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ECOS 3 Midterm > Counterstrain - Extremity review, new anterior counterstrain & Diabetes screening > Flashcards

Counterstrain - Extremity review, new anterior counterstrain & Diabetes screening Flashcards

1
Q

Counterstrain Steps (7)

A
  1. Find most significant Tenderpoint.
  2. Physician establish a tenderness scale.
  3. Monitor Tenderpoint throughout.
  4. Place patient in “Position of Ease” of at least 70% improvement.
  5. Hold 90 seconds.
  6. Slowly return to neutral.
  7. Recheck tenderness and associated TART findings.
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2
Q

Supraspinatus: counterstrain positioning/treatment

A

F Abd ER patient’s arm is flexed 45 degrees, abducted 45 degrees, and externally rotated

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3
Q

Levator Scapulae: counterstrain positioning/treatment

A

IR Abd traction IR pt’s shoulder, add mild-mod traction with minimal abduction

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4
Q

Subscapularis: counterstrain positioning/treatment

A

E IR pt’s shoulder extended and internal rotated, traction can help

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5
Q

Biceps Brachii (Long Head): counterstrain positioning/treatment

A

F Abd ir elbow and shoulder flexed, arm is minimally abducted and internally rotated

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6
Q

Biceps Brachii (Short Head)Coracobrachialis: counterstrain positioning/treatment

A

F Add ir elbow and shoulder flexed, arm is minimally adducted and internally rotated

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7
Q

Radial Head–Lateral (Supinator): counterstrain positioning/treatment

A

E SUP Val pt’s elbow in full Extension, forearm markedly supinated, fine tune with vaLgus force

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8
Q

Medial Epicondyle (Pronator Teres): counterstrain positioning/treatment

A

F PRO Add pt’s elbow Flexed, marked pronation, forearm slightly aDducted

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9
Q

Dorsal Wrist (Extensor Carpi Radialis): counterstrain positioning/treatment

A

E Abd/rd pt’s wrist passively Extended and aBducted

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10
Q

Dorsal Wrist (Extensor Carpi Ulnaris): counterstrain positioning/treatment

A

E ADD pt’s wrist passively Extended and aDducted

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11
Q

Palmar Wrist (Flexor Carpi Radialis): counterstrain positioning/treatment

A

F Abd pt’s wrist passively Flexed and aBducted

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12
Q

Palmar Wrist (Flexor Carpi Ulnaris): counterstrain positioning/treatment

A

F Add

pt’s wrist passively Flexed and aDducted

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13
Q

First CMP (Abductor Pollicis Brevis): counterstrain positioning/treatment

A

F (wrist) Abd (thumb) pt’s wrist passively Flexed, thumb is aBducted

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14
Q

Lateral Trochanter (Tensor Fasciae Latae): counterstrain positioning/treatment

A

patient’s knee is aBducted and slightly flexed •May require slight internal rotation of the hip

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15
Q

Iliotibial band: counterstrain positioning/treatment

A

f ABD patient’s hip/thigh is abducted and slightly flexed until the tenderness is ≥70% reduction •May require slight internal or external rotation of the hip

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16
Q

Lateral hamstring tender point: counterstrain positioning/treatment

A

F ER ABd patient’s knee is flexed and the tibia is externally rotated with slight abduction; compression on the calcaneus is added to plantar flex the ankle

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17
Q

Medial hamstring: counterstrain positioning/treatment

A

F IR Add patient’s knee is flexed and the tibia is Internally rotated with slight aDduction; compression on the calcaneus is added to plantar flex the ankle

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18
Q

Lateral Meniscus: Lateral (Fibular) Collateral Ligament counterstrain positioning/treatment

A

pt’s thigh abducted so leg is off table, flex knee~35-40 degrees, tibia is abducted and externally or internally rotated until the tenderness is ≥70% reduction •May require ankle dorsiflexion and eversion of the ankle

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19
Q

Medial Meniscus: Medial (Tibial) Collateral Ligament counterstrain positioning/treatment

A

pt’s thigh abducted so leg is off table, flex knee~35-40 degrees, tibia is adducted and internally rotated until the tenderness is ≥70% reduction •May require plantar flexion and inversion of the ankle

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20
Q

Anterior Cruciate: counterstrain positioning/treatment

A

towel roll or pillow under distal femur for fulcrum, apply force to proximal tibia to translate tibia posteriorly on distal femur until the tenderness is ≥70% reduction

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21
Q

Posterior Cruciate: counterstrain positioning/treatment

A

towel roll or pillow under proximal tibia for fulcrum, apply force to distal femur to translate femur posteriorly on proximal tibia until the tenderness is ≥70% reduction

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22
Q

Popliteus: counterstrain positioning/treatment

A

pt’s knee flexed and tibia is internally rotated until the tenderness is ≥70% reduction

