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Creating Relationships at Southwest Symposium
The month of May brought many interesting activities. As I have said in many previous columns this year, this profession is moving in a very exciting direction. Make sure you are getting involved. If you're not, you just might get left behind.
The Three Heater Official
This Official, belonging to the element Fire, is responsible for maintaining and regulating the heating system of the body, mind, and spirit. It is named for its function. The trunk is divided into three "burning spaces" or "jiaos."
Should You Change an Athlete's Natural Running Form?
Once past the ankle, impact forces travel at about 200 mph into the knee. In addition to allowing the quad to absorb force, bending the knee (E) prevents the hip and pelvis from moving up and down too much (F), which is important for injury prevention and efficiency.
Nomenclature and Classification of Lumbar Disc Pathology: Version 2.0
The Nomenclature and Classification of Lumbar Disc Pathology consensus, published in 2001 by the collaborative efforts of the North American Spine Society, the American Society of Spine Radiology and the American Society of Neuroradiology, has guided radiologists, clinicians and the public for more than a decade.
The Risks I Took
We all take risks when we choose this profession. For some, it is not knowing if you can make a living practicing TCM. For others, it is parental or cultural disapproval.
Meet Cheyenne: Your Future Colleague
Allow me to introduce you to Cheyenne (Chey), the daughter of some of our family's closest friends. We attend and serve at the same church together, and have known each other for many years.
Sports Medicine 101: Surgery or No Surgery?
In the world of sports medicine, many careers are saved by surgeries that correct traumatic damage to the body. Muscle tears, ligament damage, fractures, spinal disc herniations, and joint instabilities are a few of the issues frequently addressed with surgical intervention.
Going On-Site With Chiropractic Care
The Foundation for Chiropractic Progress has released a position paper highlighting the financial, clinical and patient-satisfaction benefits of providing chiropractic care at on-site corporate health clinics.
Key Changes and Updates to the 7th Edition CNT Manual
Acupuncture Today recently interviewed Jennifer Brett, ND, L.Ac. regarding the updates to the CNT manaul.
Leg-Length Inequality and Pelvic Fixation: A New Approach to the Negative Derifield (Part 3)
A patient with sacroiliac fixation and dysfunction ordinarily demonstrates a noticeable leg-length inequality when placed in the prone position on the adjusting table.
Treatment of PTSD: An Opportunity for the Practice of Integrated Medicine
PTSD is widespread across America today. Not only do many of our honored men and women in uniform bring it home with them from the war zones they have been active in, but it often follows any life-threatening event people go through when their lives have been in danger.
An International Life: An Interview with Mary Elizabeth Wakefield
I met Mary Elizabeth Wakefield during her class last summer in Seneca Falls, New York at the Finger Lakes School of Chinese Medicine.
Desert: A Metaphor from the Study of Genetics
In most of the human lives I know about, there are stretches of time which feel stagnant, or worse. We can feel adrift, or wounded and sidelined, and these times don't seem to carry much usefulness while they are unfolding.
News in Brief
Investigating the Cellular Impact of Mechanical Force; National Board Seats (Not-So) New Officers at Annual Meeting.
Marketing with a Microphone
When given an option, it stands to reason that people prefer to do business with those they know, like, and trust.
Integrative Medicine for the Underserved: A Seat at the Table
Numerous organizations have risen to the challenge of providing care to medically-underserved populations and here we feature one such group.
Free Yourself From the Pocketbook Practice
Let's take a journey together; there's an important lesson to be learned. Imagine a town or city just like yours.
Chinese Doctors Poke Holes in Australian Study
A recent Australian clinical trial, published in the Journal of the American Medical Association (JAMA) in 2014 by Rana Hinman, et el., evaluating the effectiveness of both needle and laser acupuncture for chronic knee pain.
I was sitting in a Pizza Hut in Peoria, Ill., with my friend Reggie, sometime in the spring of my senior year in college, when he started doodling on his paper placemat. In those days, the company had a picture of U.S. on the mats, showing all the locations of the "Huts" in the country.
The Source-Luo Point Combination, Part 2
The Da Cheng includes symptoms for the source-luo points that indicate when to use them for treatment. Yang defines the method as the guest-host (it is one of a variety of acupuncture point combinations called guest-host).
Q&A With the First VA Chiropractic Residents
As you may have read previously, a major step forward for the profession occurred in July 2014 when the Department of Veterans Affairs began piloting a chiropractic residency program at five locations.
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.
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