Friday, January 17, 2014

WHAT YOU NEED TO KNOW ABOUT CALIFORNIA TRAFFIC ACCIDENTS



What you need to know about California Traffic Accidents
     Driving is part of our culture here in CA, especially in Los Angeles. There is really no other viable option for most people. So being sure you understand what risks you are taking when you drive to work every day is important, as well as how to lower your risk of an accident or serious injury. The facts show that overall CA is a safer place to drive than the USA overall, but this does not mean there are not serious trends that we need to be aware of. Here are some things you need to know.
Staggering Facts
·        In 2011, there were 2,791 fatalities in CA from traffic accidents. This is up 2.6% from the previous year. Many of these were the result of distracted driving; i.e cell phone use or texting etc. That is a lot of people who died; about 54 people per week! Yikes!
·         More than 50,000 people experienced injuries from auto accidents in Los Angeles County alone in 2011. These are not fatalities, but just injuries. That is about 962 people per week who are injured in auto accidents!
·        Texting convictions increased 42 percent from 14,866 in 2011 to 21,059 in 2012. (DMV). Too many people still think they have time to text while at a light. Don’t do it!
·        Based on data from the National Highway Traffic Safety Administration, 30.4 percent of all drivers who were killed in motor vehicle crashes in California in 2011 tested positive for legal and/or illegal drugs, a percentage that has been increasing since 2006. Marijuana was by far the most common drug found in drivers who tested positive for drugs - 25.3 percent of those drivers who tested positive for drugs.[1]

Common Types of Injuries in Traffic Accidents
·        Previous studies have shown that lower extremity injuries account for a significant portion of the injuries sustained by passenger vehicle drivers in frontal crashes, and this pattern continues to hold for newer model year vehicles.[2] Lower extremity injuries include leg and knee injuries such as bruises and broken bones. Tearing of knee cartilage is also a common injury.
·        Nearly 150,000 people were injured in 2009 just by closing the car door. They were not even on the road or highway. This is an amazing statistic.  They either fell while getting out of the car, or broke a bone slamming the door on their hand.
·        Older drivers and passengers are more vulnerable in a crash. At crash speeds of just over 31 mph (50 kph), the risk of sustaining a serious injury increases dramatically. A 50-year-old female has about a 10-percent risk of a serious injury in a frontal crash, but an 80-year-old female has about a 40-percent risk. [3]
·        A closed head injury (a concussion or a traumatic brain injury) is one of the most common injuries sustained. Often, there are not immediate signs of trauma.  Because the brain is likely to be moved around in the skill during impact, the signs may take a few hours or days to show themselves.[4] Always see a doctor even if you think you are fine. 
·        Whiplash is a very common neck injury, but there is also neck strain and serious injuries to the discs in the neck. The pain from these injuries may not be felt right away either.
·        Common back injuries include sprain or strain, fracture, disc injury, thoracic spine injury, lumbar radiculopathy, and lumbar spine injury. It is not unusual for the effects of a bad back injuries to not show up for hours or weeks. Back injuries often cause long term problems for victims.




[1] http://www.ots.ca.gov/OTS_and_Traffic_Safety/Score_Card.asp
[2] Austin, R. A. (2012, March). Lower Extremity Injuries and Intrusion in Frontal Crashes. (Report No. DOT HS 811 578). Washington, DC: National Highway Traffic Safety Administration.
[3] www.ircobi.org/downloads/irc12/ pdf_files/14.pdf

