Great Imposters of Carpal Tunnel Syndrome.

14 Jul

Carpal Tunnel Syndrome (CTS) is caused by compression and subsequent irritation of the median nerve as it travels through the carpal tunnel and into the hand where it innervates the palm side of the second to fourth digits. As stated last month, the median nerve is sometimes referred to as, “…the eye of the hand” since we rely so heavily on activities of daily living (ADLs) that require its health and function. Some of these ADLs include buttoning a shirt, picking up small objects, tying a shoe or neck tie, writing, holding a book or coffee cup, gripping items such as a phone or steering wheel, opening jars, household chores, and carrying objects, especially with the finger tips.

When patients present with CTS signs and symptoms, one would think that the examination and treatment would be fairly straightforward and “routine.” The problem is, no two cases of CTS are identical because of all the possible mitigating factors, or the presence of OTHER issues that may be contributing or may be the REAL cause for CTS in that particular person. This may explain the reason surgical release of the transverse carpal ligament doesn’t always work!

The “Great Imposters” of CTS include both physical and chemical factors. Physical factors include (but are not limited to): 1) Cervical nerve root compression: Since the median nerve originates from the C6-T1 (and a little from C5) nerve roots exiting the spine, it only makes sense that a pinched nerve in the neck can mimic a pinched nerve at the wrist. The difference here is “usually” that the whole arm is involved, which is less likely in CTS only. Moving down from the neck, the next most common location for a mechanical pinch is at the 2) Thoracic outlet: Here, the nerve roots coming from C5 to T2, like merging lanes of a highway, come together to make the three main nerves that enter the arm and along with the blood vessels, this “neurovascular bundle” leaves the upper chest region and travels through the thoracic outlet to enter into the arm. The thoracic outlet can become narrowed if there is an extra rib, a shift in the collar bone or shoulder blade, from muscles that are too tight (especially the anterior scalene and/or pectoralis minor), or from anything that occupies space within the thoracic outlet. 3) Struther’s ligament: In a few of us (only about 2%), there is a ligament just above the elbow that can entrap the median (as well as the ulnar) nerve, creating a pinch and subsequent numbness below that point, mimicking CTS. 4) Pronator tunnel: The median nerve is more commonly entrapped by the pronator teres muscle just below the elbow, and treating this location can be highly rewarding when managing stubborn CTS cases. Less common is entrapment in the mid-forearm, though it’s possible by either the interosseous membrane that connects the ulna and radius or from fracture of the ulna and/or radius. The most distal point of median nerve compression is at the carpal tunnel. Entrapments can be singular or multiple and when more than one “tunnel” compresses the median nerve, the term double or multiple crush is utilized. Management MUST address ALL points of compression to obtain long-term satisfying results. Other “imposters” of CTS include a host of conditions including (but not limited to) thyroid disease, diabetes, arthritis, pregnancy, birth control pill use, obesity, and MANY others! Chiropractic makes the most sense when it comes to managing CTS from mechanical causes. If response is slow or not satisfying, we will order tests and/or consults to get to the bottom of what “imposters” may be contributing to your CTS symptoms!

We realize you have a choice in whom you consider for your health care provision and we sincerely appreciate your trust in choosing our service for those needs. If you, a friend, or family member requires care for Carpal Tunnel Syndrome, we would be honored to render our services.

WARNING: Coughs and Sneezes Travel Much Further than Expected!

