resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
Essentials of Assessment: The Squat
The squat is a simple, fast and functional tool to evaluate patient symmetry and function. As simple and easy as it is to implement, it can yield considerable amounts of valuable, clinically relevant information.
Constructing Our Reality: The Primary Channels and Perception, Part 1
My favorite topic of discussion within Chinese medicine is the acupuncture channel systems. First of all, each of us have them. They are part of our bodies; not something external to us. To learn about the acupuncture channels is to learn about ourselves.
Business Lesson #1: Adapt or Else
My wife and I recently enjoyed an excellent meal at a restaurant recommended by some friends. We often have concerns about restaurant recommendations, as many have been disappointing.
The Value of Melatonin in Breast Cancer Prevention and Adjunctive Treatment
Although melatonin (MLT) is best known for its sleep-aid properties and as a natural remedy to prevent jet lag, extensive experimental studies suggest it possesses anticancer activity through several biological mechanisms.
The Power of Eccentric Exercise: Hamstring Injury Prevention and Rehab
For almost 20 years, I've worked with professional athletes who make a living by running really fast. It goes without saying that hamstring injury (HSI) prevention and rehabilitation is a big part of what they expect from a sports chiropractor.
Energy: For Life and For Death
Energy is a deep topic in Traditional Chinese Medicine. Qi is understood to underlie all of existence, animated or not, and the qi of the living is studied with special attention.
Musculoskeletal Disorders Take Center Stage
Looking for the latest on the musculoskeletal pain epidemic and the increasing premium placed on preventive strategies including chiropractic? Check out The Impact of Musculoskeletal Disorders on Americans – Opportunities for Action.
News in Brief
A Moment of Silence for Dr. Stephen Press; New ACA President Elected; F4CP Offers New MemBership Benefit.
Recording and Appropriate Billing of Timed Physical Medicine Services
There is a common misunderstanding about timed therapy services and although you do have some knowledge of timed service documentation, based on your comment on the 8-minute rule, your understanding is correct, but incomplete.
The IME System: A Current Public Health Risk and Solutions That Are Working
I strongly believe in the independent medical examination (IME) system. There are far too many doctors in every profession who are not following E&M protocols and never claim MMI (maximum medical improvement) has occurred for their patients, which has caused financial stress for many private and public carriers.
The Rest of the Patient Story
I've written previously about allowing a patient to tell you their story – about taking the time to listen and engage all the aspects of their case history, the injury in question, and the related issues.
An Interview with Amanda Shayle
JW: Can you share with us some of your history and how you became an acupuncturist? What did you do prior to becoming an acupuncturist? Where did you go to school?
Vitamin D Fails to Help Knee OA? The Proper Perspective
The March 8, 2016 issue of JAMA includes a study about vitamin D supplementation for osteoarthritis of the knee. This is a really weird study.
Building Relationships and Referral Networks with Allopathic Practitioners
Dr. Doug, an orthopedist of 20 years, had heard stories from patients who tried acupuncture. While he was able to address many of their complaints effectively, some appeared to gain additional benefit when their care included TCM.
NCCAOM Launches New Membership Organization
The National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM) recently launched a new national membership organization, the NCCAOM Academy of Diplomates.
How to Find and Fix TL Nerve Impingements
The thoracolumbar junction (TLJ) and the peripheral sensory nerves that exit from it are frequent, important and rarely recognized sources of lower back, pelvic and hip pain. Let's outline a clear exam protocol for diagnosing the problem.
Filling the Gap: The Role of Alternative Practitioners in a Broken Health Care System
I have been asked many times what got me into alternative medicine. My answer is simple: I want to truly help and make a difference in people's health.
The Art of Listening
One of the most important clinical concepts for me was voiced by the legendary physician William Osler. "Listen to your patient, he/she is telling you the diagnosis." After treating literally thousands of patients, it can become almost second nature to quickly discover clues which reveal the underlying diagnosis.
Asking Patients the Right Questions
When was the last time you asked a patient a question? Maybe 30 seconds ago? But, are you asking the right questions to elicit valuable and useful information? As a healthcare provider, you've likely spent hundreds of hours learning to ask the right questions to gather critical health information from your patients.
Health and Wellness Partnership
Yo San University of Traditional Chinese Medicine and The Wellness Center at the LAC + USC Historic General Hospital recently joined forces to extend care to the residents of Boyle Heights area of Los Angeles.
