BA is a busy computer data inputter who presented with a main complaint of left shoulder pain that radiated down her medial arm and into her wrist. She describes a heaviness, and stiffness and early morning tingling of the first three digits. Pain is worse with activities involving sustained flexion: computing, holding a newspaper, cooking, driving and grooming. Her range of motion was limited during flexion and abduction; feeling pain also when lowering her arm.
Evaluation, clinical reasoning & treatment strategizing
Postural evaluation showed rounded shoulders bilaterally and increased thoracic kyphosis. She was unable to externally rotate her arms well and could not supinate her forearms more than 45°. Exquisite tenderness was palpated in many arm and forearm muscles. NMT addresses nerve entrapments as well as trigger points that can mimic nerve entrapment symptoms. I needed to rule out the entrapment possibilities of the four major nerves of the arm; the musculocutaneous nerve as it passes through the coracobrachialis muscle; the ulnar nerve as it passes through flexor carpi ulnaris; the median nerve as it passes through the pronator teres and the radial nerve as it passes through supinator. There was a positive Tinel’s sign over the median nerve at this location.
Positive changes were made when freeing up the pathway of the median nerve in it’s relationship to the two heads of pronator teres. The nerve exits the muscle 1/3rd the way down the forearm. Sustained shearing pressure, lateral rolling and pin and stretch was followed by gentle rhythmic pronation / supination movements with compression. The ability of the nerve to freely slip and slide was reinforced by gentle repeated stretches of pronator teres.
Outcomes and Follow-up
The tissue responded well after three neuromuscular treatments but questions arose as to perpetuating factors, especially ergonomics and prolonged, fixed postural positioning. I suggested breaking up her workday with the Wall Angel sequence of shoulder movements found on our website.