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Thoracic Outlet Syndrome Thoracic Outlet Syndrome/Brachial Plexopathy. In Memory Of DeAnne Marie.

Sternocleidomastoid Syndrome and other articles from Chiroweb

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Unread 03-31-2007, 12:36 AM   #1
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Default Sternocleidomastoid Syndrome and other articles from Chiroweb

The sternocleidomastoid (SCM) muscle is one of the most complex in the body. It functions as both a short range (clavicular head) and long range (sternal head) rotator, an upper cervical extensor, a flexor of the cervical spine on the thoracic spine, a lateral flexor, as well as a very important source of equilibrium sense.1,2,3 Likewise, when it becomes dysfunctional as a result of containing myofascial trigger points (TPs), it can present a complex clinical picture.

The pain referral pattern of the SCM includes pain over the cheekbone, in the forehead, on top of the head, in and behind the ear, over the chin, over the SC joint, over the forehead, and deep in the throat.3 The throat referral is a commonly overlooked cause of sore throat, often mistaken for pharyngitis. The patient will often feel a fullness in the throat, especially upon swallowing, which feels like a partial obstruction. The forehead referral pattern is one of the very few instances, if not the only instance, where referred pain can cross the midline, as the pain is frequently felt in the contralateral forehead area in a patient suffering from a TP in the clavicular division of the SCM.

the rest of the article-
http://www.chiroweb.com/archives/09/08/15.html
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Unread 03-31-2007, 01:02 AM   #2
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somewhat related from the same website-

Evaluating Patterns of Function: Effects of Kinetic Chain Dysfunction on the Neck and Back
midway in the article was interesting to me- this section-

[....Neck pain can also be evaluated globally. During examination, do you do the examination by the numbers, with all the orthopedic tests, and ignore their shoulders and overall posture? Posture can have a devastating effect on the way the neck functions and can cause chronic cervical joint dysfunction/subluxation. What about the jaw? If the patient's upper neck is locked up repeatedly, the jaw is most definitely involved. How can someone adjust subluxations without evaluating the effect of these structures on the spine? Obviously you cannot, and you are ignoring causative factors which can help you resolve, often for good, a neck, jaw or shoulder problem. Patients with chronic neck problems have tight, ropelike muscles which are weather sensitive. We often try to adjust through this, and create discomfort for the patient during the process. Is it any wonder you need a great deal of speed and force to adjust them? Perhaps the reason we do not look at people globally is because we were never trained to think and evaluate this way. I know I was never trained to do it.

While evaluating the upper body, I will perform a talking examination on these patients and tell them what I find, showing them where they are restricted and pointing out musculature which is contracted and preventing movement. This makes them well informed. At your report of findings, your job is much easier, and the patient will more likely follow your instructions. Current studies do indicate that patient compliance now typically hovers at about 40 percent.

Upper body kinetic chain problems are also somewhat predictable. For instance, when you look at someone from the top down, and see one shoulder more forward than the other, the anteriorly placed shoulder will be weak. I have theorized that this occurs because as a system of pulleys, the more anteriorly placed the shoulder is, the more dysfunctional the joint becomes, as the angle of pull of the shoulder muscles becomes more disadvantageous and makes the patients shoulder muscles work harder.

I often tell the patient, "This is what I will find. All the muscles in this right shoulder will be weak and your neck motion in the opposite direction will be restricted by the trapezius due to the tension it exerts on your neck from poor posture." I then muscle test them and show them what I said is true. I will then pull the shoulder back and retest. With the new angle the shoulder functions at, it is noticeably stronger. I also show them their neck moves more easily with their shoulders back vs. their current posture and make them see what posture does to their neck. Seeing is believing and our more sophisticated '90s public always wants more proof.

How can a doctor justify the ignorance of saying, "I just adjust subluxations"? The spine doesn't exist in a vacuum. While I am sure many "principled" chiropractors would beg to differ, as they download me with Palmerian philosophical stuff from the early 1900s, the fact is that ignoring the effects of the other structures on the human frame is unjustifiable. Simply put, would you go to a medical doctor practicing 1950s medicine? I wouldn't. Our profession continues to evolve and in the '90s, results are what counts, period. The game now is how to get them better, cheaper, faster, with better quality of care.

A relatively new treatment which has been rapidly gaining converts is myofascial release. Taught by Leahy, Barnes, the Rolf Institute and others, this method has received some heavy promotion and deserves the good reputation it has received so far. It solves many of the treatment problems we have come to expect and gives us a way to resolve many conditions, often in half the time and with better long-term outcomes. The great thing about myofascial release technique is it fits into today's protocols and makes us look great with managed care companies by enhancing results, shortening treatment times, and increasing patient satisfaction. I would recommend all doctors begin to learn how to use this very effective treatment tool.

