Tag Archives: diagnosis

Fibromyalgia Diagnosis: What Is It?

 

           

Fibromyalgia in San Francisco

Fibromyalgia Diagnosis and Treatment

We have been providing natural solutions for Fibromyalgia in San Francisco for over 20 years now.

Confirming the diagnosis of fibromyalgia (FM) is challenging, as there are no blood tests to verify accuracy of the diagnosis like so many other disorders. However, blood tests are needed when FM is suspected to “rule in/out” something else that may be mimicking FM symptoms. Also, FM is often associated with other disorders that are diagnosed by blood testing, so it is still necessary to have that blood test. So what is the CURRENT recommendation for diagnosing FM?

 

            The American College of Rheumatology (ACR) developed criteria for diagnosing FM in 1990 and has updated it since then. The original 1990 criteria included the following: 1) A history of widespread (whole body) pain for three months or more; and 2) The presence of pain at 11 or more of 18 tender points which are spread out over the body. The main criticism regarding this approach has come from the poor accuracy and/or improper methods of testing the 18 tender points. As a result, this examination portion of the two main criteria has been either skipped, performed wrong, or mis-interpreted. This left the diagnosis of FM to be made based on symptoms alone. Also, since 1990, other KEY symptoms of FM have been identified that had previously been ignored including fatigue, mental fog (“cognitive symptoms”), and the extent of the body pain complaints (“somatic symptoms”).

 

            As a result, it has been reported that the original 1990 approach was too strict and inaccurate because too many patients with FM were missed – 25% to be exact – by using this method. In 2010, the diagnostic approach was modified by using two different questionnaires: 1) The “Widespread Pain Index” or (WPI), which measures the number of painful body regions; and 2) the development of a “Symptom Severity” scale (SS). The MOST brain fog” common with FM, unrefreshed sleep, fatigue, and the  number of “somatic symptoms” (other complaints). The Symptom Severity scale (SS) incorporates these four categories and is scored by adding the totals from each category.  By using both the WPI and the SS, they correctly classified 88.1% of FM cases out IMPORTANT FM diagnostic variables included the WPI score and scores of “cognitive symptoms,” which includes the “of a group of 829 previously diagnosed FM patients and non-FM controls!

 

            What’s important is that this NEW approach does NOT rely on the “old” physical exam requirement of finding at least 11 of 18 tender points. Because FM patients traditionally present with highly variable symptoms, removing the challenge of determining the diagnosis by physical examination is very important! Plus, now we can TRACK the outcomes of the FM patient to determine treatment success both during and after care. Since the 2010 approach has been released, it has been published in multiple languages and is starting to be used in primary care clinics. Recently, in July 2013, a study reported that the Modified ACR 2010 questionnaire is highly sensitive and specific for diagnosing FM, and its future use in primary care was encouraged. What is most exciting about this is that a referral to a rheumatologist may not be needed since this tool can be easily administered by primary care physicians, which include chiropractors!

 

            In past health updates, we have discussed the need for a “team” of health care providers to best manage the FM patient. This multidisciplinary approach offers the FM patient multi-dimensional treatment strategies that encompass manual therapies, physical therapies, nutritional strategies, pharmacology, exercise, and stress management, cognitive management, and behavioral management. Now, with the release of the Modified ACR 2010 criteria, we can diagnose FM more accurately, track progress of the patient, and make timely modifications to the treatment plan when progress is not occurring. This is a “win-win” for the patient, providers/health care team, and the insurer!

 

            If you, a friend or family member requires care for FM, we sincerely appreciate the trust and confidence shown by choosing our services!

           

Altadonna Communications ©

To schedule an appointment for Fibromyalgia Treatment in San Francisco call 415-392-2225

Since 1992

                         

 

Eben Davis

I am a Chiropractor in the San Francisco Financial District specializing in chronic neck, arm and hand pain. I also treat herniated discs using spinal decompression, whiplash, sports injuries, headaches, and Fibromyalgia. My clinic is certified in the use of Deep Tissue Laser Therapy with the LiteCure LCT-1000 for conditions such as shoulder pain, TMJ and Plantar Fasciitis. I have been in practice for over 20 years.

