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Kinesiology for Manual Therapies

Chapter 11

Unwinding the Soft Tissues of the Forearm: Dimensional Massage Techniques for the Muscles of the Hand and Wrist

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11-2

Learning Outcomes

o 11-1 Define key terms.o 11-2 Describe the difference between entrapment and compression.o11-3 Discuss how posture and sleep positions can contribute to soft-tissue conditions.

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11-3

Learning Outcomes (cont.)

11-4 List several potential causes of carpal tunnel syndrome.

11-5 Determine safe treatment protocols and refer clients to other health professionals when necessary.

11-6 Review general pathologies and conditions of the muscles of the hand and wrist.

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11-4

Learning Outcomes (cont.) 11-7 Develop a treatment protocol for

conditions of the lateral and medial epicondyle areas.

11-8 Demonstrate safe body mechanics. 11-9 Practice specific techniques on the

hand and wrist muscles. 11-10 Incorporate dimensional massage

therapy techniques in a regular routine or use them when needed.

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Introduction

The anatomy of the forearm, hand, and wrist is a compact package. Repetitive activities come with a price of soft-tissue dysfunction.

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Injuries and Overuse Syndromes

Sprains are injuries that often tear ligaments and soft tissue and bruise nerves. Strains are injuries to the soft tissue, such as a stretch or tear to a tendon or muscle. Both injuries have levels of severity.

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11-7

Injuries and Overuse Syndromes (cont.)

Fractures and lacerations are frequent traumatic results to hand and wrist injuries. Tendonitis is defined as an inflammation of a tendon. Different types of tendonitis could include a partial tear from the bone or a lesion in the body of the tendon.

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11-8

Injuries and Overuse Syndromes (cont.)

An adhesion may be a painful scar. Tendonosis is defined as a breakdown in collagen fibers in the tissue. Collagen is made up mostly of protein and is composed of the white fibers of connective tissue.

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Injuries and Overuse Syndromes (cont.)

Tenosynovitis is an inflammation of a tendon sheath. Tendon sheaths are Saran-wrap-like connective tissue that surround individual groups of tendons.

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11-10

Other Soft-Tissue Issues

A wrist ganglion is a cyst that usually protrudes on the dorsal side of the wrist. Dupuytren’s contracture is a debilitating hand condition that can inhibit normal hand and finger function.

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11-11

Nerve Complaints

Carpal tunnel syndrome is an inflammatory condition of the median nerve. Causes include: small tumors and/or ganglion, fluid retention in pregnancy, shape of the tunnel, a depressed capitate bone, tenosynovitis, and flexed wrist positions. McGraw-Hill McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved© 2011 by The McGraw-Hill Companies, Inc. All rights reserved

11-12

Nerve Complaints (cont.)

The median nerve can be entrapped outside of the carpal tunnel by the pronator teres or pectoralis minor. Bony compressions of the brachial plexus can reduce innervation to the median nerve and produce distal symptoms.

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Nerve Complaints (cont.)

The radial nerve can become entrapped by the triceps brachii or by the supinator. Ulnar nerve entrapment in the arm and flexor carpi ulnaris can cause weakness of grip. The cubital tunnel can compress the ulnar nerve.

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11-14

Sleep Positions and Posture

Question clients about sleep positions. Upper extremities above the head in sleep can help the pectoralis minor to entrap the brachial plexus. A fetal sleep position encourages rounded shoulder postures.

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Arthritis, Osteoarthritis, Degenerative Disk Disease, and Cervical Subluxations

Arthritis is an inflammation of a joint and is common in the aging process. Osteoarthritis is a degenerative joint disease common in the spine. Spurs are bony growth on the side of the vertebrae.

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Arthritis, Osteoarthritis, Degenerative Disk Disease, and Cervical Subluxations

(cont.)

Degenerative disk disease is the depletion of the disk space between the vertebrae. It is often present with osteoarthritis. A subluxation is a joint that is slightly ajar that a chiropractor could align or adjust.

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11-17

Unwinding the Forearm Muscles

Probable muscles involved in lateral epicondylitis: brachioradialis, extensor carpi radialis longus, extensor digitorum, extensor carpi ulnaris, extensor digiti minimi, triceps, anconeus, supinator, and compensating biceps and brachialis.

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11-18

Unwinding the Forearm Muscles (cont.)

Probable muscles involved in medial epicondylitis: pronator teres, flexor carpi ulnaris and radialis, flexor digitorum superficialis, and flexor digitorum profundus. Do not overlook the biceps and brachialis in the arm.

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Unwinding the Forearm Muscles (cont.) Treatment protocol

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11-20

Dimensional Massage Therapy for the Hand and Wrist Muscles

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Not all hand and wrist pain is from repetitive action of the forearm muscles. Check infraspinatus, subscapularis, scalenes, and pectoralis major and minor. Relax the shoulder girdle muscles first and work down to the forearm.

