These tingling sensations should occur during any type of movements with the hand. the pain should be (in the begining) very dull and more annoying than anything. If the client works or uses his/her hands a lot chances are more than likely that she/he does have carpal tunnel. Pain from annoyancy to swelling and pain that is unbarable even for client to move hand will occur.
muscles involved
(supinated hand, palm up, anterior)in the hand lumbricals attached to flexor digitorum profundus tendons. opponens pollicis. Dorsal interossei, palmar interossei, adductor pollicis, opponens pollicis, tendon of flexor carpi radialis. flexor digitorum, profundus tendons, flexor digitorum superficialis tendons, palmar aponeurosis of palmaris longus, flexor digiti minimi brevis, abductor digiti minimi, flexor retinaculum. Lumbricals, flexor pollicis brevis, abducor pollicis brevis, opponens pollicis, adductor pollicis
(pronated, posterior, palm down) Extensor tendon expansion, dorsal interosseus, extensor pollicis longus tendon, extensor tendons, dorsal interossei, extensor retinaculum.
(posterior arm, pronated arm). Abductor pollicis longus, extensor pollicis brevis, extensor indicis, extensor pollicis longus, supinator, extensor digiti minimi, extensor carpi ulnaris, extensor retinaculum, anconeus, extensor carpi radialis longus, extensor carpi radialis brevis, abductor pollicis longus, extensor pollicis brevis.
(anterior arm, supinated arm) flexor carpi radialis, brachioradialis, pronator teres, palmaris longus, flexor carpi ulnaris, flexor digitorum superficialis, flexor digitorum profundus, flexor pollicis longus, median nerve, and the pronator quadratus.
assement outline
advance protocol number 3
1.phalanges: hold the hand starting with either the thumb or little finger grasp the distal phalanx. Stretch the fascia distally while gently twinsting the finger. (see which direction the tissue moves most- either medially or laterally. put your twisting part of the stretch in that direction.) Hold the stretch for a moment feeling for a lengthening into the dorsal and palmar fascia of the hand/wrist. do the same with all phalanx.
2.intrinsic muslces: (pronating the hand). With both hands, grasp the client's hand so that your fingers meet in the middle of the palm. Stretch the palm laterally (as if you were scooping out a cantaloupe that has been cut in half)
3. Flexors of the fingers and wrist: (kneel or sit by the clients hip supinate the hand) should be lieing flat on table. Begin just proximal to the wrist and stretch toward and onto the medial epicondyle of the humerus. Have the client move hand forward and backward and flex and extend fingers
4. extensors of the hand and wrist:(pronate the hand) Begin just proximal to the wrist and stretch towardand onto the lateral epicondyle of the humerus. Have the client move hand forward and backward and flex and extend fingers
5.interosseous membrane: (flex elbow at 90 degrees) place the fingertips of both hands into the space between the flexors and extensors. One of your hands will be obove the other. Melt into the interosseous space and stretch in opposite dirrections. Have the client move hand forward and backward and flex and extend fingers.