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Whiplash Treatment & Diagnosis: What Does It Mean?

Whiplash treatment SF downtown
We have been providing whiplash treatment in San Francisco since 1992.

Whiplash is, by definition, the rapid
acceleration followed by deceleration of the head causing the neck to “crack
like a whip” forwards and backwards at a rate so fast that the muscles cannot
react quickly enough to control the motion. As reported last month, if a
collision occurs in an automobile and the head rests are too low and/or seat
backs too reclined and the head moves beyond the allowable tissue boundaries,
“whiplash” injury occurs.

            When
gathering information from the patient, this portion of the history is called
“mechanism of injury” and it is VERY IMPORTANT, as it helps us piece together
what happened at the time of impact. For example, was the head turned upon
impact? Was the impact anticipated? What were the weather conditions (visual,
road conditions)? What was the direction of the strike (front, rear, side,
angular, or combinations of several)? Did a roll over occur? Was a seat belt
used (lap and chest) and were there any seat belt related injuries (to the low
back/pelvis, breasts/chest, shoulder, neck)? Any head impact injuries with or
without loss of consciousness (if so, how long)? Any short-term memory loss and
residual communication challenges (post-concussive syndrome)? All of the answers
to these questions are very important when determining the examination path,
establishing the diagnoses, and determining the treatment plan.

            We
also discussed last month the WAD classification or, Whiplash Associated
Disorders, which was coined in 1995 by the Quebec Task Force. Types I, II, and
III are defined by the type of tissues injured and the history and examination
findings. In 2001, the Quebec Task Force found that WAD II (loss of range of
motion or ROM/negative neurological findings) and WAD III (both ROM loss and
neurological loss) carried progressively greater risk of prolonged recovery
compared to WAD I injuries (those with pain but no loss of motion or
neurological findings).

            Establishing
a strong diagnosis allows for accuracy in prognosis and treatment plan
recommendations. For example, in WAD II & III injuries, flexion/extension
x-rays are needed to determine the extent of ligament damage as normally, the
individual vertebrae should not translate or shift forwards or backwards by more
than 3.5mm. Similarly, the angle created between each vertebra in flexion &
extension should be within 11 degrees of the adjacent angles, and if that’s
exceeded, ligament damage is likely to have occurred. So often, ER records
describe little to no information about the historical elements reviewed in the
1st paragraph and if x-rays were taken, they rarely include flexion/extension
stress x-rays.

            Headaches
are another component of WAD. Here, the first three sets of nerves that exit
the uppermost levels of the spine (C1, C2, and C3) innervate the head. When a
patient describes headaches that start in the upper part of the neck and
radiate up into the head, the distribution of the pain by history can tell us
which nerve(s) are most affected. In the examination, applying manual pressure
to the base of the skull can reproduce pain when a nerve is injured. Tracking
these findings on a regular basis can tell us how the condition is healing.
Chiropractic is at the forefront of diagnosis for WAD! 

            We realize you have a choice in where you choose your
healthcare services.  If you, a friend or
family member requires care for whiplash, we sincerely appreciate the trust and
confidence shown by choosing our services and look forward in serving you and
your family presently and, in the future. 

To schedule an appointment with one of our whiplash doctors in downtown San Francisco call 415-392-2225. Mention this article for a complimentary in house or phone consultation.

Eben Davis

I am a Chiropractor in the San Francisco Financial District specializing in chronic neck, arm and hand pain. I also treat herniated discs using spinal decompression, whiplash, sports injuries, headaches, and Fibromyalgia. My clinic is certified in the use of Deep Tissue Laser Therapy with the LiteCure LCT-1000 for conditions such as shoulder pain, TMJ and Plantar Fasciitis. I have been in practice for over 20 years.

