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Sports Management: Bone and Joint Injuries

By Frank M. Painter|April 15, 2013|Bone Injury, Clinical Decision-making, Diagnosis, Education, Joint Injury, Sports Management|

Sports Management: Bone and Joint Injuries

The Chiro.Org Blog

We would all like to thank Dr. Richard C. Schafer, DC, PhD, FICC for his lifetime commitment to the profession. In the future we will continue to add materials from RC’s copyrighted books for your use.

This is Chapter 15 from RC’s best-selling book:

“Chiropractic Management of Sports and Recreational Injuries”

Second Edition ~ Wiliams & Wilkins

These materials are provided as a service to our profession. There is no charge for individuals to copy and file these materials. However, they cannot be sold or used in any group or commercial venture without written permission from ACAPress.

Chapter 15: Bone and Joint Injuries

In traditional general medical practice, the musculoskeletal system is the most overlooked system in the body, yet it comprises over half the body mass. The relationship between structure and function, and the interrelationship between all body systems, cannot be denied. Muscles, bones, and connective tissues are involved in both local and systemic pathology, and in a wide assortment of functional and referred disturbances. Thus, great care must be taken in eliciting the details of a complaint when any musculoskeletal disorder is suspected. This section reviews the basis of alert management of bone and joint injuries within the health care of athletic and recreational injuries.

Bone Injuries

Correlation of the history of the present complaint with musculoskeletal dysfunction must be done in detail and with care. Maintain accurate initial and progress records with repeated monitoring. Few patients can appreciate the relationship of dysfunction in one somatic part with a distant somatic part, let alone the relationship between a somatic dysfunction and a visceral dysfunction.

Background

Musculoskeletal symptoms may be the first clues toward poor structural adaptation or stress adaptation. The most common musculoskeletal symptoms are joint stiffness, joint swelling, and joint pain. Bones, being essentially nonyielding structures, are damaged when excessive force is applied directly or indirectly. The nature of the damage depends on the direction of the applied force on the bones and the manner in which these bones are attached to other structures. The principal acute skeletal injuries are sprains, strains, subluxations, fractures, and dislocations.

Normal bone has an excellent blood supply with some exception in the metaphyseal area; but tendons, ligaments, discs, and cartilage are poorly vascularized. Yet both bone and joints challenge the host’s defensive mechanisms. The pressure of pus under hard bone blocks circulation, and emboli and thrombosis can cause additional devascularization. When circulation is deficient, local phagocytic function and nutrition are deficient, and cure is stymied.

The most accurate diagnosis can be made immediately after injury, before swelling clouds the picture. Many fracture and dislocation complications such as nerve and vessel injury occur not from the trauma itself but from poor first aid which does not provide adequate splinting prior to movement. Traumatic bone injury rarely occurs without significant soft-tissue damage. The physical examination must be gentle but thorough because soft-tissue trauma is poorly visible on roentgenograms for several days after injury. For example, a working diagnosis of stress fracture may have to be made in the absence of classic symptoms by bony tenderness alone as the fracture may not be demonstrable on x-ray films for 10-14 days or longer.

Probing the History

Symptoms of a musculoskeletal nature that cannot be linked to trauma are suspect of a chronic organic process. Unfortunately, a history of stress or strain may not be remembered. Even severe trauma is easily put out of the mind uring a game when emotions are high or forgotten once the pain and swelling have left. Whether pain is present or not, the history must be probed to determine if the dysfunction is the result of bone, the joint, or the motor apparatus involved in the joint motion. (more…)

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Medical Documentation Falls Short of ICD-10 Coding Demands

By Frank M. Painter|April 13, 2013|Documentation, ICD-10 Coding|

Medical Documentation Falls Short of ICD-10 Coding Demands

The Chiro.Org Blog

SOURCE: MedPage Today ~ April 12, 2013

By David Pittman,
Washington Correspondent

Nearly 65% of clinical documentation doesn’t contain enough information for coders to use for billing under the upcoming ICD-10 coding system, a coding expert said here at the American College of Physicians annual meeting.

The switch to the new coding system will greatly increase the specificity of diagnostic codes, and most doctors don’t provide enough detail for office coders to translate that to ICD-10, said Rhonda Buckholtz, vice-president of ICD-10 education and training at AAPC, a medical coding society based in Salt Lake City, Utah. Her estimate of the percentage of charts that were inadequately documented came from a survey of patient charts done by the AAPC, but further detail on the survey was not provided.

Complicating the switch for physicians, most payers said they won’t reimburse for unspecified codes, which are commonly used by doctors who may not know how to exactly diagnose a patient when they see them, she said. “Under ICD-10, if we’re not ready, we’re not going to get paid.”

