In every issue of our journal you will find Case of the Month which we will select among submitted ones. Everyone who is using MEDICAL MASSAGE PROTOCOLs in their practice may submit their cases for the 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 Case of the Month program click here.

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 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 saved the client from unnecessary surgery. This contribution confirms one important thing – consider available medical information but equally rely on your own judgement and experience.

Dr. Ross Turchaninov

Here is:




by Natalia Slipka, LMT

Patient is 47 years old, married and works as a car mechanic.


Initial Complaints


The client’s major complain 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 also noticed that his right forearm and hand recently got weaker.


Case History


The client 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 and 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 the neurologist who did a nerve conductance study and confirmed the presence of Carpal Tunnel Syndrome.

Because wrist brace and physical therapy didn’t bring any improvement and client’s work requires a lot of repetitive movements the neurologist recommended consultation with a neurosurgeon to discuss the option of surgical intervention. At this point the client decided to visit our clinic because I helped his close friend before.


Clinical Examination


During initial examination it was obvious that the client has Median Nerve Neuralgia. A Sensory Test showed less sensation on the right palm when equal sensory stimulation was applied to right and left palms, and this was confirmed by a nerve conductance study. However he also exhibited decrease of the sensation on the right forearm when 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 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 Compression Test was applied to the pectoralis minor muscle and 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 feelings that tension in the pronator teres muscle is 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 maybe will help him, but I needed him to give me time to try different things . He was very excited about even a slim chance of avoiding surgery.



1st session

The medical massage session I used consisted of several components. I shortly worked on the posterior and anterior neck as well on the anterior shoulder. The main part of the session I concentrated on the pronator teres muscle and I followed the steps recommended in the Video Library of MEDICAL MASSAGE PROTOCOLs. At the end of the session I concentrated on the area of 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 felt the first signs of improvement. He noticed that he didn’t have the 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 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 and anterior shoulder but concentrated more on the forearm and hand.

5th-7th sessions

By the sixth session my client didn’t have any symptoms on the hand. I used one more session to be sure that they were not coming back. Currently I see this client monthly for the past 4 months and his symptoms haven’t come back.

Natalia Slipka, LMT
Natalia Slipka graduated from Ternopol University of Physical Education and Sports in Ukraine in 1986. She was professional athlete (short distance runner) and later she worked on professional athletes from Track and Field teams. Currently 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