Neck & Limb (Shoulder, elbow, wrist) Flashcards
1
Q
What is the brachial plexus?
A
The brachial plexus is a major network of nerves transmitting signals responsible for motor and sensory innervation of the upper extremities, including the shoulder, arm, and hand.
2
Q
Where does the brachial plexus start?
A
Starts around C5, C6, C7, C8, T1
C8 means in between C7 & T1
3
Q
What is ST12 & ST13 close to anatomically?
A
ST12 is close to the brachial plexus
ST13 is close to the subclavius, pec major and minor
4
Q
What is the rotator cuff?
A
Supraspinatus, infraspinatus, teres minor and subscapularis that insert into the head of the humerus
5
Q
What muscles does LU2 act on?
A
Pec major and minor
6
Q
What muscles do SI9, SI11, SI12, SI14 & SI15 act on?
A
SI9 Teres major
SI11 Infraspinatus
SI12 supraspinatus
SI14 levator scapulae
SI15 Splenius cervicis
7
Q
What muscles do SJ13 and SJ15 act on?
A
SJ13 Triceps
SJ15 Trapezius
8
Q
What tests are good for carpal tunnel syndrome?
A
- Tinel’s Sign
- Phalen’s Test
- Reverse Phalen’s Test
- Carpal Compression Test
9
Q
What is carpal tunnel?
A
Carpal tunnel is compression of the median nerve. It can cause symptoms such as numbness, parathesis, burning pain, a feeling of the hand falling asleep decreased grip strength.
10
Q
What points can be used to treat carpal tunnel?
A
- PC 7 needle distally into carpal tunnel
- Baxie (M-UE-22)
- PC 6 or TE 5
- Dermal hammer (especially in early stages)
- Moxibustion may be beneficial
- Massage and stretching of the anterior aspect of the wrist
*C5-T1 HuatoJiaJi Points
11
Q
How are trigger points classified?
A
Location, tenderness and chronicity
Central (or primary)
Satellite (or secondary)
Attachment, diffuse, inactive (or latent) and active
12
Q
What are central trigger points?
A
Central trigger points exist in the centre of the muscle belly where the motor end plate enters the muscle
13
Q
What are satellite (or secondary) trigger points?
A
May be a created response to the central trigger point in neighbouring muscles that lie within the referred pain zone. Often resolve once the primary point have been effectively rendered inactive.
14
Q
What are inactive (or latent) trigger points?
A
Lumps and nodules that feel like trigger points. Are not painful. May lead to increased muscular stiffness.
15
Q
What is referred pain?
A
The defining symptom of a myofascial trigger point
16
Q
What points can be used for electroacupuncture for carpal tunnel?
A
PC6, PC7, H7, LU9
Connect with electroacupuncture begin with 25Hz microcurrent for 25-30 minutes, then gradually increase to millicurrent to 2 Hz if required
17
Q
What does SMART stand for in SMART treatments?
A
S = Sensory
M = Motor
A = Autonomic
R = Radiculopathy
T = Trigger / Ahshi
18
Q
What is a SMART treatment for carpal tunnel?
A
Sensory: Digital Cutaneous Branch of Median Nerve (needle obliquely towards palm PC-7). Palmar cutaneous branch of median nerve (PC-6) is spared in CTS.
Motor: Median Nerve and Anterior Interosseous Nerve (PC-3)
Autonomic: PC- 6 on asymptomatic side (Parasympathetic), Vasomotor Segments:
T5- T7
Radiculopathy: C5-T1
Trigger/Ashi: Muscle tendons of Carpal Tunnel to be considered include Flexor Pollicis Longus (LU-6) Flexor Digitorum Superficialis (PC-4) Flexor Digitorum Profundus (Bi Zhong)
19
Q
What channels contribute to CTS? Where would you needle according to the Tan method?
A
CTS affects the LU and PC Channels, so you are looking for a channel that treats both. The LR Channel fits this requirement.
Needling points at the Ankle to treat the wrist
20
Q
What are some other therapies that are beneficial in CTS?
A
- Laser (LLLT)
- Electro acupuncture
- Moxa including needle head moxibustion
- Gua sha
- Tuina techniques above and below area
21
Q
What is De Quervain’s Tenosynovitis?
A
Gamers thumb is a condition caused by repetitive movements of the extensor pollicus brevis (EPB) and abductor pollicus longus (APL) tendons
22
Q
What is Tenosynovitis?
A
- Pain
- Near the radial styloid process – suddenly or gradually
- On movement of thumb and wrist
- Worse for use
- Worse with resisted thumb abduction and extension
- Swelling if condition is severe Crepitus if chronic
Difficulty moving the joint - Look for a Positive Finkelstein’s test
23
Q
What are some local points for Gamers thumb?
A
- Treat affected channels to relieve pain
- LU 7, 8, 9, 10
- Subcutaneous needling alongside the affected tendons
- Tui Na on the upper back, shoulder and arm
- Callison adds in threading from LU7 towards LI5 under the APL tendon at an angle of less than 10 degrees
24
Q
What is a SMART treatment for Gamers thumb?