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Carpal Tunnel Syndrome: Self Diagnosis


Natural carpal tunnel treatment in downtown  san francisco
We have been providing natural treatment for Carpal Tunnel Syndrome (CTS) and Symptoms in the San Francisco Financial District for over 20 years now.

Carpal
Tunnel Syndrome (CTS) is technically a “pinched nerve” in the wrist (carpal
tunnel) that results in numbness, tingling and later, weakness in the
distribution of the median nerve (thumb, index, 3rd, and half of the 4th
finger). There is a limited amount of space within the carpal tunnel. In
addition to the median nerve, there are 9 tendons and their sheaths, a network
of blood vessels, the joint capsules, the bony “roof” and ligamentous “floor.”
Any condition that distorts the shape of the tunnel  (inflammatory conditions like rheumatoid
arthritis, ganglion cysts, bony spurs, or conditions that result in swelling
like overuse, pregnancy, taking birth control pills, hypothyroid, obesity,
and/or conditions that create neuropathy like a pinched nerve in the neck,
shoulder or elbow, diabetes and post-chemotherapy) can result in median nerve
irritation. The carpal tunnel naturally changes its shape when we flex and
extend the wrist, so occupations that require wrist bending (especially if it’s
prolonged and a fast pace is required) such as carpentry (especially the use of
vibrating tools), waitressing, assembly line work, typists, and even sleeping
at night with the wrist bent can result in CTS.

            The diagnosis can be tricky because
of all the possible causes (of which, some are described above) and to make
matters even more challenging, there can be two, three, or more of the causes
all contributing to the problem at the same time! In the clinic, there are
certain positions to test how long (in seconds) it takes for the numbness,
tingling and/or pain to occur when we place the wrist in extreme flexion or
extension. We’ll compress the carpal tunnel (and nerve pathways at the elbow,
shoulder, and neck), as well as tap over the carpal tunnel with a reflex hammer
creating a “funny bone” sensation usually into the 2nd or 3rd finger. Blood
tests for rheumatoid (and other inflammatory) arthritis, diabetes and thyroid
dysfunction are very helpful when trying to differentiate between several
possible causes. An electrical conduction test called electromyogram (EMG) and
nerve conduction velocity (NCV) can also be very helpful in determining the
severity of CTS.

            So the question is, can you “self-diagnose”
CTS? The answer is: sometimes. However, with that said, if the symptoms are
“classic” (numbness/tingling in the thumb, fingers 2-4, which shaking and
flicking your fingers relieves at least partially; it’s waking you up at night
especially, if a night splint helps reduce the frequency of waking and
intensity of numbness), then you “probably” have CTS. Here are some common
questions included in a CTS questionnaire that we often use in the clinic to
assist with the diagnosis: SYMPTOM
SEVERITY
(score each on a 0-4 scale): 1) Pain severity at night? 2)
Nighttime frequency of waking with pain? 3) Amount of daytime hand/wrist pain?
4) Frequency of daytime hand/wrist pain? 5) Duration (in minutes) of daytime
pain/numbness? 6) Severity of numbness? 7) Severity of weakness? 8) Tingling
intensity? 9) Nighttime severity of numbness or tingling? 10) Nighttime
frequency of numbness or tingling? 11) Difficulty grasping / using small
objects like keys or pens? FUNCTION
SEVERITY
(0-4 scale): 1) Writing. 2) Buttoning clothes. 3) Holding a book
while reading. 4. Gripping of a telephone handle. 5) Opening jars. 6. Household
chores. 7. Carrying grocery bags. 8. Bathing and dressing. The maximum score
for SYMPTOM SEVERITY is 11×4 = 44
and for FUNCTION 8×4 = 32. To determine
the percentage, divide your score by 76 (the maximum possible) and multiply it
by 100. In general, scores >50% may be indicative of CTS. However, as
previously stated, a definitive diagnosis must include a detailed history,
examination, sometimes special tests. Therefore, it is important to see us! If
you have CTS, we will outline the type and length of care with you and MOST
IMPORTANT, we can usually manage CTS without the need for surgery!

