Evaluation & Management

The Subluxation Complex Saves Diagnosis for Texas Chiropractors

By Frank M. Painter|June 14, 2012|Announcement, Diagnosis, Evaluation & Management, Subluxation|

The Subluxation Complex Saves Diagnosis for Texas Chiropractors

SOURCE: Dynamic Chiropractic

By James Edwards, DC

On April 5, 2012, the Third Court of Appeals of Texas issued a 58-page opinion in Cause No. 03-10-673-CV – the Texas Board of Chiropractic Examiners (TBCE) and the Texas Chiropractic Association (TCA) vs. the Texas Medical Association (TMA), the Texas Medical Board (TMB) and the State of Texas.

According to an April 6, 2012 communication by the Texas Chiropractic Association [1], the case presented three questions for the court:

1) Are the two TBCE rules that allow chiropractors to make certain “diagnoses” valid?2) Can chiropractors perform MUA?3) Can chiropractors perform needle EMG?Here’s what the Court of Appeals had to say in the matter:

Diagnosis

On the two most important issues presented by the TCA, the Court of Appeals upheld the validity of TBCE’s Rules 75.17(d)(1)(A) and (B) (“the scope of practice rules”). The first rule, 75.17(d)(1)(A), permits chiropractors to render diagnoses “regarding the biomechanical condition of the spine and musculoskeletal system,” and lists six typical diagnostic areas as examples of what is within the scope of practice. At the district court level, Judge Yelenosky had struck down that rule, stating that it created an unlimited authorization to diagnose any disease or condition, which, he said, exceeded chiropractors’ scope of practice.

The Court of Appeals disagreed and reversed Judge Yelenosky’s decision. The court found that the TBCE rule does not exceed the scope of practice because the rule limits chiropractors to making diagnoses of the biomechanical condition of the spine and musculoskeletal system.

The second rule, 75.17(d)(1)(B), permits chiropractors to diagnose subluxation complexes of the spine or musculoskeletal system, and lists three examples of what is within the scope of practice. The Texas Medical Association and Texas Medical Board had challenged that rule, claiming that the rule allowed chiropractors to diagnose neurological conditions, and pathological and neurophysiological consequences that affect the spine and musculoskeletal system. At the district court level, Judge Yelenosky agreed and struck down the rule because he found that it expanded the scope of chiropractic beyond what was allowed in the Chiropractic Act.

Again, the Court of Appeals disagreed with District Court Judge Yelenosky. The appeals court acknowledged that a subluxation complex could have functional or pathological consequences that affect essentially every part of the body. But the court found that the rule itself only allowed chiropractors to render a diagnosis regarding a subluxation complex of the spine or musculoskeletal system. That authority, the appeals court held, was consistent with the Chiropractic Act. (more…)

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TMJ Trauma and Its Rehabilitation

By Frank M. Painter|June 12, 2012|Chiropractic Care, Evaluation & Management, TMJ|

TMJ Trauma and Its Rehabilitation

The Chiro.Org Blog

Clinical Monograph 13

By R. C. Schafer, DC, PhD, FICC

TEMPOROMANDIBULAR JOINT DYSFUNCTION

Proper treatment of TMJ dysfunction must be based on a thorough case history, a complete physical workup, an evaluation of the cranial respiratory impulse and craniosacral mechanisms, and a detailed examination of the TMJ, cranium, and cervical spine. Unfortunately, radiographs to determine abnormal joint space are rarely successful unless over 30% of the bone has been destroyed.

A blow to the jaw is easily transmitted to the temporal bones. As mentioned previously, osteopathic research suggests that a subluxated temporal bone is often the focal fault. This is reported to be grossly indicated by flattening (temporal internal rotation) or protrusion (temporal external rotation) of an ear from the skull.

Symptomatology

The major symptoms of TMJ dysfunction are masticator muscle fatigue and pain, which are usually described as a severe, unilateral (rarely bilateral), dull facial ache that is often fairly localized to an area just anterior to the tragus of the ear. The onset of pain is gradual, progressively increasing over several days or months. It is aggravated by chewing and opening and closing the mouth. Precipitation is often made by eating an apple, a wide yawn, snorkeling, prolonged dental work, playing a wind instrument, prolonged chewing, a bump or pressure on the mandible, sleeping in the prone position, or a cervical whiplash.

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Forearm and Wrist Trauma

By Frank M. Painter|June 11, 2012|Chiropractic Care, Diagnosis, Evaluation & Management|

Forearm and Wrist Trauma

The Chiro.Org Blog

Clinical Monograph 18

By R. C. Schafer, DC, PhD, FICC

As with most parts of the body, traumatic effects in the forearm or wrist may occur abruptly (eg, fracture, strain, sprain) or be the result of long-term microtrauma (eg, tunnel syndromes, arthritis, entrapment by scar tissue).

BACKGROUND

Screening injuries of the forearm and wrist

Joint Motion Restriction

Restriction in pronation suggests a disorder at the elbow, radioulnar articulation of the wrist, or within the forearm. Restriction in supination is associated with a disorder of the elbow or radioulnar articulation of the wrist. Thickened tissues may cause compression symptoms. A palpable nontender ganglion may be found on either the dorsal or volar aspect of the wrist, perceived as a pea-size or slightly larger jelly-like cyst.

