This is a summary of Chapter VIII of “The Sensitive Nervous System” by David Butler.
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.
- Rieche-Cannieu anastomosis: Deep branch of ulnar and recurrent branch of median nerve.
- Absent musculocutaneous nerve.
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.
Spinal Nerve Palpation
Here are the craniocervical nerves.
Upper Extremity Nerve Palpation
The median nerve
The Ulnar nerve
The Radial Nerve
The Musculocutaneous Nerve
Lower Extremity Nerve Palpation
First, the nerves palpated anteriorly.
And then posterior.
Grab a partner or yourself and palpate away.