Have you ever told someone “hey, you’re getting on my nerves?” Well I’m about to get alllll up on those nerves. as we talk about neural tension. This video and article will cover some basic anatomy of the nervous system, causes and symptoms of neural tension in the upper extremities, testing, possible misdiagnoses, treatments, and we’ll answer some questions submitted by you, our subscribers!
Let’s start by learning what neural tension is and what causes it in the first place.
CAUSES OF NEURAL TENSION (ETIOLOGY)
Neural tension, otherwise known as nerve entrapment, is an abnormal physiological and mechanical response created by the nervous system when its normal range of motion or stretch capacity is limited. Lack of nerve mobility can be caused by compression from tight, swollen, or scarred surrounding tissues. The location of this compression is called an “entrapment site,” which is why neural tension is also referred to as “neural entrapment.”
Think of a string threaded through a straw. The string is your nerve and the straw is the surrounding tissue. If you pull either end of the nerve, it glides smoothly through the tissue. But if you pinch the tissue and pull the nerve again, the nerve becomes entrapped and can no longer move smoothly.
The resulting pressure and tension on the nerve is, well, not appreciated, so it responds by producing symptoms such as numbness, tingling, pain, burning, and more.
The reason this is important for climbers to understand is because it can easily be misdiagnosed as tennis elbow (lateral tendinopathy) or climber’s elbow (medial tendinopathy), which are two of the most common overuse pathologies in climbing. And if you don’t have the right diagnosis, you won’t be able to treat your injury and recover. In fact, you could even make things worse.
Now that we know what causes neural tension, let’s jump into the anatomy so we can get our “biological bearings.”
ANATOMY REVIEW
Reviewing some basic anatomy will be helpful in diagnosing which nerve is causing your issues, which we’ll have tests for later in the video. Don’t worry about memorizing all this stuff, you can always come back to reference this section and we’ve got all this written out in the show notes on our website (link in the description!).
So, the three nerves to be aware of here are the Median, Radial, and Ulnar nerves. These are the three main nerve branches that can become entrapped and cause issues for climbers (and the general population).
All three of these nerves technically originate from your spinal cord, but don’t really branch off and become the median, radial, and ulnar nerve until they move through the brachial plexus at the shoulder.
Once they branch off from the brachial plexus, they move in different areas of your arm to innervate muscle all the way down to your fingers.
Median Nerve Anatomy
The median nerve has roots from the cervical and thoracic spine, C6, C7, C8 and T1. It leaves through the brachial plexus in the armpit (the axilla) and descends down the arm just near the brachial artery (so on the inside aspect of your arm). It passes through the antecubital fossa deep in relation to the biceps aponeurosis (also called the lacertus fibrosus) and anterior to the brachialis muscle. The median nerve runs between the superficial and deep heads of the pronator teres at the elbow. It enters the anterior compartment of the forearm by passing beneath the fibrous arch of the heads of the flexor digitorum superficialis muscle.
In the forearm, it travels down the middle of the forearm and then into your hand. It innervates the 1st, 2nd, 3rd and half of the 4th digit.
Entrapment sites: The median nerve can be entrapped at four locations around the elbow:
1) the distal humerus by the ligament of Struthers,
2) the proximal elbow by a thickened biceps aponeurosis,
3) the elbow joint between the superficial and deep heads of the pronator teres muscle (which is the most common cause of median nerve compression), and
4) the proximal forearm by a thickened proximal edge of the flexor digitorum superficialis muscle.
I would highlight the pronator teres muscle, as it’s the most common entrapment site, as well as the flexor digitorum superficialis muscle, it’s one of the main finger muscles we use for climbing and as such is prone to irritation.
For the FULL SHOW NOTES head to the website www.hoopersbeta.com or go to:
Disclaimer:
As always, exercises are to be performed assuming your own risk and should not be done if you feel you are at risk for injury. See a medical professional if you have concerns before starting new exercises.
Written and Presented by Jason Hooper, PT, DPT, OCS, SCS, CAFS
IG: @hoopersbetaofficial
Filming and Editing by Emile Modesitt
www.emilemodesitt.com
IG: @emile166