[4] http://www.all-about-car-accidents.com/car-accident-injuries.html


Friday, January 10, 2014

NERVE CONDUCTION VELOCITY TESTING AND DIAGNOSTIC ULTRASOUND TESTING


Nerve Conduction Velocity and Diagnostic Ultrasound Testing

Nerve Conduction Velocity (NCV)
Nerve conduction velocity study (NCV) measures basic parameters of the nerve function – strength and speed of how an electrical signal (action potential) spreads through the nerve. This data complements electromyography (EMG) in making the diagnosis.
Both nerves and muscles produce electrical signals called action potentials which are detected and measured during NCV. A nerve is actually a bundle of axons - long twigs of nerve cells conducting electrical signals from one end of the nerve to another. An NCV machine is capable of detecting and analyzing these tiny electrical signals coming from active neurons.
In motor nerves, these electrical signals travel toward the muscle causing muscle contraction.
In sensory nerves, these electrical signals are travelled toward the spinal cord, bringing signals from skin and other tissues which we feel as different sensations like temperature, pain, pressure and others.
NCV and Axons
NCV measures different characteristics of action potentials traveling along the axons, and is not significant for diagnosing diseases that primarily affect nerve function. NCV uses electrodes similar to those used in electrocardiograms placed on the skin over a nerve. Ction potential is generated by giving a mild electrical shock which is then recorded by other electrodes as it travels through the nerve.
The speed of nerve conduction is influenced by a coating around axons, called myelin sheath. Myelin sheath insulates each axon and forces action potentials to "jump" quickly along the axon. Speed of action potential is slowed down when myelin sheath is damaged. Healthy axons provide a strong action potential. If axons degenerate the action potential becomes weaker.
Different diseases preferentially either affect myelin sheathing or damage axons. This is why the type of nerve damage detected by NCV is so important in making the right diagnosis.
Though some people may find the electric shocks of the NCV or the needle pricks of the EMG uncomfortable, these methods do not leave any permanent damage and are quite tolerable. NCV and EMG have remained for decades as the gold standard test for evaluating the nerve and muscle function. Considering that there are more than two hundred different diseases affecting nerves and muscles NCV and EMG are very important and valuable tools in gathering data on the type, distribution and severity of damage. This data is useful in making an accurate diagnosis and starting an appropriate treatment earlier. Patients usually understand that EMG is a valuable tool and that the benefit of precise diagnosis outweighs discomfort of the procedure.
Ultrasound

Sonography was performed by a musculoskeletal radiologist who was blinded to the subject’s symptoms, signs, and the results of NCS, using a 12–5 MHz linear array transducer (HDI 5000; Phillips Ultrasound, Bothell, WA). Subjects sat down with the arm on a table in a position of supinated forearm, neutral-positioned wrist, and semi-flexed fingers. After identifying the ulnar artery, flexor retinaculum, and median nerve, transverse images of the median nerve were scanned at 2 levels: the carpal tunnel inlet (at the level of pisiform) and the carpal tunnel outlet (at the level of the hook of hamate) (Fig. 1A). The cross-sectional area (CSA) of the median nerve at each level was measured by directly tracing with an electronic caliper around the margin of the median nerve. The margin of the median nerve was defined as the margin outside the hypoechoic nerve fascicles and inside the hyperechoic nerve sheath (Fig. 1B).16 each measurement was performed 5 times; the highest and lowest values were eliminated, and the remaining 3 measurements were averaged.

Sonographic examination of the median nerve has been suggested as a useful alternative to electrophysiologic study in the diagnosis of carpal tunnel syndrome. To determine its usefulness and the best diagnostic criterion, sonograms of patients with the disease were compared with sonograms of healthy subjects in a case–control study.

How the Test Is Performed

An ultrasound machine creates images that allow various organs in the body to be examined. The machine sends out high-frequency sound waves, which reflect off body structures. A computer is used to receive these reflected waves which use them to create a picture.
The test is done in the ultrasound or radiology department. You will be lying down for the procedure. A clear, water-based conducting gel is applied to the skin over the area being examined to help with the transmission of the sound waves. A handheld probe called a transducer is moved over the area being examined. The radiologist may ask you to change your position so that other areas can be examined.
For specific information about ultrasound examinations, please refer to the following topics:
  • Abdominal ultrasound
  • Breast ultrasound
  • Doppler ultrasound of an arm or a leg
  • Doppler/ultrasound of the heart (echocardiogram)
  • Duplex ultrasound
  • Pregnancy ultrasound
  • Testicle ultrasound
  • Thyroid ultrasound
  • Transvaginal ultrasound
  • Vascular ultrasound
Preparation for the procedure will depend on the body region being examined.

