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Massage Therapy > Head & Neck > Flashcards

Head & Neck Flashcards

1
Q 
Sternocleidomastoid (Bilaterally)
Anterior Scalene (Bilaterally)
Longus Capitis (Bilaterally)
Longus Colli (Bilaterally)
A

Flexion of the Cervical Spine

Antagonists on Extension

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2
Q 
Upper Trapezius (Bilaterally)
Levator Scapula (Bilaterally)
Splenius Capitis (Bilaterally)
Splenius Cervicis (Bilaterally)
Rectus Capitis Posterior Major
Rectus Capitis Posterior Minor
Oblique Capitis Superior
Semispinalis Capitis
Longissimus Capitis (Assists)
Longissimus Cervicis (Assists)
Iliocostalis Cervicis (Assists)
Multifidi (Bilaterally)
Rotatores (Bilaterally)
Intertransversarii (Bilaterally)
Interspinalis
A

Extension of the Cervical Spine

Antagonists on Flexion

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3
Q 
Levator Scapula
Splenius Capitis
Splenius Cervicis
Rectus Capitis Posterior Major
Oblique Capitis Inferior
Longus Colli
Longus Capitis
Longissimus Capitis (Assists)
Longissimus Cervicis (Assists)
Iliocostalis Cervicis (Assists)
A

Rotation of the Cervical Spine

Unilaterally to the Same Side

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4
Q 
Upper Trapezius
Sternocleidomastoid
Anterior Scalene
Middle Scalene
Posterior Scalene
Multifidi
Rotatores
A

Rotation of the Cervical Spine

Unilaterally to the Opposite Side

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5
Q 
Upper Trapezius
Levator Scapula
Sternocleidomastoid
Anterior Scalene (With Ribs Fixed)
Middle Scalene (With Ribs Fixed)
Posterior Scalene (With Ribs Fixed)
Splenius Capitis
Splenius Cervicis
Longus Capitis
Longus Colli
Longissimus Capitis (Assists)
Longissimus Cervicis (Assists)
Iliocostalis Cervicis (Assists)
Oblique Capitis Superior
Intertransversarii
A

Lateral Flexion of the Cervical Spine

Unilaterally to the Same Side

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6
Q

An attachment Trp (ATrP) at the lower end of the Sternal Division may refer pain downward over the upper portion of the Sternum

  • This is the only downward reference of pain from this muscle
  • True Trigeminal Facial Neuralgia is not accompanied by sternal pain, which, when also present, suggests the Sternocledomastoid Myofascial Syndrome
  • When this ATrP is present in the lowest part of the Sternal Division, those fibers may merge with a slip of the inconstant Sternalis
  • Occasionally, mechanical stimulation of this sensitive area may be associated with a paroxysmal dry cough
A

Sternocleidomastoid “Amazingly Complex”

Sternal Division Lower Attachment TrPs

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7
Q

At the midlevel of the Sternal Division, TrPs refer pain homolaterally, arching across the cheek (often in finger-like projections) and into the Maxilla, over the Supraorrbital Ridge and deep within the Orbit
-The TrPs along the inner margin at the midlevel of this division refer pain to the Pharynx and to the back of the tongue during swallowing (which causes “sore throat”) and to a small round area at the tip of the chin, including the cheek, Temporomandibular joint and Mastoid areas

A

Sternocleidomastoid “Amazingly Complex”

Sternal Division Midlevel TrPs

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8
Q

The TrPs located toward the upper end of the Sternal Division are more likely to refer pain to the Occipital Ridge behind, but not close to the ear, and to the vertex of the head like a skull cap, with scalp tenderness in the pain reference zone

A

Sternocleidomastoid “Amazingly Complex”

Sternal Division Upper Attachment TrPs

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9
Q

Autonomic concomitants of TrPs in the Sternal Division relate to the homolateral eye and nose

  • Eye symptoms include excessive lacrimation, reddening (vascular engorgement) of the conjunctiva,, apparent “ptosis” (narrowing of the palpebral fissure) with normal pupillary size and reactions, and visual disturbances
  • -The “ptosis is due to spasm of the Orbicularis Oculi muscle, rather than to weakness of the Levator Palpebrae muscle. The spasm is apparently caused by referred increased excitability of the motor units of this muscle
A

