Lab/Lecture/Ameripress and Powerpoint Notes for Midterm Flashcards
Muscle Test for SC joint
Pec Major, Clavicular branch
-Dr. pulls out and away at 20-30 degree angle from pt.
MC mislalignment of SC joint
Anterior/ Inferior/ Medial
What is LOC for SC joint challenge?
Posterior/ Lateral/ Superior
SC Supine- Same and Opposite side
- SCP
- CP
- SH
- LOC
SCP- Medial aspect of SC joint
CP- Soft pisiform (of inside or outside hand)
SH- Lateral side of head of humerus, gently tractioning P-I
LOC- M-L (95%), A-P along line of clavicle (usually I-S)
SC modified side laying
- SCP
- CP
- SH
- LOC
SCP- Medial side of SC joint
CP- Soft Pisiform of inferior hand
SH- Support pt. head (C-spine) AND inferior knee behind scapula
LOC- M-L (95%), A-P along line of clavicle (usually I-S)
- On female- use hand opposite side of joint (side) being adjusted to cover ( o )( o ). Dr. can place the forearm of the CP hand over pt’s. hand to achieve LOC
Muscle test for AC joint
Corcobrachialis
-Dr. at head of table facing down. Pt. supine with humeral flexion to 30 degrees. Push arm towards ipsilateral ASIS.
M/C misalignment of A/C joint
Superior
A/C joint Supine Adjustment
- SCP
- CP
- SH
- LOC
SCP- 12-1” medical to AC joint (distal 1/3 of clavicle)
CP- End of thumb and 2nd digit middle phalanx
SH- supporting elbow
LOC- S-I
A/C joint Seated web contact
- SCP
- CP
- SH
- LOC
SCP- 1/2-1” medial to AC joint
CP- Web of hand or 2nd MCP joint
SH- Outside hand grasping the flexed elbow jt. keeping the shoulder in same position as others. Varies from pt. to pt.
LOC- S-I
AC seated Chiro-Chiro
- SCP
- CP
- SH
- LOC
SCP- 1/2-1” medial to AC joint
CP- dominant chiro index finger overlaps the other chiro index finger
SH- Supine with arm abducted, motion joint to find where it closes and bring the arm down 5-10 degrees this is the position for stabilization. Place pt’s elbow on doc’s shoulder
LOC- S-I
*Arms flared out!
A/I Humerus relative muscle test
Anterior Deltoid and Teres Major
*Test both before considering adjusting either one
A/I humerus Same Side/ opposite side
- SCP
- CP
- SH
- LOC
SCP- Olecranon of involved side and lateral GH joint
CP- Palms of the hands
SH- Bring GH joint back into nutral position
LOC- I-S, A-P, M-L
*Pt. elbow pressed against the chest to bring GH joint to tension. Take to the midline over Xiphoid process to clear labrum
A/I Humerus seated adjustment
- SCP
- CP
- SH
- LOC
SCP- Olecranon of involved side
CP- Palms of hands with fingers interlocked (same side)
SH- Doc’s strenum against spine of scapula
LOC- M-l, A-P, I-S
Posterior Humerus Web Contact (and knife edge)
- SCP
- CP
- SH
- LOC
SCP- Posterior Proximal aspect of humerus (distal to Gh joint)
CP- Web of inside hand
SH- Outside hand grasping the humerus above flexed elbow joint with humerus slightly abducted (no more than 30 degrees) and extended- DO NOT WING- Outside hand also applies slight long axis traction
LOC- P-A, I-S, M-L (Slightly- bend elbow to demonstrate slight M-L)
Elbow Rules
Medial elbow listings where is the Doctor’s position?
Dr. stands medial to the patient’s arm
Elbow Rules
Lateral elbow listings where is the Doctor’s position?
