Thursday, December 13, 2012

December Blog

My wife (Marty) and I would like to wish everyone a Joyous and Safe Holiday Season.  Merry Christmas and Happy New Year.  We will be closed the week of Christmas from 12/25 through 1/1/13.
December's Blog is about true pinched nerves.  We call them entrapment or compression neuropathies.  Old time chiropractors often referred to pinched nerves for any mechanical joint pain.  Modern chiropractors, except for a few, recognize there is little scientific evidence for this description of mechanical back and neck pain and radiating pain.

Entrapment neuropathy results from interference with the normal path of the nerve.  Basically, the nerve gets squeezed due to a lack of space and the bony and muscular path where the nerve lies.  One of the most common entrapment areas is the carpal tunnel.  There are many factors that can narrow this canal.   Several things outside of the canal such as tumors, trauma, spurs, and even disc herniations can cause pressure on the nerve resulting in such symptoms as pain and numbness and tingling.  Certain systemic conditions such as rheumatoid arthritis and diabetes can also affect the nerve's ability to move and glide in its tract.

Chronic pressure on the nerve can damage its structure and blood flow. It is important to remove the pressure from the nerve before permanent damage occurs.  Conservative treatment such as tissue mobilization, splinting, nerve mobilization/manipulation and other therapy modalities are effective with early detection.  Steroid injections may be necessary to reduce inflammation and pain.  Surgical intervention may be necessary in nonresponsive and chronic cases and cases with tumors or spurs compressing the nerve.

There are 3 key nerves in the upper extremity that may experience entrapment syndromes.  The radial nerve, ulnar nerve and median nerve.  The median nerve is the most commonly entrapped nerve in the upper extremity (carpal tunnel) with radial nerve and ulnar nerve entrapments following.  The symptoms experiences are based on the location of the entrapment (anywhere from the neck to the wrist) and the type of nerve entrapped.  Motor nerves affect muscles and will typically result in weakness when trapped.  Sensory nerves on the other hand will typical result in decreased sensation or numbness and tingling.  Thoracic outlet syndrome is another area which involves the neurovascular bundle (nerves, blood vessels) and is another topic outside this discussion.

Accurate diagnosis to locate the entrapment location is important.  Standard orthopedic and neurological examination may help identify common entrapment conditions.  When no apparent cause is obvious or the case is non-responsive, it may be necessary to perform advanced diagnostic testing to identify the entrapment point.  Ultrasound and electrodiagnostics are frequently used.  MRI is generally less useful but may be necessary in the case of tumors.  Laboratory work may be necessary to rule out systemic conditions like rheumatoid arthritis, hypothyroidism and some cancers.  In general, it is important to identify the source in the course of the nerve which may range from the neck to the wrist.  Location drives the treatment options available.

Dr. Riggs has recently completed an article accepted for publication on non-carpal tunnel median nerve entrapments and is working on a subsequent articles on ulnar and radial nerve entrapments and lower extremity entrapments.

Tuesday, October 9, 2012

I haven't been on in a while due to studying for chiropractic orthopedic board exams.  I'm happy to say I passed my boards and have earned the Diplomate Academy of Chiropractic Orthopedists (D.A.C.O.) designation.  I have been admitted to the Academy of Chiropractic Orthopedists as a Fellow (F.A.C.O.).  I started the process several years ago 1998-2000 and due to a move dropped out.  Last fall I re-entered the process and completed the requirements to sit for the exam which I did on September 29th. 

