In every issue of our journal, you will find a Case of the Month, which we will select from among the submitted cases. Everyone who is using MEDICAL MASSAGE PROTOCOLS in their practice may submit their cases for review, and we will share with our readers the best one in every new issue.
If you would like to share with our readers your account of professional success and participate in the Case of the Month program, see Case of the Month Program.
I met Natalia several years ago during a Medical Massage Seminar. She is a very well-trained practitioner who is able to solve difficult clinical cases. This contribution in the Case of the Month section is a great example. Despite an already established diagnosis, she was able, during the initial evaluation of her client, to determine the real cause of the pathological symptoms and save the client from unnecessary surgery. This contribution confirms one important thing – consider available medical information, but rely equally on your own judgment and experience.
MEDICAL MASSAGE vs. POTENTIAL SURGERY
The patient is 47 years old, married and works as a car mechanic.
Initial Complaints
The client’s major complaint was the sensation of ‘pins and needles’ (tingling) and occasional numbness on the right palm and along the third finger. These symptoms usually appear in the middle of the working day and progress to being very uncomfortable by the end of the working day. The client feels much less tingling and numbness during weekends. He has also noticed that his right forearm and hand have recently become weaker.
Case History
The client had noticed occasional tingling sensations 4 months before seeing me. Originally, he didn’t pay a lot of attention to it and told me that shaking his right hand was enough to get rid of the ‘pins and needles’ sensation. Later, these symptoms started to become more frequent, with occasional numbness at the end of the working day.
He went to his family physician, who diagnosed him with Carpal Tunnel Syndrome, recommended wearing a wrist brace at work and prescribed physical therapy. After two weeks of treatment, his symptoms started to get worse. The family physician sent him to a neurologist, who did a nerve conduction study and confirmed the presence of Carpal Tunnel Syndrome.
Because the wrist brace and physical therapy didn’t bring any improvement and the client’s work required a lot of repetitive movements, the neurologist recommended a consultation with a neurosurgeon to discuss the option of surgical intervention. At this point, the client decided to visit our clinic because I had helped his close friend before.
Clinical Examination
During the initial examination, it was obvious that the client had Median Nerve Neuralgia. A Sensory Test showed less sensation on the right palm when equal sensory stimulation was applied to the right and left palms, and this was confirmed by a nerve conduction study. However, he also exhibited decreased sensation on the right forearm when the Sensory Test was applied there. This was above [bold by JMS] the area of the carpal tunnel. Additionally, the Compression Test applied to the carpal tunnel on the inner surface of the wrist joint didn’t increase the intensity of symptoms on the right palm.
I decided to examine the entire pathway of the median nerve. As soon as I used the Compression Test on the pronator teres muscle just below the elbow joint, I was able to trigger radiating pain and numbness on the right palm. I wasn’t able to get similar symptoms when the Compression Test was applied to the pectoralis minor muscle or to the anterior scalene muscle.
At this point, I started to suspect that my client had Median Nerve Neuralgia as a result of tension in the pronator teres muscle rather than nerve compression in the carpal tunnel. The fact that he is a car mechanic and his work requires a lot of pronation/supination movements supported my feeling that tension in the pronator teres muscle was the real cause of his problems. Of course, I wasn’t 100% sure, and I decided to tell my client that it looked like medical massage might help him, but that I needed him to give me time to try different things. He was very excited about even a slim chance of avoiding surgery.
MEDICAL MASSAGE PROTOCOL
1st session
The medical massage session I used consisted of several components. I briefly worked on the posterior and anterior neck as well as on the anterior shoulder. During the main part of the session, I concentrated on the pronator teres muscle and followed the steps recommended in the Video Library. At the end of the session, I concentrated on the area of the carpal tunnel and the palm. I also taught him how to apply passive stretching of the pronator teres muscle and carpal tunnel several times per day.
2nd session
Despite the fact that I didn’t use any deep pressure, the client’s forearm was very sore for a couple of days. For the second session I repeated the same protocol.
3rd session
At the beginning of this session, the client informed me that he had felt the first signs of improvement. He had noticed that he didn’t have episodes of numbness. He also said that his ROM in the neck had greatly improved. I was greatly encouraged and repeated the same protocol.
4th session
The client continued to improve. He told me that he had regained muscle strength and that episodes of ‘pins and needles’ had become more tolerable. He was able to reduce the intensity of tingling by shaking the hand and forearm. I adjusted the MEDICAL MASSAGE PROTOCOL and didn’t work on the neck or anterior shoulder but concentrated more on the forearm and hand.
5th-7th sessions
By the sixth session, my client didn’t have any symptoms in the hand. I used one more session to be sure that they were not coming back. I have been seeing this client monthly for the past 4 months, and his symptoms haven’t come back.
ABOUT THE AUTHOR
Natalia Slipka, LMT
Natalia Slipka graduated from Ternopol University of Physical Education and Sports in Ukraine in 1986. She was a professional athlete (short-distance runner) and later she worked on professional athletes from Track and Field teams. She has established a very successful private massage therapy practice in Phoenix, Arizona. She likes to cook, travel and design. She is married and has a son.
Category: Case Studies
Tags: JMS 2010 Issue #6
