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Clinical Chiropractic: The Shoulder and Arm

By Frank M. Painter|November 15, 2011|Diagnosis, Education, Shoulder|

Clinical Chiropractic: The Shoulder and Arm

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 7 from RC’s best-selling book:

“Clinical Chiropractic: Upper Body Complaints”

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 7: THE SHOULDER AND ARM

CLINICAL BRIEFING

Shoulder Pain

Shoulder pain can be deceiving. As in so many musculoskeletal disorders, consideration of pain in the shoulder should not give priority to sudden trauma whether it be of intrinsic or extrinsic origin. Thorough investigation of the history may reveal that trauma did not initiate the first attack or that an injury was just a precipitating event that revealed an underlying degenerative disorder. Besides trauma, shoulder pain may have an inflammatory, a neurologic, a psychologic, a vascular, a metabolic, a neoplastic, a degenerative, a congenital, an autoimmune, or a toxic origin. See Table 7.1.

The Complexities in Treating Shoulder Complaints

Many practitioners would be happy if another patient with a shoulder complaint did not enter their offices. There are five major reasons for this:

1. The shallow shoulder joint is highly unstable. Its stability is provided by muscles rather than the strong ligament straps provided in most other joints. This makes recurring disorders common. The answer is therapeutic exercise, but many patients soon get bored with such regimens and the prescribed exercises are stopped long before adequate strength is acquired. Thus thorough counseling and monitoring are required.

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Clinical Chiropractic: The Elbow and Forearm

By Frank M. Painter|November 14, 2011|Diagnosis, Education|

Clinical Chiropractic: The Elbow and Forearm

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 8 from RC’s best-selling book:

“Clinical Chiropractic: Upper Body Complaints”

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: The Elbow and Forearm

CLINICAL BRIEFING

Functional Considerations

The arm and forearm are joined by a joint that serves as both a hinge and a pivot. The semilunar notch of the ulna is hinged with the hyperboloid trochlea of the humerus. The proximal head of the radius pivots with the spherical capitulum of the humerus and glides against both the proximal and distal ends of the ulna.

The distal end of the humerus can be viewed as two columns: a larger one medially that articulates with the semilunar notch of the ulna, and a smaller one laterally that articulates with the head of the radius. The pulley-like trochlea apparatus has:

(1) a depression at the front that lodges the coronoid process of the ulna and

(2) a depression at the rear that holds the olecranon process of the ulna when the elbow is extended.

The olecranon process restricts hyperextension of the elbow and protects the ulnohumeral articulation posteriorly. The concave head of the radius glides against the spherical capitulum of the humerus. The capitulum and trochlea are separated by a bony crest that fits into the opening between the proximal ulna and the radius and serves as a fixed rudder to guide elbow motion. The elbow flexors originate from the medial epicondyle, and the extensors originate from the lateral epicondyle. This structural arrangement should be visualized during examination to discriminate normal from abnormal articular motion.

The basic range of elbow joint motion involves elbow flexion (135°) and extension (0°), and forearm supination (90°) and pronation (90°). If a motion block is found in active motion, passive motion should be checked and the type of restriction and its degree noted.

Clinical Analysis

The elbow joint was not made to be used as an organic battering ram, but it often is: purposefully in sports; by accident in falls. For this reason, the vast majority of elbow disorders has trauma as their origin or precipitating factor. (more…)

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General Factors Involved in Vitamin and Mineral Deficiencies

By Frank M. Painter|November 13, 2011|Diagnosis, Education, Nutrition, Supplementation|

General Factors Involved in Vitamin and Mineral Deficiencies

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 the Appendix from RC’s best-selling book:

“Symptomatology and Differential Diagnosis”

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.

General Factors Involved in Vitamin and Mineral Deficiencies

Several general factors are involved in vitamin and mineral deficiencies. For example, abnormal loss and utilization or subnormal absorption, intake, storage, or transport, singularly or in combination, may readily lead to symptoms of nutritional deficiency.

See Table A.1.

You may also find value reviewing the:

Nutrient–Drug Depletion Charts

Agents Contributing to Vitamin, Mineral, and Other Nutrient Deficiency Symptoms

Drugs and nutrients often have adverse interactions. Drugs usually interfere with normal cellular nutrition by:
(1) depressing the central appetite center,
(2) decreasing normal blood levels (eg, excessive excretion),
(3) interfering with the nutrient’s storage or metabolism,
(4) developing a chemical antagonism (eg, inactivate),
(5) increasing the action of ingested antivitamins or antiminerals, or
(6) destroying intestinal bacteria necessary to synthesize the nutrient.

See Tables A.2, A.3, and A.4.
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The Posterior Neck and Cervical Spine

By Frank M. Painter|November 12, 2011|Cervical Spine, Diagnosis, Education|

The Posterior Neck and Cervical Spine

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 5 from RC’s best-selling book:

“Symptomatology and Differential Diagnosis”

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 5: The Posterior Neck and Cervical Spine

Introduction

With the important exception of neurologic and vertebral artery syndromes, most of the disorders witnessed in the posterior aspect of the neck are musculoskeletal conditions. Of particular significance are the symptom complexes of cervical arthritis, deformities, disorders of muscle tone, IVD syndromes, spondylosis, vertebral subluxation, tumors, and the effects of trauma. It is helpful to keep in mind that tumors of the cervical spine are usually secondary and that chronic degenerative disc disease and congenital anomalies may be asymptomatic for many years.

Functional Considerations

Nowhere in the spine is the relationship between the osseous structures and the surrounding neurologic and vascular beds as intimate or subject to disturbance as it is in the neck. Many peripheral nerve symptoms in the shoulder, arm, and hand will find their origin in the brachial plexus and cervical spine.

