resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
Helping to Create the Healthiest Generation
The imperative to create the "Healthiest Generation by 2030," envisioned by the American Public Health Association (APHA), was in full force at the APHA's 142nd Annual Meeting held in New Orleans from November 15-19, 2014.
Professionalism and Evidence-Based Health Care
Today's chiropractors are facing a conundrum with the Affordable Care Act and its health care reform requirements, including evidence-based practice and health technology assessment.
The Static Postural Pelvic Exam
I include a static postural analysis in my evaluation routine whether you are a patient in pain or an elite-sport athlete in training. In my day-to-day practice, I require patients to stand still while I "just look" at them.
Three for One: The Cervical Distraction Test
Taking the time to do an exam is important, but it is time spent. The exam serves as a way to physically validate your clinical impression following a history and clinical consultation.
Happy New Year 2015 Gong Hoy Fat Choi
Welcome to the year of the sheep! We begin a new year guided by the sign of a quietly and creatively organized animal.
How to Use Online Video as a Tool to Market Your Practice
Health care practitioners, including chiropractors, should consider online videos as a key element of their Internet marketing strategy. In the next three years, videos are expected to account for nearly 70 percent of all consumer online traffic, according to Cisco.
News in Brief
While indignation may be your immediate reaction to H.R. 5780, the Protecting the Integrity of Medicare Act of 2014, the American Chiropractic Association suggests the legislation is just what the chiropractic profession needs.
Acupuncture and its Place in the Integrative Healthcare Practice: The Need to Move from Modality to Profession
Acupuncture and oriental medicine (AOM) has grown and flourished from its inception thousands of years ago in China. In surrounding regions of Asia, AOM developed as a response to differing cultural, pathological, health and wellness care needs.
The Conscious Evolution of Healing: Importance of Opening the Sensory Portals in Classical Chinese Medicine
The Chinese medical classics are not just clinical guides. They give advice; ways we can awaken more fully into conscious awareness.
Trouble Down Under: San Zhen Therapy for Lower Jiao Issues
In the last several columns, I have discussed many clinical options for utilizing San Zhen or Three Needle Therapy. In this installment, I will continue this trend and discuss several foundational patterns which can be found in several very common clinical presentations.
Animal Acupuncture Gaining in Popularity
We have just finished the year of the fire hoarse and now it is time to spend some time alone, daydreaming and thinking outside the box in terms of where our profession is headed. The sheep person is well organized and creative so this should not be difficult to do.
Fight Colorectal Cancer With Folic Acid
CRC is the second most common cause of cancer mortality in the U.S. and Canada. Although genetic susceptibility plays a role in the etiology of CRC, dietary factors, including certain vitamins, have also been shown to influence the development of the disease in various studies.
Age and Fertility: Why We Should Worry Less About Age and More About Overall Health
Recently, on one of the acupuncture alumni forums, the topic of age and fertility came up when a practitioner posted a question regarding a patient that was about to turn 40-years-old.
The Way of Zen Performance Enhancement
Working with elite athletes and implementing various techniques to keep athletes focused and at their optimal performance for a sustained period of time includes incorporating various meditation techniques that counterbalance their sport-specific physical and mental demands, which is an important element of success throughout the years.
Two for One: The Cervical Distraction Test
In today's healthcare system, diagnoses and treatment plans follow a western medical model - especially if you work with attorneys or insurance companies.
Show Up and Show Respect
I was recently asked about my chiropractic philosophy. My answer surprised my questioner.
Right Back Where We Started?
More than 25 years after Judge Susan Getzendanner issued her historic opinion in the Wilk v AMA anti-trust case, evidence suggests that despite increasing collaboration between doctors of chiropractic and their allopathic medical counterparts, when it comes to organized medicine, we may be right back where we started.
Environmental Toxins: Cause of Modern Illness, Part 2
In Part I of this article, we detailed the variety of environmental toxins assaulting our bodies. These include pesticides and herbicides; plastics; preservatives; cosmetics; gasoline additives, solvents and glues; and heavy metals.
I Felt it in My Fingers First
I'm not afraid to say it. Massage therapists make better acupuncturists. I'll tell you how I know, but first I have a question: What do a microcurrent device, a laser and a hippie massage therapist have in common?
Taking the Freeze Out of Adhesive Capsulitis
Adhesive capsulitis or "frozen shoulder" is a relatively common condition resulting in severe shoulder pain and global loss of glenohumeral joint range of motion. Incidence of the condition is approximately 3 percent in the general population.
We Get Letters & Email
Rethinking Our Approach to Immunization; Coming Together for the Good of Our Patients.
Ringing in the Billing New Year
What are the new modifiers that replace modifier 59? Will they allow doctors of chiropractic to be paid for 97140, manual therapy, when done with chiropractic manipulation?
Movement Assessments: The DC's Sphygmomanometer
I think back to when I was going through chiropractic school outpatient clinic. I was embarrassed to have my family and friends come in for treatment because initial evaluations took three hours to complete.
AWB Makes a Difference in the Yucatan
We are in the sleepy town of Izamal, located about an hour from the Merida airport where our group arrived last night. Later that morning, on a bus winding through the dusty roads of the Yucatan, fourteen acupuncturists, two facilitators from AWB and two tour guides make their way to the small rustic town of Popola.
Chiropractic Research in Review
Occupational LBP in Primary- and High-School Teachers; Treating MVA Complications With Chiropractic Care; Neck Pain: Immediate Effects of Active Scapular Correction; Taping Benefits Stride, Step Length in Fatigued Runners.
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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