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AAAOM – The Beginning of the End (Part II)
In 2012, the AAAOM board members met in Chicago for their annual meeting. The goal was to come to a consensus on a long list of issues the AAAOM needed to work on including a functional board and budget.
Leaving a Lasting Legacy: Donna Liewer
For the past 31 years, Donna Liewer has been on a personal mission "to comfort the afflicted and afflict the comfortable." In her role as executive director of the Federation of Chiropractic Licensing Boards, Liewer has accomplished that and much, much more.
AAAOM – Making Promises They Can't Keep
When the AAAOM first formed in 2007, their mission was clear: to support the profession through education, resources and legislative advocacy. The first years of the organization were filled with promise and hope.
News in Brief
Hamm Elected New President of the ACA; WFC / ACC 2014 Education Conference: Call for Papers; F4CP Recognizes Standard Process as $1 Million Supporter; Texas Chiro. College Begins Search for New President; League of Chiropractic Women Hosts Women's Success Summit.
Steven Rosenblatt: Birthing A Cross-Cultural Acupuncture Profession
The existence of a cross-cultural acupuncture profession in the United States, one that is legalized, licensed, supported by formalized, academic training and inclusive of non-Asian practitioners, is an important part of the medical landscape in this country and is responsible for improving the lives of hundreds of thousands of Americans.
Are You Guilty of Paternalism in Your Approach to Patient Care?
Einstein is purported to have said, "When a man sits with a pretty girl for an hour, it seems like a minute. But let him sit on a hot stove for a minute and it's longer than any hour. That's relativity." In some way, everything is relative to one's point of view.
The Healing Properties of Light: An Interview With Researcher Anna Cocliovo
This interview is with Anna Cocliovo, a light researcher and Acupuncturist in Arizona. During my own research in light, I came across the article she published for the American Journal of Acupuncture and sought her out as a result.
Flexion-Intolerant Lower Back Pain (Pt. 3): Mobilization & Soft-Tissue Treatment
What is the biggest challenge to the chiropractor in treating discogenic pain? You have to completely reframe the purpose of your manipulation. It is rarely about unlocking a stuck segment at the disc involvement level; it is not about putting a joint back in alignment.
Chiropractic Prevents ADHD? Research Shows...
Now that I have your attention, let me tell you what the latest study actually states. As you may have noticed, research over the past few years has begun to reveal that acetaminophen (the primary ingredient in Tylenol) is not as safe as once thought.
Resilience is the New Longevity
Sometimes we must enter a room through one door and not another, even though they both lead into the same space. I am talking now of the recent cachet with the concept of "resilience" regarding health, chronic pain and longevity.
Monoculture of the Mind: Part II
Cases are built within boundaries. Such bounds may be a program, event, activity or individuals. In this instance, a medical case has boundaries that include clinical interactions that are comprised of history, signs, symptoms, diagnoses, treatment plans and treatments.
Risk Factors for Heel Problems
Heel pain and gait disability are common occurrences in adults, often the result of thinning heel pads and a lifetime of exposure to heel-strike shock. One condition experienced by many people is plantar fasciitis.
Epigenetics: The Western Science Supporting Essence
Since the days of Darwin, western medicine has touted that our genes were set in stone, that our genetics were our destiny. We were told that the diseases that ran in our family were likely coming to us as well.
Successful Strategies in Integrating Acupuncture and Shiatsu in a Hospital Oncology Program
Colleagues from the Network of Researchers in Public Health in CAM recently published an article of interest to our Traditional Asian Medicine community.
One and Done: Keeping Patients From Vanishing After Just One Appointment
What happened to my 3:30 p.m. ROF? They may have rescheduled, but there are two common answers no one wants to hear: 1) "She called to cancel. I tried to get her to reschedule, but she refused." 2) "She no-showed.
Why DCs Need to Understand the Principles of "Inclusive Design"
In the past few columns, I've written about the negative effects of prolonged sitting at work. I've attempted to make the point that prolonged sitting (or prolonged standing) takes a toll on workers. Now let's discuss a related issue: the concept of "inclusive design."
Stress in the Modern Age: Impact on Homeostasis and What You Can Do (Part 1)
In 1926, Hans Selye first used the word stress in a biological context, referring to the nonspecific response of the body to any demand placed upon it.
Get That Shoulder to Move: Restoring Internal Rotation
How many times have you mobilized, performed ART, Graston, FAKTR and PIR, and stripped a patient's posterior capsule, yet on re-exam, discovered it was still blocked?
What is a Discipline in Medicine?
In my now prolonged dialogue with physicians, one question emerges with enough regularity to deserve mention and naming: what is a discipline?
Collaboration for a Cause
The Patient Protection and Affordable Care Act strongly encourages the formation of multidisciplinary practitioner teams called Patient Centered Medical Homes (PCMHs) and Accountable Care Organizations (ACOs).
Green Tea Catechins Lower PSA, Other Biomarkers in Men With Localized Prostate Cancer
A 2006 study (Cancer Research) was the first human investigation to show that green tea catechins (GTC) are highly effective in reversing premalignant prostate lesions (high-grade prostate intra-epithelial neoplasia), an established precursor to prostate cancer.
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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