How the Test Will Feel

There is generally little discomfort with ultrasound procedures. The conducting gel may feel slightly cold and wet.
The reason for the examination will depend on your symptoms.

Normal Results

Results are considered normal if the organs and structures in the region being examined are normal in appearance.

What Abnormal Results Mean

The significance of abnormal results will depend on the body region being examined and the nature of the problem. Consult your health care provider with any questions and concerns.
References
  • Caliandro P, La Torre G, Aprile I, Pazzaglia C, Commodari I, Tonali P, et al. Distribution of paresthesias in carpal tunnel syndrome reflects the degree of nerve damage at wrist. Clin Neurophysiol 2006; 117: 22831.
  • Zanette G, Marani S, Tamburin S. Extra-median spread of sensory symptoms in carpal tunnel syndrome suggests the presence of pain-related mechanisms. Pain 2006; 122: 26470.
  • Nathan PA, Keniston RC, Meadows KD, Lockwood RS. Predictive value of nerve conduction measurements at the carpal tunnel. Muscle Nerve 1993; 16: 137782.
  • Atroshi I, Gummesson C, Johnsson R, Ornstein E. Diagnostic properties of nerve conduction tests in population-based carpal tunnel syndrome. BMC Musculoskelet Disord 2003; 4: 9.
  • Lew HL, Date ES, Pan SS, Wu P, Ware PF, Kingery WS. Sensitivity, specificity, and variability of nerve conduction velocity measurements in carpal tunnel syndrome. Arch Phys Med Rehabil 2005; 86: 126.
  • Beekman R, Visser LH. Sonography in the diagnosis of carpal tunnel syndrome: a critical review of the literature. Muscle Nerve 2003; 27: 2633
  • Uchiyama S, Itsubo T, Yasutomi T, Nakagawa H, Kamimura M, Kato H. Quantitative MRI of the wrist and nerve conduction studies in patients with idiopathic carpal tunnel syndrome. J Neurol Neurosurg Psychiatry 2005; 76: 11038.
  • American Academy of Neurology. Practice parameter for carpal tunnel syndrome (summary statement): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 1993; 43: 24069.
  • Cosgrove DO, Meire HB, Lim A, Eckersley RJ. Ultrasound: general principles. In: Adam A, Dixon AK, eds. Grainger & Allison's Diagnostic Radiology: A Textbook of Medical Imaging . 5th ed. New York, NY: Churchill Livingstone; 2008:chap 3.


Monday, January 6, 2014

CHIROPRACTIC CARE FOR AUTO MOBILE ACCIDENTS





Today in the United States, auto accidents are the number one contributor to chronic and spinal pain. Out of the 6 million auto accidents that take place in the U.S annually, about 3 million people suffer injuries. The majority of these injuries are whiplash- type of injuries. Out of the 3 million injuries, about one million develop chronic pain.
Chiropractic care has proved time and again to be highly effective as an intervention method or patients following auto accidents. According to a journal of orthopedic medicine published in 1999, it was shown that out of the superiority of chiropractic care for the patients who suffered from long term effects of whiplash, 74 to 93 percent of the patients with chronic whiplash were likely to benefit from chiropractic care. Many professionals also agree that chiropractic care would be highly beneficial particularly following an accident of any sort

Auto mobile accidents in California

The state of California has been ranked as the most dangerous state for road users with regard to automobile accidents in the United States. In 2009, the state saw 3071 fatalities of traffic in 2816 fatal accidents. It has also been shown that road accidents in California are the leading causes of accidental deaths for those under the age of 34. One of the roads in the stat has also been ranked as one of the most dangerous roads in the world.
A majority of accidents involve the single vehicle with drivers under the influence of alcohol. In 2009, 30 percent (856) of the accidents in California were fueled by the problem of driving under the influence of alcohol.  

