resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
Day in the Life of an Advanced-Practice DC
Can you tell us a little about your background in the profession? Why did you want to become a DC? I studied at Boston University from 1968-1972 as a pre-med student majoring in biology.
News in Brief
Northwestern Student Honored for Addressing Concussions Head-On; Northwestern Announces New CFO; Life U. to Provide Unique Opportunity.
Excited to Share the Science of Chiropractic: An Interview With Dr. Heidi Haavik
Dr. Heidi Haavik has become known in the circle of chiropractic researchers as not only a rising star, but also one willing to do research that can have a major impact in the scientific world and how chiropractic is perceived.
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.
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.
How Many of Your Patients Have Sarcopenia?
Figure 1 demonstrates the typical appearance of sarcopenia in the paravertebral muscles. Have you considered evaluating your patients for this problem? Sarcopenia is the progressive loss of skeletal muscle mass and function that affects the older population.
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.
Specialized Pro-Resolving Mediators: 21st Century Inflammation Fighters
Specialized pro-resolving mediators, or SPMs, are a portion of the omega-3 fatty-acid spectrum that have been shown to have a powerful effect on reducing inflammation.
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.
Designing a Fitness Plan (Part 4): Blending Pain Relief With Healthy Aging
Pain relief is still the No. 1 reason patients come to my office. However, most of my patients have other goals as well, such as: "I want to lose 10 to 20 pounds"; "I feel old and want to slow down the aging process"; "My doctor says I am becoming a diabetic and need to exercise"; or "I'm tired and want more energy."
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.
Identify & Adjust the Apex Posterior Sacrum
Low back pain involving an apex posterior sacrum (+θX-axis misalignment) typically presents with signs of lumbosacral joint impingement or facet syndrome.
An Alarming Lack of Accountability
Accountability seems to be a lost quality today. The simple act of taking responsibility and doing the right thing just doesn't happen as often as it should. Maybe it is the litigious nature of our society.
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.
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.
Transparency is Key at ASA First Annual Meeting
On March 4th and 5th the American Society of Acupuncturists (ASA) held a successful first annual meeting in Albuquerque, New Mexico.
Misconceptions & Opportunities With Medicare
As I speak around the country on how to properly document Medicare patient encounters, I get questions regarding opting out of Medicare. There are many misconceptions about opting out of Medicare, including just what it means to opt out.
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.
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?
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.
Let's Streamline Your Front Desk
Your front office can be your greatest source of efficiency or a constant bottleneck. Increasing the productivity of this area without sacrificing the quality of patient interaction can be a little tricky.
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.
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.
March, 2013, Vol. 13, Issue 03
Know What to Look for in That Other Tunnel in the Wrist
By Whitney Lowe, LMT
When a client comes in complaining of pain, numbness/paresthesia or weakness in the hand, it is likely that carpal tunnel syndrome (CTS) is what comes to mind first. Yet, there is another fibro-osseous tunnel in the wrist where nerve compression occurs, called Guyon's canal or Guyon's tunnel. The ulnar nerve travels through this tunnel and is susceptible to compression here.
There are some key factors to understand about the anatomical arrangement of structures in Guyon's canal that govern the most effective treatments. The first place to begin is with a solid understanding of the anatomical structure of Guyon's canal. Treating compression in this canal differs from treating median nerve pathology (CTS).
The flexor retinaculum, also called the transverse carpal ligament, traverses the base of the hand between the pisiform and hamate on the ulnar side and the scaphoid and trapezium on the radial side. Some anatomy textbooks don't show it, but the flexor retinaculum actually splits into two divisions toward the ulnar side of the hand. There is a broad, deep band and a superficial short band. The space between these two bands is Guyon's canal (Figure 1).
The ulnar nerve artery and vein pass through this canal. Unlike the carpal tunnel which houses numerous tendons, there are no tendons traveling through Guyon's canal. The lack of tendons in the tunnel plays a prominent role in distinguishing ulnar nerve pathology from median nerve pathology.
