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What's New in Phytonutrition: Mangifera Indica, "The King of Fruits"
One hundred percent pure Indian green mango fruit (mangifera indica), harvested at a special degree of ripeness for efficacy and taste, can now be concentrated as a phytonutrient nutraceutical powder.
Insuring Quality Control in Herb Importation: An Interview with Wilson Lau
Wilson Lau is the vice president of Nuherbs, a Chinese herb importation company based in San Leandro, California. Before joining Nuherbs, he trained as a lawyer specializing in FDA law.
Multivitamin Supplement May Reduce Breast Cancer Recurrence
There is a great deal of controversy regarding the value of multiple vitamin supplements in cancer prevention.
AOM Hospital-Based Practice: A Future Reality?
The natural evolution of health care on the planet is integrative health. We may have some challenges ahead, but based on my research, all indicators are pointing in a positive direction. There seems to be an evolving consciousness among our patient population that is "getting it."
Adventures with the San Jiao
Those of us who have been in practice for several decades relish the way meridians and points reveal new diagnostic clues and new insights. I love to encourage my students to see this as an adventure that goes way beyond the textbooks.
Believe it or not, an estimated one-third of your patients have eaten some form of fast food within 24 hours of their appointment with you.
Tai Chi Documentary Premier
First Run Features recently announced the world theatrical premiere of Barry Strugatz's documentary The Professor: Tai Chi's Journey West, which premiered last month at the Laemmle Music Hall in Los Angeles.
Introducing the Acupuncture Today Digital Edition
In response to the changing habits of our readers, Acupuncture Today will introduce a digital edition of the publication (in addition to our print edition) beginning with the August 2016 issue.
Increasing the Value of Spine Care: CMS Approves New Low Back Pain Registry
The Centers for Medicare and Medicaid Services has approved the Spine IQ Low Back Pain Registry as a qualified clinical data registry for the Physician Quality Reporting System (PQRS) in 2016.
Treating Hip & Groin Pain With Abdominal Release of Upper Lumbar Nerve Impingements
Have you encountered patients with groin and hip pain you can't seem to solve? You know it's not a worn-out hip; you suspect the pain is somehow connected to the spine. But somehow, you just can't help them break through.
A Long-Overdue Win for Oregon Medicaid Patients - and the Implications for Other States
Beginning July 1, 2016, Oregon Medicaid patients with spinal pain (cervical, thoracic, lumbar, pelvic) who are determined to be low risk based on a biopsychosocial assessment tool (STarT Back – Keele University) can receive four chiropractic visits per episode.
Beating the Odds: Interview With Para-Powerlifter Adeline Dumapong-Ancheta
Since October 2015, the FICS Foundation, the charitable organization affiliated with the International Federation of Sports Chiropractic (FICS), has been supporting disabled athletes internationally.
Three Tips to Help You Analyze the Acupuncture Case Studies of the NCCAOM Exam
Confirm the answer quickly by the elimination method. Case study:
After two treatments for back pain, a patient presents for a third
session complaining of rapid breathing and wheezing that is made worse
during cold weather.
The Pertinent Negative
We all have to perform evaluations on patients. Most of us don't like doing it – exams take time, and worse it takes even more time after the evaluation to put together a narrative summary of the findings. Sometimes, this process becomes downright tedious.
How to Stay Sane During the Elections: Understanding Through the Lens of Chinese Medicine
In Chinese Medicine philosophy, everything consists of Yin and Yang. The law of polar opposites – one cannot exist without its opposite.
Acupuncture's Impact on the World
For several years, I have been hearing about the town of Rothenburg, Germany. It seemed just a dot on a map until I arrived. It is the home of the TCM Kongress which began in 1968. It has been held annually for 47 years and it has only missed one year.
What You Say Isn't Always What Patients Hear
A few years ago, my aunt Edna (name changed for the purpose of this story) suffered a stroke. After a short hospital stay, she was transferred to a nursing home for rehabilitation. When she arrived at the nursing home, Edna requested a private room.
Kansas Achieves Licensing Law
Kansas Governor Sam Brownback signed House Bill 2615 into law on Friday, May 13, 2016. HB2615 includes provisions for the licensure of acupuncturists in the state of Kansas.
Acupuncture Muscle Trigger Point and Oriental Medicine Sports Therapy
It is difficult to ascertain the internal condition of professional basketball player Lebron James during game one of the 2014 NBA finals, in which he developed debilitating muscle cramps that led to his premature removal from the game.
Sit or Stand? Analyzing a Mixed Message
I'm more than a bit confused. At my age, that seems to be a rather common occurrence. However, today more than ever, I'm getting a mixed message.