            We realize you have a choice in who
you consider for your health care provision and we sincerely appreciate your
trust in choosing our service for those needs.
If you, a friend or family member require care for CTS, we would be
honored to render our services.

To schedule an appointment for natural carpal tunnel relief in San Francisco call 415-392-2225

Altadonna Communications ©

 

Eben Davis

I am a Chiropractor in the San Francisco Financial District specializing in chronic neck, arm and hand pain. I also treat herniated discs using spinal decompression, whiplash, sports injuries, headaches, and Fibromyalgia. My clinic is certified in the use of Deep Tissue Laser Therapy with the LiteCure LCT-1000 for conditions such as shoulder pain, TMJ and Plantar Fasciitis. I have been in practice for over 20 years.

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Carpal Tunnel Syndrome: Diagnosis and Treatment

Carpal tunnel syndrome clinic san francisco
We have been providing treatment for Carpal Tunnel Syndrome in San Francisco for over 20 years.

Carpal
Tunnel Syndrome
(CTS) refers to the median nerve being pinched in a tunnel at
the wrist. As the name implies, “carpal” refers to the 8 small bones in the
wrist that make up the “U” shaped part of the tunnel and “syndrome” means
symptoms that are specific and unique to this condition. As we learned last
month, CTS can be affected by nerve pinches more proximal to the wrist, such as
at the forearm, elbow, mid-upper arm, shoulder or neck. To make matters more
complex, there are two other nerves in the arm that can also be pinched in
different tunnels, and the symptoms of numbing and tingling in the arm and hand
occur with those conditions as well. This is why a careful clinical history,
examination, and sometimes special tests like an EMG/NCV (electromyogram/nerve
conduction velocity) offer the information that allows for an accurate
diagnosis of one or more of these “tunnel syndromes” in the “CTS” patient.
Let’s look at these different tunnels and their associated symptoms, as this
will help you understand the ways we can differentiate between these various
syndromes or conditions.

            Let’s start at the neck. There are seven cervical
vertebrae and eight cervical spinal nerves that exit the spine through a small
hole called the IVF (intervertebral foramen). Each nerve, like a wire to a
light, goes specifically to a known location which includes: the head (nerves
C1, 2, 3), the neck and shoulders (C4, 5), the thumb side of the arm (C6), the
middle hand and finger (C7) and the pinky side of the lower arm and hand (C8).
If a nerve gets pinched at the spinal level (such as a herniated disk in the
neck), usually there is numbness, tingling, and/or pain and sometimes, usually
a little later, weakness in the affected part/s of the arm and hand (or
numbness in the scalp if it’s a C1-3 nerve pinch). So, we as chiropractors can
test the patient’s sensation using light touch, pin prick, vibration, and/or
2-points brought progressively closer together until 1-point is perceived and
then comparing it to the other arm/hand. Reflexes and muscle strength are also
tested to see if the motor part of the nerve is involved in the pinch. The exam
includes compression tests of the neck to see if the arm “lights up” with
symptoms during the test.

            Next is the shoulder. Here, the nerves and blood vessels travel through
an opening between the collar bone, 1st rib and the chest muscles (Pectorals).
As you might think, the nerves and blood vessels can be stretched and pinched
as they travel through this opening and can cause “thoracic outlet syndrome.”
Symptoms occur when we raise the arm overhead. Hence, our tests include
checking the pulse at the wrist to see if it reduces or lessens in intensity as
we raise the arm over the head. At the shoulder, the ulnar nerve is the most
commonly pinched nerve, which will make the pinky side of the arm and hand
numb, tingly, and/or painful. A less common place to pinch the nerves is along
humerus bone (upper arm) by a bony process and ligament that is usually not
there or resulting from a fracture. Here, an x-ray will show the problem.

