The Sensitive Nervous System Chapter VIII: Palpation and Orientation of Peripheral Nervous System

This is a summary of Chapter VIII of  “The Sensitive Nervous System” by David Butler.

Intro

Palpation is a major component to therapeutic touch, and gives us a way to build rapport and interact with our patients. When palpating the nervous system, it is important to palpate in sensitive positions so the nervous system is placed on load. Here are some general nerve anatomical rules.

  • Where a nerve has fewer fascicles and less connective tissue, palpation will be more sensitive (ulnar nerve).
  • Where there is a lot of connective tissue, there will be a more localized and less “nervy” response.
  • Where there is increased sensitivity does not mean there is damage locally. Damage could have occurred more proximally (that whole nerves fire in both directions thing).

You must also be mindful that anatomical variations are common, especially if symptoms seem anatomically weird. Here are some of the more common ones:

  • Martin-Gruber anastomosis: Median and ulnar communicate distally.
MN - Median Nerve; UN - Ulnar nerve; CB - Communicating branch.
MN – Median Nerve; UN – Ulnar nerve; CB – Communicating branch.
  • Rieche-Cannieu anastomosis: Deep branch of ulnar and recurrent branch of median nerve.
MN - Median Nerve; UN - Ulnar nerve; CB - Communicating branch.
MN – Median Nerve; UN – Ulnar nerve; CB – Communicating branch.
  • Absent musculocutaneous nerve.

Palpation 101

Here are some basic nervous system palpation guidelines.

  • Nerves feel hard and slippery.
  • Palpate with your finger tip or thumb, and follow it proximally or distally.
  • Use sustained pressure up to 30 seconds.
  • Twang if easily accessible.
  • If using a Tinel’s, tap the nerve 4-6 times.
Do not play Stairway on the superficial fibular nerve.

Spinal Nerve Palpation

Here are the craniocervical nerves.

The Trunk

Upper Extremity Nerve Palpation

Brachial plexus

The median nerve

The Ulnar nerve

The Radial Nerve

The Musculocutaneous Nerve

Lower Extremity Nerve Palpation

First, the nerves palpated anteriorly.

And then posterior.

Last Words

Grab a partner or yourself and palpate away.

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4 thoughts on “The Sensitive Nervous System Chapter VIII: Palpation and Orientation of Peripheral Nervous System

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  1. Hmm is anyone else having problems with the pictures on this blog loading? I’m trying to determine if its a problem on my end or if it’s the blog. Any feed-back would be greatly appreciated.|

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