In this post I will talk about how I diagnosed a medical issue of a displaced muscle tendon in myself and solved it. I analyse how our medical ontology is currently ill-equipped to categorize the problem. I discuss the implications for thinking about human aging and why we need to think broader than the seven hallmarks.
Personal experience with a displaced muscle tendon
While I'm normally using a trackball as a mouse, two years ago I went to go co-working and used a normal mouse. I made a bad movement while using the mouse and afterwards my right hand hurt a bit. A few days later my hand was relatively okay, but my hand and arm were still more tense than before.
I asked multiple bodywork people to fix it, but while the arm got more relaxed the issue didn't fully resolve. This week I decided to investigate how my right hand and left hand differ to find out what's going on. I noticed that if I extend my right arm my right hand goes in the direction of the ulna side unless I add tension to keep it in place.
When palpating the ulna head from the dorsal side of my left hand I was touching the ulna head directly. When doing the same thing on the right side, there was something above the ulna head. I formed the hypothesis: "Maybe, the thing I'm palpating is out of place. How about I move it laterally?" I used my fingers to slowly push it laterally.
Afterwards, my right arm started relaxing. I fixed the problem that I produced two years ago in 10-15 seconds of action. I looked up the anatomy and deduced that I moved the tendon of the muscle extensor carpi ulnaris. The tendon is supposed to be lateral of the ulna head and not dorsal. This explains why my hand moved before when extending my arm. Part of extending the arm involves turning the ulna and as the ulna turns, the ulna head presses a bit in the dorsal direction and pushed on the tendon. As a result of pushing on the tendon the extensor carpi ulnaris contract resulting in the movement I observed.
Untreated, this issue might have resulted down the line in carpal tunnel syndrome or back pain down the line. Plausibly, it would have even produced those effects in the two years if I wouldn’t regularly do effective interventions to remove tension.
Conceptualizing the displaced muscle tendon as a ICD 11 illness
Did I have an illness that I cured and if yes, what illness? The current official ontology for illnesses is written down in the International Statistical Classification of Diseases and Related Health Problems (ICD), currently at version 11.
Given that the issue was about the extensor carpi ulnaris I would expect to find a way to specify it in NC36.5 Injury of other extensor muscle, fascia or tendon at forearm level.
Other extensor muscle means that we are not talking about muscles of thumb or other fingers that have their own codes. This code does allow me to specify that the issue is about XA9304 Extensor carpi ulnaris muscle and on the right side with XK9K Right.
NC36.5 gives me four sub-choices:
NC36.50 Strain or sprain of other extensor muscle, fascia or tendon at forearm level
NC36.41 Laceration of extensor muscle, fascia or tendon of other finger at forearm level
NC36.4Y Other specified injury of extensor muscle, fascia or tendon of other finger at forearm level
NC36.4Z Injury of extensor muscle, fascia or tendon of other finger at forearm level, unspecified
While ICD 11 doesn't give me a definition of what they mean with strain, Medical-Dictionary gives me for strain "3. an overstretching or overexertion of some part of the musculature".
The nearest I found for sprain on Medical-Dictionary is:1. An injury to a ligament as a result of abnormal or excessive forces applied to a joint, but without dislocation or fracture.
This is different from the dislocation I had, my problem was not that the muscle was permanently stretched but that it got put under tension if I used my arm.
Giving that the muscle was dislocated in a way that stayed dislocated for two years, this seems to be inapplicable. This means that the only way to express it in ICD-11 terms would have been NC36.4Y and use free-text. If my issue would have been with a joint or ligament I could have used NC33 Dislocation or strain or sprain of joints or ligaments of elbow.
To me the inability of ICD-11 to express my issue directly is interesting because it points to a lack of medical interest in the issue. It's illustrative of how anatomy is currently a neglected research topic. If you are doubtful about how anatomy is neglected, the fact that the lymphatic system extends into our brains was only discovered in 2015.