            The elbow is the MOST common place to trap the ulnar nerve in
the “cubital tunnel” located at the inner elbow near the “funny bone” which we
have all bumped more than once. Cubital tunnel syndrome affects the pinky side
of the hand from the elbow down. The median/carpal tunnel nerve can get trapped
here by the pronator teres muscle, thus “pronator tunnel syndrome.” This
COMMONLY accompanies CTS and MUST be treated to obtain good results with CTS
patients. The radial nerve can be trapped at the radial tunnel located on the
outside of the elbow and creates thumb side and back of the hand
numbness/tingling.

            Hence, you see the importance of
evaluating and treating ALL the tunnels when CTS is present so a thorough job
is done (which is what Chiropractors do). Try the LEAST invasive approach first
– non-surgical treatment – as it’s usually all that is needed!

            We realize you have a choice in who
you consider for your health care provision and we sincerely appreciate your
trust in choosing our service for those needs.
If you, a friend or family member require care for CTS, we would be
honored to render our services.

To schedule an appointment with one of our San Francisco Carpal Tunnel Doctors please call 415-392-2225.

Eben Davis

I am a Chiropractor in the San Francisco Financial District specializing in chronic neck, arm and hand pain. I also treat herniated discs using spinal decompression, whiplash, sports injuries, headaches, and Fibromyalgia. My clinic is certified in the use of Deep Tissue Laser Therapy with the LiteCure LCT-1000 for conditions such as shoulder pain, TMJ and Plantar Fasciitis. I have been in practice for over 20 years.

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Hand Pain and the Role of the Neck

Hand pain doctors san francisco 94111We have been providing treatment for hand pain in San Francisco for over 20 years now. During this time we have learned much about the role of the neck when it comes to hand pain and carpal tunnel symptoms.

After-all, the nerves that innervate and control the shoulder, arm, wrist and hand, originate in the neck. The neck is the source of power, energy and life for the upper extremity.

If we were to cut-off the nerve supply from the neck to the hands, the hands would die. If there is diminished nerve supply the hands will malfunction and symptoms will manifest. In order for the hands to function at 100%, they need 100% nerve power. Some of the signs and symptoms of nerve pressure in the neck are as follows:

 

1. Neck Pain

2. Shoulder, Arm, and Elbow Pain

3. Wrist and Hand Pain

4. Numbness and Tingling in the Arms and Hands

5. Weakness of Grip

6. Night Pain

These are also the classic signs and symptoms of Carpal Tunnel Syndrome (CTS). Yes, the same symptoms result from nerve interference between the neck and had as true CTS, which is the result of pressure on the median nerve in the wrist. This is because the median nerve originates in the neck.

Interesting Huh? This is why it is SO important for a doctor to check you from the neck to the fingertips when you have hand pain or any of the other carpal tunnel SYMPTOMS.

There is a subset of chiropractors like us that specialise in the diagnosis and treatment of neck, arm and hand pain. Chiropractic upper extremity experts will incorporate tools such as deep tissue laser therapy, Graston Technique, ART, and upper extremity adjustments, in addition to cervical spine adjustments to remove nerve pressure from the neck to the hands.

Sometimes hand pain will resolve quickly…sometimes it takes a while. It just depends how long your condition has been there and the extent of the damage. One thing for sure…taking pain pills, anti-inflammatory medication such as cortisone injections, and wearing wrist splints, is not going to do much for you if the problem is nerve pressure in the neck from subluxations, bulging or herniated discs, disc degeneration, or muscle spasms.

Physical pressure on nerves (to the hand) requires the removal of the pressure on the nerves or the carpal tunnel symptoms will persist.

If you need help finding a carpal tunnel doctor in your area you can send me an email at ebendavis@yahoo.com and I will try to find a doctor I have trained in your area.

To schedule an appointment with one of our San Francisco Carpal Tunnel Doctors please call 415-392-2225. Mention this blog post for a complimentary consultation.

