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Let the Patient Tell Their Story
Often when a patient presents with an injury, they want to tell their story. People by nature like to talk about themselves, particularly when they're worried about their health.
When Big Pharma Meets Chinese Medicine
Earlier this year, Bayer made a media splash with their decision to buy the Dihon Pharmaceutical Group Co., a Chinese TCM manufacturer.
Rethinking GMO: Less Panic, More Context
Some of you may have noticed that after writing parts 1 and 2 of “Genetic Modification of Organisms for Human Consumption” a while back [Nov. 15, 2013 and Jan. 1, 2014 issues], part 3 never appeared.
Thoughts to Live By
When speaking to your patients about their health make sure to ponder the following points and have them assess if they are making themselves even more sick by the thoughts they have about life. Are these some of the traits and thoughts that your patients might have?
Uncle Sam Needs You
Scrutiny into the Department of Veterans Affairs (DVA) continues to grow after efforts to reform the DVA by the former Secretary of Veterans Affairs, Eric Shinseki, were deemed "a stunning period of dysfunction" by Senate Minority Leader Mitch McConnell (R-Ky.).
The Science Behind Happiness
Are you happy right now? Whether yes or no, there are a myriad of reasons why you feel that way. A whole academic discipline has developed to find out what causes or obstructs happiness, and how to amplify it.
News in Brief
NBCE Launches Computer-Based Testing Era; California Chiropractors Get Expanded DOT Exam Privileges; New Jeff Hays Documentary.
A Healthy Dose of Failure is Vital to Your Success
As an acupuncturist I tend to see people after they have already suffered for years and "tried everything." They are so desperate for some relief that they want to know everything about how to get better, right now.
A Commonly Missed Spinal Fixation: The Upper Lumbar Spine (Part 1)
When we think of lower back pain, we tend to think in terms of the lower lumbar spine and the SI joint. These joints and their discs are obviously important. However, we tend to miss fixations that occur just above – in the upper lumbar spine. Three questions come to mind: 1) Why is the upper lumbar spine so important? 2) Why do we miss the fixations here? 3) How can we adjust them?
The Spirit of the Point
After receiving a large amount of positive feedback on my San Zhen Protocols series, I have decided to focus this article on some relevant clinical aspects of acupuncture therapy prior to moving on to San Zhen Protocols III.
The Problem With Prolonged Sitting
We need to constantly talk to our patients about spending less time sitting and about what can go wrong with poor sitting postures. The fact is we sit too long in repetitive malpositions.
If You Get a Request for Records, Respond!
In our previous two articles, we discussed two of the main reasons for denial when chiropractic records are reviewed by Medicare contractors.
Improving Our Political Effectiveness
The November 2014 elections are right around the corner; members of Congress, governors and state legislators are all running. Now is a good time to talk frankly about our overall political involvement.
Thoracolumbar Syndrome: The Great Mimic
The thoracolumbar junction is a common area of joint dysfunction. The most obvious cause is dysfunctional breathing or lack of diaphragmatic breathing. Treating this breathing problem will ultimately be the long-term cure for the syndrome.
A Glimpse Into China's Top Brain Hospital
The sounds of the city pass through the open window are overwhelming the microphone - car horns, construction machinery - and then there's the family at the adjacent bed talking loudly on cell phones, yet you can still hear the faint beep of our patients monitoring equipment.
Healing Community Trauma in Israel and Palestine
It's the beginning of August and Israel and Hamas have just agreed to a 72-hour ceasefire after a month of brutal fighting. In the last four weeks, 1,830 Palestinians and 67 Israelis have been killed.
Get Ready For AOM Day
This year, AOM Day 2014 falls on Friday, (October 24th). This is a great opportunity to make your AOM Day celebration or event even bigger by extending it throughout the weekend!
Medicalization and Mindfulness
The past several years have seen a veritable explosion of research on mindfulness. Research abstracts we've published in each issue of Health Insights Today under the heading "Mind-Body News" have increasingly reported on studies about mindfulness interventions.
History of Animal Acupuncture: Part II
In Part I of this article, I had gone back to 1969 and tried to describe the atmosphere and events of that year that engulfed many of the younger generation, some who were all the core members of the National Acupuncture Association.
MPA Media Wins Seven Publishing Awards
MPA Media, publisher of Acupuncture Today, among other titles, has been recognized for editorial and design excellence with an unprecendented seven publishing awards by the ASBPE, the nation's largest organization for business-to-business publications.
The Truth About Herbs
I appreciate the effort and research put into the article written in the June issue of Acupuncture Today regarding pesticides and Chinese herbs.
January, 2013, Vol. 13, Issue 01
Solving a Client Puzzle
How To Know Whether It's Tennis Elbow Or Nerve Entrapment
By Whitney Lowe, LMT
Suppose a client comes to see you complaining of lateral elbow pain. She reports that the pain has been going on for quite some time despite efforts to treat it. A first consideration might be that the client has lateral epicondylitis, commonly known as tennis elbow; not an unreasonable assumption since lateral epicondylitis is a common problem. However, it's also entirely possible that the client's complaint derives from another condition called radial tunnel syndrome.