Guyon's Canal Syndrome
In CTS, structures within the carpal tunnel, such as the flexor tendons, become inflamed and compress the median nerve. Because median nerve compression results from structures within the tunnel, the focus of treatment is on reducing inflammation and compression from these intrinsic (within the tunnel) structures.
In Guyon's canal syndrome (GCS) the only structures within the tunnel are the ulnar nerve, artery and vein, so nerve compression in this condition does not result from intrinsic factors but from those outside the tunnel (extrinsic factors). The nerve compression experienced in GCS is most likely associated with activities where there is either excessive pressure on the base of the hand or pressure applied to the region for prolonged periods.
This condition is frequently referred to as handlebar palsy because of the frequency with which it occurs in long distance cyclists who have their hyperextended wrist pressing on the handlebars and absorbing road vibration. Another common reason for GCS is walking with a cane where body weight pressure is put on the cane handle right over the ulnar nerve in the canal. Falling on an outstretched hand or hitting something hard with the base of the hand can also produce an acute onset of GCS.
The key difference between these situations and that of carpal tunnel syndrome is that in each of the ulnar nerve compression situations, pressure is placed on the base of the hand by some external factor, not compression from within the tunnel. The fact that these causes are all from extrinsic and not intrinsic compression is important when constructing appropriate treatments.
The client with Guyon's canal syndrome may present with both sensory and motor symptoms. Sensory symptoms include pain, paresthesia or numbness in the ulnar nerve distribution of the hand (Figure 2). Motor symptoms include weakness or atrophy in the hypothenar muscles at the base of the hand or in the adductor pollicis muscle of the thumb. The motor symptoms of weakness or atrophy are the most common presentation with this condition.
Visual observation of the base of the hand often reveals an indication of ulnar nerve compression. If there is significant atrophy of the hypothenar muscles, they will appear far less developed than the unaffected side (the other thumb) if there isn't bilateral nerve compression.
The adductor pollicis muscle plays a key role in evaluation of this pathology with a simple orthopedic test called Froment's sign (Figure 3). Have your client hold a thick piece of paper or business card between the thumb and index finger with the fingers folded in as shown in the picture. Instruct the client to hold the paper firmly as you attempt to pull the paper from the client's grip. If you are able to easily pull the paper from the client's grip, it is likely that there is significant weakness in the adductor pollicis muscle and ulnar nerve pathology is likely to blame.
The most important strategies in treatment involve removing any factors that are compressing the nerve and giving the nerve proper time to heal. The client interview is key for determining what the precipitating factors are. Find out what the client's activities are or were that lead up to the symptoms and ask about any changes (use of a cane for example) in their behavior or lifestyle. The reasons for the compression problems are not always obvious, so ask more questions if the symptoms fit the condition but the activities don't initially.
In any nerve compression pathology, the primary goal of treatment is to reduce pressure on the affected nerve. This goal is the same for Guyon's canal syndrome. However, because the primary cause of nerve compression is extrinsic, massage techniques should not be applied directly to this area as they could cause further compression of the nerve and prolong the pathology.
Massage treatment in other portions of the upper extremity can, however, provide significant benefit. Much has been written in recent years about the key benefits of neural mobility.1 Therefore, working all of the tissues along the path of the ulnar nerve will enhance full neural mobility and give the nerve the best possible environment for healing, which sometimes is lengthy with nerve conditions.
Without knowing and understanding some of these key facets of Guyon's canal syndrome, the practitioner may inadvertently aggravate a nerve compression problem by attempting to work around the wrist and hand for someone experiencing hand pain or weakness. This is a valuable reminder that while massage is highly beneficial in most cases, there are instances in which our intervention could be problematic or cause a condition to get worse if we apply it inappropriately.
Click here for more information about Whitney Lowe, LMT.
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