Counterstrain of UE and LE Lab/OSCE - Treffer

Question 1

What point is treated first if >1 have similar tenderness?

Answer 1

Treat the most central and/or proximal.

Question 2

Anterior Acromioclavicular Joint (ACC)

1) Location
2) Treatment

Answer 2

1) TP is slightly medial to the tip of the clavicle and over the anterior aspect of the AC joint.
2) F/aDD, slight IR, traction across body.

Question 3

Posterior Acromioclavicular Joint (PAC) - Location

Answer 3

At the posterior of joint of the acromion and clavicle.

Question 4

Treatment of PAC.

Answer 4

Pt prone, pull arm back into extension and lsight horizontal adduction. Hand held at about midline.

Question 5

Subscapularis location

Answer 5

On anterolateral surface of scapula, deep in axilla of subscapularis belly. Latissimus dorsi TP slightly posterior.

Question 6

Treatment of Subscapularis and Latissumus Dorsi TP.

What’s the difference?

Answer 6

• Access subscap TP from axillary approach
• IR
• “8 o’clock” position&raquo_space; Extension and aBD
  For lat dorsi, use traction.

Question 7

Long head (LH) biceps TP location.

Answer 7

Tendon of biceps muscle’s long head in bicipital groove.

Question 8

Short head (SH) biceps TP location.

Answer 8

TP inferolateral coracoid.

Question 9

Tx of LH and SH Biceps TP.

What’s the difference?

Answer 9

• Flexion, IR
• Dorsal wrist or forearm lying on forehead
• SH - more adduction, arm across chest.

Question 10

Supraspinatus (SUP) lcoation

Answer 10

in BELLY of supraspinatus, in fossa above spine of scapula

Question 11

Tx of SUP

Answer 11

45 degree aBD, F, ER

Question 12

Extension elbow TP location

Answer 12

TP at side of olecranon process of ulna near triceps tendon.

Question 13

Tx of Extension elbow

Answer 13

• Pt supine
• Grasp elbow so thumb on TP and hand around forearm.
• HYPEREXTEND elbow over monitoring hand
• ABD/ADD to fine tune.

Question 14

Flexion elbow TP location

Answer 14

At coronoid process of ulna.

Question 15

Tx of Flexion elbow

Answer 15

• Pt supine
• FLEX elbow
• ABD arm
• PRONATE forearm
• Pull forearm out laterally.

Question 16

Radial head TP location

Answer 16

Lateral part of radial head

Question 17

Tx of radial head

Answer 17

• Elbow SUPINATED

- EXTEND elbow over knee (not hyperextension)

Question 18

Flexion wrist and thumb TP location

Answer 18

• Flexor side of base of 1st metacarpal on thenar eminence and slightly lateral.
• Along radioulnar and carpal joint line dorsally (Wrist).

Question 19

Tx of Flexion wrist and thumb

Answer 19

• Flexion of entire wrist, mild pressure on thumb.

- Fine tune with rotation of wrist

Question 20

Tx of Extension wrist

Answer 20

Wrap hand around TP by extending.

Question 21

Tx of extensor (dorsal) carpometacarpal and metacarpophalangeal

Answer 21

Extension fo fingers and wrist.

Question 22

Posterior Lateral Trochanter (PLT) TP location

Answer 22

Superolateral aspect of the posterior surface of the greater trochanter.

Question 23

Tx of PLT

Answer 23

• extension of leg, marked ER

- aBD for fine tuning

Question 24

Lateral trochanter (LT) TP location

Answer 24

inferior to greater trochanter and in mid-coronal line.

Question 25

Tx of LT

Answer 25

prone, LE in aBD of hip only.

Question 26

Diagnosis of sartorius

Answer 26

- Near attachment of sartorius to ASIS | - Palpate from about 2-3cm caudad to ASIS by pushing toward inferior aspect of ASIS

Question 27

***Tx of sartorius (2 possible ways) | When do you use one v. the other?

Answer 27

* ** 1) Hip F to about 13t degrees with slight aBD | 2) Flex hip to about 90degrees, aBD to 45, ER - This is more effective if tenderness at distal attachment of sartorius

Question 28

Knee Extensor location and Tx

Answer 28

Location - on patellar ligament. Push anterior to posterior. Tx - HYPEREXTENSION of knee

Question 29

Tx of Patellar ligament??

Answer 29

- Hyperextension/Some IR

Question 30

Tx of medial surface of tibia ??

Answer 30

Hyperextension/some IR

Question 31

Tx in front of medial meniscus??

Answer 31

Hyperextension/some ER

Question 32

Medial hamstring

Answer 32

Located at attachment of medial hamstring tendon, lateral to the medial meniscus TP

Question 33

Tx of Medial Hamstrong

Answer 33

- Doc place foot on table and pt's foot under flexed knee. - Monitor TP with cephalad hand - FLEX KNEE - ER Tibia on femur - fine tune with ADD

Question 34

***PCL location and tx

Answer 34

- TP in MIDDLE of popliteal surface. - Tx - rolled towel beneath PROXIMAL TIBIA - Push FEMUR POSTERIORLY with cephalad hand (shorten PCL)

Question 35

***ACL location and tx

Answer 35

- TP at LATERAL MARGINS of popliteal space. - Tx - Place rolled towel beneath DISTAL FEMUR. - Push TIBIA POSTERIORLY with free hand (shorten ACL)

Question 36

***Lateral ankle TP location

Answer 36

TP found anterior and inferior to lateral malleolus in the sinus tarsi (talocalcaneal sulcus)

Question 37

Tx of lateral ankle

Answer 37

- Pt lies on affected side, wiht knee bent and foot over edge of table iwth rolled up towel under ankle - Force applied with heel of hand 3cm BELOW the MEDIAL MALLEOLUS, causing EVERSION of the whole foot.

Question 38

Medial ankle tenderpoint location and tx.

Answer 38

A small arc below the medial malleolus. | Tx - inversion of foot

Question 39

Extension ankle TP location and tx. | What does it look like when dysfunction is severe?

Answer 39

- Severe dysfunction has FOOT DROP - TP is on both gastroc heads and both sides of Achilles tendon. - Tx - hold foot in doc's groin/thigh area to supply traction for an extension.

Question 40

Flexion ankle TP location and tx.

Answer 40

- TP high in front of ankle in a depression medial to the big extensor tendon. - Tx - exert force under ball of foot. Fine tune with slight rotation.