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Acupuncture Therapies 1 > Knee + Ankle > Flashcards

Knee + Ankle Flashcards

1
Q

What is the Jin Jing of the knee?

A

Bladder channel (hamstring, soleus and gastrocnemius)
GB (ITB, peroneal muscles)
Stomach channel (quads, tibialis)
Kidney (adductors of leg)
Spleen (sartorius, vastus medialis)
Liver (gracilis)

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2
Q

What is ST35 in relation to the knee?

A

ST35 - Recurrent branch Common Peroneal Nerve, ACL/Lateral Meniscus Nerve, depending on direction

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3
Q

What is XiYan in relation to the knee?

A

Medial reticular nerve, ACL/PCL medial meniscus depending on direction

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4
Q

What is Heding in relation to the knee?

A

Lateral and medial patellar nerve depending on angle

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5
Q

What is LR8 in relation to the knee?

A

Infrapatellar branch of saphenous nerve (inferior)

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6
Q

What is LR7 in relation to the knee?

A

Infrapatellar branch of saphenous nerve (superior)

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7
Q

What is KI10 in relation to the knee?

A

Fascial exit for the saphenous nerve

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8
Q

What is SP9 in relation to the knee?

A

Sartorial branch of Saphenous nerve, popliteus

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9
Q

What is ST36 in relation to the knee?

A

Trifurcation of Deep perioneal nerve, tibialis anterior MP

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10
Q

What is GB34 in relation to the knee?

A

Trifurcation of the Deep perineal nerve, tibialis anterior motor point

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11
Q

What is BL40 in relation to the knee?

A

Tibial nerve, medial sural cutaneous nerve

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12
Q

What is BL39 in relation to the knee?

A

Common perineal nerve, lateral sural cutaneous nerve

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13
Q

What is BL55 in relation to the knee?

A

Medial sural cutaneous nerve

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14
Q

What is LingHou in relation to the knee?

A

Common perineal nerve before the trifurcation behind the fibular head

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15
Q

What are some distal points for the knee?

A

Distal points on affected channels such as Xi-cleft points (acute pain)
Luo connecting points microcirculation
Jing well points affecting the entire sinew channel
LR3 & PC6 - Jue Yin to increase blood flow while moving the knee, LR3 same side, PC6 opposite side
SI1 - Acute swollen knee pain, bleed here
LI11 - LI channel affects ST/LR and KI channel joint for mirror of knee.
Bleeding and cupping BL43 area in degenerative knee conditions

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16
Q

How do the knee extensors (quads) affect the knee?

A

In terms of clinical significance, the deterioration of the functioning of the knee extensors (quads) is significantly related to the decrease in the quality of life of the patient. The quadriceps contract from medial to lateral in correct knee function.” (Oda, et al. 2021)

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17
Q

How can the popliteus and short head of the biceps femoris affect the knee?

A

The Knee flexes and extends, and the tibia rotates as this occurs. Medial rotation is due to the popliteus, and lateral rotation is due to the short head of the biceps femoris
The popliteus can be accessed at SP9 or the motor point discussed in session 24
The Short Head of the biceps femoris can be accessed at BL38.

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18
Q

What knee points can be used in EA for the knee?

A

ST34, ST35, ST36, SP10, Xiyan and SP9. Muscular input 2-4 upto 10Hz Joint higher 100-150 Hz.
This follows the Chinese medicine adage of treating at the level of the problem, treating above and below the problem

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19
Q

What are the causes of anterior knee pain?

A

Patellofemoral pain
Patella tendinopathy
Pre-patella bursitis
Infrapatellar bursitis
Pes Anserine bursitis
Rectus femoris,
Vastus Lat/Med/Inter trigger points
ACL tears

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20
Q

What are the common causes of lateral knee pain?

A

Iliotibial band friction syndrome
Lateral meniscus abnormality * Minor tear
* Degenerative changes
* Cyst
Osteoarthritis of the lateral compartment of the knee
Gluteus medius, Vastus lateralis trigger points
ACL tears

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21
Q

What are the common causes of medial knee pain?

A

Patellofemoral syndrome
Medial meniscus
* Minor tear
* Degenerative changes * Cyst
Osteoarthritis of the medial compartment of the knee
Adductor trigger points ACL tears

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22
Q

What are the common causes of posterior knee pain?

