Education

A QUIZ: Identifying Common and Dangerous Neck Masses

By Frank M. Painter|June 8, 2012|Continuing Education Credit, Education|

A QUIZ: Identifying Common and Dangerous Neck Masses

SOURCE: MedScape
Note: Registration is free

Accurate diagnosis of neck masses is critical to minimize morbidity and mortality. However, differentials vary greatly and can be challenging for the physician.

Neck masses are common presenting complaints, but differential diagnoses vary considerably based on patient age and the location of the neck mass. Most neck masses in the pediatric population have an infectious etiology, whereas an adult neck mass is considered to be a malignancy until proven otherwise. Evaluation of a neck mass depends on the history and physical examination; evaluation may also include observation, antibiotics, fine-needle aspiration, open biopsy, neck dissection, or wide local excision.

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Clinical Decision-making to Facilitate Appropriate Patient Management in Chiropractic Practice: ‘The 3-questions Model’

By Frank M. Painter|March 15, 2012|Chiropractic Care, Clinical Decision-making, Diagnosis, Education|

Clinical Decision-making to Facilitate Appropriate Patient Management in Chiropractic Practice: ‘The 3-questions Model’

The Chiro.Org Blog

SOURCE: Chiropractic & Manual Therapies 2012 (Mar 14); 20: 6

Lyndon G Amorin-Woods and Gregory F Parkin-Smith

Murdoch University, School of Chiropractic and Sports Science, South Street, Murdoch, 6150 Perth, Western Australia. L.Woods@murdoch.edu.au

Background: A definitive diagnosis in chiropractic clinical practice is frequently elusive, yet decisions around management are still necessary. Often, a clinical impression is made after the exclusion of serious illness or injury, and care provided within the context of diagnostic uncertainty. Rather than focussing on labelling the condition, the clinician may choose to develop a defendable management plan since the response to treatment often clarifies the diagnosis.

Discussion: This paper explores the concept and elements of defensive problem-solving practice, with a view to developing a model of agile, pragmatic decision-making amenable to real-world application. A theoretical framework that reflects the elements of this approach will be offered in order to validate the potential of a so called ‘3-Questions Model’;

Summary: Clinical decision-making is considered to be a key characteristic of any modern healthcare practitioner. It is, thus, prudent for chiropractors to re-visit the concept of defensible practice with a view to facilitate capable clinical decision-making and competent patient examination skills. In turn, the perception of competence and trustworthiness of chiropractors within the wider healthcare community helps integration of chiropractic services into broader healthcare settings.

From the FULL TEXT Article:

Development of the 3-questions Model

The chiropractic profession, particularly in Western countries, finds itself in a rapidly evolving healthcare landscape, with ‘modernisation’ being a consequence of escalating costs, an aging population, and an ever-diminishing relative resource base [9]. With a view to rationalising resources health system decision-makers are increasingly vigilant about the delivery of safe, evidence-based, cost-effective care, summarised as “the right care at the right time in the right place” [10, 11]. With this imperative in mind, the authors propose three straightforward questions that frame clinical decision-making within the context of diagnostic uncertainty.

There are more articles like this @ our:

Low Back Pain Page and the

A Clinical Model for the Diagnosis and Management Page

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The Facts About Fevers

By Frank M. Painter|February 19, 2012|Education, Fever Management, Immune System, Pediatrics|

The Facts About Fevers

The Chiro.Org Blog

SOURCE: To Your Health ~ January 2012

By Claudia Anrig, DC

Our body’s first line of defense when invaded by any microbe, virus or bacteria is cells called microphages; a strong, healthy immune system may be able to eliminate the problem with this first step alone. If these fail to contain the microbe/”bug,” then the body creates other pryogens and proteins to try to assist. Once these have been created, the hypothalamus in the brain recognizes there is an invader and raises the body temperature to assist in killing it off.

This elevated temperature will generally be just a couple of degrees, but the hypothalamus determines, based on the number of pryogens and proteins, what will be necessary to eliminate the microbe/bug. If the hypothalamus creates additional biochemicals to try to protect the body, then the temperature rises accordingly.

Defining a Fever

For all children above the age of 3 months, a fever is actually a good thing. It’s a sign that their immune system is functioning properly. Although many parents will panic when their child has a temperature above 98.6° F (37° C), and this is understandable since many health care providers have called this a “low-grade fever,” the reality is that children’s temperature may naturally run a little higher than what many consider the norm.