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23
Q

Extension Ankle (Gastrocnemius): counterstrain positioning/treatment

A

pt’s knee flexed and dorsum of foot on doc’s thigh, add compressive force through calcaneus until the tenderness is ≥70% reduction

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24
Q

Medial Ankle (Tibialis Anterior): counterstrain positioning/treatment

A

Inversion apply inversion force to foot and ankle with slight internal rotation until the tenderness is ≥70% reduction

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25
Q

Lateral Ankle Fibularis (Peroneus)Longus, Brevis, Tertius: counterstrain positioning/treatment

A

Eversion apply eversion force to foot and ankle with slight external rotation until the tenderness is ≥70% reduction

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26
Q

Flexion Calcaneus (Quadratus Plantae): counterstrain positioning/treatment

A

patient’s knee is flexed, dorsum of foot on doc’s thigh, marked flexion while translating calcaneus toward the forefoot until the tenderness is ≥70% reduction

27
Q

Navicular: counterstrain positioning/treatment

A

F patient’s knee is flexed, dorsum of foot on doc’s thigh, plantar flexion of subtalar joint, supination of forefoot until the tenderness is ≥70% reduction

28
Q

Why do we examine diabetic feet?

A

Elevated levels of blood sugar cause damage to nerves and smaller blood vessels ◦Loss of sensation ◦Decreased blood flow

29
Q

Lack of sensation puts (diabetes) patients at risk for:

A

◦Repetitive trauma ◦Unnoticed injuries ◦Structural deformities

30
Q

◦Decreased blood flow puts (diabetes) patients at risk for:

A

◦Infection ◦Insufficient wound healing ◦Tissue breakdown (gangrene)

31
Q

Steps for diabetic foot exam (6)

A

Steps 1.Inspection 2.Palpation 3.Vascular evaluation 4.Reflexes 5.Monofilament Testing 6.Sensation testing

32
Q

Most commonly missed foot inspection site?

A

Toe web spaces

33
Q

Monofilament Exam - how?

A

◦Patient supine or seated with eyes closed and plantar surface exposed

◦Provide patient with reference sensation

◦Instruct patient to inform you when they feel the monofilament

◦Apply monofilament perpendicularly to skin at testing sites with enough pressure to buckle the filament for 1 second

◦Testing sites should be assessed in random order so patients cannot anticipate it

34
Q

Anterior Thoracic Counterstrain Indication • Chief complaints

A

Chest Pain
•21-49% is MSK in origin

Abdominal Pain

Must rule out all other pathologies before approaching with OMM

35
Q

Anterior Thoracic Counterstrain

Anterior T1-T6 Tenderpoints (1,2,3-6)

Associated anatomy?

A
  • AT1: suprasternal notch
  • AT2: angle of the manubrium (Louis)
  • AT3 to AT6 on the sternum as the same numbered costal level.
  • Associated anatomy: Pectoralis major, intercostal muscles
36
Q

Anterior Thoracic Counterstrain

AT1-2 Treatment

A

example AT 2

•Pt: supine
•Doc: at head of bed
•Position of ease: f-F
Flex cervical to use linkage to T2

37
Q

Anterior Thoracic Counterstrain

AT3-6 Treatment

A

example AT 3

•Pt: seated
•Doc: Standing behind
•Position of ease: f-F
Arms internally rotated

–Flex by -Letting the patient slump back toward physician
-Flex cervical to link thoracic

38
Q

Anterior Thoracic Counterstrain

Anterior T6-T12 Location •AT7 (3)

A

inferior tip of xiphoid and 1/4 from xiphoid and umbilicus

39
Q

Anterior Thoracic Counterstrain

AT8 Location

A

halfway between xiphoid and umbilicus

40
Q

Anterior Thoracic Counterstrain

AT9 Location?

A

3/4 from xiphoid and umbilicus

41
Q

Anterior Thoracic Counterstrain

AT10 location?

A

1/4 from the umbilicus to the pubic symphysis

42
Q

Anterior Thoracic Counterstrain

AT11 location?

A

halfway between the umbilicus and pubic symphysis

43
Q

Anterior Thoracic Counterstrain

AT12 location?

A

on the anterior superior surface of the iliac crest at the mid-axillary line

44
Q

Anterior Thoracic Counterstrain

Anterior T6-T12 associated anatomy?

A

Associated anatomy: Rectus abdominus, obliques

45
Q

Anterior Thoracic Counterstrain AT7-9 Treatment

A

Example R AT 7
•Pt: Seated
•Doc: Standing behind
•Position of ease: F St Ra
–Thoracic flexion
–Sidebend right
–Rotate left

46
Q

Anterior Thoracic Counterstrain AT 10-12 Treatment

A

Example: R AT11

•Pt: Supine
•Doc: Standing behind
•Position of ease: F ST RA
–Flex hips (thoracic flexion)
–pull ankles to right (sidebend right)
–pull knees to the right (rotate left)
•Support with physician knees

47
Q

Anterior Lumbar and Pelvic Counterstrain Indications

A

Chief complaints

–Abdominal Pain
•UTI, Ovarian Cysts

–Low Back Pain
•Anterior musculature
pelvic ring

•Must rule out all other pathologies before approaching with OMM

48
Q

Anterior Lumbar Counterstrain

AL 1 location?

