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Introducing the Acupuncture Today Digital Edition
In response to the changing habits of our readers, Acupuncture Today will introduce a digital edition of the publication (in addition to our print edition) beginning with the August 2016 issue.
Treating Hip & Groin Pain With Abdominal Release of Upper Lumbar Nerve Impingements
Have you encountered patients with groin and hip pain you can't seem to solve? You know it's not a worn-out hip; you suspect the pain is somehow connected to the spine. But somehow, you just can't help them break through.
Insuring Quality Control in Herb Importation: An Interview with Wilson Lau
Wilson Lau is the vice president of Nuherbs, a Chinese herb importation company based in San Leandro, California. Before joining Nuherbs, he trained as a lawyer specializing in FDA law.
An Emerging Partnership Model
Maryland University of Integrative Health (MUIH) has educated integrative health and wellness practitioners for the last 40 years, originally as an acupuncture clinic and school. The institution's transformative, relationship-centered programs integrate traditional wisdom with contemporary science
Beating the Odds: Interview With Para-Powerlifter Adeline Dumapong-Ancheta
Since October 2015, the FICS Foundation, the charitable organization affiliated with the International Federation of Sports Chiropractic (FICS), has been supporting disabled athletes internationally.
Sit or Stand? Analyzing a Mixed Message
I'm more than a bit confused. At my age, that seems to be a rather common occurrence. However, today more than ever, I'm getting a mixed message.
What You Say Isn't Always What Patients Hear
A few years ago, my aunt Edna (name changed for the purpose of this story) suffered a stroke. After a short hospital stay, she was transferred to a nursing home for rehabilitation. When she arrived at the nursing home, Edna requested a private room.
A Long-Overdue Win for Oregon Medicaid Patients - and the Implications for Other States
Beginning July 1, 2016, Oregon Medicaid patients with spinal pain (cervical, thoracic, lumbar, pelvic) who are determined to be low risk based on a biopsychosocial assessment tool (STarT Back – Keele University) can receive four chiropractic visits per episode.
Increasing the Value of Spine Care: CMS Approves New Low Back Pain Registry
The Centers for Medicare and Medicaid Services has approved the Spine IQ Low Back Pain Registry as a qualified clinical data registry for the Physician Quality Reporting System (PQRS) in 2016.
Multivitamin Supplement May Reduce Breast Cancer Recurrence
There is a great deal of controversy regarding the value of multiple vitamin supplements in cancer prevention.
Kansas Achieves Licensing Law
Kansas Governor Sam Brownback signed House Bill 2615 into law on Friday, May 13, 2016. HB2615 includes provisions for the licensure of acupuncturists in the state of Kansas.
Acupuncture's Impact on the World
For several years, I have been hearing about the town of Rothenburg, Germany. It seemed just a dot on a map until I arrived. It is the home of the TCM Kongress which began in 1968. It has been held annually for 47 years and it has only missed one year.
How to Stay Sane During the Elections: Understanding Through the Lens of Chinese Medicine
In Chinese Medicine philosophy, everything consists of Yin and Yang. The law of polar opposites – one cannot exist without its opposite.
AOM Hospital-Based Practice: A Future Reality?
The natural evolution of health care on the planet is integrative health. We may have some challenges ahead, but based on my research, all indicators are pointing in a positive direction. There seems to be an evolving consciousness among our patient population that is "getting it."
What's New in Phytonutrition: Mangifera Indica, "The King of Fruits"
One hundred percent pure Indian green mango fruit (mangifera indica), harvested at a special degree of ripeness for efficacy and taste, can now be concentrated as a phytonutrient nutraceutical powder.
Acupuncture Muscle Trigger Point and Oriental Medicine Sports Therapy
It is difficult to ascertain the internal condition of professional basketball player Lebron James during game one of the 2014 NBA finals, in which he developed debilitating muscle cramps that led to his premature removal from the game.
Adventures with the San Jiao
Those of us who have been in practice for several decades relish the way meridians and points reveal new diagnostic clues and new insights. I love to encourage my students to see this as an adventure that goes way beyond the textbooks.
An MD Who Understands the Opioid Epidemic
Doctors of chiropractic have an important role to play in ending the opioid epidemic and dealing with chronic pain by conservative means (see our top story in this issue) – but who's to blame for opioid dependence and abuse in the first place?
Three Tips to Help You Analyze the Acupuncture Case Studies of the NCCAOM Exam
Confirm the answer quickly by the elimination method. Case study:
After two treatments for back pain, a patient presents for a third
session complaining of rapid breathing and wheezing that is made worse
during cold weather.
Tai Chi Documentary Premier
First Run Features recently announced the world theatrical premiere of Barry Strugatz's documentary The Professor: Tai Chi's Journey West, which premiered last month at the Laemmle Music Hall in Los Angeles.
The Pertinent Negative
We all have to perform evaluations on patients. Most of us don't like doing it – exams take time, and worse it takes even more time after the evaluation to put together a narrative summary of the findings. Sometimes, this process becomes downright tedious.
Chronic Pain: Become Part of the Solution
I have lectured to more than 7,000 chiropractic physicians over the past five years regarding the chronic pain and opioid epidemic in this country.
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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