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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.
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.
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.
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.
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.
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.
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.
News in Brief
A Moment of Silence for Dr. Stephen Press; New ACA President Elected; F4CP Offers New MemBership Benefit.
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.
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.
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.
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?
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.
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.
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.
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.
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.
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.
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.
Roots in the Community, Branches Far Beyond
The Jung Tao School of Classical Chinese Medicine (JTS) was founded in 1998 by Sean Christian Marshall in Sugar Grove, North Carolina, a small community near Boone in the state's westernmost mountains.
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.
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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