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Talking to Patients About Lumbar Facet Denervation (Medial Branch Neurotomy)
Lumbar facet denervation, more appropriately termed medial branch neurotomy (MBN), is a procedure that may be considered when patients suffer from recalcitrant non-radicular axial back and/or leg pain.
A Well-Kept Secret: 5 Element Acupuncture, Part II
Supervising acupuncture interns at a TCM college, it has always struck me how funny it is to hear the clinic manager tell the patients that the Five Element clinic specializes in treating emotions, as if patients with physical pain have no emotions!
Low Back Pain in Professional Golf: A Common Muscular Relationship
Every sport creates its own unique demands on the body. Some sports require such a myriad of body positions that assessing pathology is often difficult and unpredictable.
Turning a Blind Eye to History – and Reality
The American Medical Association is taking the Supreme Court's Feb. 25, 2015 decision exactly as it always does – by turning a blind eye to history, legal precedent and reality.
Synergy Doesn't Happen in Silos: Acupuncture in Hospitals and Other Healthcare Settings
As acupuncture and traditional East Asian medicine continue to intersect and integrate with biomedical approaches, the conversation about integration expands and becomes richer.
Recreational Cannabis Use and TCM
Many people are drawn to cannabis for its effects physically, mentally and emotionally. Medically, cannabis has some legitimate uses, however the scope of this article is limited to the recreational use of cannabis.
Applying the Thin Skull Principle
The "thin skull" principle, also known as the "you take your victim as you find them" principle, is a legal principle that can be summed up by the following statement.
Will You Be an Amplifer or a Mute?
These times are changing, and changing quickly. There have been many challenges to this profession throughout the past few years. The challenge is to talk, then talk and talk some more about this medicine.
Optimism = Compassion = Trust
A randomized clinical trial recently published online in JAMA Oncology examined how patients viewed their doctor based upon how the practitioner presented bad news to the patient.
Treating Beyond Pain
More often than not, when a patient presents to the office, it is for a pain complaint. Headache, neck pain, low back pain, sciatica, carpal tunnel... The pain is often the focus of the patient's mindset, and they don't often have any thought of what comes after the pain.
Sleep, Less Sleep or No Sleep?
I had a dream I wasn't getting enough sleep. It was a very realistic dream, even though I was probably slightly awake and not really deep dreaming. Most likely I had been dozing, caught in that twilight of sleep and wakefulness.
A House Divided?
The American Chiropractic Association's House of Delegates voted on 30 resolutions at its annual business meeting in Washington D.C., but two in particular took immediate center stage due to their controversial nature.
The Way We Are Designed: A Conversation with Gil Hedley, PhD
I was first introduced to the work of Gil Hedley by Tom DiFerdinando. He gifted me Gil's DVD series.
An Excerpt from TCM Case Studies: Pediatrics
This excerpt is reprinted with permission from Jamie Wu. TCM Case Studies: Pediatrics was released in 2014 by People's Medical Publishing House.
A View From the ER
The University of Western States has inked an innovative agreement with local nonprofit health system Legacy Health whereby UWS sports-medicine fellows can experience observational clinical rotations in emergency-room settings within the Legacy system.
Functional Hip Impingement (Part 1)
Every time I sit down to write an article, I realize how much more there is to know about musculoskeletal pain. I also learn something new every time. (I want to give special thanks to Lucy Whyte Ferguson for assisting with this article.)
The Need for a New Medical Model: A Challenge for Biopsychosocial and Ecopsychologica Medicine
Chinese medicine speaks of alignment between humans, heaven and earth. It is a complex view with a focus upon relationship. These are comprehensive ideas with no specific terms in contemporary medical practice.
The Dietary Supplement Research Dilemma
I do not care what the truth is, one way or another; I just want to know it. And when it comes to dietary supplements, the truth can be hard to find for a number of reasons.
Converting More Patients to Your Practice
In 2013 and 2014, the theme was "the money is in the list." This meant that if you had a big email list, you were really making some "cha-ching." Unfortunately, having thousands of emails doesn't equate to thousands of dollars in profit.
TCM Congress in Rothenburg is Largest in Western World
In the medieval town of Rothenburg, deep set within the Bavarian countryside in Southern Germany, the TCM Kongress Rothenburg each year draws around 1.200 participants from more than 40 different countries to attend the biggest TCM conference in the Western world.
There Really is No Room for Sexism
Recently, Matteo* (a transgender male) approached me during a break in an advanced shiatsu class in Berlin where he was one of two men in a group of 20 women. "Pamela. Don't forget to remind the translator to include male endings."
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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