Counterstrain UE/LE OSCE Flashcards
Anterior AC (AAC) TP location
-slightly medial to the tip of the clavicle and over anterior aspect of AC
AAC treatment
- patient supine, doc at side of table opposite TP
- doc monitors TP and pulls patient’s arm into flexion and adduction with slight internal rotation and traction across body
Posterior AC (PAC) TP location
-over posterior aspect of the AC joint
PAC treatment
- patient prone, doc at side of table opposite TP
- doc monitors TP and pulls patient’s arm into extension and slight horizontal adduction, then applies traction at wrist
Subscapularis TP location
anterior/lateral border of scapula, deep in axilla
Subscapularis TP treatment
- patient supine, doc at side of table next to TP
- Doc monitors TP and holds patient’s arm posteriorly over the side of the table and toward their feet. Patient arm extended, internally rotated and slightly abducted. No traction is applied
Latissimus Dorsi TP location
-deep in axilla on medial side of humerus; slightly posterior to subscapularis TP
Latissimus Dorsi TP treatment
- patient supine, doc at side of table next to the TP
- Doc monitors TP and holds patient’s arm posteriorly over the side of the table and toward their feet. Patient arm extended and internally rotated and slightly abducted
- Doc applies traction to the arm (subscapularis TP treatment + traction)
Long Head Biceps TP location
-over long head of biceps tendon in bicipital groove
LH Biceps Treatment
- Patient supine, doc at side of table, next to TP and facing head of table
- Patient’s arm flexed and internally rotated, with disarm of hand/forearm lying on forehead
- Doc applies downward pressure along the humerus to the monitoring finger
Short Head Biceps TP Location
-Inferolateral to the coracoid process
SH Biceps Treatment
patient supine, doc at side of table next to TP and facing head of table
-Same position as long head except more fine-tuning of adduction is added, with arm more across chest
Supraspinatus TP location
-in the belly of the supraspinatus muscle, in the supraspinatus fossa above the spine of the scapula
Supraspinatus TP Treatment
- patient supine, doc at side of table next to TP
- Doc monitors TP and patient’s arm is abducted to 45 degrees, flexed to 45 degrees, and externally rotated 45 degrees
Extension Elbow TP location
-side of olecranon process of ulna near triceps tendon
Extension Elbow treatment
- patient supine, doc on side of dysfunction
- Doc monitors TP and grasps patient’s elbow with ciudad hand so that thumb is on TP an hand around forearm.
- Supine wrist, hyperextend elbow over monitoring hand, fine-tuning with abduction or adduction
Flexion Elbow TP location
-coronoid process of ulna
Flexion Elbow TP treatment
- patient supine, doc seated at side of dysfunction
- Doc monitors TP and flexes patient’s elbow, pronates and abducts arm, then pulls forearm out laterally
Radial Head TP location
-anterior/lateral border of radial head
Radial Head TP treatment
- patient supine, doc seated at side of dysfunction
- Doc monitors TP with one hand while taking elbow into supination and fully extending elbow over their knee with other hand (do NOT hyperextend the elbow)
Flexion Wrist TP location
base of any of the proximal 2nd to 5th metacarpals in the muscles of the flexor carpi radialis and ulnaris
-Palmar side
Flexion Wrist TP Treatment
- patient supine, doc seated at side of dysfunction
- Doc flexes patients entire wrist with slight radial or ulnar deviation
Flexion Thumb TP Location
- anterolateral aspect of the base of the 1st metacarpal bone
- abductor pollicis brevis
Flexion Thumb TP treatment
- patient supine, doc seated at side of dysfunction
- Doc monitors TP, flexes wrist and abducts the thumb
Extension Wrist TP location
- pattern of 2-3 points over dorsal aspect of the radioulnar-carpal junction
- Dorsal wrist; extensor carpi radialis and ulnaris
Extension Wrist TP treatment
- patient supine, doc seated at side of dysfunction
- Doc monitors TP and wraps patient’s hand around TP by extending and adducting (ulnar deviation) wrist
Extensor (dorsal) carpometacarpal TP location