Dr. stands lateral to the patient’s arm
Elbow Rules
For all ULNA listings what is the position of the patient’s forearm
For all RADIAL listings what is the position of the patient’s forearm
ULNA–> supinated
RADIAL –> pronated
Note for a PL or PM elbow listing, ALWAYS test ULNA first, therefore, wrist flexion is your set up. Also, before adjusting PL, try adjusting PM 2x with appropriate re-muscle testing.
MC subluxation of the elbow
Posterior medial ulna
Posterior Medial Ulna
(web contact or End of Thumb and 2nd Digit)
- SCP
- CP
- SH
- LOC
Proximal medial ulna approximately 1 inch distal to the medial epicondyle
Web of medial hand or end of thumb and 2nd digit DIP joint
Outside hand on lateral humerus
M-L, P-A, I-S
*** Must state, I would do this adjustment twice
Posterior Lateral Ulna - 4 Finger contact
- SCP
- CP
- SH
- LOC
Proximal lateral ulna, approximately 1 inch distal to olecranon
Four finger tips of the lateral hand or end of thumb
Medial hand grabbing the medial arm, ensuring patient elbow is firmly stabilized against doctor forearm
L to M, P to A, I to S
*** Must state, I would do the PM adjustment twice before adjusting the PL Ulna
Elbow -Radius-RMT
______ muscle test with wrist in ______
Triceps
Extension
To differentiate between a posterior lateral (PL) and anterior medial (AM) radius, what RMT would your perform?
Brachioradialis
“Coffee drinking muscle”
If Brachioradialis muscle test is strong, the listing will be ____
PL
If Brachioradialis muscle test is weak, the listing is
AM
“Too early in the am, not enough coffee)
PL- Radius
- SCP
- CP
- SH
- LOC
Proximal lateral radius , approx. 1/4 inch distal to radial head
End of thumb against the proximal lateral radial head
Medial hand grabbing the medial arm, assuring the patient’s medial elbow is firmly stabilized against doctor’s forearm.
L to M, P to A, I to S
MC radius subluxation is _____
PL-Radius
For an AM-Radius listing the doctor will stand ________ to the patient arm and place CP in to the ____ ______ and _____ the patient hand during the set up.
Medial
cubital fossa
pronate
AM-Radius
- SCP
- CP
- SH
- LOC
Proximal anterior medial radial head
End of thumb against the anterior medial radial head in the cubital fossa
Outside hand grasping the lateral arm, ensuring the lateral elbow is firmly stabilized against the doctor’s forearm
M to L, A to P (elbow high, no tea pot) , I to S
What is the theory states that a muscle functioning across a misaligned joint will be inhibited by a reflex signal originating from mechanoreceptors surrounding that joint.
Mechanoreceptor Theory
Normally the G/H capsule contains .5-1.5 cc of fluid. How much fluid can the G/H capsule contain before seeing it?
30 cc
Trauma, if acute check for patient ______, joint ________, then _________.
patient safety
joint stability
subluxation/misalignment
_________ is probably responsible for most of the proprioception information for the upper extremity
Sternoclavicular joint
The elbow in closed packed position is in full ________
extension
Medial epicondylitis = golfers elbow typically from _____ ulna
PM
Tennis elbow typically from a _____ Ulna
PL Ulna
List the dynamic stabilizers
Levator Scap (medial superior border)
Pectoralis Minor (anterior border)
Rhomboids (Major and Minor- medial border)
Serratus Anterior (Lateral border)
Trapezius (middle and lower mainly- superior medial border)
The compensatory stabilizers are
BICEPS and SUPRASPINATUS
Describe the shoulder sulcus sign?
inferior and anterior instability of GH joint.
Lack of joint play will cause dysfunction and _____
PAIN
After clearing the SC joint, AC joint, G/H joint, and biceps, next check ____________?
Scapulothoracic Articulation
The most common reason for re-injury is a
Failure to properly condition the healed tissues
The concept of extraspinal management within the Chiropractic paradigm must include integration of extraspinal areas to the spine.
