Shoulder, Arm, Hand

Shoulder, Arm, Hand: Review & Practicum Lab

with Anthony Von der Muhll

Prerequisite: completion of our 16-hour Shoulder, Arm, Hand: History, Exam, Assessment & Treatment course (in-person, or distance-learning)

Monday, November 3, 2024, 9:00-6:00

at the Academy of Chinese Culture and Health Sciences, 1600 Broadway, Oakland CA

Comments from Course Evaluations

"Anthony has an outstanding breadth of knowledge, skill, and experience to offer. I wish I weren't trying to absorb this on my own–The online version is great for pacing, and I watched each video twice, but it's not enough. I wish it were a semester class with classmates, study groups, time to practice, etc....overall, it is OUTSTANDING and has already changed my practice. Now, onto the neck module!"

-- Laura Paris, L.Ac., Monterey, California

"Covered a wide range of material...Thank you for continuing this wonderful orthopedic knowledge; I also appreciated your warning and concern with needle depth and angle."

-- Elizabeth Otten, L.Ac., Bellingham, Washington

History-taking for the shoulder: key diagnostic questions

"Red flag" symptoms of urgent/serious medical conditions warranting referral to physician care: fractures, dislocations and complete tears; neuropathies; tumors
Differentiating symptoms of muscle, tendon, ligament, labral, capsular, and nerve injuries
Neural hypersensitization and psycho-social factors
Functional capacity questionnaires for reporting to managed care insurance

Physical exam of the shoulder: how findings can guide treatment with acupuncture modalities

Observation, inspection and palpation
Joint active range-of-motion and tracking exam: taking measurements and diagnostic significance
Assessment of joint stability through end-feel testing
Muscle length and manual strength testing and referred pain patterns charts for 18 key muscles of the shoulder girdle
Special orthopedic tests
Documentation of physical exam findings
Measuring and reporting functional capacity baselines and treatment outcomes
Clinical flow charts to facilitate efficiency and accuracy in examination

Diagnosis, pattern identification and treatment for shoulder girdle pain, injuries and disability

Gleno-humeral joint
- Non-capsular patterns: AMBRI and SLAP (labral) tears
- Capsular patterns: osteoarthorosis, capsulitis, and "frozen shoulder"
Acromio- and sterno-clavicular joint sprains/separations and hypermobility
Rotator cuff tendonitis/tendonosus, impingement, and bursitis
Bicipital tendinopathies

Arm, Wrist, and Hand

Clinical anatomy, kinesiology, and the jing-jin:

Elbow joints: ulnar-humeral, radio-humeral and -capitellar
Wrist joints: ulnar-carpal, radio-carpal, and distal radio-ulnar
Muscles and tendons of the upper- and fore- arm and hand

History-taking for the arm, wrist, and hand: key diagnostic questions

"Red flag" symptoms of urgent/serious medical conditions potentially warranting referral to physician care: fractures, neuropathies, complex regional pain syndrome
Differentiating symptoms of muscle, tendon, ligament, joint, and nerve injuries
Neural hypersensitization and psycho-social factors
Functional capacity questionnaires for reporting to managed care insurance

Physical exam of the arm, wrist and hand

Observation, inspection and palpation
Active and passive range-of-motion examination of the elbow, wrist, and finger joints: measurements and diagnostic significance
Assessment of joint stability through end-feel testing of the elbow, wrist and finger
Peripheral nerve sensory and motor exams
Manual and dynamometer strength testing, muscle length testing, and referred pain pattern charts for 20 key muscles of the arm, wrist and hand
Special orthopedic, neurologic and vascular tests
Documentation of physical exam findings
Measuring and reporting functional capacity baselines and treatment outcomes
Algorithmic flow charts to facilitate efficiency and accuracy in examination

Diagnosis, pattern identification and treatment for arm, wrist and hand pain, injuries and disability

Posterior & radial tracts: yangming and shaoyang

Tennis elbow, extensor strains, tendinosus, radial tunnel compression neuritis and palsy
Radial styloid stenosing tenosynovitis
Radial collateral ligament sprains and hypermobility