Transparency is Key at ASA First Annual Meeting
On March 4th and 5th the American Society of Acupuncturists (ASA) held a successful first annual meeting in Albuquerque, New Mexico.
June, 2005, Vol. 05, Issue 06
Cubital Tunnel Syndrome
By Whitney Lowe, LMT
Nerve compression problems are a frequent cause for pain and dysfunction in the upper extremity, particularly in the occupational environment. Although not as present in the popular literature as carpal tunnel syndrome, cubital tunnel syndrome is a common nerve compression pathology.In fact, it is the second most common peripheral compression neuropathy.1 It occurs when the ulnar nerve is compressed between the two heads of the flexor carpi ulnaris on the posterior elbow within a region called the cubital tunnel.
The cubital tunnel is located on the posterior elbow and is bordered by the two heads of the flexor carpi ulnaris (FCU) muscle. One head of the FCU muscle comes from the common flexor tendon attachments at the medial epicondyle of the humerus. The other comes off the medial aspect of the olecranon process. The two heads eventually join to form the belly of the FCU.
The nerve eventually passes between these two heads (Figure 1). Space within the cubital tunnel may decrease as much as 55 percent during elbow flexion, making nerve compression more likely.1 In addition, during flexion the ulnar nerve is increasingly pulled taut which may also aggravate symptoms. Subluxation (shifting position) of the ulnar nerve as the elbow moves into flexion could produce symptoms in this region as well.2
Cubital tunnel syndrome may occur as a result of direct compression of the elbow (either acute or chronic), excessive cubital valgus, bone spurs, synovial ganglions, fibrous bands within the muscle, or mechanical compression of the nerve during elbow flexion. The most frequent cause of cubital tunnel syndrome is hypertonicity of the FCU. The ulnar nerve may also be sensitive to compression if there are more proximal ulnar nerve compression pathologies such as thoracic outlet syndrome.3
Cubital tunnel syndrome usually produces a variety of sensory symptoms, including pain, burning, tingling or paresthesia. Motor symptoms such as weakness or atrophy may be seen as well. Weakness usually affects the intrinsic muscles of the hand more than other muscles in the forearm innervated by the ulnar nerve.
The client may report an acute compression injury to the posterior elbow that started the symptoms, such as striking the elbow on a hard object. This condition should not be confused with hitting one's funny bone. In this instance, the blow causes nerve compression between the medial epicondyle of the humerus and the olecranon process of the ulna just before it enters the cubital tunnel.
Cubital tunnel syndrome is more likely to occur as a chronic condition and is seen more often in men than women. The practitioner should identify actions that involved repetitive or static flexion of the elbow prior to the onset of symptoms. Prolonged compression of the elbow region, such as leaning on the elbows for long periods, should be identified. Symptoms are often aggravated at night if the client spends long periods with the elbow in a flexed position.
The client usually reports pain, aching, burning sensations or paresthesia in the ulnar nerve distribution of the hand (Figure 2). Weakness or atrophy are likely to affect the adductor pollicis muscle, which is an important muscle in grasping objects. Consequently, the client may report difficulty holding objects or having a degree of clumsiness when attempting to perform precise tasks. Atrophy of this muscle may be apparent with a decrease in the size of the muscle mass between the thumb and fingers compared to the unaffected side. Other instrinsic hand muscles innervated by the ulnar nerve are those of the hypothenar eminence (the fleshy bundle of muscles near the base of the hand on the ulnar side). Atrophy in these muscles may be evident with a decrease in size compared to the unaffected side.
Pressing directly over the cubital tunnel is likely to elicit the client's symptoms. Palpate the region when the elbow is in neutral, as well as full flexion. If the symptoms are exaggerated during flexion, this may be an indicator of cubital tunnel compression. There may also be anatomic obstructions in the cubital tunnel, such as bone spurs or synovial masses that are palpable. Tenderness or hypertonicity may be evident in the FCU muscle throughout the forearm.
Massage is helpful for cubital tunnel syndrome because a primary cause is muscular hypertonicity in the wrist flexor muscles. Techniques such as deep stripping to the flexor carpi ulnaris may help decrease compression on the ulnar nerve. Particular caution should be observed in applying pressure to the flexor carpi ulnaris near the region of ulnar nerve entrapment so as not to aggravate the pathology.
Click here for more information about Whitney Lowe, LMT.
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