FINAL LAB Flashcards
SC JOINT muscle test
Pectoralis Major (superior branch)
Is there a challenge for SC joint?
Yes, M-L
What is the correction for SC joint?
M-L, 3 ways
What are the 3 ways for SC joint correction?
Same side supine, opposite side supine, and side lying
Same side SC joint: CP, SCP, Stab., LOC
CP: Soft pisiform
SCP: Medial aspect of SC joint
Stabilize: lateral side of head of humerus (gently traction posterior and inferior)
LOC: M-L A-P along clavicle
SC joint Opposite side: CP, SCP, Stab., LOC
CP: Soft pisiform of outside hand
SCP: medial aspect of SC joint
Stabilize: Gently traction posterior and inferior (distal end of shoulder complex)
LOC: M-L A-P along clavicle
Modified side lying SC joint
Inferior hand contact and superior leg/hand stabilize back and neck. Same LOC, CP, etc.
AC joint muscle test
Coracobrachialis
Challenge for AC joint?
S-I (dugas)
How many thrusts for AC joint?
supine, seated web, and chiro over chiro
AC joint CP, SCP, Stab., LOC:
CP: end of thumb and 2nd digit middle metacarpal joint
SCP: 1/2” - 1 “ medial to AC joint (distal 1/3 of clavicle)
Stab: grasping elbow
LOC: S-I
HUMERUS first step
Anterior deltoid shoulder flexion and teres major, arm behind back (stabilize on shoulder while pulling up)
How many maneuver’s for AI humerus?
Same, Opposite, and Behind
HUMERUS CP, SCP, Stab., LOC
CP: Palm of hand
SCP: Olecranon and lateral Glenohumeral joint
Stab: (Above) tractioning GH joint
LOC: I - S and A - P
AI Humerus seated
Stabilize on the sternum and LOC is I-S, A-P, and M-L
How many Posterior Humerus set ups?
Web and Knife edge
Posterior Humerus CP, SCP, Stab., LOC
CP: Web of inside hand or knife edge of inside hand
SCP: Posterior proximal aspect of humerus (Distal to GH joint)
Stab: Long axis traction on flexed are around elbow
LOC: P-A, M-L (slightly), I-S
Glenohumeral Distraction:
Do the SC and AC muscle tests,
CP: Interlocked hands
SCP: Anterior Medial Aspect of GH joint
LOC: M-L slightly I-S
BICEPS TENDON
Test biceps, Patient supine, grab wrist with inferior hand and biceps tendon with superior hand, then slight externally rotate, (1 remove tension), then bring arm up to neck level (2 remove tension 1 thrust), bring arm back down to side, (3 take out and tension and thrust 2)
What is criteria for Scapula?
- Reduced Apleys
- Reduced SCaption
- Compare internal rotation (letting arms dangle supine)
What are the sets ups for SCAP?
inferior angle, medial angle, and superior angle
What do you do for Scapula always?
Have patient put hand in belt loop or on back, use knife edge for medial, and base of hand or palm for superior or inferior (NO PA, only which way it’s going)
ELBOW RULES
Medial = Doc stands inside. Lateral = Doc stands on outside. Ulna = Supinate. Radius = Pronate.
RMT for ELBOW
Triceps (stabilize elbow on thigh)
If triceps is + with wrist in flexion, what do you adjust
ULNA
What is the MC listing for ulna?
Posterior medial
POSTERIOR MEDIAL ULNA CP, SCP, Stab., LOC
CP: Web of medial hand or end of thumb and 2nd digit
SCP: Proximal medial ulna approximately 1” distal to medial epicondyle
Stab: Outside hand grasping lateral humerus (firmly against docs forearm)
LOC: M-L, P-A, and I-S
What is PP with Posterior Medial Ulna?
Supine with elbow Extended and hand SUPINATED
What should you do before considering Posterior Lateral Ulna?
adjust it twice!! (PM = 2 times!!)
POSTERIOR LATERAL ULNA CP, SCP, Stab., LOC
CP: End of the thumb and 2nd digit middle phalanx
SCP: Proximal lateral ulna approximately 1” distal to olecranon on the olecranon ridge
STAB: Medial hand grasping medial arm, ensuring FIRM
LOC: L-M, P-A, and I-S
ELBOW RADIUS RMT
Wrist in extension with elbow on thigh stabilizing
To differentiate between Posterior Lateral Radius and Anterior Medial Radius what do you do?
Test BRACHIORADIALIS,
STRONG = PL WEAK = AM
POSTERIOR LATERAL RADIUS CP, SCP, Stab., LOC
CP: End of thumb against the lateral proximal radial head
SCP: Proximal lateral radius approximately 1/4” distal to radial head
STAB: Medial hand grasping the medial arm, ensuring patient’s medial elbow is firmly against doc’s forearm
LOC: L-M, P-A, and I-S
PP: Supine with elbow extended and hand PRONATED
ANTERIOR MEDIAL RADIUS CP, SCP, Stab., LOC
CP: End of thumb against anterior medial proximal radial head in the cubital fossa
SCP: Proximal anterior medial radial head
STAB: Outside Hand grasping lateral arm
LOC: M-L, A-P, and I-S
PP: Supine with elbow extended and supinated initially, then PRONATE ARM so CP rolls onto thumb
What do you do after adjusting ulna or radius?