Ulnar tract: taiyang and shaoyin

Ulnar neuritis/neuropathy
- Ulnar groove compression
- Canal of Guyon compression
Acute sprains and chronic laxity of the ulnar-carpal joint
Acute tendonitis and chronic tendonosus
- Golfer’s elbow & “medial epicondylitis”
- Extensor carpi ulnaris
- Flexor carpi ulnaris
- Abductor digiti minimi
- Ulnar collateral ligament laxity & “Little league elbow”

Anterior tract: taiyin, shaoyin, jueyin

Biceps, supinator and forearm flexor tendonitis and tendonosus
Median neuritis/neuropathy
- Pronator teres syndrome
- Carpal tunnel syndrome

Intrinsic wrist conditions

1st CMC joint pain: sprains, DJD
Triangular fibrocartilage complex tears

Intrinsic hand conditions

MCP and inter-phalangeal joints
- Sprains and laxity of finger collateral ligaments
- Degenerative joint disease
Finger extensor tendonitis

Ergonomics, postural correction and exercise therapy for shoulder, arm and hand conditions:

Scapular stabilization
Rotator cuff strengthening
Forearm exercises
Wrist stabilization
Keyboard ergonomics

Build on your skills with the Review/Practicum Lab

Medical Documentation: Essential Best Practices

Professional medical charting and reports are vital for:

Supporting insurance reimbursement, surviving insurance audits and records requests
Building referral relationships and improving coordination of care with other medical professionals
Improving outcomes and learning from your patient cases
Defense in cases of malpractice and complaints to regulatory agencies

Class Topics:

Bring your charting up to the highest standards of professionalism: best practices in contents, organization, terminology for initial visit HPIs and follow-up SOAP notes
- Subjective
- Objective
- Assessment
- Plan
Practical and efficient charting techniques: save time and effort while improving quality
- Paper vs. electronic health records systems: how to choose and make them work for your clinic
- Pros and cons of templates, checklists, and narratives: avoiding the appearance of "rote" treatment
- Custodianship and transfer of patient records: keeping it safe and legal
- Further learning: developing charting skills for your areas of specialization

Distance learning/self-study, E-book and live class notes feature sample initial visit (History of Present Illness) and progress (SOAP) reports.

Live class features instructor-lead peer review/feedback regarding student chart notes.

***Please note: For Certification in Acupuncture Orthopedics, either the live class (8 hours/CEUs/PDAs), or the distance-learning class (5 hours CEUs/PDAs) + one live 3-hour clinical case mentorship meeting focused on medical documentation (no CEUs/PDAs) is required.***

Billing managed care insurance? You'll also want to take Report-Writing Workshop for Managed Care: HMO, Personal Injury, and Workers Compensation. Take both classes for -10% off each.

Acupuncture Treatment of the Taiyang Jing-Jin (“Sinew Meridian”): the Posterior Tract

**Learn classical and modern methods of treating the jing-jin, including:**

Classical needling techniques, including “crack needling,” “short puncture,” “superficial puncture,” hegu puncture, and shu-point/periosteal puncture
Myofascial trigger point and joint stabilization/mobilization ("prolo-acupuncture") needling
Cupping, gua sha, and other manual therapies

Instructional methods include:

Comparison of ancient source translationss with dissection studies and functional analyses of myofascial tissues: bony attachments and kinematic chains of muscles, tendons, ligaments and fascia
Review of postural vs. phasic muscles and balance between agonist/antagonist muscle groups
Classical palpation techniques integrated with assessment of the movement, strength, and joint stabilization functions of the taiyang jing-jin
Anatomical charts of myofascial referred pain patterns, including muscle attachment sites and functions, innervation, and trigger, motor and Chinese new/miscellaneous points for over 25 muscles and connective tissue structures that form the taiyang jing-jin

Knowing the jing-jin is a valuable complement to the cross-sectional approach of contemporary orthopedics, and opens up to avenues towards holistic rehabilitation from injuries, pain and disability, including:

Decreased muscle-tendon pain and tension, and improved strength and function
Decreased joint pain and enhanced stability and biomechanics
Increased muscle-tendon flexibility and joint range-of-motion

**Acupuncture Treatment of the Jing-Jin ("Sinew Meridians"): Introduction is strongly recommended as a pre-requisite.**

**See the other classes in this 4-part series: Shaoyang, Yangming and 3 Yin Jing-Jin. Take more than 1 for 10% off each!**

Student Comments and Ratings

From evaluations as required by NCCAOM & California Acupuncture Board.

