CSM

Question 1

What is the referral pattern of the Upper Trapezius

Answer 1

Spreads ipsilaterally from posterolateral region of the neck, behind the ear, and to the temporal region

Question 2

What is the Needling Technique for Upper Trapezius

Answer 2

Patient in Prone or Sidelying
Use Pincer Grip and insert needle perpendicular to skin towards your finger, needle should be kept between the fingers. You can needle posterior to anterior or anterior to posterior

Question 3

What are main precautions when needling Upper Trapezius and how is this minimized

Answer 3

Pneumothorax

Minimize risk by needling strictly between the fingers and using pincer grasp technique

Question 4

What is the referral pattern of the Supraspinatus

Answer 4

Mid Deltoid region, often extending down lateral aspect of arm and forearm, sometimes focusing over the lateral epicondyle of the elbow

Question 5

What is the Needling Technique for Supraspinatus

Answer 5

Patient lies prone or on uninvolved side arm close to body and relaxed
Palpate Scapular Spine and identify Supraspinous Fossa, needle is inserted in and angled toward the base of the supraspinous fossa

Question 6

What are main precautions when needling Supraspinatus and how is this minimized

Answer 6

Pneumothorax

The apex of the lung lies anterior to the scapula, avoid needling in ventral direction

Question 7

What is the referral pattern of the Subscapularis

Answer 7

Projected to the dorsal aspect of the shoulder, extends down dorsal arm and around the wrist

Question 8

What is the Needling Technique for Subscapularis

Answer 8

Supine Approach: Supine with the arm abducted to 90 and externally rotated to 90. Bring the scapula as lateral as possible. Needle is directed parallel to ribcage and perpendicular to scapula

Prone Approach: Prone with arm in hammerlock position (IR and forearm resting on back). Needle inserted from medial to lateral under the scapula.

Can also be needled while patient lies on the involved shoulder

Question 9

What are main precautions when needling subscapularis and how is this minimized

Answer 9

Pneumothorax

Direct needle away from the ribcage to avoid entering the lung field

Question 10

What is the referral pattern of the Pectoralis Major

Answer 10

Refers pain over the anterior deltoid, anterior chest, sternum, down the inner aspect of the arm, and possibly the ulnar side of the hand. Left Sided TrPs may mimic angina

Question 11

Describe the Pincer Grip Technique for needling the Pectoralis Major

Answer 11

Patient is in Supine with Arm Abducted slightly
Women may want to use opposite hand and draw breast tissue inferiorly or toward opposite side, may also require a chaperone.
Pincer grip is used, insert needle perpendicular to skin between your fingers and away from chest wall

Question 12

Describe the Bracketing Technique for needling the Pectoralis Major

Answer 12

Needle only over a rib

Bracket the rib with the index and middle fingers placed over the intercostal space, insert needle at a shallow angle

Question 13

What are the main precautions when needling Pectoralis Major and how is this minimized

Answer 13

Pneumothorax
Minimized by keeping needle between fingers and when using the bracketing technique, pay very close attention to technique and be 100% confident. When in doubt, do not needle. Maintain open communication with patient, if patient feels they will sneeze or cough, withdraw the needle. Keep firm control over patient in case of an unexpected sneeze, cough, or twitch.

Question 14

What is the referral pattern of the Suboccipital muscles

Answer 14

Spreads from the base of the occiput toward the orbit, mimicking a tension type headache

Question 15

What is the referral pattern of the Cervical Multifidi

Answer 15

Spreads upward to the suboccipital region, downward over the neck and upper part of shoulder, can cause facetogenic type pain as well

Question 16

What is the needling technique for Cervical Multifidi

Answer 16

Patient in Prone
Palpate Spinous Process; Needle is inserted approx. 1 cm lateral to the spinous process, in a medial-caudal direction toward the lamina of the vertebra

Question 17

What are the main precautions when needling Cervical Multifidi and how is this minimized

Answer 17

Be cautious when needling the lower cervical spine, cervical pleurae extends into supraclavicular fossae
Avoid needling directly medially to avoid penetrating structures within the spinal canal

Question 18

What is the referral pattern of the rhomboids

Answer 18

Pain is referred along the medial border of scapula and superiorly over supraspinatus

Question 19

What is the needling technique of the rhomboids

Answer 19

Patient lying in prone with arm at side or in hammerlock.

Bracketing technique: index and middle finger over the intercostal space, needle between fingers, insert needle perpendicular to skin and angle toward rib.

Alternate technique: Prone with arm in hammerlock position. Needle inserted from medial to lateral under the scapula.

Question 20

What are the main precautions when needling the rhomboids and how is this minimized

Answer 20

Pneumothorax
Minimized by following safe bracketing technique or alternate technique. Patient communication, if a sneeze or cough, should withdraw the needle. Maintain control over the patient while needling. Non Needling hand should be exerting firm downward pressure for safety. 100% confidence in palpation, when in doubt, do not needle. May avoid needling those with high BMI

Question 21

What is the referral pattern of the Suboccipitals

Answer 21

Pain spreading from the base of the occiput toward the orbit, mimics a tension type headache

Question 22

What is the needling technique of the Suboccipitals

Answer 22

Patient in Prone
Insert needle at a point midway between transverse process of C1 and Spinous Process of C2. Needle is inserted perpendicular to skin, angle needle in cranial-medial direction
Only the Oblique Capitis Inferior muscle is needled safely d/t the proximity of the vertebral artery above the arch of the atlas

Question 23

What are main precautions when needling Suboccipitals and how is this minimized

Answer 23

Inadvertent puncture of vertebral artery or foramen magnum
Avoid needling strictly cranially or too laterally
Must be 100% confident in palpation; sometimes difficult to identify C1 and C2

Question 24

What is the referral pattern of the Lateral Pterygoid

Answer 24

Referred to Maxilla and Temporomandibular Joint

Question 25

What is the needling technique of the Lateral Pterygoid

Answer 25

Patient in Supine
Palpate TMJ and locate Mandibular Fossa (anterior to TMJ)

Superior Division: Insert needle perpendicular to skin and through Mandibular Fossa, Angle needle upward and forward deep to zygomatic arch

Inferior Division: Open mouth slightly, insert needle perpendicular to skin and through mandibular fossa, angled toward the roots of the upper molar teeth

Question 26

What are main precautions when needling the lateral pterygoid and how is this minimized

Answer 26

Fairly safe. Multiple small veins, arteries, and nerves in this area