Find the exact site of entrapment
Finding the exact site of median nerve entrapment is very important if you are going to resolve CTS. To do this, the practitioner must take a complete history and perform an orthopedic and neurological examination looking for indications of the exact site of entrapment.
One of the most important aspects of the examination will be a hands-on examination at sites of possible nerve entrapment. It is only with the tactile sensitivity of the practitioner’s hands that changes in tissue texture, tissue tension or abnormal tissue movements will be discovered.
This hands-on examination is essential in discovering all the sites that need to be released.
It is not uncommon for patients to come into our clinic with a diagnosis of CTS (median nerve entrapment), yet have symptoms of either radial or ulnar nerve entrapment. This is because physicians do not always perform a complete examination while paying attention to the symptom patterns.
- Median nerve entrapment patterns have definitive symptoms, as do radial and ulnar nerve entrapments.
Once the areas of restriction have been located, Active Release Techniques procedures are implemented to release the area of nerve entrapment. The actual ART procedures practitioners use will vary depending on location. The basic concept of these procedures sounds quite easy to perform. ART is essentially a process of taking the affected structure from a shortened to a lengthened position with the assistance of patient motion. In reality, getting results from these procedures take a considerable amount of experience and know-how from the practitioner.
That is why it is essential to find an ART practitioner who has not only taken the upper extremity ART protocols, but has also kept up their certification. Certification in “Long Tract Nerve Entrapment Courses” would also be a great asset.
Unfortunately, it is not uncommon to have patients presenting to our clinic with a chronic case of CTS who tell me nothing they have tried has worked, including ART treatments. In many of these cases these individuals have been treated by practitioners who have never taken an upper extremity course, and have not kept current with their ART certification. You can check for current certification at www.activerelease.com .
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