First one must consider the ___________ connection, then the _____________.
Neurological, muscles
If multiple extremities are subluxated, how do you determine which one to adjust?
Use the pain scale (adjust the extremity w/highest pain level)
What are benefits of bracing vs. using tape?
Brace can be washed
No dermatitis from the brace (tape can cause
contact dermatitis)
Forces of injury, position of joint, and time of episode fall under which category?
Safety
Note that during the safety mgmt criteria, we must consider closely the MOI
A sprain with no separation is considered grade ____
1
The end of travel in a joint whereby the surfaces are at maximal congruency, the ligaments are taut, and no further movement in that direction of travel may result
in
Dislocation/fracture
The most common subluxation for the SC joint is and what is the LOC
Inferior, anterior and medial
LOC is Superior, Posterior and Lateral
Ligamentous disruption of _________ mm is a SC separation and the direction it most commonly separates is ______________ and
_________________.
5, Anterior and Superior
AC Joint separation between Coracoid and Clavicle >1.3cm =
coracoclavicular ligament disruption
What can mimic carpal tunnel syndrome. Patient is tested by pronation against resistance; symptoms follow a median nerve
distribution
Pronator teres syndrome
TMJ intra-articular involvement = synovitis and capsulitis with the focus on the disc which is considered displaced or degenerated. Studies show that ___to____% of all individuals will show some TMJ related symptom in their
lifetime
85-90%
Based off Ameripress (BOAP) what is the innervation to musculature that suspends the scapulae?
Lower cervicals
BOAP: Trigger point pain between the scapula and upper trap/levator scap is evidence of ____ and symptomatic referred pain
dysfunction
BOAP
TRUE or FALSE
Scapular efficiency determines GHJ efficiency
true
BOAP
The dynamic stabilizers of the shoulder are mostly _____ in contrast to the compensatory stabilizers, which are mostly _______
underused
overused
BOAP
Of the following two, which is a biomechanical responder and which serves as an intersection of forces with little force dissipation options
Wrist
Elbow
Wrist –> biomechanical responder
Elbow –> intersection of forces with little force dissipation options
BOAP
In the managment of an upper extremity (UE) DIRECT injury, for instance a contusion, what is the preferred modality?
Icing
BOAP
Orthopedic tests provide ______ information for teh examining doctor
stability
BOAP
Sulcus sign displays inferior and _____ instability of GH joint
anterior
BOAP
The ______ tests of the shoulder are
Neer or Hawkins-Kennedy test
BOAP
Crank test or empty can test are great indicators for ______ ______ tears
Rotator cuff
BOAP
O’Brien sign or anterior slide test indicate _____ or ______ joint instability
Labrum or AC joint
BOAP
Frozen shoulder—-> Adhesive _______
Capsulitis
BOAP
Postural Signs/Upper Cross Syndrome (UCS)
Rounded Shoulders =’s
Shortened Pectoralis
Critical thought: What would you do to lengthen the muscle?
BOAP
Postural Signs/Upper Cross Syndrome (UCS)
Forward head weight–> anterior head carriage =’s
A kyphotic upper thoracic spine
BOAP
Postural Signs/Upper Cross Syndrome (UCS)
Elevated Shoulders =’s
(Shortened and Weak)
Shortened upper trap/levator scap
Weak lower and middle trap
BOAP
Postural Signs/Upper Cross Syndrome (UCS)
Winging of the scapulae indicates a ________ and what could you do to help correct this ?
