Diagnosis

Upper Extremity Technique: Adjustment of Upper Extremity Joint Subluxations-Fixations

By Frank M. Painter|October 15, 2009|Diagnosis, Education, Subluxation, Technique|

Upper Extremity Technique: Adjustment of Upper Extremity Joint Subluxations-Fixations

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 2 from RC’s best-selling book:

“Upper Extremity Technique”

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 2: Adjustment of Upper Extremity Joint Subluxations-Fixations

This chapter describes adjustive therapy as it applies to articular malpositions of the lateral clavicle, shoulder, elbow, wrist, and hand. Manipulations to free areas of fixation are also covered.

Screening Tests for the Upper Extremity as a Whole

The Shoulder Girdle

As with other areas of the body, it is good procedure during observation to first note the general characteristics and then inspect for details. Visualize the anatomy involved while observing the overall bilateral symmetry, rhythm of motion, swing during gait, smoothness in reach, patterns of pain, and general circulatory and neurologic signs. Inspect for gross abnormal limb rotation or adduction. Note skin discolorations, masses, scars, blebs, swellings and lumps, abrasions, and overt signs of underlying pathology. Carefully note the biomechanical relationship of the neck with the shoulder girdle and both with the thorax. Observation should be conducted on all sides.

With the patient sitting, inspect the anterior aspect of the shoulder girdle starting with the clavicle. A fracture or dislocation at either the medial or lateral end of the clavicle is usually quite obvious by the apparent change in contour and exaggerated round shoulders to protect movement. Note the normally symmetrical fullness and roundness of the anterior aspect of the deltoid as it drapes from the acromion over the greater tuberosity of the humerus. Unusual prominence of the greater tuberosity of the humerus suggests deltoid atrophy, while a sharp change in contour unilaterally suggests dislocation. A forward displacement of the tuberosity exhibits an indentation under the point of the shoulder and a loss of normal lateral contour. The most common points of abnormal tenderness are at the acromioclavicular joint and in the rotator cuff.

To test the general integrity of the shoulders, have the patient place the hands on top of the head and pull the elbows backward. This will be painful, if not impossible, in shoulder bursitis, arthritis, and rotator-cuff strains. Apley’s scratch test is another good screening procedure. Note if the scapula and humerus move in harmony.

Branch points out that spasm above or over the scapula will be readily recognized if the examiner observes the patient from the back during horizontal abduction. If such spasm exists (eg, from cervical radiculitis), horizontal abduction of the arm will occur with little motion of the scapula. However, if the origin of pain is within the shoulder, a “shrugging” motion occurs, in which the apex of the scapula sharply swings laterally but glenohumeral motion is restricted.

The Elbow and Forearm (more…)

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Lower Back Trauma

By Frank M. Painter|October 11, 2009|Diagnosis, Education, Low Back Pain|

Lower Back Trauma

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 12 from RC’s best-selling book:

“Chiropractic Posttraumatic Rehabilitation”

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 12: LOWER BACK TRAUMA

Although it is easier to teach anatomy by dividing the body into arbitrary parts, a misinterpretation can be created. For instance, we find clinically that the lumbar spine, sacrum, ilia, pubic bones, and hips work as a functional unit. Any disorder of one part immediately affects the function of the others.

BACKGROUND

A wide assortment of muscle, tendon, ligament, bone, nerve, and vascular injuries in this area is witnessed during posttrauma care. As with other areas of the body, the first step in the examination process is knowing the mechanism of injury if possible. Evaluation can be rapid and accurate with this knowledge.

Low-back disability rapidly demotivates productivity and athletic participation. The mechanism of injury is usually intrinsic rather than extrinsic. The cause can often be through overbending, a heavy steady lift, or a sudden release —all which primarily involve the muscles. IVD disorders are more often, but not exclusively, attributed to extrinsic blows and intrinsic wrenches. An accurate and complete history is invariably necessary to offer the best management and counsel.

INITIAL ASSESSMENT

A player injured on the field or a worker injured in the shop should never be moved until emergency assessment is completed. Once severe injury has been eliminated, transfer to a back board can be made and further evaluation conducted at an aid station.

Neurologic Levels

(more…)

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Motion Palpation of the Cervical Spine

By Frank M. Painter|October 7, 2009|Cervical Spine, Diagnosis, Education, Motion Palpation|

Motion Palpation of the 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 3 from RC’s best-selling book:

“Motion Palpation”

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 Cervical Spine

This chapter describes the basic biomechanical, diagnostic, and therapeutic considerations related to motion palpation and the cervical spine. Emphasis will be on relating the general concepts previously explained about the chiropractic fixation-subluxation complex to specific entities that can be revealed by motion palpation and frequently corrected by dynamic chiropractic. Some aids to differential diagnosis are also included.

APPLIED ANATOMY CONSIDERATIONS

There are seven sites of possible “articular” fixation in the cervical spine. They are at the bilateral apophyseal joints, the bilateral covertebral joints, the superior and inferior intervertebral disc (IVD) interfaces, and the odontal-atlantal articulation (Table 3.1).

