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Muscle News Vol I.22:  Pronator Teres  
 
Misdiagnosed Carpal Tunnel Syndrome  
& The "Pinch Me" Nerve
Greetings!  We hope you are enjoying the start of this Holiday Season!

In this issue of Muscle News, we will address the irritating, painful and sometimes disabling condition of a nerve being compressed in our bodies. 

With even just a brief instant of compression on a nerve, such as when we hit our "funny bone" in the elbow (the Ulnar Nerve), we can experience shooting pain, numbness, tingling and weakness.  When prolonged compression of a nerve occurs, such as a pinched nerve in the neck or low back (for example, sciatica), it can be extremely painful or even debilitating. 

In this issue, we will discuss a nerve that is commonly compressed and creates serious pain, numbness and weakness in the forearm, wrist, hand and fingers.  This nerve is called the Median Nerve, and it can be a tricky, evading proper diagnosis and thwarting attempts at treatment.  Its tendency to get trapped and compressed at multiple places from the neck to the wrist earns it the nickname the "Pinch Me" nerve. 

Although the Median Nerve is best known for causing problems when it gets compressed down by the wrist, called Carpal Tunnel Syndrome, this nerve can get pinched in two additional primary places:  the neck and the elbow. 

When the compression is at either of these two areas, it's easy to misdiagnose the condition as Carpal Tunnel Syndrome and apply incorrect treatments (including surgery) that fail to resolve the problem or make it worse.



Where's the Pinch?

True Carpal Tunnel Syndrome

The most well-known place the Median Nerve (shown above in yellow) can get trapped is at the Carpal Tunnel.  The Carpal Tunnel is created by a band of fascia at the wrist called the Flexor Retinaculum (shown In green).  The Flexor Retinaculum overlies the bones in your wrist, holding the bones together as they connect to your hand.  This position happens to create a tunnel through which the Median nerve travels to the reach the hand, the thumb and the first two fingers.  If pressure builds up in this tunnel or space is crowded, it can compress the nerve and cause numbness and weakness in the hand, thumb and first two fingers.

Studies vary on the incidence of true Carpal Tunnel Syndrome and we know why!  It's because of the other places the "Pinch Me" nerve gets compressed which can lead to symptoms that look like Carpal Tunnel Syndrome, such as the neck and the elbow. 

The good news about these two areas is that the culprit pinching the nerve is a muscle, which means we can use trigger point therapy techniques to relieve the compression and often resolve our symptoms naturally!

Please enjoy this information below and follow the simple tests and self-care tips to figure out where your hand pain, numbness and weakness is coming from and what you can do to possibly improve it.  If you know someone who could benefit from this information, PASS IT ON!

*The information in this article is not intended to diagnose or treat any medical condition and does not substitute for a thorough evaluation by a medical professional.  Please consult your physician to determine whether these self-care tips are appropriate for you.
The Pinch Could Be in Your Neck:  (Scalenes)

By now you might be saying, "Oh here we go with the Scalenes again."  Well, we have to mention them because we're talking about nerve entrapment.  The Scalenes are so likely to entrap a nerve that goes down the arm, including the Median Nerve, they are nicknamed "The Entrappers."

We won't go into the tests and self-treatment that we covered in previous issues, but we will show you one new test that helps in determining if the Median Nerve problems are coming in part from your neck muscles.

Test:   Scalene Relief Test

To perform the Scalene Relief Test, bring your arm up and slightly forward and drape it loosely over your head.  You can turn your head slightly toward the shoulder and down keeping the neck relaxed (See picture).  In this position, the pressure from the Scalenes  is greatly reduced on the nerves exiting the neck and going down the arm.

Hold this position for several minutes.  If your hand symptoms improve, that's an indication that the Pinch is occuring in the neck.  If so, apply the protocol of  Heat, Compression & Stretching.  Follow the self-care recommendations in our previous newsletters on the Scalenes or schedule a trigger point therapy session.


The Pinch Could Be in Your Elbow:


At the elbow, the Median Nerve (shown in yellow) passes right through the two heads of a muscle called the Pronator Teres (indicated by the green arrow).  When compression occurs here, it is called the Pronator Teres Syndrome and is a reason for misdiagnosis and failed treatment of Carpal Tunnel Syndrome.


Test:   Pronator Teres Test

We can help determine if this elbow muscle is the cause by testing its range of motion.  The Pronator Teres "pronates" the forearm, which means it turns the hand and wrist inward. 

To test this function, have your elbow resting at your side and bring your forearm up to 90 degrees in front of your body as shown.  Hold a ruler, pencil or other long thin object in your hand.  See if you can turn your hand inward and down so your palm is facing the floor. 



A Pass means that you will be able to turn far enough so that the ruler is parallel to the floor and the palm of the hand is facing directly downward.  Now try to go the opposite direction.  Turn the hand outward so that the palm of the hand is facing straight up.  This is called "supination."  A pass is when the ruler is again parallel to the floor with the palm facing upward. 



A Not Passing result is when the arm can either not fully turn inward (pronation) or outward (supination) or both.  The ruler will not reach parallel to the floor.  This means that the Pronator Teres is not able to fully shorten or fully lengthen.  If this is the case, it is possible that the Median Nerve is at risk of compression at the elbow.

Heat: 
Applying moist heat to the Pronator Teres can help loosen the fibers.  Use a Fomentek bag, bath or other form of moist heat for 10 minutes prior to treating it with compression.

Compression:

Now, it is important to realize that compression of a muscle is different than compression of a nerve.  Compressing a muscle is a very effective way to improve myofascial function, range of motion, etc.  This is not the case with a nerve.  Compression of a nerve is the problem we are trying to resolve.  So, here we are applying compression to the Pronator Teres to loosen the fibers of the muscle in order to relieve compression on the Median Nerve.

The best method for compressing trigger points in the Pronator Teres might be to use a self-care tool rather than your fingers. 

Work from the origin of the muscle just above the inside of the elbow across to the other side of the forearm halfway down toward the wrist (following the line shown in green).  When you find a tender spot, press into the muscle to pain tolerance ("good pain" - not sharp pain).  Hold for 10 seconds while completing at least two full breaths in and out.  Then continue searching for more trigger points.


Finish with Stretching:   Range of Motion with Resistance (Pronation & Supination)



The goal of this exercise is to provide slight resistance with the opposite hand while you try move the forearm through full pronation and supination.  In the picture above, the left hand (bottom hand) is twisting from full supination (palm up) to full pronation (palm down) while the right hand is resisting with the fingers.



Now switch the right hand to the back of the left hand as shown and use the fingers to resist as the left forearm rotates outward to full supination (palm up).

Perform 10 - 15 repetitions from full supination to pronation back to supination.  Repeat that 2-3 times per day following compression with your self-care tool.

If you successfully perform these self-care steps for the Scalenes and the Pronator Teres,  you will likely find a great improvement in pain, numbness and weakness in the hand.  As always, self-care is best accompanied by consultation and supervision with a trigger point therapist and other qualified healthcare professionals!
  
  
Sincerely,
  
Your Friends at The Pressure Positive Co.
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Link Highlights:

NAMTPT LOGO National Association  of Myofascial Trigger Point Therapists

________________
"Healing through Trigger Point Therapy: A Guide to Fibromyalgia, Myofascial Pain and Dysfunction" by Devin J. Starlanyl and John Sharkey, with illustrations by Amanda Williams.
 This book is written in reader-friendly language for patients and care providers, with treatment options for migraines, irritable bowel syndrome, plantar fasciitis, symptoms associated with aging, and much more. The book explains the source of pain and many non-pain symptoms.
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