ulnar nerve impingement/cubital tunnel syndrome

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I've searched and read other posts here regarding this, but aside from working the scalenes, pecs, and upper arm - if the impingement is at the elbow, how would you work this?
I am planning on ordering the DVD highly recommended in another thread about this - from realbodywork.com on nerve mobilization. just thought I would see if anyone had any other thoughts, suggestions, etc. in the meantime before the dvd gets here 8)
thanks in advance for any tips!

a little more detailed info for you:
client is having numbness and pins & needles in left pinky and ring finger. She sleeps with her arm bent and under her, spends time during the day with elbow bent and on the table, is having difficulty doing pinching motions with that hand.
I worked scalenes, pec minor, along with entire upper body really... and showed her some pec stretches, forearm stretches, and self massage techniques to do at home along with ice and anti-inflammatory like ibuprofen. she is trying to stop sleeping with her elbow bent, and has been very good at doing her other homework and she is working on correcting the habits that are contributing to this. she definately felt a connection to the work we have done and her finger pain/ numbness.

how would you proceed?
 


Massage to the Pronator & Supinator is helpful for relieving nerve impingements at the elbow. Here are links to pictures of muscle locations:

Pronator Teres:
http://www.waynesburg.edu/depts/ccink/armpics/pronatorteres.jpg

Supinator:
http://www.waynesburg.edu/depts/ccink/armpics/supinator.jpg

Use the picture to locate the general area of thee Pronator Teres. Hold your fingers on where you think the muscle is, and then pronate/supinate your client's hand back and forth. You'll feel the muscle contract, so you'll know you're in the right place. Press a little stronger on the muscle, and continue that motion, creating a massage effect on the muscle. Move your fingers to different locations on the muscle, so you're sure to massage the whole thing. Experiment with pronating/supinating your client's hand slowly vs. quickly, for different effects. You can also experiment between using your fingers or thumb to apply pressure. Do this treatment on yourself, to get the feel of it, before trying on clients.

Do the same technique for the supinator, placing your fingers on the opposide side of the arm. Again pronate/supinate your client's hand back & forth, to feel for the contraction (locating the muscle). Massage accordingly.

I incorporate this work in many massages. Clients love it!
 


oh yes yes - I LOVE that stuff - I forgot to mention that I did do that work also on the forearms. but when I did the tingling pins/needles feeling intensified... so I backed off. And actually, I was surprised to not find as much tension there as I expected. (but maybe I'm just too used to MY forearms!!)
those pics are great and really help illustrate those muscles, thanks! 8)
 


Where you able to help the client. I think I have Cubital Tunnel Syndrome and need help without going to a neuro., in between insurance comp. What did you work to get relief? I would like to pass it on to the therapist I share space with who will be working on me. THX
 


The nerve DVD from real body work is very good.

if you can find someone who has the Active Release Techniques (ART) upper extremity text and DVD, that has some excellent stuff for this problem and other nerve entrapments.

Remeber the the ulnar nerve runs down the ulnar side of the forearm along side the Flexor Carpi Ulnaris...you can work that muscle all the way down if you assess it and find that it is affecting the issue.

Anything coming from that medial epicondyle needs to be assessed (all the flexor tendons/muscles, pronator teres and palmaris longus) as they can be impinging the nerve.

Working the triceps can help as well as the intermuscular septum of the humerus.

scales, pec minor, etc....as you stated also need to be checked.


What sort of things re-create her symptoms? Also, make sure you have good postural assessment to determine where movement faults and postural deviations are taking place. This is a big one! Most people want to get in there and jsut work everything! Be specific with your treatment and determine what things are affeting this problem. Remeber that symptoms are just a presentation of the problem. They are just letting you know that something is wrong, however they are not letting you know WHAT is wrong. you need to determine that! I mean, sometimes we will see people with medial epicondyle or lateral epicondyle problems (usually throwing athletes or tennis players) and it will be because they have a weak core musculature and instead of having good transfer of power from the lower extremity to the upper extremity, they have all these energy leaks and are forced to develop greater torque at the shoulder or elbow. All of these things....static posture, active movement, passive ROM, active ROM, resisted muscle strength testing, muscle length testing, should be addressed!

Good luck!

Patrick
 


It's me. Bending my arm increases tingle and numbing feeling and also increasing the number of fingers. All of pinky and ring then increases to the tips of mid and index.
 


