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Shouldn't the Pentagon Know More About Chiropractic Care? Office Flow: Have You Reviewed the Patient Experience Lately? Let's Stop Confusing the Public About Chiropractic; Cutting Down the Cherry Tree.
Anti-Aging: Educating Your Patients About The Skin
We know that cosmetic acupuncture works but what then? Education is a key part to the practice of Chinese medicine and when you practice cosmetic acupuncture, facial rejuvenation, etc., it is time talk about skin with your patients.
Are You Driving Patients Toward Dependence on Big Pharma?
Over the years I have had the opportunity to talk to doctors of chiropractic about health promotion, wellness and preventive care in chiropractic practice.
Colorado to Have the First Acupuncture Medical Reserve Corps in the U.S.
In the summer of 2012, Colorado was on fire. Literally. Many acupuncturists from around the state, especially those who had received disaster response training through AWB, wanted to help those affected by the fires as well as the first responders and tireless state and local officials, with the healing and stress-relief of acupuncture.
The Right Idea at the Right Time
On Feb. 28, 2014, Virginia Governor Terry McAuliffe appointed David Brown, DC, as new director of the Virginia Department of Health Professions.
Evaluating Prenatal and Pediatric Automobile Injuries
Often in a family practice, one of your patients or an entire family is in an automobile accident and you are sought out to provide care for their soft-tissue injuries.
Your Chance to Go Back to High School
As the father of a student who recently entered high-school sports (soccer), I have come to recognize an untapped opportunity for the chiropractic profession.
Alternatives to the Rainy Day Fund: Better Things to Do With Your Money
Google "rainy day fund" and you'll find the predominant and traditional advice given today is that you need to have three months of living expenses saved for an emergency. Some even recommend six months or more.
News in Brief
In Remembrance: A Moment of Silence for Dr. Dick Versendaal; NYCC Named Chiropractic College of the Year by ACA; National University Partners With Indiana VA Facility.
Chiropractic Management of Sports-Related Tendinopathy
Tendinopathy is increasing in prevalence and accounts for a substantial percentage of sports injuries. Despite the magnitude of the disorder, research on chiropractic treatment is limited.
Making Sense of Chronic Inflammation
Inflammation is big business, evidenced by not only the laundry lists of medications patients bring me aimed at managing inflammation, but also the never-ending stream of advertisements for anti-inflammatory supplements that constantly find their way to my desk.
No Whining on the Yacht
This admonition – no whining on the yacht – may sound familiar to you. Many claim its origination.
Shoulder Strategies: Reduce Pain, Improve Function With Proper Taping
Shoulder pain / dysfunction is a common problem for chiropractic patients. Clinicians who utilize elastic therapeutic taping as part of their treatment approach know it can be effective for a variety of shoulder problems.
Through the Eyes of a Child
Once upon a time there was a girl name Lucy. Lucy had cancer, but she had a heart filled with love and compassion. Please come along to hear this story of an amazing child, her tenacity and her dream to help other children.
Arch Height and Running Shoes: The Best Advice to Give Patients
Because runners with different arch heights are prone to different injuries, running shoe manufacturers have developed motion-control, stability and cushion running shoes for low-, neutral- and high-arched runners, respectively.
Revisiting the Neurological Exam
In spinal trauma or disease, the neurological exam chiefly aims to determine whether one (or more) of three basic neurological conditions is present: myelopathy, radiculopathy and peripheral nerve disorder.
How Much is Enough?
One of the primary arguments used against acupuncture care is the overuse of treatment. Some people say, "once you go, you have to go forever."
Socializing In My Slippers
When I graduated college, I had grandiose dreams of becoming an amazing acupuncturist. I wanted to build a great practice and make a good living. For four years, 13 semesters to be exact, I had a spreadsheet.
Environmental Toxins: Cause of Modern Illness (Part I)
Environmental toxins have created burdens on the human body that put demands beyond our evolutionary development. Modern diseases that historically did not exist to any great degree have been rising sharply in the last 40 years.
Dietary Supplement Research: Contradictions, Bias, Misinterpretation and Confusion
I do not care what the truth is, one way or another; I just want to know it. And when it comes to dietary supplements, the truth can be hard to find for a number of reasons.
San Zhen Protocols Part II: Case Studies
In my last article, I presented a collection of three-point acupuncture combinations which can provide effective clinical results.
Dry Needling is Acupuncture: Anatomy of a Legal Victory in Oregon
On January 23, 2014, the Oregon Court of Appeals overturned the Oregon Board of Chiropractic Examiners "dry needling" administrative rule, which allowed chiropractic physicians to perform acupuncture after only 24 hours of training.