Myofascial release comes in different flavors: Leahy's "active release techniques," Barnes' rolfing, Mock and others. My own methods, drawn from the others previously mentioned, have evolved with the realization that not one approach works equally well on all tissue density types; that it is certainly helpful to change to different techniques for the same area, depending on the patient's muscular topography. This is not dissimilar to changing adjustive methods for different patients, because some techniques work better in different situations.

full article here-
http://www.chiroweb.com/archives/16/04/22.html
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Unread 03-31-2007, 01:33 AM   #3
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Default Levator Scapula Syndrome

by Joseph Kurnik, DC

A common complaint often seen in practice is pain, discomfort, and/or tightness in the levator scapula muscle. Its tendon origin is on the transverse process of the first four cervical vertebrae. It passes downward and lateral to insert on the vertebral border of the scapula above the scapula spine. Its contraction elevates the scapula, tends to draw it medial, and rotates it to lower the lateral angle. It is affected by various motions of the arm relative to attachments and tonus of the infraspinatus muscle.
Motions of the neck also affect the levator scapula muscle because of the mechanics of its attachments.

From clinical observations, this disorder has an affinity for the left side. It also appears to relate most closely to upper cervical fixation dysfunctions, and is most frequently associated with C-1/ C-2 fixations where the listing appears like LPS or LPS-RA.

In previous articles I have described the C-1 LPS fixation. The left side fixates left lateral and resists rotation from left to right. The right side also may be fixated at C-1/C-2 from going anterior to posterior. This fixation dysfunction appears to alter levator scapula function by increasing its tonus and, eventually, irritability.

This syndrome may be associated with headaches, neck pain and neck and shoulder stiffness. It can lead to increased irritability of the infraspinatus and teres muscles, or it can be exacerbated by tension in these muscles. Irritability of the levator scapula muscle can be detected by firm finger probing of the muscle or with instrumentation, such as the DSR zone finder, which can measure increased skin resistance over the muscle.
more-
http://www.chiroweb.com/archives/16/13/08.html
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Unread 03-31-2007, 01:38 AM   #4
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Default Management of Vertebral Artery Syndrome: A Conservative Approach

Physiatry -- The Practice of Physical Therapy by a Physician
By R. Vincent Davis,DC,PT,DNBPME


Management of Vertebral Artery Syndrome: A Conservative Approach
Vertebral artery syndrome is considered synonymous with vertebral artery compression syndrome and vertebral-basilar artery insufficiency, and presents with recurrent transient episodes of cerebral symptoms, principal among which are dizziness, nystagmus, with sudden postural collapse without unconsciousness. These symptoms may be precipitated by rotation and hyperextension of the cervical spine which may result in temporary occlusion of the vertebral artery following which there is relative ischemia at the base of the brain. This syndrome commonly presents with a combination of cerebrovascular arteriosclerosis and cervical spondylosis as fundamental clinicopathological components.

To be brief, relative to this arterial anatomy, the vertebral artery ultimately supplies components of the brain via the basilar artery, and also provides for twigs to the cervical nerve roots which anastamose with the anterior and posterior spinal arteries. Since the internal carotids and vertebral arteries are the main tributaries to the basilar artery, occlusive arterial disease would gradually reduce arterial flow to a critical point at which further reduction in vascular caliber, prior to the development of an adequate collateral supply, would result in cerebral ischemia with respective clinical symptoms.

Normally, hyperextension with rotation of the cervical spine results in compression and occlusion of the vertebral artery on the contralateral side at the level of the atlas and axis. Occlusion may occur when vessels are subject to atheromatous disease and compression by osteophytes. If collateral blood flow is insufficient, symptoms develop with transient vertebral artery occlusion following rotation and/or hyperextension of the cervical spine. Symptoms are transient and subside as the arterial compression is released and blood flow is re-established. With degenerative disease of the cervical spine, arterial compression is increased due to encroachment by osteophytic projections at the level of the intervertebral foramina on the contralateral side during rotation/hyperextension movements. C5/6 is the site most often subject to osteophytic compression. With advanced degenerative disease, only a limited degree of motion may be necessary to produce complete vertebral artery compression. If the degenerative pathology develops slowly enough, the effects of vertebral artery stenosis may be offset by the formation of sufficient collateral circulation distal to the obstructive site to maintain adequate basilar arterial flow.

more-
http://www.chiroweb.com/archives/12/17/23.html
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Unread 03-31-2007, 01:40 AM   #5
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Default The Difficult-to-Diagnose Thoracic Outlet Syndrome

by Warren Hammer,MS,DC,DABCO

Thoracic outlet syndrome (TOS) may be more prevalent than you think. It is a condition that requires a diagnosis made more by a history and physical examination than by radiological or electrodiagnostic tests. While cervical ribs and other anatomic variations may be more common in TOS, they are not necessarily a prerequisite for a diagnosis. Of the 282 patients who required surgery for TOS, two-thirds had had normal electromyography testing results.