A

Knee joint effusion
Referred pain
* Lumbar spine
* Patellofemoral joint
* Neural impingement / sciatica
Biceps femoris tendinopathy Popliteus trigger points
PCL tears (poorly defined) pain

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23
Q

What are the four major ligaments of the knee?

A

The Medial Collateral Ligament (MCL) the Lateral Collateral Ligament (LCL) Anterior Cruciate Ligament (ACL) and the Posterior Cruciate Ligament (PCL).

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24
Q

What do the ligaments of the knee provide?

A

Each provides stability to the knee, and all can be strained, usually from impact or sudden torsions to the knee, landing awkwardly after jumping.
Patient may have heard/felt a pop or tear during trauma.
Usually, the injuries are only partial tears/sprains.

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25
Q

What are the special tests for knee ligaments?

A

MCL – More commonly injured
Valgus Stress test
LCL – Varus Stress test
ACL – Anterior Draw test, Lachman’s Test
PCL –Posterior Drawer test, Posterior Sag sign

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26
Q

What are legge’s ideas for treating the ligaments?

A

Disperse local stagnation and regulate the local circulation
Acupuncture
Local pts
BL 40, GB 33, GB 34 (LCL),
Xiyan (MCL/LCL/Cruciates depending on needle direction SP 9, SP 10, SP 8, LR 7 (MCL)
Ear points
Moxa, including needle head moxa
Massage / Tui Na
Electro between Medial knee eye and BL 40
Liniment
Graduated strengthening exercises as knee injury heals

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27
Q

What is a meniscus lesion?

A

Meniscus lesions
* Any activity that causes a twist to the knee, esp with forceful pressure, can lead to a torn meniscus
* Commonly affects the medial meniscus
* A popping / clicking sound on movement
* Swelling (12-24hrs) and stiffness
* Pain when twisting or rotating the knee or extension
* Pain along the joint of the affected side
* Can be from impact or gradual wear due to poor quadriceps mechanics (leads to OA)

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28
Q

What is the medial meniscus attached to?

A
  • The medial meniscus is attached to both the MCL and ACL
    Both of these may be damaged
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29
Q

What is the prognosis for a meniscus lesion?

A

May take 8-12 weeks to completely eliminate the swelling after initial injury. If you are dealing post surgery, there may be increase in joint swelling initially.
Initially 2-3 treatments per week for 2 weeks there should be a noticeable reduction in pain and inflammation. Continue for 2x week for 3 weeks before stepping or tapering down back to 1x per week as required.

30
Q

What is patella tendinopathy?

A

Repetitive stress injury accumulation due to microtrauma.
Commonly seen in people that have impact or jumping activities (running, basketball players).
Usually affects ST and SP channels.
The lower portion of the patella tendon, anywhere from the attachment at the tibial tuberosity to the patella.
The common presentation of pain is local but worsens when the patella is loaded.
Sharp pain during exercise and dullness at rest.

31
Q

What palpation can you do for patella tendinopathy?

A

Pinch the patella from the Knee eyes, look for positive pain sign.
Press on the tibial tuberosity, and if this is tender most likely cause is the patella tendinopathy.
Also, look at the quadriceps muscles for trigger and motor points.
This can also present as a chronic phase as the early stages of OA of the patellofemoral joint.

32
Q

What is the special test for patella tendinopathy?

A

McConnell test

33
Q

What local points are the best for patella tendinopathy?

A

Knee eyes.
For this condition you needle them under the patella obliquely to a depth of 1 cun.
You will need the bolster under the knee and have about a 30°of the knee.
You may need to play around with the angles to get this correct. Medial Xiyan is directed towards GB 34 and lateral Xiyan to SP 10. Electro and needle head moxa are recommended.

34
Q

What are the special tests for ITB friction syndrome?

A

Noble’s Compression Test
Ober’s Test
Gluteus Medius/Minimus Strength test

35
Q

What is ITB friction syndrome?

A
  • Repetitive stress injury due to microtrauma
  • Commonly seen in people who have impact such as runners
  • Sharp lateral knee pain during flexion and extension
  • May be accompanied by popping or snapping as the ITB slides over the bony surface
  • Stiffness and tightness by extend up to the lateral aspect of the thigh and into the gluteal area
  • Look for tenderness around GB33, also anterior and posterior to this
  • Positive pain tests on palpation and compression as the patient flexes and extends the knee may reproduce pain felt by the patient
36
Q

What is the SMART treatment for patella tendinopathy syndrome?