Sternocleidomastoid “Amazingly Complex”

Sternal Division Concomitants

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10
Q

The client may have to tilt the head backward to look up, because of inability to raise the upper eyelid

  • Visual disturbances can include not only blurring of vision, but also dimming of perceived light intensity
  • Sometimes coryza and maxillary sinus congestion develop on the affected side
A

Sternocleidomastoid “Amazingly Complex”

Sternal Division Concomitants

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11
Q

Unilateral deafness with no complaint of tinnitus has been traced to TrPs in the Sternocleidomastoid

  • Tinnitus may be attributed to TrPs in either the Sternocleidomastoid, Upper Trapezius, or Cervical Paraspinal muscles
  • Unilateral tinnitus may be associated with a TrP in the Deep Division of the Masseter muscle
  • Tinnitus is usually associated with the deep part of the Masseter rather than the Sternocledomastoid
  • A crackling sound in the homolateral ear may occur and can be reproduced by pinching the superficial fibers of the Sternal Division at its midlevel
A

Sternocleidomastoid “Amazingly Complex”

Sternal Division Concomitants

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12
Q

Myofascial TrPs in the midfiber part of this division refer pain to the frontal area and when severe, the pain extends across the forehead to the other side (cross reference), which is very unusual for TrPs

A

Sternocleidomastoid “Amazingly Complex”

Clavicular Division Midlevel Attachment TrPs

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13
Q

The upper part of this division is likely to refer pain homolaterally deep into the ear and to the posterior auricular region
-These TrPs sometimes refer poorly localized pain to the cheek and molar teeth on the same side

A

Sternocleidomastoid “Amazingly Complex”

Clavicular Division Upper Attachment TrP

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14
Q

Proprioceptive concomitants of TrPs in the Clavicular Division relate chiefly to spatial disorientation

  • Clients complain of postural dizziness (in the form of a disagreeable movement or sensation within the head), and less often, of Vertigo (the sensation of objects spinning around the client, or of the client spinning
  • During severe attacks, Syncope following sudden turning of the head may be due to stretch-stimulation of active TrPs in the Clavicular Division
A

Sternocleidomastoid “Amazingly Complex”

Clavicular Division Concomitants

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15
Q

Episodes of dizziness lasting from seconds to hours are induced by a change of position that requires contraction of the Sternocleidomastoid muscle, or that places it on a sudden stretch

  • Disequilibrium may occur separately from, or be associated with postural dizziness and may cause sudden falls when bending or stooping, or Ataxia (unintentional veering to one side when walking with the eyes open)
  • The client is unable to relate the Vertigo or dizziness to a particular side of the head, even though it can be shown to depend on trigger mechanisms in only one Sternocleidomastoid muscle
A

Sternocleidomastoid “Amazingly Complex”

Clavicular Division Concomitants

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16
Q

Postural responses are exaggerated in some clients:

  • When looking up, they feel as if they will “pitch over backwards”
  • When glancing down, they tend to fall forward
  • The illusion of a tilted bed is not rare
  • Nausea is common, but vomiting is infrequent
  • -Dimenhydrinate (Dramamine) may relieve the nausea but not the dizziness
  • Symptoms of dizziness can be attributed to TrPs in either the Sternocleidomastoid or the Upper Trapezius muscles
A

Sternocleidomastoid “Amazingly Complex”

Clavicular Division Concomitants

17
Q

These symptoms apparently derive from a disturbance of the proprioceptive contribution of this neck muscle to body orientation in space

  • In man, the Sternocleidomastoid is apparently on of the chief muscular sources of proprioceptive orientation of the head
  • Abolition of either of these systems produces spatial disorientation that is similar in form and magnitude
A

Sternocleidomastoid “Amazingly Complex”

Clavicular Division Concomitants

18
Q

When objects of equal weight are held in the hands, the client with unilateral TrP involvement of the Clavicular Division may exhibit an abnormal Weight Test

