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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.
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.
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.
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?
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.
Believe it or not, an estimated one-third of your patients have eaten some form of fast food within 24 hours of their appointment with you.
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.
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.
Multivitamin Supplement May Reduce Breast Cancer Recurrence
There is a great deal of controversy regarding the value of multiple vitamin supplements in cancer prevention.
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.
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."
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
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.
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'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.
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.
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.
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.
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.
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.
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.
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.
May, 2010, Vol. 10, Issue 05
Flexor Pulleys of the Fingers
By Whitney Lowe, LMT
The human hand is critical to our daily activities, especially as massage practitioners. Yet, rarely do we stop and consider what an engineering marvel the hand actually is. The human hand is capable of fine precision movements, as well as generating large forces during grasping activities.The skeletal structure of the hand and fingers is a set of rigid bones. Consequently, it takes great muscular control to perform the fine movements of the hand. Without this highly specialized level of control, we would have serious challenges performing all kinds of activities from simply grasping an object to the detailed motor control required to play a musical instrument or perform surgery.
A unique biomechanical pulley system provides the high level of control necessary to move the rigid finger bones with precision. The flexor tendons of the fingers run along the anterior surface of the fingers, and these tendons are tethered close to the bones by connective tissue "pulleys" at eight different locations from the metacarpophalangeal (MCP) joint to the distal phalanx. Because the tendons are closely tethered to the bones, their pulling force is more efficient. Let's take a look at these pulleys, how they work and what happens when they don't.
There are five pulleys in the fingers, called annular pulleys, and they are named A1 through A5 (Figure 1). The A1, A3, and A5 pulleys are smaller and considered minor pulleys (mostly due to size and lack of importance). The A2 and A4 pulleys are larger and are sometimes called the major pulleys.1 The A1, A3, and A5 pulleys are located at the MCP, PIP and DIP joints respectively. The A2 and A4 pulleys are located in the middle of the proximal and middle phalanx respectively (Figure 2).
A second set of connective-tissue pulleys, called cruciate pulleys, gives additional support and stability to the tendon sheaths. The term cruciate means cross, and you can see by their structure where they get their name (Figure 1). The cruciate pulleys are much smaller than the annular pulleys. There are three cruciate pulleys, designated as C1, C2, and C3. Their role for improving the flexor tendon's angle of pull is not as great, so if they are damaged, finger movement is not impaired as much as with the annular pulleys.
The annular pulleys may be damaged from an acute injury or from various degenerative conditions in the fingers. An example of the detrimental effect of rupture of the annular pulleys is shown in Figure 3. In this image, the A3 pulley has been completely ruptured and there is a partial rupture to the A2 pulley. As a result, the tendon is pulled away from the PIP joint, in what is referred to as a bowstringing effect. With the tendon pulled away from the PIP joint, its power is reduced and it is no longer able to produce normal range of motion. As a result, the hand is significantly weaker in gripping activities.
Stenosing tenosynovitis, also called trigger finger, is another disorder involving the flexor pulleys. In this condition, a fibrous nodule develops on the tendon near the edge of the tendon sheath. The nodule prevents the tendon from freely gliding in and out of the surrounding synovial sheath. Stenosing tenosynovitis is usually a problem with the tendon sheath, but in some cases, the nodule on the tendon catches on the edge of the flexor pulleys. If this is the case, the offending flexor pulley can be surgically cut to allow the tendon greater freedom of movement. However, if the pulley has been cut, that flexor tendon is less efficient, so the benefits of this procedure need to be weighed against the potential drawbacks.
While massage practitioners may not see a large number of clients with flexor pulley dysfunctions, there is still great value in understanding these details of hand mechanics. After all, the hand is our primary tool that we use in our work as soft-tissue therapists, and we need to keep it in good condition. Overuse problems may affect our ability to keep working, and physical injury is one of the primary reasons people leave this profession. Understanding more about proper mechanics helps keep you in better condition.
Click here for more information about Whitney Lowe, LMT.
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