A
  • Sensory: Saphenous Nerve (SP5, LR4), Medial retinacular Nerve (Xi Yan),
  • Motor: Femoral Nerve trunk (SP12)
  • Autonomic: T10-L2. Auricular Knee.
  • Radiculopathy: HTJJ L2-L4
  • Trigger/Ashi: Vastus Medialis (SP10, SP11, Bai Chong Wo), Vastus Lateralis (ST34, ST33), Quadricep Tendon (He Ding)
37
Q

What is the SMART treatment for ITB friction syndrome?

A
  • Sensory: Guan Yi (profound to distal ITB): Pacinian corpuscle vibration/ pressure receptors.
  • Motor Superior Gluteal Nerve for TFL (BL53); Inferior Gluteal Nerve for Glute max (BL54);
  • Autonomic: T10-L2 HTJJ
  • Radiculopathy: sacral plexus (L5-S2)
  • Trigger/Ashi: Tensor Fascia Late MP (GB29), Gluteus Maximus (GB30)
38
Q

What is an additional treatment idea for ITB friction syndrome?

A
  • The best local points are to tread the tendon
  • Needles are inserted under the ITB from both directions both anteriorly and posteriorly
  • The posterior needle is directed anteriorly
  • The anterior needle is directed posteriorly
  • Both needles are at an oblique to transverse angle
  • EA can be used on both anterior and posterior needles
  • Cupping, heat therapy, periosteal needling at ITB attachment (Gerdy’s tubercle on the tibia condyle)
39
Q

What muscles act on the knee?

A

Biceps femoris
Popliteus
Rectus femoris
Semimembranosus
Semitendinosus
Vastus lateralis
Vastus medialis

40
Q

What muscles act on the ankle and foot?

A

“Abductor digiti minimi
Abductor hallicus longus
Extensor digitorum longus
Extensor hallucis longus
Flexor digiti minimi brevis
Flexor digitorum brevis
Flexor digitorum longus
Flexor hallucis brevis
Flexor hallucis longus
Gastrocnemius
Interossei dorsal
Interossei plantar
Lumbricals
Peroneus brevis
Peroneus longus
Peroneus tertius
Soleus
Tibialis anterior
Tibialis posterior”

41
Q

What are the channel sinews involved in the leg and foot according to Legge?

A

Sinew channels
ST, GB, BL, SP, LIV, KID

42
Q

What are the long. muscles of the leg?

A

Tibialis anterior, extensor hallucis longus. extensor digitorum longus (ST)
Peroneus longus, peroneus brevis (GB)
Gastrocnemius, soleus (BL)
Tibialis posterior (SP)
Flexor hallucis longus (LIV)
Flexor digitorum longus (KID)

43
Q

What is ST37?

A

Innervation to extensor digitorum longus

44
Q

What is ST38?

A

Innervation to extensor hallucis longus

45
Q

What is ST39?

A

Extensor hallucis longus (muscle)

46
Q

What is ST40?

A

Superficial peroneal nerve

47
Q

What is ST41?

A

Deep perineal nerve at the ankle joint

48
Q

What is GB35?

A

Extensor hallucis longus muscle

49
Q

What is GB36?

A

Peroneus brevis MEP

50
Q

What is GB37?

A

Cutaneous branch of superficial perineal nerve

51
Q

What is GB39?

A

Medial cutaneous branch of superficial perineal nerve, peroneus tertius

52
Q

What is GB40?

A

Articular nerve branch of deep perineal nerve to the sinus tarsi ATF ligament

53
Q

What is BL59?

A

Flexor hallucis longus motor point

54
Q

What is BL60?

A

Sural nerve PTF ligament

55
Q

What is BL62?

A

Lateral dorsal cutaneous nerve (LDCN) of sural nerve CFL ligament

56
Q

What is KI3?

A

Posterior tibial nerve

57
Q

What KI2?

A

Abductor hallucis MP

58
Q

What is LV3?

A

Fascial exit of deep peroneal nerve (cutaneous)

59
Q

What is KI1?

A

Deep branch of lateral plantar nerve, lateral plantar arch

60
Q

What is LV4?

A

Dorsal medial branch of the saphenous nerve

61
Q

What is GB40?

A

GB 40 sits at the talus sinus, an opening that accesses the talus region.
Rotate the foot while palpating the point to find where the depression is most pronounced.
Deep needling at this point is often effective
especially with the lingering pain, decreased
ROM and stiffness

62
Q

What is a SMART treatment for inversion ankle sprain?