-along junction of carpal and metacarpal bones on dorsum of hand
Metacarpophalangeal TP location
-On metacarpal bones on dorsum of hand
Extensor carpometacarpal and metacarpophalangeal TP treatment
- patient supine, doc seated at side of dysfunction
- Doc monitors TP and extends fingers and wrist
Posterior Lateral Trochanter (PLT) TP location
superolateral aspect of the posterior surface of the greater trochanter (lateral aspect of performs muscle)
PLT Treatment
- patient prone, doc standing at table on side of dysfunction
- Doc monitors TP and extends patient’s leg with marked external rotation and fine-tunes with abduction
Lateral Trochanter (LT) TP location
-5-6 inches inferior to greater trochanter in mid-coronal line
LT treatment
- patient prone, doc standing at table on side of dysfunction
- Doc monitors TP and abducts patient’s hip and may slightly flex
Sartorius TP location
-2-3 cm inferior to ASIS (near attachment of Sartorius at the ASIS)
Sartorius TP treatment
-patient supine, doc same side of dysfunction. Doc monitors TP with one hand. Flex knee/hip 135 degrees, slight external rotation with other hand
Patellar Tendon TP location
-on patellar ligament tendon, just below the patella
Patellar Tendon TP treatment
- Patient supine, doc standing at table on side of dysfunction
- Doc places pillow under distal tib/fib. Doc monitors TP and pushes anterior to posterior on the distal femur and hyperextends knee (some internal rotation may be added
Medial Hamstring TP location
-on the medial hamstring muscle/tendon near its distal attachment at the posterior medial surface of tibial condyle
Medial Hamstring TP treatment
- patient supine, doc standing at table on side of dysfunction with foot on table, may place patient’s foot under doc’s knee for support/positioning
- Doc monitors TP with cephalad hand while flexing patient’s knee, externally rotate the tibia on femur and fine tune with adduction
Posterior Cruciate Ligament (PCL) TP location
-close to middle of popliteal space
PCL treatment
- patient supine, doc standing at table on side of dysfunction. Place a rolled up towel on table beneath proximal tibia
- Doc monitors TP and places ciudad hand on TP, pushes femur posteriorly with cephalad hand (which shortens the PCL)
Anterior cruciate ligament TP location
-on medial and lateral aspects of the popliteal fossa
ACL TP treatment
- patient supine, doc standing at table on side of dysfunction. Place a rolled up towel on table beneath distal femur
- Doc monitors TP and places ciudad hand on TP, pushes tibia posteriorly with ciudad hand (which shortens the ACL)
Lateral Ankle TP location
-anterior and inferior to lateral malleolus in the sinus tarsi (talocalcaneal sulcus)
Lateral Ankle TP treatment
- patient lateral recumbent on affected side, with knee bent and foot over the edge of table with rolled up towel under ankle to protect fibula. Doc standing at end of table
- Doc monitors TP and applies force with heel of hand (up to 40 degrees) 3 cm below the medial malleolus causing eversion of whole foot, with midl external rotation
Medial Ankle TP location
-small arc below medial malleolus
Medial Ankle TP treatment
- patient lateral recumbent on non-affected side, with knee bent and foot over edge of the table with rolled up towel under ankle. Doc standing at end of table
- Doc monitors TP and inverts foot without much internal rotation
Extension ankle TP location
-on both gastrocnemius heads and both sides of Achilles tendon
Extension ankle TP treatment
- patient prone, doc standing at table on side of dysfunction, with distal leg on table.
- Doc monitors TP and flexes patient’s affected knee, plantar flexes ankle and places dorsum of ankle on doc’s thigh.
- Doc adds axial compression through ankle, keeping pressure high on instep to avoid straining metatarsals
Flexion ankle TP location
-high in the front of the ankle in a depression medial to the big extensor tendon
Flexion ankle TP treatment
- patient prone, doc standing at table on side of dysfunction
- doc monitors TP, flexes patient’s affected knee, and exerts force on the ball of the foot to dorsiflex the ankle (fine-tune with slight tibial rotation)
