Lost A Sale, But Initial Phone Consultations — A Big Part Of Brilliant Customer Service
I just got finished with a ...
resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
Lower-Extremity Overuse Injuries: Primer on Causes and Corrections
From ankle sprains to stress fractures, shin splints to plantar fasciitis, the research is clear: These common overuse injuries of the lower extremities – among dozens of others – may be related to abnormal foot function in your patients.
Data: The New Frontier in Health Care
Your practice is empowered with the data you need to improve patient health, run a more efficient (read: profitable) practice, get paid in timely fashion and help show the efficacy of chiropractic on the national stage in the midst of sweeping changes in health care!
A War You Can Help Patients Win
The average American consumes approximately 60 percent of calories from sugar, flour and refined oils. A donut is a good example of a so-called "food" that represents these calorie sources.
Merger Creates New Model of Care
Two San Francisco powerhouses of holistic healing, the American College of Traditional Chinese Medicine (ACTCM) and California Institute of Integral Studies (CIIS), are merging. Together they are building a visionary approach to applied integral health.
Medicine as Metaphor
The practice of medicine is both an art and a science. We study and learn the system so that when the time comes to apply it, there is a greater possibility of successfully helping others.
ICD-10 Is Not Scary (and Not About Billing)
In my 13 years of consulting with doctors on billing and coding matters, ICD-10 has aroused the biggest combination of misguided fear and ignorance I can remember.
The Roots of TCM in Depression Treatment
In traditional Chinese medicine, there is historical precedent for the treatment of so-called "Shen" (Heart-Mind) disorder, or disorder/dysregulation of the spirit, which is also considered as distinct but not separate from the cognitive function of the brain.
The Art of Creating a Healing Space
I always advise my graduates to examine their group practice or treatment rooms with fresh eyes after they leave my CE workshops. I tell them, "Ask yourselves - is your space qi filled, welcoming and healing? Or is it cold and clinical?"
Exploring and Learning from the Gift of Life
I'm grateful to have had the opportunity to teach cadaver dissection classes and workshops with Stephen Cina at the New England School of Acupuncture over the past seven years, first through the Sports Medicine Acupuncture Program and later as a NESA elective course.
Treating LBP in Golfers: Beyond Basic Assessment
The drive to master the most efficient swing demands a tremendous amount from the lower back. Maintaining stability in a flexed posture, supporting torso rotation and repetitively supporting the golf swing all put the lower back in a vulnerable position.
The Integrative Medicine Puzzle: Putting the Pieces Together
The conversation is changing in the broader healthcare community with patients actually moving the discussion toward more integrative topics. Patients today want to know their options.
The Source-Luo Point Combination, Part 3
Dr. Nguyen Nghi (NVN) was born in Vietnam and is one of the most important scholars, writers, teachers and practitioners of modern time. Many of his theories and applications are the source of modern teachers from Europe and the United States.
Abdominal Acupuncture for Eye Healing: The Sacred Turtle and Ba Gua Map
Our ideas about western medicine have shifted in recent decades, while the public is asking more from health care providers.
Colon Health and TCM
I still remember many years ago, the loud "Yuck" from my wife at the time when we were together watching the Chinese movie "Last Emperor."
News in Brief
Support of F4CP Continues With Latest Donations; Walter Reed Honors Dr. William Morgan; Recognizing 40 Years of Public-Health Activism; Allstate Decision Reversed.
Melatonin: A Promising Natural Agent in the Prevention of ALS
A number of years ago, experimental studies suggested melatonin could block key steps in the development of Alzheimer's disease, primarily by acting as a brain antioxidant and inhibiting the build-up of beta-amyloid plaque in the brain.
Aetna Updates 97140 Policy
In a development the Association of New Jersey Chiropractors is calling "a resounding victory for chiropractors nationwide," Aetna Insurance Company has updated its national reimbursement policy regarding 97140 (manual therapy), reaching an agreement two years after the association filed a declaratory judgment suit in federal court against the insurer.
Treat Every Patient as an Athlete
Frontal-plane movement pattern dysfunction can set the stage for musculoskeletal injury. Frontal-plane stabilization is essential during the normal activities of daily living: think single-leg stance and gait cycle.
Technology Meets Practice: Chiropractic Every Day
About a year ago, I had an interesting conversation with a DC who made house calls. When I asked why, she was quick to explain she learns much more about her patients when she sees them at home than she could ever observe in the office.
Can Acupuncture Treat Knee Pain?
Recently, an article in the Journal of the American Medical Association concluded that, "neither laser nor needle acupuncture conferred benefit over sham for pain or function" among older chronic knee pain patients.
Adding Microneedling to Your Clinic for Results and Profit
Microneedling has taken the beauty world by storm over the last 10 years. Under the names dermaroller, microneedling or skin needling you will see these treatments listed in the services of nearly every fashionable beauty salon and day spa in the country.
Making Public Health a Chiropractic Priority
As highlighted in this edition's News in Brief, Rand Baird, DC, MPH, FICA, FICC, editor and occasional author of our long-running column, "Chiropractic in the American Public Health Association", was recognized by the organization recently for 40 years of membership.
