resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
Connections Worth Making
"If most doctors are like me, [they are] isolated physically and professionally. I do not make the time to connect with other doctors and also a lot of doctors do not want to be connected for a lot of reasons. Dynamic Chiropractic keeps me grounded and connected.
Are You Really a Healthy Eater?
I always giggle a little bit (to myself) when someone comes into my office and informs me that they are a healthy eater. What exactly does that mean? Does that mean they eat sugar in moderation? And what's that, exactly?
It might have been a miserable start to the day in the heart of downtown San Diego. A heavy rain had soaked the large homeless population congregating near the intersection of Third Avenue and Ash Street as they waited for a free breakfast to be served at the First Lutheran Church on the corner.
The Easy Way to Learn How to Document ICD-10
The 2015 Work Plan for the Office of the Inspector General (OIG) includes a focus on chiropractic services. This means chiropractors can expect to see more audits and reviews in the coming year because private payers pay attention to the OIG's focus as well.
What's Triggering That Point?
An orthopedic friend recently saw a patient of mine. He felt an injection of a trigger point (TP) at the upper trapezius and surrounding areas was necessary, since that was the patient's area of chief complaint and there was a tender, radiating nodule.
Case Histories from Bali: Treating Balinese Chidren with TCB and Shonishin
When I moved to the island of Bali in 2005, I offered my services in Bumi Sehat, which means Healthy Mother Earth, a free birthing center for poor and disadvantaged local women located in Ubud.
Leg Length and Pelvic Fixations
A common component of low back pain is sacroiliac joint dysfunction. Signs of SIJ dysfunction can include fixation with reduced range of motion, and localized pain or joint laxity and inflammation.
Finding Balance in the Clinic
This past December, I celebrated 11 years in practice. I seriously don't know where the time went. I feel beyond blessed and grateful to be practicing our profound and beautiful medicine and to be helping guide my patients restore a state of optimal health.
A New Era of Injury Awareness Means a New Focus on Prevention
Despite a dramatic Super Bowl last month, the National Football League has taken quite a few hits lately concerning player injuries, particularly concussions.
Adjusting the Occiput on the Atlas
You may never see a particular set of patients in your office – the ones who are either afraid of neck adjustments or have had a bad experience. A vast majority of those who had a bad experience did not have a life-threatening vascular event.
The Conscious Evolution of Healing, Part 2
The idea of transmission is very important in the Chinese medical classics. According to author Claude Larre, the ancient Chinese were highly interested in the connection between things. Nothing was looked at as an isolated entity.
It's Time to Create a Strong Acupuncture Footprint
Footprints in the sand. Footprints in the snow. Where do these footprints go? Some are big, some are small, but footprints are made by all.
Reflections: The Art of Teaching Asian Medicine
Over the past three decades, my global workshops have been translated into German, Swiss German, French, Romansch, Spanish, Lithuanian and Xhosa. Time to offer you new teachers a few tips!
Joint Supplements for Athletes (Part 1)
Maintaining joint health should be a daily focus for athletes. Joint health is a complex issue for everyone, but for athletes it poses a greater concern.
Neuroscience: Where Western Medicine and Chinese Medicine Can Come Together
The recent advances in neuroscience are truly incredible. With this expansion of scientific knowledge, I would like to see even more research into the neuroscientific basic of acupuncture and Chinese Medicine.
Acupuncture and Homeopathy: Bioenergetic Brothers
Acupuncture and homeopathy share an important healing principle: bioenergetics. "Bio" means "life," so bioenergetics is literally "life energy."
Online Efforts That Convert Traffic Into Patients
Most chiropractors are using "dinner with the doc," "refer a friend," customer appreciation days, grand openings, health fairs, chamber of commerce meetings, and other networking events to get new patients.
Put the Social Back Into Social Media
Social media is more than a passing fad, it is definitely here to stay. Social media apps and channels of distribution may evolve, but the concept of social media is now big business and a part of all our lives.
We Get Letters & E-Mail
We Have Come a Long Way – But There's a Long Way to Go; Grounded and Connected.
Old TCM Sayings: Treat the Front to Treat the Back
Chinese medicine college was, and always will be, a memorable time. It was a time of massive personal and professional growth.
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.