resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
Acupuncture Points: Broadening Our Scope and Diagnostic Work
As every practitioner knows, the correct diagnosis is everything. Most healing disciplines rely on the use of symptomatology for their treatment implementation. Beyond symptomatology, we have clinical tests to provide more objective findings.
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.
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.
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.
We Get Letters & Email
Our Country Needs Us Between Elections, Too; Continuing Care: We Aren't There Yet; Our Associations Need to Do More.
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.
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.
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 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.
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.
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.
Scar Reduction With Acupuncture & Microneedling (Part 2)
Protocols & treatment Timing
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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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