Serving local 94111 since 1992

Eben Davis

I am a Chiropractor in the San Francisco Financial District specializing in chronic neck, arm and hand pain. I also treat herniated discs using spinal decompression, whiplash, sports injuries, headaches, and Fibromyalgia. My clinic is certified in the use of Deep Tissue Laser Therapy with the LiteCure LCT-1000 for conditions such as shoulder pain, TMJ and Plantar Fasciitis. I have been in practice for over 20 years.

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How Do You Know If It’s Fibromyalgia?

Fibromyalgia therapy san franciscoFibromyalgia (FM) symptoms are characterized by chronic generalized pain, and can include debilitating fatigue, sleep disturbance, joint stiffness, numbness or tingling, bowel/bladder dysfunction, and sometimes effects our ability to process thought clearly (cognitive dysfunction).  It can come on fast, almost overnight, or, develop very slowly over years of time. This highly variable onset makes establishing a diagnosis very challenging, and can also sometimes take years before the diagnosis is firmly established. In fact, the term “fibromyalgia” was not formally recognized as a diagnosis by the American College of Rheumatology and American Medical Association until 1987, and it remains a diagnosis made by excluding other diseases!

POPULAR MYTHS

MYTH: “Your symptoms are all in your head.” TRUTH: FM is a “MEDICAL DISORDER” where the nervous system’s ability to process pain is different when compared to those who don’t have FM. Why there is a difference between individuals is the big question. Some research suggests these brain processing differences may be the result of childhood stress, or prolonged or severe stress.

MYTH: “Only lazy, inactive people get fibromyalgia.” TRUTH: Research shows this not to be the case. In fact, most people with FM are focused and driven, and that stress associated with that intense drive may play a significant role in the development of FM symptoms.

MYTH: “There are no effective fibro treatments.” TRUTH: The good news is that as more studies on FM arise, we are beginning to understand more about FM, resulting in more effective treatments. The “catch” is that what works for one individual may not work for another making it essential to find a “good doctor” (or rather, a good team of health care providers) who is willing to listen and continually try different approaches until an effective management approach is found.

COEXISTING CONDITIONS

                There are some specific conditions that go hand in hand with FM, and though it’s not clear which comes first (FM or the condition), a clear relationship has been established. Some of these co-existing conditions include irritable bowel syndrome, arthritis (several different types can be associated), chronic fatigue syndrome, various sleep disorders, post-traumatic stress syndrome, anxiety, depression, and others. Often, blood and other lab tests come back negative and hence, the diagnosis is made by excluding those other conditions. What is MOST important is that to feel your best, these other conditions also need to be managed.

TREATMENT

                As stated above, the management of FM is aimed at all the condition(s) affecting the person with FM. This is why a multidiscipline “team” of health care providers is so important, as we all have our own emphasis and perspective on what to do for patients. Options include: a clinical psychologist to manage the chemical and hormonal imbalances, a primary care doctor whom “believes in FM,” and a chiropractor to manage the musculoskeletal issues of FM. Other alternative approaches such as massage therapy, Yoga classes, and acupuncture can also provide significant relief. Nutritional counseling is also highly effective in the management strategy of FM. Most important is the fact that coordination between these various approaches be supervised. Since we deal with the whole person, chiropractors are the PERFECT CANDIDATE for that job!

                If you, a friend or family member requires care for FM, we sincerely appreciate the trust and confidence shown by choosing our services!

To schedule an appointment with a fibromyalgia doctor in San Francisco call 415-392-2225

 

 

Eben Davis

I am a Chiropractor in the San Francisco Financial District specializing in chronic neck, arm and hand pain. I also treat herniated discs using spinal decompression, whiplash, sports injuries, headaches, and Fibromyalgia. My clinic is certified in the use of Deep Tissue Laser Therapy with the LiteCure LCT-1000 for conditions such as shoulder pain, TMJ and Plantar Fasciitis. I have been in practice for over 20 years.

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