Rotator Cuff

The picture at the top of this post shows the four muscles which make up the Rotator Cuff.  We use the acronym SITS but, we can do one better by spelling it as "SItS" with a small 't' which helps remind us that it's the teres minor and not teres major which makes up part of the rotator cuff muscles.  We can also think of a big league pitcher who has injured his rotator cuff muscle because then he has to SIT out and eventually gets sent back to the minors.
We also note with the accompanying picture that we will start about about the 1 o'clock position and move clockwise to obtain the word "SItS"
While we're looking at these muscles we can do a quick review of the nerve innervation to each muscle.

• S - Supraspinatus and Infraspinatus are both innervated by the suprascapular nerve
• T - Teres Minor is innervated by the axillary nerve
• S - Subscapular m. is innervated by the subscapular nerve

Carpal Tunnel Syndrome!

Pretty much everyone has heard of this one.  A lot of people will associate this condition as being caused by repetitive overuse of the wrist joints or hands.  This would fall under the category of trauma but, as our nifty little mnemonic would show, trauma is one of 10 different possible causes for Carpal Tunnel Syndrome (CTS).  The mnemonic is "MEDIAN TRAP" and it's a good mnemonic because the median nerve is exactly what's being disturbed in CTS.  The mnemonic is as follows;

• Myxoedema
• Edema premenstrually
• Diabetes mellitus
• Idiopathic
• Acromegaly
• Neoplasm
• Trauma
• Rheumatoid arthritis
• Amyloidosis
• Pregnancy

For anyone that's found this blog entry because you actually have CTS, you may wish to consider a theurapeutic technique known as Graston.  Here is a main graston website, http://www.grastontechnique.com/.  and if you Google "graston carpal tunnel" you can get a lot of specific information pertaining to CTS.

On the Outcome Data page (http://www.grastontechnique.com/Outcome_Data.html) Graston Technique (GT) boast a success rate of 86% with an average of 8 treatments.  

With GT a doctor, probably a chiropractor, will use a very expensive set of tools to help work on your muscles and connective tissue.  The set of tools pictured here runs for $2,755.00

I have got to practice with these a bit (although not yet certified in their use) and the website explains it pretty well.  These are surgical steel instruments which actually resonate in the physicians hands which allow isolation of adhesions and restrictions and very precise treatment.  The analogy of a stethoscope is often used since just as a stethoscope amplifies what the human ear can hear, so do the instruments increase significantly what the human hands can feel.

Anyway, given a choice between someone cutting into your arm with a knife or giving Graston a shot first, I would definitely Graston and perhaps even an adjustment or two a shot first.

Wow - the main point of this post was to talk about the carpal bones and help prep for an upcoming video but, it's 5:22 a.m. and I'm starting to get a bit tired.

I'd like to get another video posted on YouTube that's as popular as my Brachial Plexus video which, in itself is a tall order.

The carpal bones are the bones that make up your wrist.  There are eight of them.  In the foot we have tarsals and there are seven of them.  (3 cuneforms, a cuboid, navicular talus and calcaneus)  The remaining bones of the hands and feet are pretty much the same after that with a total of 27 bones in each hand and 26 in each foot for a total of 106 bones for those of us with both hands and feet.  I'm always amazed by that.  We generally cite 206 bones total in the human body and over half those bones can be found in the hands and feet.

For the carpals we have two rows of bones, a proximal row (that row closest to the body) and a distal row, further away from the body, towards the fingers.
Each row has four bones and we generally name these from lateral to medial which means from the thumb side of the hand to the pinky side of the hand.
Scaphoid, Lunate, Triquetrum (aka triquetral) and pisiform

on the distal row we have the trapezium, trapazoid, capitate and hamate.

