Dylan Crake RMT & R.KIN

Radial Neuropathy

Draping and Positioning

• Put into neuropathic position :
  • elbow flexed, wrist flexed, shoulder adduction and elbow pronation
• Take out of that position and put onto a pillow
  • elbow extended, elbow supinated and wrist extended
  • do NOT put into more flexion

Specific Treatment

• Begin with Tinel’s down Radial nerve path
  • Deltoid to brachioradialis to base of thumb
  • Tell client to let you know if they feel a sensation and where do they feel it
• Work on high tone in wrist flexors, do NOT compress the nerve
• Flaccid in wrist extensors and triceps, facilitated techniques
• Perform 4 engrams
  • Triceps activation
  • Wrist extension
  • Finger extension
  • Wrist supination

Communication

• Ask specifically if any sensation is felt
• Check in on safety and comfort
• Make sure no pressure or stretch to nerve

Medial Neuropathy

Draping and Positioning

• Put into neuropathic position
  • Supinate forearm, extend wrist, extend 2^nd and 3^rd fingers
• Take out of position and put on pillow
  • Pronate forearm, slightly flex the elbow and neutral hand
• Do NOT put into more supination, extension and thumb adduction

Specific Treatment

• Tinel’s down Median nerve path
  • Medial epicondyle between the tendons of the FDS
  • Tell client to let you know if you feel any sensation and where
• Work on high tone in wrist extensors
• You will see flaccidity in wrist flexors and pronators
• Perform 4 engrams
  • wrist flexion
  • wrist pronation
  • finger flexion of 2nd finger
  • finger flexion of 3rd finger

Ulnar Neuropathy

Draping and Positioning

• Put into neuropathic positions
  • Extrinsic finger extension, flexion at PIP and DIPs at 4th and 5th digits
• Take out of position and put on a pillow
  • Flex MCP at the 4th and 5th digit, extension of IP at 4th and 5th digits, keep elbow slightly flexed, don’t abduction shoulder

Specific Treatment

• Tinel’s down Ulnar nerve path
  • Olecranon to ulnar border of the hand
  • Ask client to tell you if they feel any sensation and where
• High tone will be in the wrist extensors
• Flaccidity will be in the wrist flexors – facilitation techniques

Overall Neuropathy Notes

• Communicate about comfort
• Perform short, cross-fibre strokes
• Don’t compress flaccid muscles
• Perform vibration and tapping with engrams
• Don’t stretch the nerve
• Off help for them when. getting off the table and remind them to be careful