We can all physically palpate (touch) many parts of the nervous and muscular systems. Muscles and joints are quite accessible and for many clinicians, but the nervous system may seem hidden and difficult to palpate. Many peripheral nerves are very easy to palpate. For clinicians, this is a skill worth learning, and learning well.
Palpation serves as a quick way to learn or brush up on peripheral neuroanatomy. It also serves as a reminder to many clinicians that their training was primarily based on muscles and joints and when tender/painful structures were identified during the patient examination, those could be nerves.
Sometimes peripheral nerves are visually obvious. The best place to see this is on the top of your foot. When you point your toes down to the floor the superficial peroneal nerve is quite noticeable.
Another benefit of palpation is to assist in your diagnosis. I find it quite difficult to diagnosis a spinal subluxation, soft tissue injury or a peripheral nerve entrapment without using palpation skills.
Peripheral nerves palpation skills are a part of management. Use these skills to educate your patients about the nature of their injuries. My patients often ask “what is this tender spot in my leg?” Knowing your peripheral nerve anatomy can make it simple to answer these questions.
Palpation is of course a primary skill for anyone treating patients with manual therapies. Chiropractors, physical therapists, massage therapists, osteopaths, medical doctors and others use palpation routinely to assess patients and assist in treatment protocols.
As an Certified Active Release Technique (ART) provider, palpation is important for locating the problematic area and treating the area successfully. Proper palpation comes with time and cannot be memorized, it is something that develops year after year with increased usage. Another method of palpation, motion palpation, is used to assess joint mobility, hypermobile vs hypomobile. Palpation of soft tissue structures (muscles, ligaments, tendons, nerves, blood vessels) can give us important feedback on how well these tissues are sliding past one another. We can use palpation to pinpoint the area of concern and successfully manage peripheral nerve dysfunction.
It is exciting to be involved in this kind of work on a daily basis. I am always learning new ways to palpate and treat patients. When I think I have a good handle on a technique or treatment method, another cutting edge idea has surfaced and caught my attention. Bottom line, as clinicians we never stop learning.
Go ahead and get out your peripheral nerve anatomy textbook and re-visit the fun!
Live your best,
Dr. Brian
Source: The Sensitive Nervous System – David S. Butler
Photo courtesy of biology.clc.uc.edu
Tags: nerve entrapments, nerves, nervous system, palpation