Trigger points that cause nerve symptoms- how to deactivate?

[oldtimekid2]

I have a new client with a brachial plexus injury and resulting numbness/coldness of the hand. I've been trying to locate and deactivate trigger points that would be making the nerve symptoms worse, and I've found two (rhomboid and subscapularis) that cause his hand to go cold and numb. I've tried both static pressure and friction, but I can't get them to release. Frankly, I'm a little unsure how to deactivate the TrPs that cause nerve symptoms. I've truly never encountered any this bad before.

With normal TrPs I know how to use a pain scale and continue until the pain begins to lessen, but what do I do with numbness? Should the numbness eventually lessen? Is that a sign that I should try something else?

My options are a bit limited, because he concurrently has rotator cuff damage and loss of ROM to his shoulder. A lot of the positional release techniques would be putting his arm into a position that he can't quite get to yet.

I'd love some ideas if anyone can point me in a good direction.

 

[ALLURING]

What is the type of injury to the brachial plexus? Is it a tension injury or a compression one? Either way, nerve injuries take a longer time to heal.

Whether it is compression or tension, you may get better results by working the areas around the situation just be careful not to make the symptoms worse. You can use stripping and myofascial techniques and focus primarily on the scalenes, pec minor, subclavical muscle. Also helpful is working the anterior deltoid, biceps and triceps (and the last three are good when working with the rotator cuff issue).

I've had numbness occur from trigger point referrals and if it doesn't relieve very shortly then you are probably not helping by continuing to add the pressure to that area.

What is the rotator cuff damage? Can you use muscle testing to determine which muscle is torn or has tendonosis?

I would ask the client which one he would like you to address first. There's no point in stressing out his body more by trying to address both issues at once.

 

[Czech.]

Thanks for your reply! The brachial plexus injury happened when his arm was pulled violently. He's not sure exactly what they did when they repaired his rotator cuff, but he knows that he still has a bicep tear and frozen shoulder that still needs to be repaired. The surgeon told him that he has too much inflammation in his shoulder for surgery, which is why he was sent for massage.

I've been doing some research and I'm going to try some MET techniques in his scalenes/ pec minor next to see if that helps his nerve symptoms. If I can't release them within the next appointment or so I'm going to just let them go and focus strictly on his rotator cuff. Do you have any advice on how to address swelling within a joint? I have him doing Somatic shoulder exercises (very, very gentle) to get some movement, and am hoping that it will help the swelling flush out. I'm not trained in lymph drainage and neither is anyone in this area, so I don't even have another therapist to refer him to.

 

[Laser Girl]

Ouch! I've also had clients injured on the surgery table--not fun. If the over-stretch injury is in acute or sub-acute seforum.xxxe, then work the area accordingly (no deep work), meaning any of the muscles that were overstretched along with the nerves. The nerves themselves being overstretched like that can't really be helped by massage and will just take extra time to heal.

I have found that working around the area of injury seems to help the issue area (in your case the subscap/biceps) open up more when you get to those last. So what I mean is working the other muscles that cross the joint first before the affected ones. Also include the serratus ant. since that muscle works along with the pecs.

When there's swelling in a joint, I wouldn't work over the joint but around it to give somewhere for the swelling to go into. Since your client can't see anyone who does lymph, I guess you can just wait for it to go down before working directly over that area.

You probably know this already, let your client know everything you are going to do and ask if that's okay with them beforehand. Being injured while in the care of health professionals can make a person anxious for anything done to that area of injury and they can be comforted knowing they have control of what you are doing.

 

[Patrick D]

another possibility?

Could a person work the subscalpulas?

 

[massiel248]

I'd love to see Walt & Breathe jump into this - as well as CSTBrian, I'm sure all of them could be of major help to advise you further on handling this injury.

I certainly agree with Kathyrn that working around the joint would be helpful so you can open the pathway for the swelling to be reduced. In the meantime, depending on if the client is not taking other meds to interfere he could take herbal inflamatories. Find out what if anything he is currently taking & have him discuss it with his doctor & you as well. There are homeopathics such as Arnica which would be fine to take for the pain & strain he's been through.

Other techniques which would assist without causing further pain would include a number of energy work techniques, such as Reiki & Jin Shin Jyutsu. If you would be interested in checking out a JSJ practitioner there is a locator service available through their website, http://www.jsjinc.net.

Good luck & let us know how things progress

 

[Steven Miles]

Beetlejuice. :

Well... older thread, I wonder if the OP is still working with this client. Also, there is a lot of information missing, critical stuff like how long ago was the injury, ROM information, visual information such as posture, is the swelling visible and feel-able, etc.

I think people here probably know I'm not a fan of TPT as a first-line treatment. I believe that much of the other work needs to be done first, then a determination can be made regarding TPs that still exist.

That being said, it is worth considering that the "TP" that was causing nerve sensations was actually a nerve. If you are doing TP work and consistently getting a nerve reaction in a certain area, with no abatement, this is at least a caution, if not a C/I for that spot. Nerve pathways can be a little different from individual to individual.

 

[Ade494]

sensation

thank for the reply. Is there a better way to work the lesser trocanter and releaseing those areas? such as the vastus medialis