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A Question of Ethics
Recently, after I had finished teaching a class on ethics, I  read a blog post on the AAAOM
website regarding "gainful employment." The published information made me reflect on what I had just discussed with the students — the acupuncturists' ethical responsibility to the patient, the profession and the public.

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Massage Today
November, 2007, Vol. 07, Issue 11

Wrist Pain

By Ben Benjamin, PhD

Question: If passive ulnar deviation of the wrist causes pain on the thumb side of the wrist, what structure is likely to be injured?

Answer: Radial collateral ligament of the wrist.

The radial collateral ligament, also known as the external lateral ligament, attaches the styloid process of the distal radius to the trapezium and scaphoid bones, as well as to the base of the first metacarpal bone.

This short, narrow band of fibrous tissue is located right in the center of the anatomical snuff box - the space between the abductor pollicis longus and extensor pollicis tendons. Pain in this region also can be caused by a fracture of the scaphoid bone, so be sure your client has seen a physician to check out this possibility.

Anatomy of the radial collateral ligament. - Copyright – Stock Photo / Register Mark Fig. 1: Anatomy of the radial collateral ligament, which attaches the styloid process of the distal radius to the trapezium and scaphoid bones.
The function of the radial collateral ligament is to protect the wrist joint by limiting ulnar deviation of the wrist (i.e., the side-bending movement of the wrist toward the small finger). Injury to this ligament is common in massage therapists with wrist problems, as well as in carpenters, construction workers, gymnasts and other athletes who use their wrists in stressful positions.

To assess the right wrist, use your left hand to support the client's forearm a few inches above the wrist. Then use your other hand to grasp the thumb side of the client's hand. Next, you should side-flex the hand medially toward the fifth digit to passively stretch the radial side of the wrist. If the ligament is injured, this will be uncomfortable. (To test the left wrist, reverse these directions.)

Assessing a radial collateral ligament injury. - Copyright – Stock Photo / Register Mark
Fig. 2: Test (Assessing a radial collateral ligament injury.)  

Palpating the radial collateral ligament. - Copyright – Stock Photo / Register Mark Fig. 3: Palpation (Palpating the radial collateral ligament.) The radial collateral ligament usually is injured at its origin, but also might be injured distally. To palpate the ligament, place your thumb against the tip of the styloid process at the distal edge of the radius. When the ligament is injured, palpating it in this way usually is uncomfortable. To palpate the distal end, move to the other end of the snuffbox, to the attachment at the trapezium. To palpate the scaphoid attachment, use your other hand to slightly ulnar-deviate the wrist so that the scaphoid bone moves laterally and is more easily accessible.

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