Injuries related to vehicle accidents

According to the national highway traffic safety administration report, about 5,500,000 Americans experienced injuries related to motor vehicle crashes in 1995. In 1999, an estimated 6,289,000 car accidents were reported with about 3.4 million injuries and 41, 345 deaths in auto accidents. According to studies, it was also shown that there is a three times increased probability of developing neck pains for those injured in motor vehicle crash 7 years later, where 39 percent of those injured in rear end motor vehicle tend to experience chronic pain 7 years after the accident.
Following the accident, the soft tissues tend to experience the primary injury. The initial injury also results in increased flexibility of the injured joints. These injuries can not be identified using the available imaging methods, and can result in a good percentage of those with chronic symptoms, which become chronic with time due to clinical instability.
Injuries to the soft tissues of the neck as a result of motor vehicle crash are on the rise in north America. These can lead to substantial levels of disablement, even following rear- end collisions that may appear innocuous at the period of the crash. Whiplash, which is an injury to the neck may result to physical and psychological problems for victims as well as financial burdens.
Injuries to the spine bring about a cycle of degeneration that result in nerve damage. According to research, permanent scar tissues form if left uncorrected. These damages may begin within two weeks following the accident.
In 2 to 3 months, 75 percent of the patients with whiplash injuries heal spontaneously. However, these are patients who sustained minor injuries to their ligaments and muscles, but none to their zygophyseal or disc joints.  10 percent of patients with whiplash were shown to develop constant severe indefinite neck pains while 1 percent of those in the entire population experience chronic neck pains as a result of whiplash injuries and 0.4 percent have severe neck pains.
About 25 percent of patients with whiplash injuries, who injured their zygapophyseal joints, alar ligaments or intervertebral discs progress to chronic symptoms.
Following a period of two years (follow up)
o       44 percent of patients, who initially presented with only symptoms, had residual complaints,
o       81 percent of patients with initial symptoms and physical findings were symptomatic,
o       90 percent of those with neurologic involvement were symptomatic,
Women, who are most vulnerable in automobile accident, are likely to suffer long consequences from injuries.

Rear end collisions

Extension acceleration whiplash injuries are most likely to occur as a result of rear end collisions, and are considered to result in the greatest damage.
Head rotations at the moment of impact result in increased injuries on the both sides the head turned.
The lack of awareness (being caught unaware) before the impact aggravates the prognosis. Moreover, the injury would be compounded by the presence of a degenerative disc disease of the spine or degenerative diseases of the disc (s) where tissues tend to become inelastic an easily torn in advanced age.

Chiropractic

According to a good number of studies, the overuse of pain pills has been linked to kidney failure. Drug business has also become one of the most profitable business in the united states of America, where 50 percent of the drugs in the world are consumed in the U.S.
As an alternative, chiropractic has proved to be a much reliable method with no side effects or negative effects to the body. This method is based on two reality facts, these being;
o       That the body is a self regulating, self- healing organism,
o       That the nervous system is the master system and controller of the body,
93 percent of patients improved following chiropractic treatment. From the retrospective study, the results suggest that positive results can occur in well above 90 percent of patients undergoing this form of treatment for chronic `whiplash’ injury'. According to another retrospective study from the journal injury (1996), it was shown that 26 out of 28 patients (93 percent) who suffered from chronic whiplash syndrome benefited from chiropractic treatment.
This was also supported by a controlled experiment and clinical trials, which gave evidence that early and controlled mobilization tends to be superior to immobilization for musculoskeletal soft tissue injuries.
Chiropractic adjustments
The controlled movement allows the injured tissue to heal quicker and better. These movements improve fluid exchange of the disc and synovial fluid thus reducing pain and joint degeneration. Simply stated, the controlled movements initiate a neurological sequence of events that result in the inhibition of pain.
  References
Conlin a, bhogal s, sequeira k, teasell r (2005). "treatment of whiplash-associated disorders--part i: non-invasive interventions". Pain res manag 10 (1): 21–32. Pmid 15782244.
 hurwitz el, carragee ej, van der velde g et al. (2008). "treatment of neck pain: noninvasive interventions: results of the bone and joint decade 2000–2010 task force on neck pain and its associated disorders". Spine 33 (4 suppl): s123–52.
 villanueva-russell y (february 2005). "evidence-based medicine and its implications for the profession of chiropractic". Soc sci med 60 (3): 545–61.
U.s. national highway traffic safety administration, traffic safety facts, annual. See also <http://www-nrd.nhtsa.dot
.gov/cats/index.aspx>.
Links