Respondents: 40 of 45 enrolled

Comments:

"Thank you for the great class! From clinical pearls to an important review of cautions and contraindications, these courses are very useful, even after practicing in this specialty for over 7 years! The material presents a truly integrative approach to orthopedics and sports medicine. In the past, I've found courses to apply either a TCM or a western orthopedics lens, but Dr. Von der Muhll does a wonderful job of blending the concepts in a way that is practical for patient care, logical for the practitioner, and provides language to discuss findings and treatments with our TCM and western colleagues." --Leslie Yedor, L.Ac.
“Very articulate and precise…great 1-on-1 attention.“ –Jessica Giese-Garderner, L.Ac.
“Amazing–Thank you!“ –Jessica Luehrs, L.Ac.
“This class was a really great review as well as including new material” —Daniele Uzes, L.Ac.
“Great knowledge of anatomy, very in-depth. Thank you for adding to the written notes on-line…I really appreciated Anthony’s in-depth clinical experience and his willingness to share..I’m taking more classes!!!” –Monica Bowditch, L.Ac.
“Tons of great info, many applicable tools, with some practice indeed…great for sports acu/pain/ortho.” —Joe Sarti, L.Ac.
“I especially enjoyed reviewing anatomy whilst doing practical exercises to improve my skills…very good explanations…great that notes are digital and linked.” –Michael E. Brown, Jr., L.Ac.
“I like the charts and photos, this is truly useful!” —Anonymous, L.Ac.
"Excellent!" --Anonymous
"I learned a lot. Anthony is very knowledgeable." --Anonymous
“I wish I had taken this when I got my license in 2006.” —Anonymous, L.Ac.

Average Ratings. Overall: 5/5

The class met its goals/objectives and covered subject materials as stated: 5/5

The class material will be useful in my clinical practice: 5/5

The instructor made effective use of learning aids: slideshows, notes, videos: 5/5

The class provided enough depth, breadth and detail of information: 5/5

The instructor provided adequate instruction in the skills and subjects addressed in the class: 5/5

The written notes were clear, adequate and helpful: 5/5

The number of CEUs/PDAs was appropriate for the time and work required: 5/5

Source Texts Referenced in this Class

Acupuncture: A Comprehensive Text. Shanghai College of Traditional Chinese Medicine. O’Connor and Bensky, trans. and ed. (1981)
Kendall, Donald E. The Dao of Chinese Medicine: Understanding an Ancient Health Art. (2002)
Legge, David. Jing Jin: Acupuncture Treatment of the Muscular System Using the Meridian Sinews. (2010)
Meyers, Thomas W. Anatomy Trains: Myofascial Meridians for Movement Therapists. (2009)
Simmons, Travell, Simmons and Cummings. Myofascial Pain and Dysfunction: The Trigger Point Manual, vols. 1-2. (any edition)

Suggested Class Preparation

**Acupuncture Treatment of the Jing-Jin ("Sinew Meridians"): Introduction is strongly recommended as a pre-requisite.**

Prior review of clinical musculoskeletal anatomy and kinesiology of the posterior body structures listed above (including joints and their planes of motion, ligaments, tendons, muscle attachments and functions, innervation) is recommended to make the most of this learning opportunity. Students are advised to have ready access to clinical anatomy references texts, apps or on-line resources during live webinars and in-person classes.

With Instructor Anthony Von der Muhll, L.Ac., DAOM, DNBAO, FAIPM

Includes lifetime access to high-definition videos, slideshows, and class notes

See below for detailed description of class contents

In-Person Classes & Live Webinars