Weak Serratus Anterior
Use wall pushup, squeezing shoulder blades together, thus opening up the chest and diaphragm
BOAP
When managing the UE, the soft tissue involvement should be categorized into _____ or ______
Acute or Chronic
BOAP
What are the 3 S’s for Chiropractic Extremity Management
Safety
Stability
Subluxation
BOAP
As it pertains to Safety what must we consider in management criteria
“FD-PUP”
fracture dislocation pathology underlying condition pain tolerance
BOAP
Safety mechanism of injury (MOI) 3 considerations
_______ involved, _______ of joint, and time of episode
Forces involved
Position of joint
Time of episode ( was it quick/slow/insidious/or gradual, or occurred over a long period of time)
BOAP
Mgmt criteria for Stability
Perform____ evaluation of injured area or area of pain
Do we adjust sprains and strains?
Do we adjsut grade III injuries? Why?
Orthopedic
Yes
No, bc tissue no longer is attached
BOAP
Sensations transmitted from joints include ___ and _____
Pain and position
T or F
Joints and muscles acting on joints have same nerve supply ? And this is based off what law?
True
Hilton’s Law
The principle that the nerve supplying a joint also supplies both the muscles that move the joint and the skin covering the articular insertion of those muscles.
LAB Rules of Thumb
_____ spine first
Establish criteria for adjustment utilizing the _______
Clear
3 S’s (safety, stabilization, subluxation/misalignment)
BOAP
Regarding the safety criteria for UE adjusting, neurological involvement means there is _______ dysfunction
sensory
BOAP
Regarding the stability criteria for UE adjusting, what two methods of evaluation can be used ?
ROM
Orthopedic tests
BOAP
Regarding the subkuxation criteria for UE adjusting, we always start ______ and go _______
Proximal
Distal
SC joint most common subluxation
AIM
During SC RMT, the arm is ______ rotated with the palm facing ____.
Internally rotated
During RMT in general you want to always ask the patient?
Do they have any problems in the respective area you are evaluating?
During the SC muscle test, the arm is extended forward and how many degrees with the table
How many degrees is the arm brought down during the aforementioned RMT?
90
45
During RMT we are looking for joint lock, ________ or ________
compensation or recruitment
After completing a challenge what is the next step?
Redo RMT
When adjusting a SC joint what direction is the traction of the humerus during stabilization
Posterior and inferior
BOAP
RMT for AC joint?
How many degrees does this muscle flex the shoulder
Coracobrachialis
15-30 degrees
MC subluxation for Ac joint
Superior
As with the SC jint, the AC joint RMT has the arm extended forward with the _____ bent and the forearm is kept parallel to the chest. SH point is the _______
elbow
Olecranon fossa
The challenge set up for an AC joint is similar to what Orthopedic test set up?
Dugas
involved side hand is rested on opposite shoulder, with elbow firmly against the chest
LOC for Ac joint and SCP
S to I
1/2 inch or 1 medial to the AC joint (aka distal 1/3 of clavicle)
BOAP
What are the various methods to evaluate for joint play? (5)
Motion (tests fo joint proper motion) Muscle testing (based on mechanoreceptor theory) MOI Symptoms X-rays
3 ways to adjust extraspinal area(s)
hands
instrument (i.e. activator)
mechanically assisted “drop”
What three ways does a SC compensate (Lab tidbit)
What way does AC joint compensate?
SC: protraction, shoulder shrug, body roll
AC: humeral abduction
When setting up for AC joint adjustment, how many degrees is attained for stabilization before impulse/thrust is delivered?
5-10 degrees
hydrodynamics are essential for
Proper ______
Transport of _________
Removal of waste material form ______ surfaces
Lubrication
Nutrients
articular surfaces
BOAP
AI Humerus
Arm is extended 40-__ degrees to the table, per lab it is and is MC 95% of the time
RMT is and if weak what RMT do we do next?
40-60 degrees, per lab its 45 degrees
Anterior deltoid
Teres MAJOR
What type of subluxation is the biceps tendon? and what direction is the sub-x in?
Soft tissue sub-x
Lateral
- Ask patient if they have any problems with shoulder or elbow*
BOAP
ST Articulation Criteria
__ of ___ must be met
1.
2.
3.
