Counterstrain UE

Question 1

8 steps of counterstrain

Answer 1

• find sd
• find tp
• establish pain scale
• wrap around the TP while monitoring
• reduce pain at least 70%
• hold for 90 sec
• passively return to neutral
• reassess

Question 2

anterior AC

Answer 2

• slightly medial to the tip of the clavicle and over the anterior aspect of the AC joint
• Tx: pt supine, doc on opp side, monitor tp and flex and adduct the pts arm with slight internal rotation and traction across body

Question 3

Posterior AC

Answer 3

• over the posterior aspect of the AC joint
• Tx: pt pron, doc on opp side of df, monitor tp and pull pts arm into extension and slight horizontal adduction, then applies traction at wrist

Question 4

subscapularis

Answer 4

• anterior/lateral border of scapula, deep in axilla
• tx: pt supine, doc at side of table next to tp, monitor tp and hold pts arm posteriorly over the side of the table and toward their feet, pt’s arm extended, internally rotated, and slight abducted
• NO TRACTION FOR THIS ONE

Question 5

latissimus dorsi

Answer 5

• deep in axilla on medial side of humerus slightly posterior to the subscapularis tp
• tx: just like subscap but with traction

Question 6

Long head of biceps

Answer 6

• over the long head of biceps tendon in bicipital groove
• tx: pt supine, doc at side of tp facing head of table, pts arm flexed and IR with dorsum of hand lying on forehead, doc applies downward pressure along the humerus to the monitoring finger

Question 7

Short head of biceps

Answer 7

• inferolateral to the coracoid process
• tx: patient supine, doc at side of table, next to TP and facing the head of the table
• smae position as long head except more fine tuning of adduction is added, with arm more across chest

Question 8

Supraspinatus

Answer 8

• in the belly of the supraspinatus muscle, in the supraspinatus fossa above the spine of the scapula
• tx: pt supine, doc at side of tp
• doc monitors tp and pts arm is abducted to 45 degrees, flexed to 45 degrees and externally rotated 45 degrees (muscle gets soft)

Question 9

extension elbow

Answer 9

• side of the olecranon process of ulna near triceps tendon
• tx: pt supine, doc on side of df
• monitor tp and grab pts elbow with caudad hand so that thumb is on tp and hand around forearm
• supinate wrist, hyperextend elbow over monitoring hand, fine tuning with abduction or adduction

Question 10

flexion elbow

Answer 10

• coronoid process of ulna
• tx: pt supine, doc seated at side of df
• doc monitors tp and flexes pts elbow, pronates and abducts arm, then pulls forearm out laterally

Question 11

radial head

Answer 11

• anterior/lateral border of radial head
• tx: pt supine, doc seated at side of df
• doc monitors tp with one hand while taking elbow into supination and fully extending elbow over their knee with other hand (do NOT hyperextend)

Question 12

flexion wrist

Answer 12

• base of any of the proximal 2nd to 5th metacarpals in the muscles of the flexor carpi radialis and ulnaris
• tx: pt supine, doc seated at side of df
• doc flexes pts entire wrist with slight radial or ulnar deviation

Question 13

Flexion thumb

Answer 13

• anterolateral aspect of the base of the 1st metacarpal bone
  tx: pt supine, doctor seated at side of dysfunction
• doc monitors tp, flexes wrist and abducts the thumb

Question 14

extension wrist

Answer 14

• pattern of 2-3 points over dorsal aspect of the radioulnar carpal junction
• tx: pt supine, doc seated at side of sydfunction
• doc monitors tp and wraps patient’s hand around tp by extending and adducting (unlar deviation) wrist

Question 15

extensor carpometacarpal location

Answer 15

-along the junction of metacarpal bones on the dorsum of hand

Question 16

metacarpophalangeal location

Answer 16

-on metacarpal bones on dorsum of hand

Question 17

tx for extensor carpometacarpal and metacarpophalanageal joints

Answer 17

• pt supine, doc seated at side of df

- doc monitors tp and extends fingers and wrist