Significance of Tenderness

Tenderness over the medial collateral ligament, which rises from the medial epicondyle, is a sign of valgus sprain. Muscle tenderness in the wrist flexor-extensor group is characteristic of flexor-pronator strain (eg, tennis, screwdriving motions). Tender, possibly taut, wrist extensors on the lateral aspect are often associated with tennis elbow. Tenderness in the first tunnel on the radial side is a common site for stenosing tenosynovitis associated with a positive Finkelstein’s sign. (more…)

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Initial Case Management Following Trauma

By Frank M. Painter|June 1, 2012|Chiropractic Care, Chiropractic Education, Clinical Decision-making, Evaluation & Management|

Initial Case Management Following Trauma

The Chiro.Org Blog

Clinical Monograph 2

By R. C. Schafer, DC, PhD, FICC

Without a doubt, no other health-care approach equals the efficacy of chiropractic in the general field of conservative neuromusculoskeletal rehabilitation.

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.

INTRODUCTION

The word trauma means more than the injuries so common with falls, accidents, and contact sports. Taber [1] 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.

Taber [1] states rehabilitation is “The process of treatment and education that lead the disabled individual to attainment of maximum function, a sense of well being, and a personally satisfying level of independence. The person requiring rehabilitation may be disabled from a birth defect or from an illness. The combined effects of the individual, family, friends, medical, nursing, allied health personnel, and community resources make rehabilitation possible.” It is surprising that Taber excludes trauma as a prerequisite for rehabilitation for it is the most common factor involved.

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Upper Back and Thoracic Spine Trauma

By Frank M. Painter|May 29, 2012|Chiropractic Care, Diagnosis, Evaluation & Management, Neck Pain, Spinal Manipulation|

Upper Back and Thoracic Spine Trauma

The Chiro.Org Blog

Clinical Monograph 23

By R. C. Schafer, DC, PhD, FICC

Upper-thoracic spasms and trigger points are common within the milder complaints heard in a chiropractic office. Typical posttraumatic injuries of the posterior thorax involve the large posterior musculature, thoracic spine, spinocostal joints, and tissues supporting and mobilizing the scapula (especially the rhomboids). Upper right abdominal quadrant ailments (eg, gallbladder, liver) commonly refer pain and sometimes tenderness to the right scapular area.

BACKGROUND

Severe biomechanical lesions of the thoracic spine are seen less frequently than those of the cervical or lumbar spine. But when they occur, they may be serious if related to disc protrusion or a dynamic facet defect. Shoulder girdle, rib cage, spinal cord, cerebrospinal fluid flow, and autonomic visceral problems originating in the thoracic spine are far from being scarce. Common biomechanical concerns are the prevention of thoracic hyperkyphosis, flattening, or twisting, as each can be suspected to contribute to both local and distal, acute and chronic possibly health-threatening manifestations.

Thoracic Fixations

The study of the thoracic spine is often perplexing. It was Gillet’s opinion that many fixations found in the thoracic spine were secondary (compensatory) to focal lesions in either the upper cervical spine or the sacroiliac joints. Thus, a maze of potential variables exists. Empiric evidence has suggested that many thoracic problems have their origin in its base, the lumbar spine or lower, while others are reflections of cervical reflexes. Also, a thoracic lesion may manifest symptoms in either the cervical or the lumbar spine. Foremost in an examiner’s thoughts should be the recognition that the thoracic spine is the structural support and sympathetic source for the esophagus, heart, bronchi, lungs, diaphragm, stomach, liver, gallbladder, pancreas, spleen, kidneys, and much of the pelvic contents. Referred pain and tenderness from these organs to the spine are common.

Screening Thoracic Vertebral Fractures (more…)

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A Basic Rehabilitative Template

By Frank M. Painter|May 24, 2012|Chiropractic Care, Clinical Decision-making, Diagnosis, Evaluation & Management, Evidence-based Medicine, Nutrition, Physical Therapy, Rehabilitation|

A Basic Rehabilitative Template

The Chiro.Org Blog

Clinical Monograph 1

By R. C. Schafer, DC, PhD, FICC

INTRODUCTION

Injuries can be classified into 13 types: abrasions, contusions, strains, ruptures, sprains, subluxations, dislocations, fractures, incisions, lacerations, penetrations, perforations, and punctures. This paper will not detail the management of burns or injuries requiring referral for operative correction, suturing, or restricted chemotherapy.

Objectives

Except for the most minor injuries, traumatized neuromusculoskeletal tissues are benefited by alert restorative procedures. The more serious the injury, the more prolonged is and the greater the need for professionally guided rehabilitation. The first step in rehabilitation is to explain to the patient that rehabilitation is just as important as the initial care of the injury. The goal is not only to restore the injured part to normal activity or as near normal as possible in the shortest possible time but also to prevent posttraumatic deterioration. It is an individualized process that requires patient dedication. The author recognizes that it is easier to write about comprehensive planning than to motivate some patients to follow prescriptions after pain has subsided.

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Chiropractic Rehabilitation

Most authorities would agree with Harrelson when he lists the goals of rehabilitation as:

decreased pain;
decreased inflammatory response to trauma;
return of full pain-free active joint ROM;
decreased effusion;
return of muscle strength, power, and endurance; and
regain of full asymptomatic functional activities at the preinjury level (or better).

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