9 Jul

Researchers have known for some time that coughs and sneezes travel quite a distance. You have probably seen slow motion videos showing the huge droplet mist caused during a sneeze. Well, new research conducted by researchers at Massachusetts Institute of Technology (MIT) shows that coughs and sneezes have associated nearly invisible gas clouds that travel much further than previously thought. According to Dr. John Bush, a Professor of Applied Mathematics at MIT, “When you cough or sneeze, you see the droplets, or feel them if someone sneezes on you. But you don’t see the cloud, the invisible gas phase. The influence of this gas cloud is to extend the range of the individual droplets, particularly the small ones.” The new research shows the smaller particles travel between 5 to 500 times further! Even more shocking is that because particles are suspended in a gas, they are much more likely to be picked up by air circulating systems such as heating and air conditioning vents. This can spread “germs” throughout an entire building, just about instantly. Oh the horror!!! Or is it?
The first thing to understand is while this research is new, the distance traveled by sneezes and coughs is not. In other words, “germs” from sneezes and coughs have been suspended in small gas clouds that travel large distances and possibly through heating and air conditioning vents since there have been sneezes, coughs, and vents. Researchers (and you and I) knowing about it is the only thing that is new. So, two things are clear. (1) Knowing about it does not mean more people will get sick and (2), which is the most important, this is just further evidence that “germs” are everywhere. Everyone breathes them in constantly. If you are breathing “germs” in all day, and germs make you sick, then why aren’t you constantly sick?
The answer is quite simple. Germs will never be eradicated, and they should not be. They are an essential part of our ecosystem. Beyond living in a bubble, you are always going to be in contact with germs. So, the best way to deal with “germs” is to make sure your immune system is functioning to your genetic potential. This is because “germs” easily invade a body with a weak or weakened immune system, take hold, and make that person sick. On the contrary, “germs” are easily fought off by a strong, well functioning immune system. This is why), holding all other factors constant, people who do not get enough sleep, drink excessively, smoke cigarettes, have high stress levels, and eat a poor diet (loaded with processed food and sugar) are more likely to get sick when exposed to the same “germs.” Even worse, their sickness can be worse and last longer which is all the more reason to focus on the things you can control like diet, sleep, and stress reduction.

The Mysteries of Low Back Pain!

8 Jul

Do you realize how complicated the low back region is when it comes to investigating the cause of low back pain (LBP)? There can be findings on an x-ray, MRI, or CT scan such as degenerative disk disease, arthritis, even bulging and/or herniated disks that have NOTHING to do with why the back hurts. Similarly, there are often other abnormal findings present in many of us who have NO low back pain whatsoever! Because of this seemingly paradoxical situation, we as clinicians must be careful not to over-diagnose based on the presence of these “abnormal findings” AND on the same hand, be careful not to under-diagnose them as well.

Looking further into this interesting paradox, one study reported findings that support this point. Investigators examined 67 asymptomatic individuals who had NO prior history of low back pain and evaluated them using magnetic resonant imaging (MRI). They found 21 of the 67 (31%) had an identifiable disk and/or spinal canal abnormality (which is where the spinal cord and nerves run). Seven years later, this same group of non-suffering individuals were once again contacted to see if they had developed any back problems within that time frame. The goal of the study was to determine if one could “predict” who might develop low back pain based on certain abnormal imaging findings in non-suffering subjects. A questionnaire was sent to each of these individuals, of which 50 completed and returned the questionnaire. A repeat MRI scan was performed on 31 of these subjects, and two neurologists and one orthopedic spine surgeon interpreted the MRI studies using a blinded approach (without having knowledge about the subject’s symptoms or lack thereof). Each level was assessed for abnormalities including disk bulging/herniation and degeneration. Those who had initial abnormal findings were defined as “progressed” (worsened) if an increased severity of the original finding was evident or if additional or new spinal levels had become involved over the seven-year time span.

Of the 50 who returned the questionnaire, 29 (58%) had NO low back pain, while 21 had developed LBP. In the original group that had the MRI repeated seven years later, new MRI findings included the following: twelve remained “normal,” five had herniated disks, three had developed spinal stenosis, and one had “moderate” disk degeneration. Regarding radiating leg pain, four of the eight had abnormal findings originally, two of the eight had spinal stenosis, one had a disk protrusion, and one an “extruded” (“ruptured”) disk. In general, repeat MRI scans revealed a greater frequency of disk herniation, bulging, degeneration, and spinal stenosis compared to the original scans. Those with the longest duration of LBP did NOT have the greatest degree of abnormalities on the original scans. They concluded that the original MRI findings were NOT PREDICTIVE of future development of LBP.