Wednesday, July 18, 2012

July-August Blog

Just a reminder we have moved to theColonnade (Chile's, Jason's Deli, Abuelo's area).  We are on the Southeast side of the complex opposite of where we used  to be.  Drop by and say hi.  We are right next door (right side) of the entrance to Tuesday Morning's.  Our overhead sign is up reading CHIROPRACTOR

Clinical Condition:

Systemic Lupus Erythematosis (SLE):

 Lupus is an arthritic condition which is less destructive than Rheumatoid Arthritis (RA) and is referred to as the great immitator.  It mimics a lot of other conditions.    Typically, it is found more frequently with women than men and its cause is not known, although autoimmune issues and genetics may be factors.  Environmental factors are also suspect.  Patients frequently present with a fever and joint pain affecting the hands, wrists, knees and other joints.  75% of patients have joint pain.  A percentage (about 30-50%) of patients also present with what is called a malar or "butterfly rash" on their cheeks.  It can lead to inflammation of the heart, kidneys and joints.  It also causes a decrease in red and white blood cells and platelets.  This condition, called pancytopenia, can cause such things as fatigue, infection, nose bleeds, petechiae, rapid heart beat, shortness of breath, and pallor.  Lab tests are necessary to diagnose the condition and generally demonstrate an increase anti-nuclear antibody (ANA), anti-Smith antibodies and HLA-DR3 and sometimes a positive rheumatoid factor as well as the decrease blood red, white and platelet cell findings.  Liver enzymes and renal function need to be assessed as well.  A complete blood count is generally ordered.

Lupus can wax and wane with respect to symptoms.  It can affect the joints, lungs, heart, skin, liver and kidneys.  Neuropsychiatric conditions can exist as well such as:  headache (most common), depression seizures, mood disorders and anxiety.  In younger patients, 3-15 years old, females are 4 times more likely to have lupus than males.  The butterfly rash also shows up commonly. 

Medical NEWS:
  • AUTISM:  a recent National Academy of Sciences article by CALTECH researches has found a connection with an overactive immune system and autism.  It makes me wonder if there is connection to vaccines given to those with an overactive autoimmune system thereby triggering the autism.
  • ABUSED CHILDREN are more likely to have cancer as adults.

Friday, March 23, 2012

March Blog

Just a reminder we have moved to theColonnade (Chile's, Jason's Deli, Abuelo's area).  We are on the Southeast side of the complex opposite of where we used  to be.  Drop by and say hi.  We are right next door (right side) of the entrance to Tuesday Morning's.  Our overhead sign is up reading CHIROPRACTOR.

Nutrition News:

  • Alzheimer's:  6th leading cause of death in the aging.  Research at MIT has found a form of magnesium that targets factors involved in the onset of Alzheimer's.  Magnesium-L-threonate.
  • Inflammatory Joint Damage:  Stanford scientists have found that osteoarthritis has the same pro-inflammatory immune factors as involved in rheumatoid arthritis.  The drugs used to combat this inflammation, such as prednisone, may result in complications including obesity, diabetes and osteoporosis.  A form of undenatured type II collagen (UC-II) when combined with Boswellia serrata (found also in Osteobiflex-glucosamine + 5 Loxin) and glucosamine sulfate and boron.
  • Controlling after-meal (postprandial) blood sugar surges.  Such surges, especially after a high carbohydrate meal, can creat a diabetic-like state in your body lasting for hours and causing some damage.  The enzyme glucose-6-phosphatase detrimentally stimulates this process.  Chlorogenic acid (gree coffee bean extract) targets this enzyme and can blunt the post-meal blood sugar surges by almost 1/3.  You can also reduce the blood sugar drops in several wasy
    • Plant extracts-propolmannan, irvingia, white ean, green tea, cinnamon.
    • Optimizing DHEA levels
    • Healthy lifestyles-Mediterranean diet, avoid dietary sugars, exercise, calorie restriction (1400-1800 calories per day or less -hard to do).
    • Anti-diabetic drug metformin
    • In men, testosterone levels can reduce insulin sensitivity.  Optimal free testosterone in more youthful ranges.
High Blood Pressure:
  • Olive leaf extract (oleuropein)- appears to modulate arterial stiffness affecting blood pressure.
Manual Medicine/Chiropractic: 
  • Thumb osteoarthritis:  mobilization increased pain pressure threshhold but did not increase muscle function. 

Tuesday, March 6, 2012


We've moved our office to:

4610 N. Garfield Street, B4
Midland, TX 79705

We are right next to Tuesday Morning's in the Colonnade.