“I never knew how hard it could be to button a shirt without feeling my fingers.” As I work with patients experiencing nerve damage, conversations often turn in this direction. Our bodies are incredibly complex, and yet most of the time they function very well.   It is easy to take this for granted. After all, we don’t retain our infant memories of the neurological boot camp where we toddled and fell for years before learning to run, jump, swim and type.   But when systems fail, we suddenly realize what miracles had been occurring all the time. In this…

A patient comes to see you with numbness and tingling of the right ring and little fingers. As you are an astute clinician you infer that the patient either has an ulnar nerve injury or a possible C8 cervical radiculopathy, but how do you know exactly where the likely cause of injury is? A careful and considerate clinical exam should lead you in the right direction.  Paresthesia of the medial hand.  Image source: Flickr Commons First and foremost, it can be challenging to distinguish between a cervical radiculopathy versus ulnar neuropathy with clinical exam testing alone. However, with an experienced…

Apply Today! EMG Solutions’ Residency in Clinical Electrophysiology is now LIVE! On the APTA’s Residency and Fellowship Physical Therapy Centralized Application Service (RF-PTCAS) Search for EMG Solutions to apply today! EMG Solutions is excited to announce the development of our new residency program in clinical electrophysiology. It is only the second Clinical Electrophysiology residency offered in the United States and we are the first and only fully immersive residency program that pays you while you learn! Our intensive program includes one-on-one mentoring with a comprehensive didactic learning experience. A resident completing our program will be qualified to apply for and take the American Board of Physical Therapy…

Although carpal tunnel syndrome affecting the median nerve is designated as the most common entrapment mononeuropathy in the upper extremity, another player deserves honorable mention: the ulnar nerve in Guyon’s canal.  EMG/NCV plays an important role in helping identify and localize a compromise of the ulnar nerve at the wrist.  A brief anatomical review of Guyon’s canal highlights the structures surrounding the ulnar nerve through this infamous tunnel.  The Floor: transverse carpal ligament and hypothenar muscles. The Roof: volar carpal ligament. Ulnar border: pisoform bone and pisohamate ligament and abductor digiti minimi muscle belly. Radial border: hook of hamate bone. …

A patient comes to see you with wrist drop. As you are an astute clinician you infer that the patient has a radial nerve injury, but how do you know where the likely cause of injury is? A thoughtful and thorough clinical exam should shed some light on the situation. Wrist Drop. Image source: Flickr Commons Radial nerve injuries occur most frequently after fracturing the middle third of the humerus.1 However, there are many sites of possible compromise leading to wrist drop including at the axilla, at the spiral groove, or at the arcade of Frohse. Let us take a…