The most effective results occur when you choose treatment techniques whose physiological effects best address the client's existing complaint. Conditions and treatment techniques both have physiological effects, which are the specific ways in which tissues respond either to the pain/injury or the intervention. Treating a client suffering from radial tunnel syndrome with techniques appropriate for someone suffering from lateral epicondylitis would aggravate the problem rather than help it. So, let's take a look at these two problems and explore how one might mistake radial tunnel syndrome for lateral epicondylitis.
Exploring the Conditions
Most people are aware that lateral epicondylitis is a chronic overuse condition affecting the common extensor tendons where they attach at the lateral epicondyle of the humerus. Despite the implication from its name, because it ends in –itis, epicondylitis is rarely an inflammatory problem and is not caused by the common explanation of torn tendon fibers. Instead, it is caused by collagen degeneration in the extensor tendons. Pain is most pronounced where the tendons attach at the lateral epicondyle of the humerus.
Epicondylitis presents several clear signs and symptoms that can be picked up during the evaluation process. There is likely to be pain with palpation of the extensor tendons and it is likely to be particularly tender where they attach at the lateral epicondyle. It is also common for pain to be reproduced when stretching the extensor tendons by moving the wrist into full flexion. Resisted wrist extension also reproduces the client's pain, especially if the affected tendons are palpated during the resisted wrist movement. (See Figure 1)
Unlike lateral epicondylitis, radial tunnel syndrome is not as common. However, when present, it can easily be confused with epicondylitis. Radial tunnel syndrome is frequently called resistant tennis elbow, because the symptoms are very similar to tennis elbow and they persist even after attempts at treatment (usually for lateral epicondylitis).
In the elbow region, the radial nerve divides into a superficial sensory branch and a deep motor branch. The primary problem in radial tunnel syndrome is compression of these branches as they course through fibro-osseous tunnels created by surrounding muscles, ligaments and bones. The deep motor branch innervates the wrist extensor muscles and is called the posterior interosseous nerve (PIN). Compression of the PIN most commonly causes weakness or atrophy in the wrist extensors because the PIN contains motor fibers almost exclusively. However, pain similar to lateral epicondylitis is possible because the superficial sensory branch of the radial nerve may also be compressed in this region. (See Figure 2)
Nerve compression occurs in radial tunnel syndrome where the PIN courses under the supinator muscle. The archway created by the edge of the supinator muscle under which the PIN passes is called the Arcade of Frohse. (See Figure 3) The Arcade of Frohse often has fibrous bands that compress the nerve causing the tunnel compression syndrome. These fibrous bands are small and deep under the extensor muscle mass, so they are challenging to palpate.
Although radial tunnel syndrome and lateral epicondylitis may initially present with similar symptoms, there are some key aspects of assessment that will help differentiate the problems. Lateral epicondylitis is most likely to cause pain during resisted wrist extension. Radial tunnel syndrome, on the other hand, is more likely to present with less pain but significant weakness during resisted wrist extension because it is the PIN motor fibers that are most affected.
Pain can be reproduced during palpation with both these conditions. However, when palpating the lateral elbow region, radial tunnel syndrome pain is more likely to be felt somewhat distal to the epicondyle in the soft tissues. Epicondylitis pain is predominantly in the extensor tendons and right at the epicondyle. In addition, pain arising from nerve compression in radial tunnel syndrome is likely to be less specific and extend into the forearm. Epicondylitis pain is usually far more local right at the proximal extensor tendon group and their attachments.
Based on her initial symptoms, our client could have either one of these conditions. This is a great illustration of why it is so important to perform a thorough assessment and not immediately jump to conclusions. Assuming she has lateral epicondylitis, the most likely treatment approach would include deep transverse friction of the common extensor tendons. The physiological effects of this treatment technique (stimulation of fibroblast activity which encourages collagen rebuilding) would match the physiology of the tissue injury (collagen degeneration). The friction technique would be valuable in addressing the chronic tendon degeneration of epicondylitis.
However, if the primary problem is radial tunnel syndrome, applying deep friction could significantly aggravate the problem by placing adverse pressure on the nerve. For radial tunnel syndrome it would be far more important to address muscular hypertonicity throughout the wrist extensors and the supinator muscle so they don't further compress the nerve. In addition, neural mobilization techniques for the radial nerve would encourage full freedom of movement of the nerve and eventually reduce symptoms. Neural mobilization engages gentle pulling actions during certain motions of the upper extremity that encourage smooth and free gliding of the nerve near any adjacent structures.
This case illustrates two very important points that will make your treatments more successful. It is valuable to know about soft-tissue pathologies in order to be able to distinguish between conditions. In addition, in cases like this, it is possible to make treatment errors that make a client's condition worse. Performing accurate assessment and considering the physiological effects of the treatment on the specific tissues being treated will make your treatments far more effective and successful.
Click here for more information about Whitney Lowe, LMT.
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