Doctors have bemoaned the switch to ICD-10 — short for International Classification of Diseases, version 10 — because of the tremendous increase in complexity from the current ICD-9. The number of diagnostic codes will increase from nearly 14,000 to around 69,000. The number of procedure codes will jump from around 3,000 to roughly 87,000.

ICD-10 requires much greater detail on location of ailments, cause and type, and complications or manifestations compared with ICD-9. For example, diabetes will require complications to be incorporated within a single code. And asthma is listed as “mild,” “mild intermittent,” “mild persistent,” “moderate persistent,” or “severe.”

Therefore, Buckholtz said physicians need to start work now to ensure they will provide enough information for billers to properly code. (more…)

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Multiple Sclerosis Puzzle: Vitamin D and the Month of May

By Frank M. Painter|April 12, 2013|Autoimmune, Multiple Sclerosis, Vitamin D, Vitamin Deficiency|

Multiple Sclerosis Puzzle: Vitamin D and the Month of May

The Chiro.Org Blog

SOURCE: MedPage ~ 4-11-2013

By Nancy Walsh, Staff Writer, MedPage Today

Fetal defects in thymic function and inadequate circulating levels of vitamin D may explain the well recognized influence of birth month on risk for multiple sclerosis, British researchers suggested.

Tests for a surrogate marker for thymic output of T cells found about twice the levels in cord blood of autoreactive T cells among individuals born in May compared with those born in November (P=5.5 × 10−5 versus P=1.2 × 10−6), according to Sreeram V. Ramagopalan, DPhil, of the University of Oxford, and colleagues.

Editor’s Note: If you are born in May, you would have been conceived the previous August or September, so the baby would have been carried to term during the low sunlight period of winter.

Mounting evidence has linked MS with vitamin D deficiency, and individuals born in May had lower levels of circulating 25-hydroxyvitamin D, at a mean of 38.4 nmol/L compared with 50.9 nmol/L, P=0.02), Ramagopalan’s group reported in a research letter in the April JAMA Neurology.

The association of birth month with later MS has been observed in many populations, although the phenomenon remains unexplained.

“We hypothesized that birth month influences T-cell production and may impair T-cell central tolerance and/or T-regulatory/T-effector cell balance, predisposing to MS,” the researchers wrote. To test this hypothesis, they examined cord blood from 100 healthy infants, half born in May and the other half in November.

Not only were the numbers of T-cells higher and the vitamin D levels lower in the May cohort, but an inverse correlation also was found between cord blood 25-hydroxyvitamin D and autoreactive CD4+ cells (ρ=−0.37, P=0.009) and CD8+ cells (ρ=−0.04, P=0.004).

These findings, in conjunction with recent observations that genes associated with MS have been found activated in cord blood, support the hypothesis that autoimmune conditions may represent a complex interplay of genetic and environmental factors, according to the researchers. (more…)

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Clinical Disorders and the Sensory System

By Frank M. Painter|April 11, 2013|Chiropractic Education, Diagnosis, Education, Evaluation & Management, General Health, Health Promotion, Neurology, Orthopedic Tests, Radiculopathy, Spinal Manipulation|

Clinical Disorders and the Sensory System

The Chiro.Org Blog

We would all like to thank Dr. Richard C. Schafer, DC, PhD, FICC for his lifetime commitment to the profession. In the future we will continue to add materials from RC’s copyrighted books for your use.

This is Chapter 4 from RC’s best-selling book:

“Basic Principles of Chiropractic Neuroscience”

These materials are provided as a service to our profession. There is no charge for individuals to copy and file these materials. However, they cannot be sold or used in any group or commercial venture without written permission from ACAPress.

Chapter 8: Clinical Disorders and the Sensory System

This chapter describes those sensory mechanisms, joint signals, and abnormal sensations (eg, pain, thermal abnormalities) that have particular significance within clinical diagnosis. The basis and differentiation of pain are described, as are the related subjects of trigger points and paresthesia. The chapter concludes with a description of the neurologic basis for the evaluation of the sensory system and the sensory fibers of the cranial nerves.

THE ANALYSIS OF PAIN
IN THE CLINICAL SETTING

Although all pain does not have organic causes, there is no such thing as “imagined” pain. Pain that can be purely isolated as a structural, functional, or an emotional effect is rare. More likely, all three are superimposed upon and interlaced with each other in various degrees of status. This is also true for neural, vascular, lymphatic, and hormonal mechanisms.