Conceptualizing the displaced muscle tendon as aging damage
As people age they usually become more tense and stiff. Many people develop back pain as they age and it becomes more common with advancing age. I consider it plausible that a lot of different untreated damage that's in nature similar to my dislocated muscle tendon contributes to this problem.
While only a minority of people will develop a dislocated extensor carpi ulnaris tendon, if we solve all aging damage that develops in all humans, a myriad of different classes of unrepaired damage are likely to still kill everybody as more and more of it accumulates in individual.
Given that damage like this can accumulate even if the specific type of damage doesn't exist in every aging individual, Aubrey's idea that it's enough to cure the seven types of damage he identified or the nine hallmarks is flawed.
What do we need to go forward from here?
A lot of progress in our biomedical knowledge of the last two decades is driven by open-source bioinformatics. Databases like UniProt provide every researcher the ability to freely access data about genes and proteins and do science with them.
We created those databases by funding molecular biology centric approaches. Given that we have access to fMRI technology we can use it for more than pretty pictures of brains. The data about where muscles happen to be is accessible via fMRI and we can use computer analysis to find a lot more on fMRI's that doctors currently see with the limited focus of their field of expertise. While proprietary fMRI software might successfully diagnose some medical issue that doctors don't see, we need open scientific exchange to conceptualize medical issues.
We need an open system that takes in data like fMRI data and that translates them into 3D anatomical models like the anatomical model of BioDigital, ZygoteBody or Anatomy3dAtlas. We need those models to study how the anatomy of individual humans differs, diagnose anatomical problems like dislocated muscles in a systematic way and study the effects of our interventions. Once we conceptualize the problems we need ICD codes to get the problems into our medical system.
Besides improving our general medical knowledge, 3D anatomical models of individual patients that can be explored in VR would help physiotherapists and other bodyworkers work more effectively.
If you care about illnesses such as cancer, better understanding of anatomy might help us detect abnormal anatomy due to cancer better.
If the goal you care about is ending aging, developing technology like this is important to find more of the accumulating damage that goes beyond the nine hallmarks.
Some images will be helpful to understand what you are saying.
Ironically, if what I would advocate would happen it would be a lot easier to provide good images ;)
I took a screenshot from my anatomy atlas app, hopefully it's a bit helpful. https://i.ibb.co/RpMfpJX/Screenshot-20210603-191621.png
The muscle Christian is talking about is highlighted in blue, and the tendon sheath is the blue tube at the bottom. My read is that that sheath had moved to the side a bit, closer to the others?
Anatomy atlases like that often include the tendon of the muscle in the marked muscle, so I'm talking roughly about the end of the thing that's marked in blue on the image. From the view of that image, the blue muscle is the thing that's most left at that point. In my case, it was moved right from that and so that you would still see it when looking at the hand from that perspective instead it being hidden on the other side of the hand.
This is orthogonal to your point, but you're conflating two different descriptions of the mechanisms of aging when you attribute "7 hallmarks of aging" to Aubrey de Grey. Aubrey talks about seven distinct forms of damage that result from metabolic activity. There's a separate discussion that addresses 9 hallmarks, though that is less attributable to any single researcher. The framework has been adopted by the NIH, AFAR, and extensively discussed in Sinclair's book Lifespan.
There's a fair amount of overlap between the two, but they're distinct frameworks. de Grey's theory talks about 7 distinct types of cellular damage that might be mitigated by separate interventions. (e.g. "mitochondrial mutations" by outsourcing the production of proteins, "extracellular linkages" by AGE breakers). The 9 Hallmarks approach identifies vaguer clouds of disfunction, only some of which are amenable to direct intervention. (e.g. "epigenetic alterations", "loss of proteostasis", "deregulated nutrient sensing").
I fixed it in the text. From https://www.lesswrong.com/posts/RcifQCKkRc9XTjxC2/anti-aging-state-of-the-art I got the impression that they frameworks are very similar so I took the to be more or less the same thing.