The gross mechanical function of the neck is determined by analysis of joint motion and muscle strength.

EVALUATING JOINT MOTION OF THE NECK

Gross joint motion is roughly screened by inspection during active motions. When a record is helpful, it is usually measured by goniometry. The prime movers and accessories responsible for voluntary joint motion in the cervical region are shown in Table 5.1.

EVALUATING MUSCLE STRENGTH OF THE NECK

Muscle strength is recorded as from 5 to 0 or in a percentage and compared bilaterally whenever possible. The major muscles of the neck, their primary function, and their innervation are listed in Table 5.2.

Structural and Neurologic Considerations

The healthy posterior neck provides stability and support for the cranium, a flexible and protective spine for movement, balance adaptation, and housing for the spinal cord and vertebral artery. From a biomechanical viewpoint, primary cervical subluxation syndromes may reflect themselves in the total habitus; from a neurologic viewpoint, insults may manifest throughout the motor, sensory, and autonomic nervous systems. Unlike the lumbar region, cervical disc herniations are not frequently associated with severe trauma; however, traumatic nerve root or cord compression has a high incidence in this area.

A general classification of musculoskeletal disorders of the neck is shown in Tables 5.3, and the function of the nerves of the cervical plexus and the brachial plexus is shown in Tables 5.4 and 5.5.

Anomalies and Deformities

Gross anomalies are rarely seen in chiropractic practice unless well adapted to the individual’s life-style. Those cases that have biomechanical significance vary in severity from minor to severe and occur multiply or singly. The cause is purely genetic transmission in about 35% of cases, and the remainder is due to environmental factors or a mixture of genetic and environmental factors. (more…)

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New International Health Survey of Sicker Adults Finds Those With a Medical Home Fare Better

By John Wiens DC|November 10, 2011|Health Care|

Chronically and Seriously Ill U.S. Adults Stand Out for Skipping Needed Care Due to Costs and Struggling with Medical Debt

Source Commonwealth Fund

New York, NY, November 9, 2011—Chronically and seriously ill adults who received care from a medical home—an accessible primary care practice that helps coordinate care—were less likely to report medical errors, test duplication, and other care coordination failures, according to a new Commonwealth Fund international survey of patients’ experiences in the U.S. and 10 other high-income countries. Published as a Health Affairs “Web First” article, the study also found that patients connected with medical homes had better relationships with their doctors and rated their care more highly.

The 2011 survey of more than 18,000 sicker adults in Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States included people who reported they were in fair or poor health, had surgery or had been hospitalized in the past two years, or had received care for a serious or chronic illness, injury, or disability in the past year. The study identified patients as having a medical home if they reported having a regular source of care that knows their medical history, is accessible, and helps coordinate care received from other providers.

Sicker adults in the U.K. and Switzerland were most likely to have a medical home, with nearly three-quarters connected to practices that have characteristics of a medical home, compared to about 33 percent to 65 percent in the other nine countries. U.K. and Swiss patients also reported more positive health care experiences than sicker adults in the other countries: they were more likely to be able to get a same- or next-day appointment when sick and to have easy access to after-hours care, and they were less likely to experience poorly coordinated care.

Sicker adults in the U.S. stood out for having the highest rates of problems paying medical bills and going without needed care because of the cost. Forty-two percent reported not visiting a doctor, not filling a prescription or skipping medication doses, or not getting recommended care—a significantly higher proportion than in all the other countries, and more than double the rates in Canada, France, the Netherlands, Norway, Sweden, Switzerland, and the U.K. Moreover, U.S. patients had among the highest rates of self-reported medication, lab, or medical errors, as well as gaps in coordination of care. (more…)

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Two Federal Studies Undertaken by the University of South Florida Point to Chiropractic Engagement to Aid in Injury Prevention

By John Wiens DC|November 7, 2011|Research|

Source Enhanced Online News

The Federal government has awarded the University of South Florida (USF), School of Physical Therapy & Rehabilitation Sciences $1.42 million to research the effectiveness of specific exercise interventions for reducing the risk of back injuries amongst some of the nation’s most vulnerable — firefighters and military personnel.

“Back injury is a primary condition that dramatically affects our nation’s heroes — cited as a top reason for disability and early retirement amongst firefighters, and a top non-combat reason for service men and women being displaced from active duty,” says John Mayer, D.C., Ph.D, associate professor and Lincoln College Endowed Chair in Biomechanical and Chiropractic Research at USF, and lead researcher in the $715,000 Department of Defense (DOD) and $701,000 Federal Emergency Management Agency (FEMA) studies. “These studies will be the first to be led by a Doctor of Chiropractic at a major university that will attempt to identify the preventive outcomes of applying specific exercise interventions amongst firefighters and soldiers.”

Each study will be conducted in several phases carried out over the next few years.

With research already in progress, the FEMA study will include 106 participants headquartered at a Tampa, Fla., fire department. Participants will undergo 24 weeks of bi-weekly supervised training sessions consisting of particular stability and resistance exercises with the goal of improving back muscular endurance — commonly documented as a direct link to back pain.

Expected to begin in spring 2012, the DOD study will include 600 active duty US Army soldiers and will provide a perspective that complements traditional directions of treatment-focus. Instead, the study will assess preventive methods by implementing and evaluating targeted high intensity exercise interventions designed to strengthen the back extensor muscles.

“Chiropractic engagement with regards to specific exercise interventions and their potential to prevent back conditions has continued to gain momentum,” says Mayer. “Federal agencies are now recognizing the skills of Doctors of Chiropractic to address prevention and treatment of back injury for our national heroes.”

To learn more about either study, visit www.health.usf.edu.

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