The fun mnemonic we have to help remember these bones is "Some Lovers Try Positions They Can't Handle"
The scaphoid is the most commonly fractured carpal bone and 70% of the time that fracture is in the "waist" area (about midway down).  The scapohid has an interesting blood supply.  There's generally two arteries that enter the scaphoid and the oddity here is that one enters distally and the other around the waist or middle of the bone.  I can't think of a lot of bones offhand where the blood supply goes to the far end of the bone only to make a u-turn to infiltrate the bone.
The big deal with the blood supply configuration is that it makes the scaphoid bone more prone to AVN, avascular necrosis since a fracture below the blood supply can result in death of the parts of the bone to which the blood is cut off.
The capitate is the largest of the carpal bones.
Scaphoid means boat and, is kinda shaped like a boat.  Lunate gets it's name derivation from Luna which means moon and is somewhat crescent shaped.  The pisiform is like a pea and rest on top of the triquetrum.

going to have to call it a night and get an hour or two of sleep.  so much more to talk about regarding those nifty little bones....

Definition of a Derivative - Math?

Up and Running - Opening a Chiropractic Office (Google Affiliate Ad)

I've been doing a bit of math tutoring lately and it got me thinking about branching out and trying an educational Math video on YouTube.  I've been away from formal math classes for about 20 years now but, I still remembered the definition of a derivative so I made a video out of that.  There was a time when I was able to integrate the Gaussian Curve (i.e., Bell Curve) to 1 but, I've since forgotten how to do that.  At least now I won't have to forget this basic math definition.  Below are the five videos with links that I've uploaded so far.

#5 - Definition of a Derivative:  http://youtu.be/3kR7A10hMHU

#4 - Heart Murmurs:  http://youtu.be/sL0vHiXLZ-4

#3 - The Bohr Effect:  http://youtu.be/D_fmHT82mK0

#2 - Collateral Arteries:  http://youtu.be/5B0kK7p2lfc

#1 - Brachial Plexus:  http://youtu.be/gTas7ijp0YE

The analytical data regarding these videos is fascinating.  The Heart Murmur video I uploaded only two days ago has already been viewed in the Czech Republic, Germany and the United Kingdom.  The Bohr Effect video has also been viewed in Hong Kong and Saudi Arabia in addition to the US and UK.

Total viewing time of these videos has been estimated by YouTube at 1,067,452 minutes!  that takes a bit of calculating to put it in more familiar terms but basically, it's a tad over 2 solid years of viewing of the above videos.  The Brachial Plexus video makes up about 960,000 of the viewed minutes.

I will have to get back into the medical videos and have been thinking of doing one on visual fields and maybe a couple more mnemonics.  There's two, off the top of my head for the cranial nerves (CN), one to remember the CN names and the other to help remember if they are motor, sensory or both.  Another mnemonic that comes to mind is for the TCA cycle or the Kreb's cycle.

Sunday, November 25, 2012

I've got a couple new videos up on YouTube in the past week.  One is on the Bohr Effect and the other is on heart murmurs in diastole.
for the Bohr Effect: http://youtu.be/D_fmHT82mK0
Heart Murmurs http://youtu.be/sL0vHiXLZ-4

and, for completness,

Collateral & Recurrent Arteries: http://www.youtube.com/watch?v=5B0kK7p2lfc
Brachial Plexus:  http://youtu.be/gTas7ijp0YE

Tri-10 Wk10 Day? - Friday 3/15/12 - 2 days away...

2 days, 0 hours, 0 minutes until Part III.

9:54 a.m. - 1 day, 22 hours, 5 minutes until Part III....

I think I need to go for quantity over quality. I very much like going in depth with things... diseases, etiologies and so forth but I can probably be better served with simple associations.

Quick review - DR CUMA

Drop Wrist - Radial Nerve

Claw Hand - Ulnar Nerve

Median Nerve - Ape Hand

for shoulder orthopedic test: CAADDYS

Codman's - rotator cuff

Apley's - ROM

Apprehension - Chronic Disclocation

Dugas' - Dislocation (Kocker's maneuver)

Dawbarn's - Bursitis

Yerguson's - Bicipital tendon instability (transverse humeral ligament)

Speed's - Tendonitis

Cervical Orthopedic Test

Compression, Jackson's, Maximal - IVF encroachment

Spurling's - disc & IVF encroachment

Bakody's - (Xu pain) nerve root syndrome

Shoulder depressor - nerve root adhesions

distraction - nerve root v. musculoskeletal

O'Donohue - Sprain v sprain

Soto Hall's - General

Lhermitte's - Cord degeneration (MS)

Tri-10 Wk10 Day? - Wednesday, March 14, 2012

3 days, 20 hours, 18 minutes until Part III - interspersed focused study needed.

