resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
A Conversation With Dr. Betty Edmond
This month's column is an exclusive interview with Betty Edmond MD, newly elected CEO/President of the AOMA Graduate School of Integrative Medicine in Austin, Texas.
Qigong for Substance Abuse
It is commonly believed that substance abuse, in addition to harming one’s physiological state, hurts the spirit. There is also a belief that one’s spirit does not weaken due to substance abuse, but rather, the person finds solace in addiction due to an already weak spirit.
Low Back Pain in Running Athletes
After 7 million years of adapting to upright postures, the lumbar spine and pelvis have become remarkably adept at managing ground-reactive forces associated with running.
We Get Letters & Email
Our Country Needs Us Between Elections, Too; Continuing Care: We Aren't There Yet; Our Associations Need to Do More.
An Opportunity & a Responsibility
Nearly 80 Americans die from an opioid-related overdose every day, and spine-related pain is one of the principle drivers of opioid use. This unfortunate situation creates both an opportunity and a responsibility.
True Practice Mobility for the Chiropractic Profession
When natural disasters occur, chiropractors can literally travel to the other side of the world to offer humanitarian relief in less than a day. The chiropractor's license to legally practice, however, can't make it past the state line.
News in Brief
Updated Neck Pain & Whiplash Guideline; Attention, IHS DCs; New VP of Institutional Advancement At Palmer; N.J. DC Interns At U.S. Olympic Training Center; Chiropractic Society Of R.I. On The Front Lines.
Prepare for the End, From the Beginning: Wealth Building and Retirement with the Tao
Yin and yang flow into and out from one another continually. Beginnings become endings and endings become beginnings again. Wholeness and cycles are the nature of Tao.
Five Branches University Has First Hospital TCM Residency
Established in 1984, Five Branches University (FBU) has campuses in Santa Cruz and San Jose, Calif., which serve the communities of Santa Cruz, the Monterey Bay, and Silicon Valley.
Anti-Aging With Dr. Ping Zhang
Jennifer Waters, TCM practitioner and writer of the Acupuncture Today column, "Talking With the Masters" sat down with Dr. Ping Zhang to discuss aniti-aging with acupuncture.
Shoulder Rehab: Start With the Scapula
The scapula is an incredible display of elegance and movement within the biomechanics of human motion. It's evolved for mobility and stability in the scapulo-thoracic region, giving us the ability to do things that are uniquely human, such as throwing with accuracy.
Scar Reduction With Acupuncture & Microneedling (Part 2)
Protocols & treatment Timing
Flirting With Alternative Therapies
There are about as many adjunct therapies being marketed to acupuncturists as there are acupuncturists. While some may remain purist in their application of traditional Chinese medicine, others choose to explore new horizons of treatment.
The Acupuncture Channel System (Part 1)
The earliest Chinese reference to channels is in the Mawangdui Medical Manuscripts,1 which are dated to the Warring States period of the Zhou Dynasty (475 BC-221 AD). The text presents 11 channels. There are no acupuncture points listed in those channels.
The Case Report: A Valuable Tool
Case reports are a valuable form of descriptive research. The most basic form of practice-based research, a case report is a detailed account of the history, presenting symptoms, assessment, observations, treatment and follow-up of an individual patient, discussed in the context of prior and potential future research.
Another Step Forward for Chiropractic
Chiropractic is now available to 86,000-plus Latter-Day Saints missionaries and you are invited to become a provider. LDS membership in not required; our only concern is that our missionaries get the best quality care available.
Crow Like the Rooster
As we welcome in the Year of the Rooster, we look at some of its major characteristics: confidence and communication, which suits the image we have of the Rooster...strutting in the farmyard, crowing to the others that it's time to wake up.
Let's Clear Up the Collection Confusion
This is an often-misunderstood practice swirling with misinformation. First, a few basics: Insurance is a contract between the patient and the insurance company. The insurance company is simply making a payment for services or care on behalf of the patient.
A New Year and Vision for the ACA
Inadequate pain management coupled with the epidemic of prescription opioid overuse and abuse has taken a severe toll on the lives of millions of people in the United States. Every day, more than 1,000 people are treated in the ER for misusing prescription opioids.
The winter season is upon us and offers unique challenges for the clinician and patient alike. To effectively navigate through the winter season there are two main TCM medicinals, Huang Qi and Gan Jiang, to consider, as well as two important formulas which feature these two TCM treasures.
An Education in Gluten Sensitivity
A relatively new syndrome officially documented as non-celiac gluten sensitivity (NCGS) or gluten sensitivity (GS) was officially recognized and published in the new list of gluten-related disorders in 2012.
Nutrition for Menopause: Front-Line Therapy for All Phases
Of all the changes women experience during their reproductive life, there is no doubt the most dreaded are the three phases of menopause. This is not surprising since all of the symptoms associated with menopause are replete with unpleasantness.
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.
Join the conversation
Comments are encouraged, but you must follow our User Agreementcomments powered by Disqus
Keep it civil and stay on topic. No profanity, vulgar, racist or hateful comments or personal attacks. Anyone who chooses to exercise poor judgement will be blocked. By posting your comment, you agree to allow MPA Media the right to republish your name and comment in additional MPA Media publications without any notification or payment.