  • When asked to judge which is the heaviest of two objects of the same weight that look alike but may not be the same weight (two vapocoolant dispensers, one of which may have been used) the client will evidence Dysmetria by underestimating the weight of the object held in the hand on the same side as the affected Sternocleidomastoid muscle
  • -Inactivation of the responsible Sternocleidomastoid TrPs promptly restores weight appreciation by this test
A

Sternocleidomastoid “Amazingly Complex”

Clavicular Division Concomitants

19
Q

Apparently, the afferent discharges from these TrPs disturb central processing of proprioceptive information from the upper limb muscles as well as vestibular function related to neck muscles
-Mechanical stimulation of active TrPs in the Clavicular Division also can refer the autonomic phenomena of localized sweating and vasoconstriction (balancing and thermographic cooling) to the frontal area of referred pain

A

Sternocleidomastoid “Amazingly Complex”

Clavicular Division Concomitants

20
Q

This Central TrP (CTrP) can be found in the midportion of the anterior border of this muscle and involves the most vertical fibers that attach anteriorly to the Clavicle

  • TrPs in this area consistently refer pain unilaterally upward along the posterolateral aspect of the neck to the Mastoid Process, and are a major source of “tension neckache”
  • The referred pain, when intense, extends to the side of the head, centering in the temple and back of the orbit and may include the angle of the jaw, described as the region of the Masseter
A

Trapezius “The Coat Hanger”

Upper Trapezius TrP1

21
Q

Occasionally, pain extends to the Occiput, and rarely, some pain is referred to the lower molar teeth

  • When referred pain from TrPs in this muscle overlaps with referred pain from Myofascial TrPs in other muscles (namely the Sternocleidomastoid, Suboccipital, and Temporalis muscles), the resulting overlap can produce a typical tension-type headache
  • Pain referred from TrP1 may occasionally appear in the Pinna, but not deep into the inside of the ear
A

Trapezius “The Coat Hanger”

Upper Trapezius TrP1

22
Q

A shoulder component of the pain is to be expected when the underlying Supraspinatus muscle also harbors active TrPs

  • Symptoms of dizziness or “Vertigo” are associated with TrP activity of these fibers
  • -This postural dizziness may be referred directly from this muscle or it may result from reflex stimulation of active TrPs in the Clavicular Division of the synergistically related Sternocleidomastoid muscle
A

Trapezius “The Coat Hanger”

Upper Trapezius TrP1

23
Q

TrPs in this TrP1 region can cause additional pain by activating satellite TrPs in other muscles

  • Pain referred down the arm in response to stimulation of this TrP is usually referred from satellite Scalene muscle TrPs
  • Similar “extension” of the referred pain pattern caused by this TrP also can come from its satellite TrPs in the Temporalis, Masseter, Splenius, Semispinalis, Levator Scapulae, and Rhomboid muscles
  • -When clients have both neck and shoulder pain, Levator Scapulae and Infraspinatus TrPs are more frequently the cause
A

Trapezius “The Coat Hanger”

Upper Trapezius TrP1

24
Q

The location of Central TrP2 (CTrP2) is caudal and slightly lateral to TrP1

  • The TrP2 region is located in the middle of the more nearly-horizontal fibers
  • The referred pain pattern of this TrP lies slightly posterior to the essential cervical reference zone of TrP1, blending with its distribution behind the ear
A

Trapezius “The Coat Hanger”

Upper Trapezius TrP2

25
Q

These muscle TrPs are a common (and often overlooked) source of back, shoulder, and arm pain

  • Although these TrPs rarely refer pain to the head, they are commonly associated with TrPs that do
  • Active TrPs may refer pain anteriorly to the chest, laterally to the upper limb, and posteriorly to the medial scapular border and adjacent interscapular region
  • -It is important to remember that any one of these muscles can produce any part of the referred pain patter
A

Scalenes “The Entrappers” TrPs

26
Q

Posteriorly, pain is commonly referred from TrPs in the anterior muscle to the back, over the upper half of the vertebral border of the Scapula

A

Scalenes “The Entrappers” TrPs

Massage Therapy (1 decks)

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