The Recliner Test
"Hi, Bill, how are you?" "Oh, I'm OK, Doc. I've got pain down the leg again, so I thought I would stop by and get you to check it."
AAAOM: Facing An Ultimatum
On the heels of the growing discontent with leaders of the AAAOM, the Council of State Associations (CSA) recently took it upon themselves to present the organization with an ultimatum: for all board members to resign from the board and turn the organization over to the CSA or they will proceed on their own to become the primary representative of the AOM profession.
Chinese Herbs Debut at the Cleveland Clinic
Chinese herbal medicine is now being prescribed at the Cleveland Clinic thanks to a trailblazing team of people.
October, 2004, Vol. 04, Issue 10
Median Nerve Compression Pathologies
By Whitney Lowe, LMT
The most researched and well-defined upper extremity nerve-entrapment problem is carpal tunnel syndrome (CTS). CTS involves compression of the median nerve at the base of the hand in a region called the carpal tunnel.Because this condition is studied so often, we have a very good understanding of how it occurs; however, because it has become such a "popular" condition, clinical practitioners may be too eager to assume the presence of CTS simply because their patient/client experiences median nerve compression symptoms.
This article will look at the entire length of the median nerve where there are numerous locations that median nerve entrapment may occur. We will follow the nerve's course from the spinal cord to its termination in the hand and describe common locations of compression pathology. It is essential to thoroughly evaluate the problem before coming to a conclusion about the presence of the ever-popular CTS.
The median nerve carries both motor and sensory fibers. Therefore, compression of the nerve may create both sensory and motor deficit. The sensory symptoms are located primarily in the palm (See Figure 1). They include pain (often described as sharp, shooting, or electrical in nature), paresthesia ("pins and needles"sensations), and numbness. The median nerve and its branches innervate primarily the flexors of the wrist and fingers, as well as several muscles of the thumb. Motor problems from median nerve compression usually show up as weakness in grip strength or atrophy of the thenar eminence (fleshy part of the palm near the base of the thumb).
The first location where median nerve compression may occur is at the cervical nerve roots. The median nerve is derived from the C5-T1 nerve roots. Intervertebral discs, bone spurs, small tumors, or other obstructions may press on these nerve roots and produce symptoms that affect the median nerve. Since the nerve roots also contain fibers for other peripheral nerves, symptoms of compression at the nerve root level may extend outside the commonly mapped area for median nerve sensory involvement illustrated in Figure 1.
Thoracic outlet syndrome is not consistently defined in the medical literature, so there is a great deal of confusion about it. Fibers of the median nerve can get compressed against a pathological bony extension of the C7 transverse process, called a cervical rib. This is called true neurological thoracic outlet syndrome. Other thoracic outlet syndrome variations that may compress the median nerve include the region between the anterior and middle scalene muscles, between the clavicle and first rib, and underneath the pectoralis minor muscle.
Moving distally after leaving the axillary region, the next location where median nerve entrapment is likely, is just proximal to the elbow. This location is only a possible source of nerve entrapment in a small percentage of the population. A ligament called the ligament of Struthers is present in 1 percent to 3 percent of the population. It runs between the medial epicondyle and the shaft of the humerus, and has no function. The median nerve passes underneath it and can get compressed here although it is not very common.
While the biceps brachii attaches primarily to the radius, there is a fibrous attachment to the ulna through a slip of fascia called the lacertus fibrosus, which is also called the bicipital aponeurosis. The median nerve runs underneath the lacertus fibrosus at the elbow and can get compressed by it here. If symptoms are aggravated during strong elbow flexion movements (when the biceps brachii is contracting strongly) there is a good likelihood that compression exists here.
After leaving the elbow, the median nerve runs between the two heads of the pronator teres muscle. This is a common region of median nerve compression and is commonly mistaken for CTS. The sensory and motor signals are almost identical, making it difficult to distinguish these two regions of entrapment without more specific physical examination, such as orthopedic special tests and nerve conduction studies.
The last common location of median nerve entrapment is within the carpal tunnel. While this region is the most common site of median nerve entrapment, it is not the only one. There are a large percentage of failed carpal tunnel treatments; this could very well be due to improper identification of the precise location of median nerve entrapment.
Keep in mind that compression may occur at several sites simultaneously. Therefore, you may have a problem that is not in just one of these locations, but in two or more.
One of the great benefits for using massage to treat nerve compression problems is that massage treatments are frequently applied to the whole length of the nerve and can easily work on multiple sites of compression at the same time.
A summary of the locations for median nerve entrapment are:
Click here for more information about Whitney Lowe, LMT.
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