2 of 3
Apleys Inferior
1inch to 1.5 inch lower is +
the lower side is the fixated side
Scaption
Less movement +, and the less moveable scapulae is the fixated one
Internal rotation
70 degrees is normal the higher side of the two is the fixated side!
What does compensation look like while RMT Elbow baseline
Clenching of fist
Wrist rotates
If during examination, you are thinking the trauma is chronic yo must
- Check for ____ joint______
- Then ______
- Residual joint instability
2. Then subluxation
A forgotten acute injury to extraspinal areas by patients lead to altered joint mechanics
1.
2.
- Fixations
2. Hypermobility
3 Reasons the body compoensates for injury
Abnormal stress upon normal structure
i.e. pregnancy
Normal stress upon abnormal structure
i.e. spondylolisthesis, hemivertebra, scoliosis
Normal stress upon normal structure that is NOT prepared t receive stress
i.e. stepping off curb and twisting ankle
FYI: Five questions must be answered prior to extrasinal adjusting
- is this chronic or acute
- What tissues are damaged
- What is severity of damage
- Is there instability or restiction of motion
- Is this pre or post surgical area
Ligaments _______
Muscles ______
Sprain
Strain
Grade 1
7- __ days
NO _____ laxity
NO residual ______
7 to 10 days
No residual laxity
No residual weakness
Grade 2
______ deformation
residual laxity
______ muscle tear
Plastic
residual laxity present
Partial muscle tear
Grade 3
Complete ______ of structure –> complete tear
rupture
MC grade injuries seen in DCs office
grade 1 or MILD grade 2
Remember serious grade 2 and grade 3 legally require a referral OUT
Grade 3 injuries will heal without ____ and almost will never return to normal Stability and/or function
reconstruction
In CPP (closed pack position) End of travel in a joint Surface is at maximum\_\_\_\_\_\_ Ligaments are \_\_\_\_\_\_ and
Further direction of travel in CPP leads to
congruency
taut
Fracture or dislocation
Loose or Open packed position (OPP)
Position of travel of joint away from CPP
Capsule and ligaments are _____ _______
Extreme movement in that direction of OPP leads to
NOT TAUT
strain/sprain
Degenerative changes in joint (loss of normal joint mechanics)
Produces _______, leading to fibrotic response aka _____ tissue
Ultimately degenerative changes promote altered ______ ______
inflammation
scar tissue
joint mechanics
Initial healing 3 - __ days
Regeneration 6 - __ weeks
Remodeling __ months to ____ Years
3 to 10
6 to 8 weeks
6 months to 2+ years
Proper hydrodynamics occur during
- Intermittent ______ activity
- Full ROM of ______ and capsule
Weight bearing
Intermittent muscle activity
Full ROM of joint and capsule
“running is a good example”
How many degrees is the elbow bent for elbow baseline muscle test?
70 degrees
The GH joint capsule may contain up to 3o cc of lfuid, which is equivalent o about ____ oz
1
Note, you can not always see edema on average you the space contains 0.5 to 1.5 cc ( 0.02 to 0.05 ounces)
What is the osseous link to the GH joint?
SC
SC joint elevation 4 to ____ degrees
depression 5 ____ degrees
Protraction and Retraction _____ degrees
Rotation ____ to ___ degrees
Adjusting SC-joint helps what 4 lung pathologies
60
15
15
30-50
Asthmatics, COPD, Emphysema, Bronchitis
Sc joint seperation in 3 directions
1.
2.
3.
It does not move posterior due to _____, if it does you nede to call 911 as this could occlude ___ or ______ arteries, veins, or lung tissue
MC seperation
superior, inferior, and anterior
1st and 2nd ribs are behind it
carotid or jugular arteries
Anterior and Superior
Note, upon care if x-rayed, the post should be less than 5mm in height difference. If not better by 6 weeks REFER OUT
FILL OUT BLANK OUTLINES from BB
FILL OUT BLANK OUTLINES from BB
