ULNAR NERVE ENTRAPMENT: IMPORTANCE OF FUNCTIONAL NEUROLOGICAL PHYSICAL EXAM AND MANIPULATION
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1
NeuroWorks Healthcare LLC, United States
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2
Carrick Institute, United States
BACKGROUND: A 67-year-old female was referred to our clinic for further examination and treatment for a one-year duration of numbness and tingling in her left hand. Left carpel tunnel and cubital tunnel entrapment decompression was scheduled following nerve conduction testing and little improvements with therapy. Her intake information revealed she suffered subdermal hematoma secondary to head impact two years ago. Also reported was an episode of lightheadedness leading to loss of consciousness about six months ago.
METHODS: A thorough neurological examination was conducted and posturography was performed. A majority of findings were within normal limits (WNL): heart rate and blood pressure (sitting, supine and standing), breath rate and heart sounds, dermatomal sensory exam, myotatic stretch response, equivocal sense of vibration, negative extinction, cranial exam. Abnormalities were noted with the following: decreased pursuit gain in the horizontal and vertical plane with catchup saccades; visually directed saccades were hypometric vertically and horizontally to the right. Also observed was reduced left alternating hand movements; reduced Luria sequencing bilaterally; and dysmetria of left heel/shin glide seated. Gait revealed a reduced left arm swing that was also present during dual tasking. The following had reduced motion: medial to lateral left elbow joint; radial ulnar joint play with tenderness at the wrist; left sternal clavicular joint; left gleno-humoral joint; cervical joint motion with increased tone; left upper rib motion with inspiration; and reduced left hand strength compared to right. When placing her head into plane of right posterior canal, Luria hand sequencing improved. Treatment consisted of graded (small-degree, head turn and time) right posterior canal repositioning; manipulation of the left humoral-ulnar joint, left distal radial ulnar joint, left carpels, and coupled left shoulder/clavicular manipulation. Three follow-up visits consisted of repetitive peripheral somato-sensory stimulation (rPSS) to right side trigeminal nerve branches with ocular holding; left biased median nerve; left biased posterior tibial nerves; left biased multiplanar joint integration; gaze stabilization utilizing vestibular and cervical ocular integration, orthogonal ocular movements saccading up to the left and pursuing down to the right; and manipulation using mechanical device (Activator) to C7/T1/1st rib on the left.
RESULTS: After one visit there was reduced numbness and tingling in the left arm. After two visits strength felt normal in the left hand. Her surgical decompression for the elbow and carpal tunnel were canceled and exploratory cervical procedures were canceled.
CONCLUSION: Thorough evaluation and treatment utilizing proper manipulation techniques by a trained chiropractic neurologist can help reduce peripheral nerve involvement and should be exhausted prior to surgical intervention.
Keywords:
Ulnar nerve entrapment,
neurological rehabilitation,
nerve conduction,
Carpel tunnel syndrome,
Joint manipulation
Conference:
International Symposium on Clinical Neuroscience, Orlando, United States, 24 May - 26 May, 2019.
Presentation Type:
Poster Presentation
Topic:
Clinical Neuroscience
Citation:
Behrendt
BR
(2019). ULNAR NERVE ENTRAPMENT: IMPORTANCE OF FUNCTIONAL NEUROLOGICAL PHYSICAL EXAM AND MANIPULATION.
Front. Neurol.
Conference Abstract:
International Symposium on Clinical Neuroscience.
doi: 10.3389/conf.fneur.2019.62.00042
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Received:
02 Apr 2019;
Published Online:
27 Sep 2019.
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Correspondence:
Mx. Benjamin R Behrendt, NeuroWorks Healthcare LLC, Marietta, United States, drben@neuroworkshealthcare.com