They summarized, “…clinical correlation is essential to determine the importance of abnormalities on MR images.” These findings correlate well with other studies, such as 50% or more of all asymptomatic people HAVE bulging disks and approximately 30% of us have herniated disks – WITHOUT PAIN. To be of diagnostic (clinical) value, the person MUST have signs and symptoms that agree with the imaging test, which is used to CONFIRM the diagnosis. Bottom line, If you have LBP, come see us, as we will evaluate and treat YOU, NOT your x-rays (or MRI) findings!

We realize you have a choice in whom you consider for your health care provision and we sincerely appreciate your trust in choosing our service for those needs. If you, a friend, or family member requires care for back pain, we would be honored to render our services.

Headaches.

7 Jul

Headaches (HA) play a significant role in a person’s quality of life and are one of the most common complaints that chiropractors see. This comes as no surprise, as one survey reported 16.6% of adults (18 years and older) suffered from migraines or other severe headaches during the last three months of 2011. Another study reported that head pain was the fifth LEADING CAUSE of emergency department (ED) visits in the United States and accounted for 1.2% of all outpatient visits. These statistics are even worse for females (18-44 years old), where the three month occurrence rate was 26.1% and the third leading cause for ED visits! Because of the significant potential side effects of medications, many headache sufferers turn to non-medication treatment approaches, of which chiropractic is one of the most commonly utilized forms of “complementary and alternative approaches” in the management of tension-type headaches. So, why are headaches so common? Let’s talk about posture!

Posture plays a KEY ROLE in the onset and persistence of cervicogenic headaches. If there is such a thing as “perfect posture,” it might “look” something like this: viewing a person from the front (starting at the feet), the feet would flair slightly outwards symmetrically, the medial longitudinal (inside) arch of the feet would allow enough space for an index finger to creep under to the first joint (and NOT flat like so many), the ankles would line up with the shin bones (and NOT roll inwards), the knees would slightly “knock” inwards and hips would line up squarely with the pelvis. The shoulders would be level, the arms would hang freely and not be pronated (rolled) inwards, and head would be level (not tilted). From the side view, the knees would not be hyperextended nor flexed, the shoulders would not be forward (protracted) and MOST IMPORTANT (at least for headaches), the head would NOT be forward and be able to have a perpendicular line drawn from the floor through the shoulder, as this line should pass through the outer opening of the ear. As the head “translates” or shifts forwards, for every inch of “anterior head translation” (AHT), it essentially gains 10 pounds in weight, which the upper back and neck muscles have to counter balance!

A leading University of California medical author, Dr. Rene Calliet, MD, wrote that this altered posture can add up to 30 pounds of abnormal weight to the neck and can “…pull the entire spine out of alignment.” It can also reduce the lung’s vital capacity by 30%, which can contribute to all sorts of breathing-impaired health problems! Think of carrying a 30-pound watermelon around your neck all day – the muscle pain from fatigue would be tremendous! If this is left uncorrected, chronic neck pain and headaches from pinching off the top three nerves in the neck is likely. The combination of AHT and shoulder protraction may also lead to the development of an upper thoracic “hump” and potentially into a “Dowager Hump” if the Midback vertebrae become compressed (wedged). An increased rate of mortality of 1.44 is reportedly associated with this faulty posture!

Between chiropractic adjustments, posture retraining exercises, other postural corrective care, and strength exercise training, we WILL help you correct your faulty posture so that neck pain and headaches STOP and don’t progress into a chronic, permanent condition.

We realize you have a choice in whom you consider for your health care provision and we sincerely appreciate your trust in choosing our service for those needs. If you, a friend, or family member requires care for headaches, we would be honored to render our services.