Hey Amyisms -

I did all of the above, including purchasing the dvd from realbodywork, lol. (I'm not so good with learning from a video though, I need to feel the work on myself to really get it, but that's just me!)
the client did get some relief, but I'm not really sure how she's doing now as she lives an hour away and I don't see her often. I didn't get to work with her as much as I had hoped on this issue.
I think Patrick's suggestion of ART would be really beneficial. Please let us know what you try and how it works for you!
 


amyisms said:
It's me. Bending my arm increases tingle and numbing feeling and also increasing the number of fingers. All of pinky and ring then increases to the tips of mid and index.

start by palpating the area where the cubital tunnel is and see if that recreates symptoms. The ulnar nerve may be pressed between the Flexor Carpi Unlaris and the Cubital Tunnel there. Look for hyperonicity in the flexor carpi ulnaris and work that muscle. Get it soft and then stretch the wrist flexors. Try some ART too....the techniques are pretty much pin-and-stretch techniques and you can use them over the flexor carpi ulnaris and the other flexors originating at the medial epicondyle. Use short but more frequent massage sessions through the week (every other day or once every two days) instead of just going for one long full body massage once a week. Get on a specific treatment plan.

look at your activities of daily living and limit the movement that creates pain for awhile as you try and rehab.

patrick
 


Being a massage therapist with a full sched, it's kind of hard to stop what I'm doing. I could always just do a one handed massage :)
 


amyisms said:
Being a massage therapist with a full sched, it's kind of hard to stop what I'm doing. I could always just do a one handed massage :)

I realize that, but you have to take care of yourself! Like people who work at a desk all day and have a kyphotic posture or carpal tunnel syndrome...they can't just stop working....but they must do something that allows them to break that poor activity of daily living which is contributing to the problem. Some ideas would be:

- schedule less people during the work day
- leave more time between clients to allow yourself to stretch, rest and recover.
- work less, and take a day off inbetween massage work days.
- take a vacation


The problems don't go away on their own unless you fix them.

Most of the time, those in the 'healing' field (massage therapists, physical therapists, doctors) are the worst patients because they know what is wrong, they know what to do to fix it, and they end up not doing a darn thing.

Patrick
 


amyisms said:
Being a massage therapist with a full sched, it's kind of hard to stop what I'm doing. I could always just do a one handed massage :)

This is absolutely possible! When my hand was injured and I had a full schedule that I couldn't take time off from, I did one handed massage. I used the elbow and forearm of the "broken" hand, and the hand and elbow and forearm of the other hand. I had to change a lot of my strokes and the way I worked, but I still gave a great massage. I think with enough motivation (ie pain! lol) and creativity you can do this.
 


Patrick W said:
amyisms said:
Being a massage therapist with a full sched, it's kind of hard to stop what I'm doing. I could always just do a one handed massage :)

I realize that, but you have to take care of yourself! Like people who work at a desk all day and have a kyphotic posture or carpal tunnel syndrome...they can't just stop working....but they must do something that allows them to break that poor activity of daily living which is contributing to the problem. Some ideas would be:

- schedule less people during the work day
- leave more time between clients to allow yourself to stretch, rest and recover.
- work less, and take a day off inbetween massage work days.
- take a vacation


The problems don't go away on their own unless you fix them.

Most of the time, those in the 'healing' field (massage therapists, physical therapists, doctors) are the worst patients because they know what is wrong, they know what to do to fix it, and they end up not doing a darn thing.

Patrick

I just wanted to quote this because it is so important. Patrick says it best, if we don't take care of ourselves, we will break down. I am currently one more time learning this, needing to take time off, listen to my body/mind and what it wants/needs.

For your issue, though remember random fascial restrictions can alter the articulation of the ulna and radius.

Also elbow issues sometimes indicate a liver issue. If you cannot find someone who does Visceral Manipulation, pay particular attention to your diaphragm/ ribcage especially over the right side. Alter your diet for a time if necessary to detox the liver a bit. Google Liver Detox and you can get lots of information on this.

For the fascial restrictions, a good friend can do an arm pull that is amazing for the whole quadrant.

hope this helps, even if I came into this discussion a bit late.
 


I took the week off, the numbness isn't constant any more, some pain in the elbow. Worse after a nights sleep. I'm not the best sleeper. We'll see how it goes come Monday after a day of work.

Unfortunatly I can not decrease my sched. any more than it is. In the last 3 years I have gone from 32hrs. a week to 16 hrs. a week. I'm at bare min. financially.

I spent the week revising my resume and have sent it out. Maybe it's time for a complete change and back to school to finish some loose ends.

Thanks for all of your help.
 


Amyisms, Do I detect a sound of regret?
hard to 'hear' through text.