Table 3.1. The 27 Sites of Possible Spinopelvic Articular Fixation

In the cervical spine (7 possible sites of fixation)
Bilateral apophyseal joints	2
Bilateral covertebral joints	2
Superior and inferior IVD interfaces	2
Odontal-atlantal articulation	1
In the thoracic spine (8 possible sites of fixation)
Bilateral apophyseal joints	2
Superior and inferior IVD interfaces	2
Bilateral costovertebral joints	2
Bilateral costotransverse joints	2
In the lumbar spine (4 possible sites of fixation)
Bilateral apophyseal joints	2
Superior and inferior IVD interfaces	2
In the pelvis (8 possible sites of fixation)
Bilateral superior sacroiliac joints	2
Bilateral inferior sacroiliac joints	2
Sacrococcygeal joint	1
Pubic joint	1
Bilateral acetabulofemoral joints	2

The Apophyseal Joints of the Spine

Throughout the spine, paired diarthrodial articular processes (zygapophyses) project from the vertebral arches. The superior processes (prezygapophyses) of the inferior vertebra contain articulating facets that face somewhat posteriorly. They mate with the inferior processes (postzygapophyses) of the vertebra above that face somewhat anteriorly. Each articular facet is covered by a layer of hyaline cartilage that faces the synovial joint. The angulation of vertebral facets normally varies with the level of the spine and can be altered by wear and pathology.

In visualizing the motion of any joint, it is helpful to keep in mind that the hyaline-coated articulating surface is not the shape of the often flat bony surface exhibited on an x-ray film. Most apophyseal joints of the spine have a convex-concave shape.

Fisk states that the posterior joints of the spine are more prone to osteoarthritic changes than any other joint in the body: “Evidence of disc degeneration precedes this arthritis in the lumbar spine, but there is no such relationship in the cervical spine.” However, most authorities agree with Grieve that the presence of arthrotic changes in the facet planes does not, of itself, necessarily have any effect on ranges of movement, neither does the presence of osteophytosis.

Regional Structural Characteristics

Review the complete Chapter (including sketches and Tables) at the ACAPress website

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Posttraumatic Rehabilitation: The Rationale of Rehabilitative Therapy

By Frank M. Painter|October 6, 2009|Diagnosis, Education, Rehabilitation, Technique|

Posttraumatic Rehabilitation: The Rationale of Rehabilitative Therapy

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 1 from RC’s best-selling book:

“Chiropractic Posttraumatic Rehabilitation”

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 1: The Rationale of Rehabilitative Therapy

Preface

For many centuries, therapeutic rehabilitation was a product of personal experience passed on from clinician to clinician. In the last 20 years, however, it has become an applied science. In its application, of course, much empiricism remains that can be called an intuitive art –and this is true for all forms of professional health care.

The word trauma means more than the injuries so common with falls, accidents, and collision sports. Taber* defines it as “A physical injury or wound often caused by an external force or violence” or “an emotional or psychologic shock that may produce disordered feelings or behavior.” This is an extremely narrow definition for trauma can also be caused by intrinsic forces as seen in common strain. In addition to its cause being extrinsic or intrinsic, with a physical and emotional aspect, it also can be the result of either a strong overt force or repetitive microforces. This latter factor, so important in treating a unique patient’s specific pathophysiology, is too often neglected outside the chiropractic profession. (more…)

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Physical Examination of the Neck and Cervical Spine

By Frank M. Painter|October 2, 2009|Cervical Spine, Diagnosis, Education|

Physical Examination of the 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 8 from RC’s best-selling book:

“Spinal and Physical 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 8: Physical Examination of the Neck and Cervical Spine

In general, the neck viscerally serves as a channel for vital vessels and nerves, the trachea, esophagus, spinal cord, and as a site for lymph and endocrine glands. From a musculoskeletal viewpoint, the neck provides stability and support for the cranium, and a flexible and protective spine for movement, balance adaptation, and housing of the spinal cord and vertebral artery. Cervical flexion, extension, and rotation contribute to one’s scope of vision.

From a biomechanical viewpoint, primary cervical dysarthrias may reflect themselves in the total habitus; from a neurologic viewpont, insults many manifest themselves throughout the motor, sensory, and autonomic nervous systems. Many peripheral nerve symptoms in the shoulder, arm, and hand will find their origin in the brachial plexus and cervical spine. 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.

Neck pain must be differentiated as to its date of onset and chronology, site and distribution, type (intermittent, constant), duration (acute, chronic), character (sharp, dull, lanciating), relation to posture (rest, occupation, recreation), and associated problems. Nonpharyngeal pain on swallowing may be traced to an anterior cervical spinal pathology such as bony protuberance or osteophytes, infection, mass or tumor. Pain is often referred to the neck from the TMJ, mandibular or dental infection, or sinus infection.

Inspection of the Neck (more…)

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Sports Management: Basic Spinal Subluxation Considerations

By Frank M. Painter|October 1, 2009|Diagnosis, Education, Subluxation|

Sports Management:
Basic Spinal Subluxation Considerations

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 19 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 19: Basic Spinal Subluxation Considerations

The concept that an “off centered” vertebral or pelvic segment parallels a unique effect upon the neuromuscular bed which may be the cause of, aggravation of, or “triggering” of certain syndromes is a major contribution to the field of functional pathology and clinical biology by the chiropractic profession.

This section discusses the basic biomechanics and effects of vertebral subluxations as related to the management of sports-related and recreational injuries.

Spinal Biomechanics

While the erect spinal column is a concern in static postural equilibrium, it is never actually in a static state in life. It is alternately changing from a state of “quiet dynamics” in the static postural attitude to a state of “active dynamics” in movement. These kinetic aspects of normal spinal biomechanics are an important consideration since the totality of spinal function is the sum of its individual component parts.

The Vertebral Motor Unit

An intervertebral motor unit consists of two vertebrae and their contiguous structures forming a set of articulations at one intervertebral level. Thus, what is called a vertebral “subluxation” in chiropractic is the alteration of the normal dynamics, anatomical or physiological relationships of contiguous articular structures. The components of the spinal column (the vertebral motor units) confer a quality and quantity of motoricity to the relationship of two vertebrae. They are firmly interconnected by the intervertebral disc and restraining ligaments, which are activated by muscles which respond to both sensory and motor stimulation. (more…)

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