The Benefits of Happiness.

2 Jul

The feeling of happiness – whether you equate it with optimism, joy, well-being, personal achievement, or all of the above – goes hand-in-hand with healthier habits. People who are in good spirits tend to eat better, exercise more frequently, and get better sleep than those who are not. This could be because leading a healthy lifestyle helps you achieve your goals, which leads to happiness. It could also be that such habits lead to better health, which, in turn, lends itself to a better mood and contentment.
Beyond these rather common-sense associations, there’s something more about happiness that makes you healthy. It appears that a positive mental state may have a much more direct effect on your body. Positive thoughts and attitudes are able to prompt changes in your body that strengthen your immune system, boost positive emotions, decrease pain and chronic disease, and provide stress relief. Happiness, optimism, life satisfaction, and other positive psychological attributes are associated with a lower risk of heart disease. People with a deep sense of happiness and well-being have lower levels of inflammatory gene expression and stronger antiviral and antibody responses.

Awesome Person Alert! If you found a stranger’s wallet with money in it and no one else knew, what would you do? What this person did is incredible…

1 Jul

It’s a very old and commonly used ethical question. If you found a bag of money and no one knew, would you keep it or return it? A quick Google search of this topic reveals many important things…
First, there are a lot of people who jump into the legal debate. In other words, whether they keep or return the money is solely dependant on what they are legally bound to do. They say, if it is legal, they will keep it and vice versa. The situation gets more complicated depending on the amount of money in the bag. For example, it is much easier returning $20 than it is $1 million. What if the person who finds the money is poor? Does this mean it is okay to keep someone else’s money? It all depends on your situational ethics.
That’s why this story is so impressive.
Christian Reyes lost his wallet at a Florida Marlins’ baseball game and the person who found it did something amazing. He looked in the wallet and found Reyes’ Miami Senior High School student ID card. He brought the wallet to the school and turned it in. When he went to the front office, all he said was, “Somebody lost this wallet. One of your students. I think it’s one of your students from this school, lost this wallet at the game, and I just want to make sure he gets it back.”
Then, the good Samaritan left, not even telling the office staff his name. But here is the most amazing part: When Reyes got his wallet and opened it, he found there was EXTRA money in it and a note. Whoever found and returned his wallet actually put an extra $20 in the wallet with a note that said…
“I added $20 to it so you know the world is a great place. Do me a favor, when you get the chance, do something nice for someone else.”
Reyes is reported as saying he is looking forward to holding up his end of the deal. This is incredible because not only did this kind person add money to the wallet, he did not even tell anyone his name. He is obviously just looking to make the world a better place and not looking to make himself look good.
But this is not the only good Samaritan case. According to the Boston Globe, last October, Red Sox player Shane Victorino lost his wallet on a plane. A good Samaritan actually shipped the wallet back to him from Paris! Victorino told the press, “There’s honest, trustworthy people in this world.”
Here is one more good Samaritan story that is nothing short of awesome…
A bunch of college kids got intoxicated and were smart enough to not drive home. They decided to take a chance and knock on the front door of a house at 11:00 p.m. and see if they could get a ride back to their house. What greeted them when the door opened was a little scary…
You see, the house they chose was being rented out by several professional mixed martial arts (MMA) fighters and the guy who answered the door was 6’3” pro MMA fighter Jake Gombocz. As you can imagine, this story could have gone very wrong for these drunken college kids pounding on a stranger’s door at 11 p.m.
But it didn’t. Jake is a gentle giant and one of the nicest people you will ever meet. Jake offered them a ride home all the way across town. When the college kids offered Jake money, he refused to take it and told them to pay the kindness forward to someone else.
The most amazing part of all these stories is the good Samaritans did not give their names and did not try to take credit for their acts of kindness. We only found out Jake’s name because one of his friends was there and posted the story about Jake on his Facebook account.
Maybe these are the real heroes we should pay attention to, praise, and look up to. 

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