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Universal Design: Principles & Practice
In many respects, universal design serves as the core of ergonomics. It's also a good tool to use when designing a return-to-work program for injured and/or ill patients. Let's take a closer look at universal design and why it should matter to you and your patients.
An Unexpected Diagnosis: The Result of Lacking Communication
A couple years ago I had a case that showed me the importance of open communication between health practitioners. We need to show up with less fear, and let go of our judgments so we can do better for the patient.
Bill With Confidence: Learn What to Collect
Q: I am trying to understand what I may collect from my patient when there is insurance. Do I have to accept the amount allowed by the plan or may I collect up to my billed amount? Please note, I am not a member of any insurance plan.
Creating Good Business Buzz
What do patients really think about working with you? Rarely do you hear the whole truth. Those who improve may be candid in their gratitude.
A Major Role in Back Pain: The Multifidus
Back pain affects roughly 80 percent of the population at one time or another and is one of the leading causes of doctor visits.
Is It Time to Rethink Mental Illness? (Pt. 1)
Invariably, patients will ask their chiropractor about depression or various mental illnesses. Some practitioners will reflexively offer a cervical adjustment, suggest St. John's wort or contemplate a referral to a specialist.
Why I Quit Doing House Calls
My father was a chiropractor who did house calls, so when I became a DC, I figured doing house calls was part of the job. My March article recalled my experience as a small boy, accompanying my dad while he went to patients' homes to treat them.
Balancing Spring Challenges
As the winter months come to a close and warmer spring weather appears, patients may begin to present with new challenging pattern presentations.
Eczema & Acupuncture: A Sound Solution (Part 1)
Eczema affects approximately 3.5 percent of the global population and is one of the most common skin complaints seen by dermatologists.
Clearing Blocks: A Way to Improve Cosmetic Acupuncture
As a Five Element acupuncturist who teaches facial acupuncture classes nationally, I was surprised to learn that one of the basic principles I was taught in school is unfamiliar to most acupuncturists.
Taking the Chiropractic Message to the Press
"There is no better place on earth to have a news event," the National Press Club boasts, and it's easy to understand why: Every year, the 108-year-old Washington, D.C.-based organization hosts countless press conferences on the hottest topics impacting America and often the world.
Give Yourself the Digital Advantage
When you see this article in the print version of this issue and swear you read it already, don't be alarmed: you probably did. That's because by that time, the May issue will have been available online in digital format for three weeks.
Women's Hormones: A Western & Eastern Perspective
Sometimes it may seem that you require a degree in medicine to understand hormones and how they function.
News in Brief
ACA Adopts New Governance Model; ACA 2017 Awards; CCA Helps Calif. DCs "Share the Love"; $1 Million to Help Advance the Profession; D'Youville Raises the Bar on Anatomy Education; ErRatum.
The Visual Error Scoring System: A Concussion Tool
Postural stability and oculomotor function are the most easily recognized physical indicators of neurologic motor dysfunction associated with concussions.
An Integrated Approach to Chronic Pain
Findings from a unique Medicaid pilot project in Rhode Island involving high-use Medicaid recipients from two health plans were recently presented to the state's Department of Health, demonstrating stellar outcomes with regard to medication use, ER visits, health care costs and patient satisfaction.
A Daily Strategy for Heavy-Metal Detox
In modern society, we are constantly exposed to heavy metals such as cadmium, lead and mercury. These heavy metals have no essential biochemical roles in our body, and conversely, can cause us a great deal of harm if they build up to toxic levels.
Raditation & Your Smartphone: Is it Worth the Risk?
If radial arteries could talk (and in my experience they can to some extent), they would say, "Step away from the smartphone." At least that is the message I am receiving loud and clear as I feel the pulses of many patients.
New Relationships, Old Trauma: AOM & Other Healing Strategies
Being in love is one the most beautiful and enjoyable experiences. Most of us are willing to pay almost any price to have that experience, and still often find it elusive or fleeting. Navigating the ups and downs of loving relationships are often challenging — even for the most psychologically balanced among us.
July, 2003, Vol. 03, Issue 07
By Neal Cross, PhD, NCTMB
In 1964, Davis published a wonderful monograph describing the functional anatomy of the Giant Panda,1 including a detailed description of the panda's "thumb." Although not a real thumb, this connective tissue pad and underlying bony anatomy functions as a thumb in helping to grasp bamboo: the mainstay of the panda's diet.
Stephen J.Gould's 1980 volume, discusses various functional anatomical adaptations that have occurred in many different taxa over evolutionary time; chapter one discusses the panda's thumb specifically. As functional as this tissue is, it is a far cry from our opposable thumbs. One could, in fact, make the argument that our thumbs are one hallmark of being human - certainly our hands are the mainstay of the massage profession.
The thumb, or first digit, is made up of two phalanges and associated soft tissue. It is attached to the wrist at the first carpometacarpal (CMC) joint. This is a classic saddle joint where the base of the proximal first phalanx and the distal surface of the trapezium are reciprocally saddle-shaped. This allows for considerably more degree of motion than found with any of the other four digits.
The motions allowed at this joint are flexion/extension; abduction/adduction; opposition/apposition/reposition; and circumduction:
The ligaments surrounding the first CMC are very important to the integrity and function of this joint. There have been five ligaments described.4 These ligaments generally allow considerable motion, thus they are not as commonly injured as the metacarpophalangeal (MP) joint; however, the CMC is commonly affected by osteoarthritis. 5 The ulnar ligament of the thumb's MP is frequently stretched or torn. This has been referred to as "gamekeeper's" thumb (early gamekeepers used to dispose of farmyard fowl by placing the bird's neck between the thumb and forefinger and snapping the neck) or "bowler's" thumb.
Currently, the most common injury here is related to ski pole usage. At any rate, the injury is the result of a traumatic event that tears the ulnar collateral ligament when the thumb is forced into hyperabduction/extension. By gapping the MP joint using a valgus force, one sees a dramatic gap on the ulnar side of the joint. Splinting is indicated for a stretched ligament, and surgery for a torn ligament.5
Another common problem of the thumb is de Quervain's tenosynovitis.5 This involves inflammation of the abductor pollicis longus and extensor pollicis brevis tendons within their tendon sheaths at the lateral (anterior) border of the anatomical snuffbox. Remember, the anatomical "snuffbox" is that region bounded by the tendons of the abductor pollicis longus and extensor pollicis brevis, laterally (anteriorly); and the extensor pollicis longus, medially (posteriorly). The radial artery runs along its floor; here, the artery's pulse can be palpated. Treatments of de Quervain's tenosynovitis include immobilization, steroid injections and surgery.
Back to the panda's thumb: Where did it come from? It seems to be a modification of the connective tissue overlying a modified sesamoid bone. We have two sesamoid bones associated with our first metacarpophalangeal joint. These bones serve as attachments of thenar muscles. The abductor pollicis brevis and flexor pollicis brevis attach to the lateral sesamoid and the proximal phalanx, while the two heads of the adductor pollicis attach to the medial sesamoid and the proximal phalanx. Both of these attachments continue on to the extensor hood, as well. It seems that over evolutionary time, some carnivore taxa had a more developed lateral sesamoid bone. This developed into a large sesamoid bone, as seen today in the Giant Pandas. Other mammals, like the raccoon, have sophisticated grasping function, but not nearly as sophisticated as ours.
Take good care of your thumbs. They serve you well.
Click here for previous articles by Neal Cross, PhD, NCTMB.
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