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What's New in the NCCIH Strategic Plan
The NIH National Center for Complementary and Integrative Health (NCCIH) released its draft strategic plan 2016-2021 for public comment in early spring of 2016.
The National Institutes of Health (NIH) lists more than 80 common autoimmune diseases including asthma, Crohn's disease, Guillain-Barré syndrome, multiple sclerosis, myasthenia gravis, psoriasis, rheumatoid arthritis, and lupus.
Are Probiotics Doing More Harm Than Good?
Considerable controversy exists concerning the efficacy of probiotic supplements. Very few human studies show any real positive impact on the microbiome or health. The "promise" of probiotics is based on the few animal studies that suggest a positive effect.
Illuminating the Hidden, Freeing the Source
Amongst the Primary Channels, from a classical point of view, the small intestine is perhaps the most important channel to understand. It is one of the least used acupuncture channels in modern acupuncture, yet it within it can be found a wealth of theories from the Ling Shu.
Traditional Chinese Herbal Medicine in Taiwan Hospitals
This spring, a team of Western medical doctors and TCM practitioners from Cleveland Clinic traveled to Taiwan to visit Kaiser Pharmaceutical Co. (KP), and China Medical University (CMU), Taiwan's leading integrative medicine hospital.
A Study of Relationships
Sa-Ahm's five element acupuncture method is known to be one of the most effective acupuncture techniques in Korea because it gives an instant response at the time of treatment and has a high success rate in resolving chronic problems.
Adventures with the Pericardium
My previous column on the San Jiao deserves equal time for SJ's loving partner, the pericardium. I nicknamed SJ the travel meridian – but pericardium can also play a crucial role in air travel.
International Congress on Integrative Medicine
"Bridging Research, Clinical Care, Education and Policy" was the theme for the International Congress on Integrative Medicine and Health 2016 (ICIMH).
Analyzing Acupuncture Case Studies
Confirm the answer quickly by the elimination method. Take this case study as an example. 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.
What are the Meridians?
The meridian and collateral system (jing luo, hereinafter referred to as "Meridians") is comprised of the main meridian channels (jing mai) and the collateral vessels (luo mai). Jing takes from meaning of the Chinese word pathway (also jing) and are the main branches of the system.
Lessons from Functional Neurology
Chiropractic neurology, also known as clinical neuroscience or functional neurology, is moving the chiropractic profession forward by leaps and bounds.
The Professional and Practice Benefits of Political Activism
Welcome to election season, a vital part of our American culture. Every two years, without fail, we are bombarded with TV, print materials and phone messages seeking our vote.
Don't Ignore the Lower Half of the Pelvis (Part 1)
When your patient complains of lower back or pelvic pain, but your usual treatments are not getting the job done, what do you examine and treat? You may be missing important structures in the lower half of the pelvis.
Overuse Injuries in Young Athletes (Part 1)
More than 45 million children ages 6-18 participate in some form of organized athletics, and 75 percent of American families with school-aged children have at least one child participating in organized sports.
Time to Fight for Your Medicare Right
I have heard a lot of noise and a lot of debate about what is going on with Medicare. As an ACA delegate, I often get asked: 'What is the ACA even doing?'
Guidelines for the Use of Modifier -52
Modifier -52 identifies that a service or procedure has been partially reduced or eliminated at the physician's discretion. This is to indicate the basic service described by the procedure code has been performed, but not all aspects of the service have been performed.
Know Your Research: Tips for Evaluating Literature Reviews
Clinical and experimental studies are not the only types of published research we might encounter as we look for evidence to inform our practices. One of the most useful types is the literature review, which summarizes a group of studies.
Less Time Than Required
Q: When is it appropriate to use a modifier -52? Can I use it for a timed service when I do less than the time required by the code?
Chiropractic in the Eyes of the Public: 2nd Gallup-Palmer Poll
The second Gallup / Palmer College poll has been completed, yielding significant additional data regarding Americans' experiences with and perceptions of chiropractic care.
Work Stress and Musculoskeletal Health: Do Your Patients Get the Connection?
Most people underestimate the impact their job has on their health, especially if that job isn't particularly physically demanding. Big mistake.
MPA Media Wins More Publishing Awards
The American Society of Business Publication Editors (ASBPE) has honored Dynamic Chiropractic with a national award and two regional awards for editorial excellence, and sister publication DC Practice Insights with two regional awards for graphic design excellence.
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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