Http://www.ots.ca.gov/media_and_research/data_and_statistics.asp



Friday, January 3, 2014

Chiropractic and Spinal Decompression



www.skylinechiro.com



Chiropractic and Spinal Decompression
     Experiencing lower back pain (LBP) is an extremely common occurrence and accounts for much lost time from work and family obligation. There is nothing worse than doing a simple action only to feel that sharp piercing pain in your lower back that forces you to stop your life for a moment.  Science now understands that this pain is likely caused by spinal compression. While most LBP does resolve itself within 1-2 weeks[1], the odds are high that patients will have another episode of LBP in the future.  LBP can be treated successfully with chiropractic and spinal decompression.
     For years, the most common treatment options for lower back injuries have been yoga, abdominal exercises, heat therapy, cognitive behavioral therapy, topical analgesics and prescription muscle relaxants[2]. Sometimes doctors will provide a shot of cortisone. Only in rare circumstances will legitimate doctors recommend surgery. Surgery is risky and its results are not consistently useful, although surgical techniques are getting better.
     What is known for a fact is that most LBP is caused by compression of discs in the lumbar region of the back. Further, LBP can also be accompanied by sciatic nerve pain in the lower back area and legs. Discs in the spine, usually L4-L5 are compressed or “herniated”. This constant pressure is the source of pain. Often, an episode of LBP resolves itself as the spine is able to release a minute amount of pressure on its own. The problem is that this release of pressure is not enough to fully solve the problem of LBP. This is why most people have another bout of back pain again and again.






Traction:    
When you have a herniated disc, it means that at least two discs are painfully pressed together.  The “obvious” treatment is to pull the discs back to where they are supposed to be so that there is the right amount of space or “separation” between the discs. This process is called “traction”. It is a non-surgical option that has been around for decades. What is called “spinal traction” refers to the separation of the discs, bones and joints in the spinal area. The idea is that doing this will relieve pain and restore function.  Although this treatment is not proven to be based on a one to one relationship between disc compression and pain, the literature shows that most patients experience dramatic relief from lumbar pain and regain function and range of motion.[1][2] Spinal decompression traction devices come in many forms from at home “hanging upside down” to the new and elaborate DRX-9000 Systems.  When decompression is provided by a health care professional, the patient will be asked to lie on their back or stomach, depending on the machine used. Treatment sessions range from about 10 to 30 minutes, depending on the patient. The average amount of force administered is about 45 kg.[3]
     Today, most chiropractors or back doctors will use a traction device that is regulated by a computer so that the amount of traction force is documented and regulated accurately. The computer will determine what angle the force is coming from and keep track of the amount of time the force is administered. Most patients undergo spinal decompression treatment for several sessions spanning weeks or even months. After each treatment, time is allowed for the body to adapt and heal itself.
     The bottom line is that should the usual treatments of exercise and topic therapies fail, spinal decompression has become accurate and reliable enough to be your next treatment option. For now, spinal decompression allows for most people to avoid back surgery.



Useful links



[3] http://www.udel.edu/PT/PT%20Clinical%20Services/journalclub/caserounds/06_07/oct06/pellecchialumbartractionrevoflit.pd

http://www.skylinechiro.com