Who is treating you?
Are you happy with the idea of changing channels as it were?
I would hate you to change professions if your heart isn't in it.

But I am sure you have thought all this through.

Just wanted to acknowledge what sounds a bit like regret.
 


After 8 yrs. it's time to make this my part-part-time gig. I love what I do and I'm a damn great therapist, but my heart isn't in it like it use to be.
 


ah I so understand.
I have been at this over 25. LOVE IT.
the last 5 years full time. It makes a huge difference in the work to be sure.
and the toll on the body.

It isn't easy.

Best of luck to you!
 
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    wonderspa: . ๐ŸŒบ๐ŸŒบWonder spa,(9421Jane st unit127)call416-5000-800โ˜Ž๏ธbest massage in vaughan,Tuesday RMT available, Today's special recommendation ๐Ÿ’„sexy very young girl Mimi,natural c cup,very good looking amazing massage nice body slide,really popular ๐Ÿ˜ป ๐ŸŽlong hair Lucy Q smile,very good strong to relax oil massage,got a lot experience,๐Ÿ˜very nice good looking sunny,amazing massage
  32. EMSpa_schedule:
    Tomorrow's sneak peek: On Thursday May 8, 2025, our attendants will be Ada ๏ธ, Cici ๐Ÿ˜˜, Vicky ๐Ÿค—, Sophie ๐Ÿคฉ and Monica ๐Ÿค—. Call us at โ˜Ž๏ธ(905) 479-6668โ˜Ž๏ธ to book!
  33. wilson holistic centre:
    ๐Ÿ’•๐Ÿ’•Beautiful Korean girl working at 382 Wilson Ave ๐Ÿ’•๐Ÿ’•โ˜Ž๏ธโ˜Ž๏ธ416-840-0071โค๏ธโค๏ธ
  34. Fantomas:
    DATY
  35. DareDevil:
    ARIA WELLNESS ๐Ÿฌ๐ŸญADDRESS: 360 HWY 7, UNIT #6, โ™ฅ๏ธRICHMOND HILL,647-222-5683 (PHONES CALL ONLY, NO TEXT'N AVAILABLE) โ™ฅ๏ธTODAY'S Schedule!โ™ฅ๏ธ Loaded lineup with Beautiful Girls : New Young RMT Student Helen, , New Girl Linda, Magical Mia and Work out๐Ÿ‹๐Ÿšด๐Ÿ’ช Babe Amy! BUY 10 HOURS (GET 11 HOURS) **TODAY'S PICK OF THE DAY IS ๐Ÿฌ๐ŸญHelen and LInda๐Ÿฌ๐Ÿญ
  36. Golden Sunshine Spa:
    โœจClick on our Username and FOLLOW US for updates and special services ! โœ… Click Here Today๐ŸŒธAkame๐ŸŒธChristina๐ŸŒธXuka๐ŸŒธLynda๐ŸŒธVivian Call us โ˜Ž 905 - 265 - 2158โ˜Ž๏ธ Your ultimate service awaits! โœจ
  37. SL East Spa:
    ๐Ÿ’†โ€โ™€๐Ÿ’–WooHoo Wed๐Ÿ’– Ultimate destination for Asian massages๐ŸŽ‰ Two fab spots: Richmond Hill & Oakvilleโœจ Your passport to paradise with 9 enchanting girls fr China, HK, Japan & Korea โ€” ๐Ÿ†•Gigi, Cindy, Coco,Cici, Amber, JPN Yui, Akino, Jasmine & Lucyโ€” ready to pamper you๐ŸŽ๐Ÿ Ring us ๐Ÿ“ž647-695-6354 or text us ๐Ÿ“ฑ647-578-8169โœจ 160 East Beaver Cr., Unit 12, RichmondHill ๐Ÿ’ฐWhere Eastern charm meets Western comfort - your bliss awaits๐Ÿ™Œ