A true low-grade fever is anything between 100°F and 102.2°F (37.8° C and 39° C). This level of fever is beneficial; with most microbes/”bugs” that a child will be exposed to, this fever will assist the body in repelling the invader.

A moderate-grade fever is typically between 102.2° F and 104.5° F (39° C and 40° C). This temperature is still considered beneficial; if a child’s body has reached this temperature, it’s what’s needed to kill whatever bacteria or virus their body is attempting to fight.

A high fever is a fever greater than 104.5° F (40° C). This fever may cause the child some discomfort and result in a bit of crankiness. Generally indicative of a bacterial infection, this fever means that the body is fighting something a little more serious than the common cold. While it will not cause brain damage or any other harm to a child, it is wise to seek assistance from their medical provider.

A serious fever is one that is at or above 108° F (42° C); this fever can be harmful.

Can a Fever Be Dangerous? (more…)

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Cervical Spine Trauma

By Frank M. Painter|January 23, 2012|Chiropractic Care, Education|

Cervical Spine 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 4 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 4: CERVICAL SPINE TRAUMA

The cervical spine provides musculoskeletal stability and supports for the cranium, and a flexible and protective column for movement, balance adaptation, and housing of the spinal cord and vertebral artery. It also allows for directional orientation of the eyes and ears. 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 cervical region.

BACKGROUND

Whether induced by trauma or not, cervical subluxation syndromes may be reflected in total body habitus. IVF insults and the effects of articular fixations can manifest throughout the motor, sensory, and autonomic nervous systems. Many peripheral nerve symptoms in the shoulder, arm, and hand will find their origin in the cervical spine, as may numerous brainstem disorders.

COMMON INJURIES AND DISORDERS OF THE CERVICAL SPINE

Cervical spine injuries can be classified as

(1) mild (eg, contusions, strains);

(2) moderate (eg, subluxations, sprains, occult fractures, nerve contusions, neurapraxias);

(3) severe (eg, axonotmesis, dislocation, stable fracture without neurologic deficit); and

(4) dangerous (eg, unstable fracture-dislocation, spinal cord or nerve root injury).

Spasm of the sternocleidomastoideus and trapezius can be due to strain or irritation of the sensory fibers of the spinal accessory nerve as they exit with the C2—C4 spinal nerves. The C1 and C2 nerves are especially vulnerable because they do not have the protection of an IVF. Radicular symptoms are rarely evident unless an IVD protrusion or herniation is present.

PREVALENCE

Because of its great mobility and relatively small structures, the cervical spine is the most frequent site of severe spinal nerve injury and subluxations. A large variety of cervical contusions, Grade 1—3 strains and sprains, subluxations, disc syndromes, dislocations, and fractures will be seen as the result of trauma.

The most vulnerable segments to injury are the axis and C5—C6 according to accident statistics. Surprisingly, the atlas is the least involved of all cervical vertebrae. In terms of segmental structure, the vertebral arch (50%), vertebral body (30%), and IVD (30%) are most commonly involved in severe cervical trauma. While the anterior ligaments are only involved in 2% of injuries, the posterior ligaments are involved in 16% of injuries.

EMERGENCY CARE

In the emergency-care situation, the patient with spinal cord injury must be treated as if the spinal column were fractured, even when there is no external evidence. Immediate and obvious symptom of spinal cord injury parallel those of fractures of the spinal column. The establishment of an adequate airway takes priority over all other concerns except for spurting hemorrhage. (more…)

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Brain Impact: Concussions, Chiropractic and New Laws

By Frank M. Painter|January 3, 2012|Concussion, Education, Traumatic Brain Injury|

Brain Impact: Concussions, Chiropractic and New Laws

The Chiro.Org Blog

SOURCE: Dynamic Chiropractic

By Robert “Skip” George, DC, CCSP, CSCS

Concussions are (finally) getting the attention of the athletic world, state governments and health care providers of all disciplines.

On Oct. 23, 2011, San Diego Chargers offensive guard Kris Dielman suffered a concussion during a football game against the New York Jets with 12:31 left to play.