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Dimensional Massage Therapy for the Hand and Wrist Muscles – Supine

Compression of the Forearm Muscles

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Dimensional Massage Therapy for the Hand and Wrist Muscles (cont.) – Supine

Jostle the Brachioradialis

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11-23

Dimensional Massage Therapy for the Hand and Wrist Muscles (cont.) – SupineElliptically Move the Forearm Muscles

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11-24

Dimensional Massage Therapy for the Hand and Wrist Muscles (cont.) – SupineMyofascial Stretch of the Brachioradialis

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11-25

Dimensional Massage Therapy for the Hand and Wrist Muscles (cont.) – SupineParallel Thumbs on the Brachioradialis

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11-26

Dimensional Massage Therapy for the Hand and Wrist Muscles (cont.) – Supine

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Locate and palpate forearm tendons. Check for hypertonicities, tenderness, and pain tolerance levels at attachment sites.

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Dimensional Massage Therapy for the Hand and Wrist Muscles (cont.) – Supine

Compressive Effleurage

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11-28

Dimensional Massage Therapy for the Hand and Wrist Muscles (cont.) – Supine

Alternating Petrissage of the Forearm

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11-29

Dimensional Massage Therapy for the Hand and Wrist Muscles (cont.) – Supine

Broadening of the Forearm Muscles

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11-30

Dimensional Massage Therapy for the Hand and Wrist Muscles (cont.) – Supine

Myofascial Humeral Twist

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11-31

Dimensional Massage Therapy for the Hand and Wrist Muscles (cont.) – SupinePetrissage Elbow Joint with Distraction

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11-32

Dimensional Massage Therapy for the Hand and Wrist Muscles (cont.) – SupineElliptically Move the Carpals and

Metacarpals

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11-33

Dimensional Massage Therapy for the Hand and Wrist Muscles (cont.) – Supine

Short Cross Stroke to the Antebrachial Fascia

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11-34

Dimensional Massage Therapy for the Hand and Wrist Muscles (cont.) – Supine

Thumb Stripping to the Antebrachial Fascia

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11-35

Dimensional Massage Therapy for the Hand and Wrist Muscles (cont.) – Supine

Thumb Stripping to the Flexor Retinaculum

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11-36

Dimensional Massage Therapy for the Hand and Wrist Muscles (cont.) – Supine

Strip the Forearm Tendons

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11-37

Dimensional Massage Therapy for the Hand and Wrist Muscles (cont.) – Supine

Flex, Extend, and Strip Tendons

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11-38

Dimensional Massage Therapy for the Hand and Wrist Muscles (cont.) – Supine

Treat Lateral Origins

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11-39

Dimensional Massage Therapy for the Hand and Wrist Muscles (cont.) – Supine

Treat Medial Origins

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11-40

Dimensional Massage Therapy for the Hand and Wrist Muscles (cont.) – SupineBroaden with Active Engagement

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11-41

Dimensional Massage Therapy for the Hand and Wrist Muscles (cont.) – Supine

Lengthen with Loose Fist

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11-42

Dimensional Massage Therapy for the Hand and Wrist Muscles (cont.) – Supine

Lengthen with Thumbs

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11-43

Dimensional Massage Therapy for the Hand and Wrist Muscles (cont.) – Supine

Light Hacking

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11-44

Dimensional Massage Therapy for the Hand and Wrist Muscles (cont.) – Supine

Flipping Hand

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11-45

Dimensional Massage Therapy for the Hand and Wrist Muscles (cont.) – Supine

Ulnar and Radial Flexion Shake

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11-46

Chapter Summary

This chapter discussed the vulnerability of the forearm, hand, and wrist structures. Injuries and overuse syndromes including fractures and dislocations, tendonitis, tendonosis, and tenosynovitis were reviewed.

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11-47

Chapter Summary (cont.)

Soft-tissue issues and nerve complaints were explored. Arthritis, osteoarthritis, degenerative disk disease, and cervical subluxations were reviewed.

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11-48

Chapter Summary (cont.)

Treatment protocol and sequence of the forearm, hand, and wrist areas were outlined for unwinding the forearm muscles.

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11-49

Chapter Summary (cont.)

Dimensional Massage Therapy techniques for the muscles of the forearm, hand, and wrist were depicted for the supine position.

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11-50

Chapter Review

The Chapter Review is divided into true and false, short answers, and multiple choice questions. The questions are designed for the students to test their knowledge.

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11-51

Explore and Practice

Activities in this section are for practice and demonstration. Every opportunity should be utilized to locate muscular attachments on as many different bodies as possible to support kinesthetic learning.

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11-52

Explore and Practice

Use the muscle cards and book in technique classes, for log hours, or for case studies for reference purposes.

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