I'll be using the Part III Study Prep guide obtained from NBS to help with the focus.

NMS Exam consist of 13% of our exam

1. Posture & Gait knowledge

2. Ortho & Neuro Test purposes

3. Peripheral vascular conditions especially TOS, claudication and RSDS.

RSDS is kind of a favorite of mine.

DR CUMA

Drop Wrist - Radial Nerve

Claw Hand - Ulnar Nerve

Median Nerve - Ape Hand

I remember there is a ddx on the Claw Hand -

Claw Hand, Ulnar nerve, Tunnel of Guyon

Dupuytren's - flexed 4th & 5th digit - Hereditary, red ropey fascia

Volkmann's - flexed 4th & 5th digit - Post Trauma

Parkinson's - Parkinsonian Gait - Seen in the basal-ganglia defects of Parkinson disease. Posture is stopped, with flexion of head, arms, hips and knees. Patients are slow getting started. Steps are short & shuffling with involuntary hastening (festination). Arm swings are decreased and patients turn around stiffly (all in one piece). Postural control is poor (retropulsion)

Key Words: Propulsion / Festinating / Shuffling / Mincing, Rigid, subthalamic, forward leaning posture w/ small shuffling steps.

Scissors Gait - Seein in spinal cord disease cuasing bilateral lower extremity spasticity including adductor spasm and abnormal proprioception. Gait is stiff. Patients advance each leg slowly and the thighs tend to cross forward on each other at each step. Steps are short. Patients appear to be walking through water.

ddx - Cerebral Palsy / adductor spasm, Knees together (ddx from waddling (MD) in which knees are apart)

Waddling (hip flexors) - Muscular Dystrophy -

L4 - Steppage Gait - Seen in food drop, usually secondary to peripheral motor unit disease. Patients either drag the feet or lift them high with knees flexed and bring them down with a slap onto the floor thus appearing to be walking up stiars. They cannot walk on their heels. The steppage giat may involve one or both legs Tibialis anterior and toe extensors are weak.

Key Words/ ddx - L4, Anterior Compartment Syndrome (ACS), foot drop, L4 Lesion / paresis of tibialis anterior

L5 - Gluteus Medius Lurch - Lateral sway over the weight bearing leg

S1 - Glueteus Maximus Lurch - AP sway (leans back during mid stance)

Spastic Hemiparesis - Seen in corticospinal tract lesion in stroke, causing poor control of flexor muscles during swing phase. Affected arm is flexed, immobile and held close to the side, with elbow, wrists and interphalangeal joints flexed. Affected leg extensors spastic; ankle plantar-flexed and inverted. Patients may drag toe, circle leg stiffly outward and forward (circumduction) or lean trunk to contralateral side to clear affected leg during walking.

Slappage gait - Sensory Ataxia - posterior column disease; sensory ataxia (difficulty walking in the dark) gait is unsteady with a wide base (feet wide apart) patients throw their feet forward and outward adn bring them down, first on the heels and ten on hte toes with a double tapping sound. They watch the ground for guidance when walking. With eyes closed, they cannotstand steadily with their feet together (positive Romberg sign) and the staggering gait worsens.

Tri-10 Wk10 Day? Tuesday, March 13, 2012

Tri-10 Wk10 Day ? Monday, March 12th, 2012

...up late last night reading a bunch of stuff for my Senior Research Project (SRP). Very interesting material though and quite engaging. My head was swimming with new information yesterday. I remember some of the studies we went through in advanced Basic which included one on the decrease of melatonin production for kids who sleep with nightlights. Another study was the correlation between platelet calmodulin levels and predictability in scoliosis patients.

Today my mind got put through the grinder with Dr. Ketner in our differential diagnosis class. I think it's going to take me four days of study and review to even start to fully appreciate & digest everything he told us today.

Super nice outside ...I do believe I'll be going for a walk :)