Upper Limb Neuropathy Examination and Treatment - CCSR Calgary NW

1. 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. Diagnosis: Exam: Symptom: Nerve: Our Doctors: Dr. Robert LaBelle D.C., B.Sc., Owner Dr. Lynda Chen D.C., B.Sc., Acu- puncture Pro- vider Dr. Edward Wong D.C., B.Sc., Acupunc- ture Provider • Median Nerve Paresthesia, weak- ness in thumb oppo- sition and digit flex- ion may be present Sustained pas- sive wrist exten- sion Paresthesia along the palmer first 3 digits of the hand and thenar emi- nence Median nerve entrap- ment at carpal tunnel • Weakness and tight- ness in anterior fore- arm Median nerve entrap- ment at pronator teres/ flexor digitorum • Resisted Prona- tion Radial Nerve Paresthesia and wrist drop or tender- ness around lateral Resisted wrist extension/ supination Treatment Methods: • Active Release Technique; • Acupuncture; • Ball Release; • Low Level Laser Therapy; • Manual Therapy; • Myofascial Re- lease Therapy; • Registered Mas- sage Therapy; • Stretching and Strengthening. Radial nerve entrap- ment along supinator Paresthesia along the dorsal first 3 digits of the hand and lateral Trauma: Frac- ture of humerus or extended use of crutches Radial nerve damage along humerus spiral groove or entrapment within axilla thumb Ulnar Nerve Paresthesia 4th and 5th digits and hypothenar Passive elbow flexion with tap- ping of cubital tunnel Ulnar nerve entrapment along medial elbow (Tunnel of Guyon) Paresthesia and weakness in hand Clinical Pearl: The median, ulnar and radial nerves are all branches of the brachial plexus. Upon exit- ing 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 re- lease of the surrounding soft tissues to repair the affected soft tissues. Patients re- spond 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 Open: Mon-Fri 6am-7pm admin@drlabelle.com | www.drlabelle.com Sat 8am-2pm P: 403-282-8989 | F: 403-282-8950