Associated anatomy?

A

•AL 1: Medial to ASIS

Associated anatomy: Obliques (AL 1), Illiopsoas(AL1-4)

49
Q

Anterior Lumbar Counterstrain

AL2 location?

Associated anatomy?

A

AL 2: Medial to AIIS

Associated anatomy: Illiopsoas(AL1-4)

50
Q

Anterior Lumbar Counterstrain

AL 3 location?

AL 4 location?

Associated anatomy?

A

AL 3: Lateral to AIIS
AL 4: Inferior to AIIS

Associated anatomy: Illiopsoas(AL1-4)

51
Q

Anterior Lumbar Counterstrain

AL5 location?

Associated anatomy?

A

AL5: Anterior superior aspect of pubic ramus

Associated anatomy: Adductor longus (AL 5)

52
Q

Anterior Lumbar Counterstrain

AL 1 Treatment

A

Example R AL 1 (medial ASIS)
•Pt: Supine
Doc: ipsilateral side
•Position of ease: F St RA
–Flex hips (lumbar flexion)
–Pull ankles toward doc (sidebend right)
–Pull knees toward doc (rotate left)
•Support with physician knees

53
Q

Anterior Lumbar Counterstrain

AL 2 Treatment

A

Example R AL 2 (Medial AIIS)
•Pt: Supine, Doc: contralateral side

•Position of ease: F SA RT
–Flex hips (lumbar flexion)
–Pull ankles toward doc (sidebend right)
–Pull knees toward doc (rotate left), lots of rotate!

•Support with physician knees

54
Q

Anterior Lumbar Counterstrain

AL 3 & 4 Treatment

A

Example R AL 3 (Lateral AIIS) or R AL 4 (Inferior AIIS)

•Pt: Supine, Doc: contralateral side

•Position of ease: F SA Rt
–Flex hips (lumbar flexion)
–Pull ankles toward doc (sidebend right)
–Pull knees toward doc (rotate left)

•Support with physician knees

55
Q

Anterior Lumbar Counterstrain

AL5 Treatment

A

Example R AL 5 (superior/lateral to pubic symphysis)

•Pt: Supine, Doc: ipsilateral side

•Position of ease: F SA RA
–Flex hips (lumbar flexion)
–Pull ankles away doc (sidebend right)
–Pull knees toward doc (rotate left)

•Support with physician knees

56
Q

Anterior Pelvic Counterstrain

Psoas Major tenerpoint location?

A

2/3 distance from ASIS to midline

57
Q

Anterior Pelvic Counterstrain

Iliacus tenderpoint location?

A

Iliacus: 1/3 distance from ASIS to midline

58
Q

Anterior Pelvic Counterstrain

Low Ilium tenderpoint location?

A

Low Ilium: Superior pubic ramus, where psoas passes pelvic rim

59
Q

Anterior Pelvic Counterstrain

Inguinal Ligament tenderpoint location?

A

Inguinal Ligament: Lateral Pubic Tubercle

60
Q

Anterior Pelvic Counterstrain

Psoas Major Treatment

A

Example Right Psoas Major TP (2/3 from ASIS to midline)

•Pt: Supine, Doc: ipsilateral side

•Position of ease: F ST er
–Extreme hips flexion
–Pull ankles toward physician (Sidebend left external rotation)

•Support with physician knees

61
Q

Anterior Pelvic Counterstrain

Iliacus Treatment

A

Example R Iliacus TP (1/3 distance from ASIS to midline)

•Pt: Supine, Doc: ipsilateralside

•Position of ease: F ER Abd
–Flex hips
–Cross ankles (external rotation)
–Let knees drop out (abduction)

  • Support with physician knees
  • Criss cross Iliacus sauce
62
Q

Anterior Pelvic Counterstrain

Low Ilium Treatment

A

Example Right Low Ilium TP (Superior pubic ramus, where psoas passes pelvic rim)
•Pt: Supine, Doc: ipsilateralside
•Position of ease: F
–Flex hips >90

63
Q

Anterior Pelvic Counterstrain
Inguinal Ligament Treatment

A

Example R Inguinal Ligament TP (Lateral pubic tubercle)

•Pt: Supine, Doc: ipsilateralside

•Position of ease: F ADD IR
–Flex hips to 90
–Cross contralateral knee over (adduction)
–Pull ankles toward TP (Internal rotation)

•Support with physician knees

ECOS 3 Midterm (14 decks)

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