  38. SugarLoveSpa:
    Hi today have Ella, Susan, Tifany, Nancy come baby Sugar Love spaโ˜Ž๏ธโ˜Ž๏ธ (437) 365-2688๐Ÿ“ฒโ˜Ž๏ธ
  39. Lilyspa1:
    Lily Spa : โค๏ธโค๏ธ SuSu ( Asian )Slim , ๐Ÿ˜๐Ÿ˜Porn Service ๐Ÿฉท๐ŸฉทElena 22, Latino French, 36 DDD and ๐Ÿ‘๐Ÿ‘ASS, ๐Ÿ’‹๐Ÿ’‹Yuki 24, Korean Slim , ๐Ÿ˜ˆbbbj , DFk ๐Ÿ”ฅDuo ๐Ÿ”ฅ,โ˜Ž๏ธ 6475318288
  40. wonderspa:
    ๐ŸŒบWonder spa,(9421Jane st unit127)call416-5000-800โ˜Ž๏ธbest massage in vaughan,Wednesday RMT available,๐Ÿ’„sexy very young girl Joey natural c cup,very good looking nice body slide,really popular ๐ŸŽlong hair Q Lucy good strong to relax oil massage, Relieve pain and remove stress,more experience,๐ŸŒนyoung beautiful new girl Cici slim body,amazing body slide,Deep massage,nice ending,must try๐Ÿ˜๐Ÿ˜
  41. Jennyโ€™s Spa:
    ๐ŸŽ‰๐Ÿ’JENNYโ€™S SPA๐ŸŽ‰๐Ÿ’ โœ…5170 DUNDAS STREET WESTโœ… ๐Ÿ‘ŒETOBICOKE ONTARIO M9A 1C4๐Ÿ‘Œ โ˜Ž๏ธ( 647-893-5196)โ˜Ž๏ธCall or Text โ˜Ž๏ธ( 437-888-3759)โ˜Ž๏ธCall Only (ETOBICOKE) OPEN 10am to 9pm MONDAY to SUNDAY ๐Ÿ”ฅโœ…GRAND OPENING๐Ÿ’ฏNEW GIRLS EVERYDAY๐Ÿ”ฅEXCELLENT MASSAGE + SERVICE QUEENS NOW AVAILABLE AT JENNYโ€™S SPA FOR ALL YOUR MASSAGE AND SPECIAL EXTRA NEEDS๐Ÿ”ฅ๐Ÿ’ฏ๐Ÿ˜˜๐Ÿ”ฅโค๏ธ๐Ÿ‘Œ ๐Ÿ”ฅTWO BEAUTIFUL NEW YOUNG ASIAN GIRLS EVERYDAY๐Ÿ”ฅ ๐Ÿ’ฏREAL PICTURES OF ATTENDANTS๐Ÿ’ฏ ๐Ÿ”ฅ๐Ÿ’‹Limited Time Special Promotion๐Ÿ”ฅ๐Ÿ’‹ โœ…๐Ÿ’ฆ30 Minutes Nude Mass
  42. AliceSpa:
    WEDNESDAY at ๐—”๐—Ÿ๐—œ๐—–๐—˜ ๐—ฆ๐—ฃ๐—” 416-298-0898, 4915 Steeles Ave. E, Scarborough 3 very nice girls here today. Open 10am to 9pm: APPLE: from Hong Kong, very small body, 5' 100Lbs, petite with natural C Cups, small waist, pretty baby face, smooth skin, very clean. Shaved tight Pu**y, strong professional massage. Available FS bbbj cim cof rim. LUCKY (12:30pm-9pm): is Vietnamese, small body, busty D
  43. Lulu1980:
    Phoenix Blossom Spa ๐ŸŒน๐ŸŒน๐ŸŒน2 girls๏ผŒNina ใ€Cindy ๐Ÿ”ฅ๐Ÿ”ฅ๐Ÿ”ฅ5124 Dundas St W Etobicokeโ˜Ž๏ธ416-817-3366๐Ÿ‘ Table Shower Sea Salt Bath Body Scrub๐Ÿ˜˜ Japanese girl Nina โค๏ธ Natural Big Boobs 38 DD ๐Ÿ˜˜Pink Mini Nipples Hot body slide, super enjoyable๐Ÿ˜˜๐Ÿ˜˜๐Ÿ˜˜๐Ÿ˜˜ very provocative service๐Ÿ˜˜๐Ÿ˜˜๐Ÿ˜˜, New girl Yuki Round buttocks ๐Ÿ˜œpretty boobs 36D๐Ÿ˜˜Superb service ๐Ÿ‘ massage, has therapeutic effect to loosen bones and relieve muscle pressure and will bring you unexpected service effects, she will bring you a little surprise
  44. wilson holistic centre:
    ๐Ÿ’•๐Ÿ’•Beautiful Korean girl working at 382 Wilson Ave ๐Ÿ’•๐Ÿ’•โ˜Ž๏ธโ˜Ž๏ธ416-840-0071โค๏ธโค๏ธ