Common Causes of Pain and Paresthesia

The common causes of pain and paresthesia are:

(1) obvious direct trauma or injury;

(2) reflex origins in musculoskeletal lesions, which deep pressure often exaggerates, such as trigger areas;

(3) peripheral nerve injury (eg, causalgia), which results in an intense burning superficial pain;

(4) the presence of nerve inflammations and degeneration of the peripheral or CNS, which frequently cause other changes indicative of such lesions; (more…)

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The Horizontal Neurologic Levels

By Frank M. Painter|April 8, 2013|Chiropractic Care, Chiropractic Education, Clinical Decision-making, Diagnosis, Education, Evaluation & Management, Health Promotion, Neurology|

The Horizontal Neurologic Levels

The Chiro.Org Blog

We would all like to thank Dr. Richard C. Schafer, DC, PhD, FICC for his lifetime commitment to the profession. In the future we will continue to add materials from RC’s copyrighted books for your use.

This is Chapter 4 from RC’s best-selling book:

“Basic Principles of Chiropractic Neuroscience”

These materials are provided as a service to our profession. There is no charge for individuals to copy and file these materials. However, they cannot be sold or used in any group or commercial venture without written permission from ACAPress.

Chapter 4: The Horizontal Neurologic Levels
and Related Clinical Concerns

This chapter describes the basic functional anatomy and clinical considerations of the horizontal aspects of the supratentorial, posterior fossa, spinal, and peripheral levels of the nervous system.

OVERVIEW

The reader should keep in mind that the various aspects of the nervous system as described in this manual (eg, longitudinal and horizontal systems) are only reference guides that are visualizations of a patient’s nervous system in the upright position. They can be likened to the lines of longitude and latitude on a globe of the earth.

Such systems do not exist physically, but they do serve as excellent mental grid-like tools (viewpoints) during localization and areas in which and from which relationships can be described. For example, although the longitudinal systems take a general vertical course within the spinal column there are numerous alterations and they actually become horizontal when decussating. While the horizontal levels are spatially placed in and extend from the CNS in a general segmental manner, they soon take a widely diffuse course as they project toward their destinations. Thus, references to longitudinal and horizontal levels are just general viewpoints.

It is helpful for study purposes to isolate the body into certain systems, as described above, organize systems into organs, organs into tissues, tissues into cells, and cells into their components. However, we should keep in mind that, physically and functionally, there is only one integrated body and it is more than the sum of its parts. And even the body cannot be thought of as truly separate from its external environment. Although we may do this for study purposes, it is a limited viewpoint.

(more…)

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The Longitudinal Neurologic Systems

By Frank M. Painter|April 5, 2013|Chiropractic Education, Clinical Decision-making, Diagnosis, Education, Evaluation & Management, Neurology|

The Longitudinal Neurologic Systems

The Chiro.Org Blog

We would all like to thank Dr. Richard C. Schafer, DC, PhD, FICC for his lifetime commitment to the profession. In the future we will continue to add materials from RC’s copyrighted books for your use.

This is Chapter 3 from RC’s best-selling book:

“Basic Principles of Chiropractic Neuroscience”

These materials are provided as a service to our profession. There is no charge for individuals to copy and file these materials. However, they cannot be sold or used in any group or commercial venture without written permission from ACAPress.

Chapter 3: The Longitudinal Neurologic Systems

This chapter succinctly describes the basic structure and function of the six major longitudinal systems; viz, the sensory, motor, visceral, vascular, consciousness, and cerebrospinal fluid systems.

As we begin this chapter, it might be well for the reader to subjectively grasp the significance of the motor and sensory systems as far as possible. One exercise in this is to imagine that you had become unconscious and someone has placed you in a remote dark empty cellar, far beyond any source of environmental sound. The first thing you realize is that you are a total sensory and motor paralytic from the neck caudad. You are unable to move even a fingertip because your motor system is not functioning. Because there is no feeling, you do not know whether you are recumbent or tied in a chair. Your vision is normal, but there is no light. Your hearing is normal, but there is no sound. Your taste buds are functional, but there is nothing to eat or drink. Your olfactory organs are functional, but there are no detectable odors. There is little left except thought and memory.

After a time in this predicament, thoughts undoubtedly arise such as, “I wish I had really looked at the beauty of the world when I had a chance. I wish I had listened to the music of the masters and even the birds in my backyard when I had a chance. I gulped down so many delicious meals. I had a beautiful garden, but I rarely took time to appreciate its design and fragrance. I even failed to take time to appreciate the texture of my own clothes. I was in such a hurry to go nowhere that was more important. I missed so much.”

OVERVIEW

The human nervous system is a marvel in organizing and adapting to internal and external environmental changes:

(1) The receptors and afferent neurons of the visceral and somatic input systems are necessary to detect internal and external environmental changes.

(2) The visceral efferent neurons and the muscles of the motor output system must be stimulated if action is to be taken.

(3) The integrative system serves as intermediary stations via a complex arrangement of interneurons whose synapses control impulse strength and signal direction from the sensory system to the motor system.

(more…)

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