Skeptical about our kinesiologist

[Dembadon]

Hello,

I'll start with a brief background:

My wife has been experiencing soreness in her forearms accompanied by numbness and 'tingling' in her fingers for quite a few years now. This happens about 3-4 times a week and lasts for hours sometimes. These conditions arose after serving as a dishwasher in college about 10 years ago. The college paid for an ulnar nerve relocation, which did not resolve the issues.

Approximately 2 years ago we were referred to a local kinesiologist by a good friend of ours. I am skeptical of what I saw in the appointment I attended. I was not able to attend the first appointment, however, when my wife came home and described what he did, I wanted to be sure and be at the next one.

Here is an example:

He put his finger in her mouth (supposedly on a specific 'pressure point'), asked her to extend her arm and resist the force of his arm which was being administered in a downward direction. He did this many other times using different 'pressure points' (for lack of a better term). He would even grab small vial containing various elements/vitamins/substances and put them at certain places on her body and ask her to resist force in a similar manner.

I am by no means educated in any field of medical study, however, I consider myself a pretty logical individual who prefers to have data and conclusions which are derived from reliable testing/study methods, not chance occurrences. To me, this type of testing does not seem very reliable and/or scientifically based. Would this not be considered a way of making conclusions based on things that had a high probability of being mere chance correlations? What if she had been working out that day and this method did not elicit an expected response from her muscles due to this fact?

Is my ignorance in the medical field blinding me here? My logic is screaming "This guy is a wacko".

-Robert

 

[turbo]

Quack! Sorry.

 

[Moonbear]

Yeah, sounds a bit quacky...the half about putting a finger in her mouth. The rest of the test, of holding her arm and having her extend it against resistance is something you would expect. I'd find someone else a little more grounded though.

Out of curiosity, where in her forearm does the pain occur? And is it mostly associated with times when she is using it a lot? Since she has already had ulnar nerve relocation, I'm assuming she has seen a physician about the problem and so far not been successful in finding a diagnosis that you have sought out a kinesiologist on the referral of a friend rather than a physician. Has anyone considered the possibility of a chronic compartment syndrome? It's the same type of thing that would cause "shin splints" in the leg, but can be overlooked in the arm since it's less common.

This link should take you to a case study report about a case that might be similar. It'll automatically download a PDF file (the article is freely available to the public).
http://www.jbjs.org.uk/cgi/reprint/78-B/5/780

In case it doesn't work, here's the reference:
Söderberg TA. 1996 Bilateral chronic compartment syndrome in the forearm and the hand. J Bone Joint Surg Br. 78(5):780-2.Here's an excerpt from another case report that you won't be able to download freely without going through a library.

A forty-seven-year-old man was referred to the upper-limb unit of our institution with a history of vague pain in the forearm and hand of about seven years' duration. The symptoms were aggravated by use of the upper limb. He reported that he had difficulty driving even short distances and said that his arms felt like lead weights. A carpal tunnel decompression had been performed elsewhere six years previously with no appreciable relief of symptoms. Physical examination demonstrated bulky musculature in both forearms. Exercising the hands for five minutes reproduced the symptoms. Vascular and neurological examinations revealed normal findings.

Bilateral Chronic Exertional Compartment Syndrome of the Dorsal Part of the Forearm:The Role of Magnetic Resonance Imaging in Diagnosis
Kumar et al. J Bone Joint Surg Am.2003; 85: 1557-1559

In case this hasn't be considered before by her doctors, these case reports also describe the diagnostic tests done and the treatment (fasciotomy), so she could take them to her doctor to provide them with the information.

 

[fleem]

This is called "applied kinesiology". All known studies show it is bogus:

http://www.quackwatch.com/01QuackeryRelatedTopics/Tests/ak.html

 

[Dembadon]

Out of curiosity, where in her forearm does the pain occur? And is it mostly associated with times when she is using it a lot? Since she has already had ulnar nerve relocation, I'm assuming she has seen a physician about the problem and so far not been successful in finding a diagnosis that you have sought out a kinesiologist on the referral of a friend rather than a physician. Has anyone considered the possibility of a chronic compartment syndrome? It's the same type of thing that would cause "shin splints" in the leg, but can be overlooked in the arm since it's less common.

Thank you very much for the info, Moonbear. We have been out of town without internet access for a few days. We are looking forward to researching chronic compartment syndrome and reading through the case study together.

She says the pain is primarily along her "upper forearm" muscle (Brachioradialis?). This is the area she has me massage whenever she is experiencing pain.

We are continuing the search for a reliable physician. Our location (Tahoe City) is a small town in the Sierra Nevada Mountains, which unfortunately requires us to travel long distances to meet with qualified medical help. Work schedules permitting, we'll be making a trip to Stanford soon in hopes of getting this dealt with while we still have insurance.

This is called "applied kinesiology". All known studies show it is bogus:

http://www.quackwatch.com/01QuackeryRelatedTopics/Tests/ak.html

Thank you for the link, fleem. It is always nice to get scientific confirmation of one's intuition.

-Robert

 

[Moonbear]

She says the pain is primarily along her "upper forearm" muscle (Brachioradialis?). This is the area she has me massage whenever she is experiencing pain.

Okay, that fits with what I was thinking (I wasn't sure if the pain was elsewhere if they relocated her ulnar nerve; I guess that was based on the symptoms in her hand, not the location of pain in the forearm/elbow area). There are several muscles that help flex the wrist/hand as well as those that flex the elbow located in the area you describe. It wouldn't likely compress the ulnar nerve if there was swelling in that area, but it could compress the median and radial nerves as well as both the ulnar and radial arteries where they branch there. This is a lot of what supplies the hand with nerves and blood, so it's no surprise she'd experience tingling or numbness in her hand as a result of a problem in that flexor compartment. It's also consistent with the motions involved in dishwashing. The clues to me are that it was an occupational injury type situation, pain in one area, and then the numbness and tingling distal to that location, not at the site of the pain.

Since you may not have your pick of physicians, depending on what specialists you can find, three specialty areas that might be able to best make the right diagnosis (whether it's what I suspect, or something else), would be a hand surgeon (they need to know about the forearm too, because it controls the hand functions too), an orthopedist (it's not a bone problem, but they too need to know about all the structures affecting movements and know a lot about the extremities...certainly they would know about acute compartment syndrome which can occur following fractures, even if they haven't a lot of experience with chronic forms), or a sports medicine physician since aside from occupational injuries, athletes are the other group of people who most commonly experience these types of symptoms. A general practitioner might not recognize these symptoms, because they are probably first thinking about neurological problems, they may have never seen such a case in their entire career to consider it. Hence why they first considered ulnar nerve entrapment, although it doesn't really fit with the forearm pain in the places you're describing it, just the tingling in the hands. They also wouldn't have the ability to do the proper diagnostic tests to confirm the diagnosis, which is why she'd need to see a specialist anyway. It may take some collaboration between a neurologist and an orthopedist to make a proper diagnosis anyway, because it still could be something else.