the other side. It has never been intolerable, but it is a serious annoyance that interferes with my life and job. "I work for an airline at the ticket Classic Thoracic Outlet Syndrome (not!) By Douglas Nelson "I am so grateful! I can't believe it is still better." These kind words greeted me from the enthusiastic woman tagging my luggage as I was checking in at the airport ticket counter. It took me a moment to place her and the condition she first presented with several years ago. Ms. L. came to an advanced training at my office. We focused on the relationship of soft tissue and symptoms of neural entrapment. She presented with sensations of numbness and upper extremity pain she had experienced for months. She had been to her physician and numerous other health-care providers to no avail. My co-instructor counter. It has been particularly busy in the last year; staffing cuts eliminated the person who used to help me with baggage. That means I am handling a lot of bags during the day, as well as ticketing passengers." For the benefit of the seminar participants, Seth demonstrated precise neural testing for each major upper extremity nerve that might possibly be implicated. Not surprisingly, the tests did not point to any specific nerve as the likely culprit. What would account for neural symptoms, when no specific nerve seems to be compromised? By the look we exchanged, both Seth and I were pretty sure that we were looking at classic thoracic outlet syndrome (TOS). While this seemed really promising, none of the common tests for TOS were positive either. When a client presents with neural symptoms similar to TOS and concomitant Celebrate ABMP's 25th anniversary and you may win a refund on your membership. 33

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