  45. Nu spring spa888:
    ๐ŸŒน๐ŸŒน๐ŸŒนsexy hot Philippine ๐Ÿ’– ๐Ÿ’– Malaysia ๐Ÿ’– ๐Ÿ’– Korean girls ๐Ÿ‘working at Nu spring spaโ˜Ž๏ธ416-669-8508๐ŸŒน๐ŸŒน๐ŸŒน
  46. ForeverWarden:
    Wednesday at ๐Ÿซฆโค๏ธ๐Ÿ”ด๐ŸŸฅโ™พ๏ธ๐“•๐“ž๐“ก๐“”๐“ฅ๐“”๐“ก ๐“ข๐“Ÿ๐“โ™พ๏ธ๐ŸŸฅ๐Ÿ”ดโค๏ธ๐Ÿซฆ2190 Warden Ave, Unit 201, Scarborough ๐Ÿฐ๐Ÿญ๐Ÿฒ-๐Ÿด๐Ÿฌ๐Ÿฌ-๐Ÿณ๐Ÿด๐Ÿด๐Ÿณ: Bella, Cindy & Sasa. Bella is around 5โ€™3โ€ with a thin to medium build, C Cups, and a pleasing personality. She can offer dfk, bbbj and cfs as well as a good massage experience. Cindy is a slim beauty, 5โ€™4โ€, natural C Cups. Her massage is nice, her services will drive you wild & her finish is a dream
  47. Moneylee:
    Full season wellness center: Young girl Big-breasted big big butts Aris , Young girl big breasted beautiful buttocks charming temperament big boobs Rose,Young girl big breasted beautiful buttocks charming temperament big boobs Julia ,Young beautiful face sexy body and good deep massage maggie,Enchanting sexy petite deep massage Mary. ๐Ÿ  2560 Shepard ave Mississauga unit 1 โ˜Ž๏ธ 4379857899 ๐Ÿฆต๐Ÿฆต๐Ÿ‘„๐Ÿ‘„๐Ÿ‘…๐Ÿ‘…๐Ÿˆต๏ธ๐Ÿˆต๏ธ
  48. Moneylee:
    All season wellness center : New Young girl big boobs beautiful face deep massage Zoe ,young girl pretty face nice figure Thai deep massage Helen,Young girl big breasted beautiful buttocks charming temperament summer ,Young girl Big breasted saucy naughty Ella , Enchanting sexy petite deep massage Sherry ,address: #5-30 Rambler dr Brampton ,Ontario L6W 1E2โ˜Ž๏ธ4376655510 ๐Ÿฆต๐Ÿฆต๐Ÿˆต๏ธ๐Ÿˆต๏ธ๐Ÿ‘…๐Ÿ‘…๐Ÿ‘„๐Ÿ‘„
  49. HolidaySpa:
    Wednesday at ๐ŸŒด๐Ÿ˜Ž๐ŸŒ…๐“—๐“ธ๐“ต๐“ฒ๐“ญ๐“ช๐”‚ ๐“ข๐“น๐“ช๐ŸŒ…๐Ÿ˜Ž๐ŸŒด3517 Kennedy Rd, Unit 4, Scarborough โ˜Ž๏ธ๐Ÿฐ๐Ÿฏ๐Ÿณ-๐Ÿฎ๐Ÿฐ๐Ÿณ-๐Ÿญ๐Ÿญ๐Ÿต๐Ÿตโ˜Ž๏ธ: FIONA, KIKI & CINDY. FIONA is a slim hottie with long dark hair, great melons and ass, and nice services. Kiki is very attractive, young, about 5โ€™4โ€ and 110 Lbs., slim with a banging body. Kiki is very popular for her great attitude and services. CINDY is slim & incredibly sexy
  50. SugarLoveSpa:
    Wednesday at โค๏ธ๐Ÿ’™ ๐Ÿ’œโŽ๐—ฆ๐—จ๐—š๐—”๐—ฅ ๐—Ÿ๐—ข๐—ฉ๐—˜ ๐—ฆ๐—ฃ๐—”โŽ ๐Ÿ’–๐Ÿ’—๐Ÿ’˜: ELLA, NANCY, SUSAN & TIFFANY. 1270 Finch Ave W (at Keele St), Unit 18. North York, ON โ˜Ž ๐Ÿฐ๐Ÿฏ๐Ÿณ-๐Ÿฏ๐Ÿฒ๐Ÿฑ-๐Ÿฎ๐Ÿฒ๐Ÿด๐Ÿด โ˜Ž ELLA is a lovely Thai sweetheart, 5โ€™1โ€ with C Cups, smooth skin and a very pleasing attitude. NANCY is a curvy and very friendly Spanish girl, who has all the versatile skills you need. SUSAN is a small, slim & sexy Latina girl
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