An Emerging Partnership Model
Maryland University of Integrative Health (MUIH) has educated integrative health and wellness practitioners for the last 40 years, originally as an acupuncture clinic and school. The institution's transformative, relationship-centered programs integrate traditional wisdom with contemporary science
Chronic Pain: Become Part of the Solution
I have lectured to more than 7,000 chiropractic physicians over the past five years regarding the chronic pain and opioid epidemic in this country.
February, 2001, Vol. 01, Issue 02
You Know It Like the Back of Your Hand
By Neal Cross, PhD, NCTMB
While it is unfortunate that many of you may not have access to human cadavera, the amount of anatomy that may be learned and reviewed on one's own body parts is quite amazing! We often go to the books (two dimensional) first, even when we have a 3-D anatomy right in front of us.It seems to me that when we do not take advantage of reviewing anatomy on ourselves or on another living person, we are truly missing out on a wonderful opportunity.
There is a level of disconnect in going from cadaveric anatomy in the lab to that warm, pliable tissue we feel on our clients. This disconnect goes away when we study living anatomy. It also makes our hands better educated when exploring bodies. And better-educated hands make for more accurate assessments.
Let's try a simple exercise. I am sitting in a jet somewhere over New York, headed to Chicago, then to Miami. I place my left hand on my left knee, palm down. I observe that the hair pattern changes from dense to sparse as I look distally. The transverse creases on each digit indicate the underlying MCP, PIP and DIP joints. These abbreviations refer to rather cumbersome names: metacarpophalangeal, proximal interphalangeal and distal interphalangeal joints, respectively. A nail covers each digit distally. I see the dorsal carpal venous rete and the origins of the basilic and cephalic veins medially and laterally, respectively. If I extend each digit, I clearly see its extensor tendon move just beneath the skin. I also observe that when I extend any of my fingers, its tendon and an adjacent tendon move.
All this lets me know that I have connecting tendons between the extensor tendons of digits two through five. The pattern of these intertendons varies widely from person to person. I can palpate these tendons. If I palpate carefully, I find that digits two and five each have a pair of tendons. One is from the common digital extensor (extensor communis); the other is from a muscle named for that digit. These are the extensor digit minimi and extensor indicis. I do not have the additional tendons to digits three and four, as some people do. These tendons are from the muscle extensores digiti tertii et quarti. I also note that all of these tendons "disappear" proximally under the extensor retinaculum.
If I abduct a finger against resistance, I can readily palpate a dorsal interosseous. I also know that the four dorsal interossei attach only to digits two, three and four. The third digit has two dorsal interossei, as its midline is the reference for finger movements. If I abduct the thumb and little finger against resistance, I can palpate their abductors one for digit five and two for digit one. When I hyperextend my thumb against resistance, a prominent depression appears proximally to the thumb's base. This is the anatomical snuffbox, bounded by the tendons of the short and long extensors of the thumb and the long abductor. Exploring the distal attachments of these, I can readily palpate more than one tendon associated with two of these muscles.
This is a very common phenomenon, even though it is not mentioned in many standard textbooks. I know of no significant functional consequence, other than perhaps driving a few of my medical students to some level of madness. I can readily palpate the pulse of a branch of the radila artery in the floor of the snuffbox. If I press harder and discover point tenderness, it may be indicative of a scaphoid fracture. This is arelatively common injury caused by falling backward onto a hyperextended wrist.
I can readily palpate all of my phalanges and metacarpals. I can also distinguish the major landmarks on each. If I carefully examine the range of motion of each of the joints in each digit, I note several things. In digits two through five, the range of motion is generous about one axis, but extremely limited about the other two axes. When examining the metacar-pophalgeal joint of the thumb, I notice it has generous motion about two axes and very limited motion about the third. I also discover that the ranges of motion differ if I utilize passive rather than active movements.
So, while sitting here on the plane, I have reviewed most of the salient anatomy of the dorsum of my hand. I have considered what is normal (i.e., usual) and compared my hand anatomy to "textbook" hand anatomy. In this way, I am reminded of the great wealth of variety in the human anatomy. This variation is an easily overlooked feature, yet it is so very important to understanding human form and function. As clinicians, we should strive to learn as much as we about this variation.
Some aspects of our anatomy indicate something especially unique to the individual being examined. Unique to the back of my hand are two scars. One is about two centimeters long, lying transversely at the base of the thumb. This resulted from the errant path of a knife while I was filleting a fish a few years back. The second is a very faint, perfectly rectangular scar overlying the midline of my extensor retinaculum. This was created by a burn from a popcorn popper at a Cub Scout meeting in 1958. I hadn't thought about that in decades.
So as you can see, the human hand is a marvelous instrument far more interesting than peering out the window at the top of the clouds.
Click here for previous articles by Neal Cross, PhD, NCTMB.
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