He landed hard on the ground after a wicked collision with a Jets linebacker, then got up, wobbled and went back to playing the rest of the game, taking several more hits to the head. Neither the Chargers training staff nor the NFL referees recognized how serious his head injury was as he “waved off” his sideline training staff to return to the huddle. On the flight home to San Diego after the game, Dielman suffered a “grand mal” seizure and will most likely not play for the rest of the season.

Magnitude of the Problem

Concussions are getting much-needed attention in the press, especially given the short- and long-term cognitive loss, early-onset dementia, physical disability and even death resulting from traumatic brain injury (TBI). Chronic traumatic encephalopathy is a chronic, degenerative neurologic disease linked to repetitive head trauma and is known as an invisible killer that can make a 35-year-old brain look more like 80 years old.

There are 250,000 concussions annually in football alone. The prevalence in high-school and college athletics is a major concern, especially considering how big, fast and strong high-school and college athletes have become, and how their play emulates the professionals. This “evolution” is exacting a terrible toll regarding TBI in not only football, but also soccer, hockey, wrestling, water polo and cheerleading.

Three Purdue University professors tracked 21 football players from Lafayette Jefferson High School in Indiana. For two years they kept a record of every hit in practice and during games. They found that half of the players had neurophysiologic changes from contact. They also discovered that the repetitive hits the players were receiving had a cumulative effect on the brain and resulted in brain wave changes that mimicked concussion, even when the contact did not result in a concussion!

Concussion Basics

What is a concussion? It can be defined as “a complex pathophysiological process affecting the brain, induced by traumatic biomechanical forces” or “an immediate and transient loss of neuronal function secondary to trauma.” Signs and symptoms include but are not limited to thinking deficits, lack of sustained attention; amnesia; confused mental status; dazed look / vacant stare; slurred or incoherent speech; vomiting; nausea; emotional liability; slow motor or verbal response; memory deficits; poor coordination; dizziness; headache; restlessness; nervous weakness; exhaustion; and irritability. (more…)

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Chiropractic Perspectives On Myofascial Therapy

By Frank M. Painter|December 22, 2011|Education, Technique|

Chiropractic Perspectives On Myofascial 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 15 from RC’s best-selling book:

“Applied Physiotherapy in Chiropractic”

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: Chiropractic Perspectives On Myofascial Therapy

The purpose of this chapter is to improve the doctor of chiropractic’s understanding of the significance of myofascial pain and dysfunction, and to improve the chiropractor’s level of competence in diagnosing the myofascial component of the subluxation complex.

The myofascial orientation in the chiropractic setting directs the doctor to look first for a myofascial source of the patient’s pain, and when found, to use numerous techniques and procedures to offer rapid relief. Lowe recommends broad spectrum therapeutics to be employed after the performance of myofascial therapy to assure maximum flexibility. [1]

Definition

Myofascial therapy may be defined in several ways. Basically, it is the treatment of the myopathophysiologic component of the vertebral subluxation complex. It is also the treatment of trigger points, areas of increased neurologic activity in muscle tissue, causing the secondary referral of pain with subsequent associated autonomic changes. [2]

The pain attributed to myofascial dysfunction is usually restricted to a certain region such as the cervical or upper thoracic area, lumbar and buttock area, or the cranial/TMJ area. A trigger point, often the cause of such pain, is always tender and palpably taut. This prevents full lengthening of the muscle and produces muscle weakening, altered proprioception, predictable referred pain patterns, and an objectively verifiable local twitch response during palpation. [3]

Historic Background

Several key figures have contributed to our understanding of the widespread cause of muscular pain syndromes, among them Travell, Rolf, and, in our own profession, Nimmo. Another chiropractor who added greatly to our understanding of the role of muscles in various pain syndromes was Gillet of Belgium. Gillet wrote, “Concerning the subluxation or misalignment, we prefer the term fixation, which describes far more accurately the actual status of the [peri]articular soft tissues, where we will find that it is the state of these tissues that actually keeps the two surfaces from moving. The osteopaths, very early on, stated that the soft tissues can vary from the simplest muscular contracture to a complete degenerative fibrosis of the muscles. The previous facts are not new ….unfortunately, x-rays, introduced early in chiropractic history, have done much to propagate the idea of the spine as a string of bones. Even today, many practitioners act as if they still believe the childish propaganda they so nimbly offer to the public, that it’s a bone out of place in the back.” [4] (more…)

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