A
  • Sensory: Superficial Peroneal nerve- Lateral Dorsal Cutaneous Nerve (GB37), Articular nerve branch of deep peroneal nerve to sinus tarsi (GB40), Intermediate dorsal cutaneous nerve (GB41)
  • Motor: Common Peroneal Nerve (Ling Hou)
  • Autonomic: T10-L2 HTJJ
  • Radiculopathy: HTJJ L5- S1
  • Trigger/Ashi: Extensor Digitorum Longus (GB35), Peroneus Longus, Brevis (GB36, GB34.5)
63
Q

What is achilles tendinopathy?

A
  • The achilles tendon is the largest in the body and the tendon of the gastrocnemius, soleus and plantaris
  • This structure allows huge forces to be placed upon it, walking, jumping and running
  • The achilles tendon has a poor blood supply, and this can make it difficult to heal
  • A combination of degenerative changes and overuse that can occur
  • A complete rupture will need surgery
64
Q

What are the special tests for achilles tendinopathy?

A

Primary test: Diagnosed through the presentation Other tests: Thompson test
Tests: Achilles tendon rupture (rule this out) Prone with feet off the table
Squeeze calf (repeat a few times)
Positive: absence of plantar flexion at the ankle joint

65
Q

What is the treatment for achilles tendinopathy?

A

TCM point categories – BL 63 – (Xi Cleft), BL 58 (Luo Connecting), BL 40 (He Sea)
KI 7 & 8 (Jing River and Xi Cleft of Yin Qiao Mai)
KI 4 & 5 (Luo Connecting and Xi Cleft point)
Local and adjacent points – focused either side of the injury – site are found through palpation and pinching of the tendon
Look between 2-6 cm from the insertion onto the calcaneus
After insertion thread the needles thread under the tendon inferiorly.
Gua Sha Massage/Laser/Moxa and Zheng Gu Shui are often
used.

66
Q

What is foot over pronation?

A

Foot Over Pronation must be considered a postural long-term treatment strategy for many of these patients. This includes fallen arches when weight bearing.
Over-pronation creates muscular imbalances through the lower leg, thigh, hip and lower back.

67
Q

What is plantar fasciitis?

A
  • A common cause of heel pain
  • The plantar fascia is a thickened fibrous aponeurosis and runs underneath the foot
  • 50% may also have a heel spur
  • Stiffness and pain that may extend from the heel to KD1
  • In some cases it comes up to the toes
68
Q

What is a differential diagnosis for plantar fasciitis?

A
  • Differential diagnosis – achilles tendinopathy
69
Q

What is a SMART treatment for plantar fasciitis?

A

SMART treatment
* Sensory: Sural Nerve (BL60), Cutaneous junction of the saphenous and medial plantar nerve (SP4),
* Motor: Tibia Nerve Trunk (BL40), Tibial Nerve (KI3); Lateral and Medial Plantar Nerves (KI5/KI6);
* Autonomic: SP 6 (parasympathetic switch), SP 6 is also MP of FDL, to which the quadratus plantae and lumbricals attach.
* Radiculopathy: Lower Extremity (HTJJ L4-S3)
* Trigger/Ashi: Soleus (BL56, KI9, SP7), Gastrocnemius (BL57)
* Additional Points/ Treatment Tips:
* Evaluate soleus and gastrocnemius for shortness/tension/Ashi
* Evaluate hamstrings, erector spinae and neck extensors (UB10) as this is along the channel sinew (Bladder channel sinew)

70
Q

What are some additional treatments for plantar fasciitis?

A

Additional treatments
* TCM point categories BL63 (Xi cleft), BL58 (luo connecting), BL40 (He sea)
* KI7 and KI8 (Jing river and Xi cleft of the Yin Qiao Mai)
* KI4 and KI5 (Luo connecting and xi cleft point)
* Local and adjacent points – focused on either side of the injury
* SP6 – crossing point of the 3 leg yin
* BL57/58 – release the gastrocnemius and soleus
* BL59 – Xi Cleft point of Yang Qiao Mai
* Massage, moxa, EA and zheng gu shui often used
* Extra point Shi Mian – is the target zone (location where plantar fascia attaches to the calcaneus

71
Q

In practice with knee problems, what should you do?

A

In practice looking at knee problems, you look at the quadriceps and the hamstrings (knee flexion/extension) and combine these with the corresponding HJJ points segmental innervation.

Acupuncture Therapies 1 (11 decks)

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