September, 2001, Vol. 01, Issue 09
Common Structural Oddities in the Human Body
By Neal Cross, PhD, NCTMB
There are a number of common anatomic variations and developmental changes related to aging. Some of these structural "oddities" can be mistakenly interpreted as abnormalities, or worse, a neoplastic disease of some sort.Usually these anatomic variations are nothing more than the result of normal developmental changes, daily activity patterns, or some genetic-based multivariate characteristic. Examples of each of these will now be discussed.
One common phenomenon is the presence of "extra" muscles or absence of common muscles. Perhaps the most well-known variation in this category is the palmaris longus in the anterior compartment of the forearm. This muscle lies superficial to the flexor digitorum superficialis and is roughly in the exact center of the forearm. Its tendon is long and thin and travels over the carpal tunnel to blend with the palmar fascia. You can easily determine if you have one or both muscles by flexing your wrist against resistance and looking for the prominent centrally located tendon.
This muscle is absent about 11 % of the time either bilaterally or unilaterally. More interesting for our purposes here is the fact that the position of the muscle belly can vary quite dramatically. The small muscle belly is usually situated proximally along with the muscle mass of the common forearm and digital flexors. Occasionally, however, the muscle belly of palmaris longus is situated distally just proximal to the flexor retinaculum. In this position it can be confusing. No muscle should be there -- what is wrong with this person? Nothing's wrong; these are just thoughts that might run through the mind of the naïve examiner.
Another similar example is the peroneus (fibularis) tertius. This muscle is commonly present but very variable in its presentation. Arising from the extensor digitorum longus, it runs to the lateral aspect of the ankle and foot and attaches at any number of places, usually including the fifth metatarsal. Palpation in this region of the foot will lead one to discover nothing; a rather dramatic muscle mass; and everything else in between. Unless these sorts of variations are accompanied by other clinically significant findings, they are usually just the result of normal anatomic variation.
Recently in a palpatory anatomy course I teach, one of the students became concerned because of a large and significant bulge right in the middle of her fellow student's popliteal fossa. She called me over, and I examined the young healthy male. My first impulse was correct. After asking a number of questions related to his medical history, I learned that he had a third head of gastrocnemius. This is often referred to as the gastrocnemius tertius. It was particularly prominent in this muscular young male.
Just yesterday in my medical gross anatomy course, I had two students approach me somewhat concerned about unusual muscle masses in the anterior forearms. In the first case, a young healthy male showed me large bilateral masses just medial to the tendon of the palmaris longus and three fingerbreadths proximal to the flexor retinaculum. They certainly did not look pathological at all. I simply asked what he did that might lead to this dramatic hypertrophy of the medial sides of both the flexor digitorum superficialis and the flexor digitorum profundus. At first, he couldn't think of anything; then suddenly he said, "Lacrosse -- I played lacrosse." The repetition of "twirling" the stick led to the muscular hypertrophy we were observing.
Not 10 minutes later, a young woman approached me and showed me the exact same situation, only just on her right forearm. I jokingly asked if she played lacrosse with one arm. She looked puzzled. Then I explained the situation with her classmate; she then saw the humor. I asked her if there was anything unusual about daily activities. She immediately put together her "anomaly" with the fact that her job as a pharmacy technician required her to inject solutions out of a 30ml syringe into a container. This was done hours on end and resulted in the observed muscular hypertrophy. I have found that many if not most of the muscle "abnormalities" I have witnessed over the last 25 years are in this category.
Of course, not all palpatory findings that might concern someone involve muscles. Another very common tissue that can fool us is lymph nodes. Normally lymph nodes are very difficult to palpate unless they are inflamed or the site of neoplastic disease. There are some exceptions to this, however. The superficial inguinal nodes lying along the inguinal ligament and surrounding the cribrifrom fascia in the femoral triangle can sometimes be very large. I distinctly remember a young female student in palpatory anatomy who had herself and her fellow students in a fit over her lymph nodes. Not only were they readily palpable, they were visible! After calming the group down, I discussed variability of lymph nodes with them. It turns out that her inguinal nodes were the largest I had ever seen in a healthy individual, but as the conversation continued, the "patient" described an interesting situation. She had been concerned about these "bumps" for several years, but was too scared to have a physician check them out. Had they been pathological, this could have been a terrible mistake. Palpable nodes can sometimes be felt in the axilla. A physician should always check these in female patients, but by far the most common nodes I have palpated are associated with nearby insect bites (we do have plenty of mosquitoes in Maine) or a recent cold.
As an example of a dramatic developmental change that can lead to unnecessary concern, let us consider the xiphoid process. This structure is found at the inferior end of the sternum. It begins as a pliable cartilage structure with an osseous core. Upon palpation in the epigastric fossa, one can feel the xiphoid give against digital pressure. However, as we age, the bony core enlarges at the expense of the cartilage. This can lead to a structure that feels like a bone growth -- which it is -- but it is part of the normal aging process. I always try to remember to tell the students in my palpatory anatomy class to be wary of such changes in their more mature classmates.
I never tire of the rich variation I experience in the cadaver lab or in the palpation lab. I always try to pass on this experience to my students and clients.
Click here for previous articles by Neal Cross, PhD, NCTMB.
Join the conversation
Comments are encouraged, but you must follow our User Agreementcomments powered by Disqus
Keep it civil and stay on topic. No profanity, vulgar, racist or hateful comments or personal attacks. Anyone who chooses to exercise poor judgement will be blocked. By posting your comment, you agree to allow MPA Media the right to republish your name and comment in additional MPA Media publications without any notification or payment.