The problem with establishing a diagnosis is that since both nerves and blood vessels may be compressed, a patient may present with a variety of signs and symptoms. Originally, it was thought that vascular compression created most of the symptoms, but recent studies show that neural compression is responsible for most of the complaints.2

Forty-one percent of the 282 patients had a history of trauma preceding the onset of symptoms, with the shoulder girdle most affected, followed by the neck, arm and hand. Thirty-two percent of the patients blamed their symptoms on the workplace. Poor posture was a significant cause.

more-
http://www.chiroweb.com/archives/18/04/07.html
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Unread 03-31-2007, 01:45 AM   #6
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Default Forward Head / Forward Shoulders

by Warren Hammer,MS,DC,DABCO

Probably one of the most common postural distortions we see is the forward head, forward shoulders posture. This distortion often appears in teenagers and progresses to old age. Porterfield and DeRosa1 have provided some important information regarding this problem. They state1 that while lengthening or weakness of the scapular retractors is often blamed, a major cause is weakness and lengthening of the abdominal muscles, allowing the chest to descend and shifting the weight of the upper trunk anteriorly. This causes the chest to descend with the scapula shifting forward around the rib cage, pressing the clavicle to the first rib. In this position, the humerus internally rotates and the head and neck are brought forward.

As the head and neck are brought forward, the patient is forced to extend the occiput to keep the eyes horizontal, resulting in overactivity of the suboccipital muscles. With the head in a forward position, a passive tensile force is created in the hyoid muscles resulting in hyoid muscle tension, causing the mandible to be depressed and translated posteriorly. The patient is therefore forced to contract the temporalis and masseter muscles to keep the mouth closed.

This abnormal mandibular positioning can cause myofascial stress to the masseter and temporalis and temporomandibular problems. Porterfield and DeRosa1 state that symptoms such as excessive dry mouth due to mouth breathing, dysphagia, suboccipital headaches, teeth clenching, pain in the head and face over the temporalis area, and tightness over the throat region may occur.

A particular problem with the anterior sagittal glide of the head is the effect on the cervical facet joints. The facets are forced to go into extension and become impacted.2 Impacted facet joints prevent the hyaline cartilage compression and decompression necessary for normal nutrition, resulting in increased facet degeneration. The internally rotated shoulders increase the axial compression of the acromioclavicular joints to the sternoclavicular joints. There is usually a shortening of the pectoral fascia. Internally rotated shoulders can cause scapular protraction, narrowing the thoracic outlet and thereby compressing the neurovascular bundle. The forward shoulders may also narrow the subacromial space predisposing to subacromial impingement.

more-
http://www.chiroweb.com/archives/17/18/06.html
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Unread 03-31-2007, 08:54 AM   #7
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THanks for all this info!
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Unread 03-31-2007, 02:43 PM   #8
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Unread 04-05-2007, 02:07 PM   #9
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Unread 04-05-2007, 11:56 PM   #10
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Quote:
Originally Posted by jo55 View Post
by Warren Hammer,MS,DC,DABCO

Probably one of the most common postural distortions we see is the forward head, forward shoulders posture. This distortion often appears in teenagers and progresses to old age. Porterfield and DeRosa1 have provided some important information regarding this problem. They state1 that while lengthening or weakness of the scapular retractors is often blamed, a major cause is weakness and lengthening of the abdominal muscles, allowing the chest to descend and shifting the weight of the upper trunk anteriorly. This causes the chest to descend with the scapula shifting forward around the rib cage, pressing the clavicle to the first rib. In this position, the humerus internally rotates and the head and neck are brought forward.

As the head and neck are brought forward, the patient is forced to extend the occiput to keep the eyes horizontal, resulting in overactivity of the suboccipital muscles. With the head in a forward position, a passive tensile force is created in the hyoid muscles resulting in hyoid muscle tension, causing the mandible to be depressed and translated posteriorly. The patient is therefore forced to contract the temporalis and masseter muscles to keep the mouth closed.

This abnormal mandibular positioning can cause myofascial stress to the masseter and temporalis and temporomandibular problems. Porterfield and DeRosa1 state that symptoms such as excessive dry mouth due to mouth breathing, dysphagia, suboccipital headaches, teeth clenching, pain in the head and face over the temporalis area, and tightness over the throat region may occur.

A particular problem with the anterior sagittal glide of the head is the effect on the cervical facet joints. The facets are forced to go into extension and become impacted.2 Impacted facet joints prevent the hyaline cartilage compression and decompression necessary for normal nutrition, resulting in increased facet degeneration. The internally rotated shoulders increase the axial compression of the acromioclavicular joints to the sternoclavicular joints. There is usually a shortening of the pectoral fascia. Internally rotated shoulders can cause scapular protraction, narrowing the thoracic outlet and thereby compressing the neurovascular bundle. The forward shoulders may also narrow the subacromial space predisposing to subacromial impingement.

more-
http://www.chiroweb.com/archives/17/18/06.html

In plain english....watch you posture.

1. Head should be over spine...neck/cervical vertebrae in line with spine. Chin parallel.
2. Shoulders down and back. Retracted, not protracted. Lift from your chest ...up...don't collapse your chest down.
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