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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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
January, 2004, Vol. 04, Issue 01
By Whitney Lowe, LMT
The highly refined palpation skills of massage practitioners are such that we often identify tissue abnormalities before the client is aware of them. An indication that we should refer a patient for further evaluation is when we identify something we aren't sure of but know shouldn't normally be there.One such example may occur with a synovial ganglion cyst, which occurs most commonly around the wrist, though they may occur elsewhere.
Exactly how and why these ganglions form is poorly understood. This makes it difficult to formulate a consistently reliable treatment. Despite the similarity in name, a ganglion cyst is different than the ganglion that is a collection of nerve cells. The ganglion cyst is a fibrous swelling that occurs near joints and is often associated with joint capsules or tendon sheaths. It contains a clear mucinous fluid that is different than the synovial fluid contained within joint capsules.
It is estimated that about 60 percent to 70 percent of all ganglions are dorsal wrist ganglions. Those on the volar surface of the wrist make up about 20 percent, and the remaining percentage occur in other regions of the body. The cysts are more common in women than men, and there does not appear to be any association with hand dominance. They are most commonly evaluated through clinical examination, although much greater detail about the makeup of the ganglion can be derived from a detailed diagnostic study, such as MRI. They usually become evident from a visible bump under the skin and may or may not be painful; however, as they get larger, they will likely become painful, especially if pressed. In some cases, the cysts may not be visible at all. These are called occult ganglions. You may discover them with palpation and treatment of the wrist region before the client is aware of them.
How and why ganglions occur is still something of a mystery. Various theories have suggested that they involve growths on the retinacula of tendons, knots of dysfunctional tissue, herniation of the synovial sheath of joints, or various other lesions. Some people report noticing them after an acute injury, but there is no significant evidence that suggests they are caused by another mechanical trauma to the region. Because the swelling can become pronounced, there is often concern about the nature of the problem. While for some it is a cosmetic issue, others may fear it is related to a more serious problem like a cancerous growth.
It is important to evaluate these other possibilities; however, the most likely pathology - especially with wrist ganglions - is not serious. In many cases, the ganglion itself will not be painful, but may cause pain because of where it is has developed. For example, ganglion cysts are one possible cause of pain from nerve entrapment in certain regions. Compression of the ulnar nerve in Guyon's canal or the median nerve in the carpal tunnel can occur from ganglions. Since nerve entrapments in these regions can be relatively common, it is easy to overlook the presence of the ganglion as a cause in favor of one of the more common explanations for nerve entrapment pain.
There are a number of options for treatment of ganglion cysts. Ironically, pressure directly on the ganglion is still advocated by some as a means of treating it; however, you should not treat the ganglion by pressing on it. It is better to leave treatment decisions to other professionals. The more common procedure for ganglions is aspiration with a needle to remove the excess fluid and then let the ganglion dissipate on its own.
Luckily, few people today advocate the former treatment, which was to whack the ganglions with the Bible! There are a number of reports in the medical literature about distal radius fractures that occurred from this "treatment." Knowing a little more about ganglions will help you address the problem when you come upon it.
Click here for more information about Whitney Lowe, LMT.
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