CLEAN UP MOVE, AP and PA shearing with thenar pads
Resets proprioception and breaks up adhesions
CARPAL ASSESSMENT:
- Palpate
- Motion
- Pinch, Distract, Shear
- RMT (opponens pollicis)
- Bilateral palpation
- Adjust
- Recheck #4
What is PP with CARPAL ASSESSMENT?
Supine with elbow extended and hand pronated
SCP: carpal on 1/2 of fixated joint
CP: thumb and thumb
LOC: P-A and A-P
How do you do Carpal MT?
pull apart with PINKIES
If weak on carpal MT, what is MC?
ANTERIOR LUNATE
ANTERIOR LUNATE CP, SCP, Stab., LOC
CP: Thumb and thumb
SCP: Anterior lunate
LOC: A-P
PP: Supine with elbow extended and hand supinated (pressing in carpal tunnel region almost)
POSTERIOR LUNATE CP, SCP, Stab., LOC
CP: Thumb and thumb
SCP: Posterior Lunate
PP: Supine with elbow extended and hand pronated
LOC: P-A
2-5th METACARPAL ROTATION
Nail angle toward the 5th digit
CP: Thumb of dominant hand, other hand distract the involved MCP joint
SCP: Involved metacarpal on medial side of the bone proximal to the MCP joint
PP: Supine with elbow ext. and hand pronated
PIP and DIP joint ROTATION:
CP: Thumb of dominant hand, other hand distracts joint
SCP: Distal to the involved joint while stabilizing proximal to the joint
PP: Supine with elbow ext. and hand pronated
LOC: M-L or L-M
1st MCP JOINT:
CP: Thumb of dominant hand and other hand distracts joint
SCP: Distal to the involved MCP joint while stabilizing proximal to the joint
PP: Supine with elbow ext. and hand pronated
LOC: Along axis distraction and P-A
What 3 things do you need to TMJ?
Pain in TMJ, neck pain, and headaches
How do you assess TMJ
ACTIVE AND PASSIVE open and close, protract and retract, right and left lateral translation
What are you visualizing with TMJ?
INITIAL deviation, the fossa created SECOND on the affected side (deviation)
SUPERIOR/ LATERAL/ POSTERIOR Jaw aka ANTERIOR DISC CP, SCP, Stab., LOC
CP: 5th MCP/1st MCP/Soft Pisi
SH: Upper cervical spine and non involved TMJ
LOC: With mouth AJAR, P-A, S-I, and L-M
ANTERIOR JAW aka POSTERIOR DISC CP, SCP, Stab., LOC
CP: DIP of chiro finger overlapping other chiro DIP
SCP: Mental Protuberance
PP: Patient’s head resting on doc’s belly
LOC: Patient’s mouth open apply constant A-P pressure while patient closes mouth repeat 2-3 x’s !!!! (INCREASE PRESSURE)
POSTERIOR RIB angle RMT:
Serratus Anterior
If Serratus Anterior is weak, what next?
(POSTERIOR RIB)
Lay patient prone, and palpate for posterior rib, once found, palpate for pain above or below involved rib
POSTERIOR RIB ANGLES (UPPER 6) CP, SCP, Stab., LOC
CP: Knife edge or finger tips
SCP: Superior aspect of the involved rib angle in the intercostal space
(DEEP BREATH 1/2 through inhale = superior, and 1/2 through exhale = medial)
DS: Superior corner of the table opposite side of involved rib
POSTERIOR INFERIOR RIB ANGLES (LOWER) CP, SCP, Stab., LOC
CP: Fingertips or knife edge
SCP: Inferior aspect of the rib angle in the intercostal space
DS: Opposite side by waist of patient
LOC: 1/2 through inspiration = I-S, and exhale 1/2 out = M-L
COSTO TRANSVERSE and COSTO VERTEBRAL (RIB HEADS) CP, SCP, Stab., LOC
Rhomboid RMT (only upper 5)
CP: Pisiform of superior hand
SCP: Posterior superior surface of rib head (approx 2” out from spine)
SH: Thenar pad of inferior on opposite TP
LOC: P-A (1/2 insp.) and S-I (1/2 exhale)
INTERCOSTAL NEURALGIA/NEURITIS
RMT = Pec Major Sternal division (out and up), after this palpate anterior ribs to see where pain is worse
INTERCOSTAL NEURALGIA/NEURITIS CP, SCP, Stab., LOC
CP: Finger tips
SCP: Superior aspect of prominent rib in intercostal space
PP: Supine
LOC: S-I on 1/2 through insp. and then M-L 1/2 through exp.
Anterior dorsal rules:
T9-T12: tuck chin to chest
T4-T9: Extend head
T1-3 : Flex their knees and put their feet on the table
COSTOCHONDRAL ANTERIOR
CP: Fingertips hook with the superior hand pulling from L-M and knife edge of the inferior hand
SCP: Hook the sternum with the superior hand and the inferior contacts anterior rib
LOC: Superior hand hook pulls towards the sternum (L-M) and the knife edge hand pushes M-L (2x’s 1/2 through both inhale and exhale)
