Figure 18: Elbow Distally
Begin with the client’s arm palm down on table, and place your elbow tool at the inferior end of lateral epicondyle landmark (see Figure 18). Slowly glide the elbow distally until muscle bellies end (where tendons begin to be felt). Repeat two to three times.
Figure 19: Soften Brachioradialis Muscle
As seen in Figure 19, begin with client’s arm palm down on table, and grasp the brachioradialis muscle with a pincer grip (using fingers and thumbs). Pull the muscle away from bone and apply friction and petrissage strokes. Try to grasp the entire muscle both proximal and distal to the elbow (cubital fossa) region. In many people, this muscle can be felt a third of the way into the brachium region.
Figure 20: Address Pronator Teres Muscle
Two steps: 1. Locate the distal pronator teres tendon at the radial tuberosity landmark of the radius (Figure 20), which lies deep in the brachioradialis muscle; ensure this muscle has softened before attempting to go deeper. Pull the brachioradialis laterally as you place fingers approximately three fingers distal to the elbow (cubital fossa) crease. Curl your fingers into the antebrachium to feel for an almond shaped piece of bone. Hold pressure firmly at the radial tuberosity landmark for 5 to 10 seconds. 2. Slowly, holding firm pressure, glide fingers toward the medial epicondyle landmark. Your fingers will move in a diagonal direction toward the medial side of the antebrachium. End stroke when medial epicondyle is contacted.
Figure 21: Work Trigger Points within Flexors
Using thumbs, knuckles or fingertips, strip through the antebrachial muscles, both anterior and posterior, to feel for trigger points within the flexors and extensors (see Figure 21). To apply effective therapy, pause when twitch responses and radiating pain are experienced. Turning the hand to create pronation and supination of the proximal radial–ulnar joint will make efforts more intense
Figure 22: Locate Trigger Points within Hands
Spread the palmar surface of the client’s hand (Figure 22). Use your thumbs to apply pressure into the thenar and hypothenar musculature. Trigger points here may feel as small as grains of rice or sand. Close your eyes to sense changes in muscle texture and tonicity. Stretching the hand will be a welcome addition to the therapy.
RECOMMENDATIONS AND PATIENT EDUCATION
Recommending exercises and activities for a patient to perform between manual therapy sessions is a necessary part of client–therapist communication. Here are 10 recommended items to suggest to patients to augment
their self-care regiments and carpal tunnel recovery care (Butler, 2020): ● Be mindful of how much torquing and bending an activity creates on the wrist joints. Excessive flexion (bending) and rotation (torquing) of the wrist can
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