A
Sensory: Superficial Branch of the Radial Nerve (LI-4, LI-5) Motor: Posterior Interosseous Nerve (LI-9)
Autonomic: HT-6, Vasomotor Segments: T5-T7 Radiculopathy: C6-C8
Trigger/Ashi: Extensor Pollicis Brevis (TE-6), and Abductor Pollicis Longus (TE-8)
Additional Points and Considerations:
(LI-5) as it is the tendon pathway of Extensor Pollicis Brevis (LU-9) due to tendonous attachment of Abductor Pollicis Longus (LU-6) Flexor Pollicis Longus for its antagonist role
25
What is Rheumatoid arthritis?
It is a chronic inflammatory disease that begins in the synovial membrane. It is an autoimmune condition.
26
What are the symptoms of RA?
* Gradual Onset (Systemic)
* Malaise, lethargy, weight loss, generalised muscle pains
* Joint pain and stiffness (after rest)
* Swelling & deformity
* Affects small, peripheral joints first (symmetrical)
27
What is RA in terms of TCM?
RA is a Wind Cold Damp Bi that has now turned to heat. In the Active RA phase, the heat is more predominant or possibly is more swelling rather than heat; dampness is predominant
28
What points can be used during the heat phase of RA?
Heat phase - Points such as LI4, LI11, GV14, ST44 are required as well as local joint bleeding jing well points, Wuhu 11.27 points, local Baxie and Shangbaxie points
29
What points can be used during the damp phase of RA?
In the more damp phase points such as SP9, SP6, ST36, SP5, Master Tung Points 88.09, 88.10, 88.11 are used
30
What are tension headaches?
* Involves pain in the head. The most common type is tension headache
* Tension headaches usually originate from the sub occipital region and can often be reproduced with palpation through the neck and shoulder girdle region
* GB20 & BL10 surrounding muscles are often involved
31
What are distal points that can be used in the treatment of tension headaches?
* Vertex LR3/LI1, LU7, HT7
* Frontal LI4, ST36, ST43, PC channel muscle points PC3
* Temporal / Parietal regions GB31, TE3, TE5, GB41, GB40
* Taiyang HT3, muscular areas of the Heart channel
* Occipital SI3, BL60, BL62, BL65, BL67, LU7, Occipital regions
* Acute three Yin or three Yang Jing Wells on either hand or foot
* Ear points
32
What points can be used for electroacupuncture for headaches?
* GB2 superficial threaded downwards towards SI17, connected to the same side
* LI4 bilateral (neck innervation from C1-T1)
* ST36 connected to the same side SP6 bilaterally
* EA dosage 25Hz
* 2/100 Hz for subsequent treatments (targeting the opioid release system)
33
What are some other points that can be used to treat tension headaches?
* Local points combined with distal points on the same channel or a channel that balances
* Distal if very acute
* LI4 for pain and expelling pathogens
* Moxa over cold areas
* Electro & laser
* Ear acupuncture (vagus nerve)
* Needle retention for longer than 20 minutes of they have a headache during treatment
34
What is TMD?
* Consists of the masseter muscle and temporalis muscle
35
What is a treatment/s for TMD?
* The masseter muscle can be accessed through ST6 & ST7
* LI4 can be used as it is the command point for the mouth and face, useful to needle with jaw movement
36
What are some treatment ideas for muscular neck conditions?
* Local points GB20, BL10, Dijia, GB21, SI16, GV14, GV16, Chonggu, neck HJJ
Distal points
* LU7 to LU9 threading for nape and pain going to the occiput (BL sinew)
* SI3/BL62 for occipital pain (Taiyang)
* GB40 for GB20/GB21 pain (shaoyang)
* BL60 for BL10 pain
* Opposite SP5.5 for levator scap insertion pain (SI or TE)
* Opposite SP5/LR4 scalene pain referral along TE or SI channels
* Opposite side KI3-KI7 zone SCM pain (LI channel)
37
What is a treatment for muscular neck problems according to Legge?
* Legge suggests tender points on the back of the opposite hand for acute neck pain
* Luozhen and SoJin
* Needle with strong stimulation while the patient moves their neck within pain free range
38
What methods can be used to treat muscular neck conditions?
* EA, heat, laser, cupping and gua sha
* Cupping with small cups on the larger muscles and posterior to SCM
* Moxa to get muscles out of spasm and to increase blood flow
* Zheng gu shui or Po sum on
39
What is the Levator Scapulae in neck pain?
* Common muscle in neck pain to release
* Look for elevated LS
40
How to treat the levator scap contributing to neck pain?
* Extra point Dijia
* Motor point for the LS
* HJJ points spinal segments C3-C5 perpendicular insertion 0.5-1.5
* Electro or pointer 10Hz
41
What is CERVICAL SPONDYLOPATHY?
* Neck degeneration
* Common cause of chronic neck pain
* Abnormal wear on the cartilage and cervical vertebrae of the neck, spurs may also be present
* Degeneration of the discs causes compression on the nerve roots
42
What is Whiplash?
* Rapid neck flexion and extension with tissue damage to the muscles, ligaments and joints of the neck and upper thorax
43
What are the four grades of whiplash?
* Four grades of Whiplash
* GR1: complains of neck pain, stiffness or tenderness only
* GR2: neck complaints and decreased ROM and point tenderness
* GR3: decreased ROM + neurological signs such as deep weakness, insomnia and sensory deficits
* GR4: neck complaints and fracture or dislocated, or injury to the spinal cord
44
What are some treatment ideas for whiplash?
* Acute: Luozhen, SI3, BL62 and local points
* After first week: HJJ, BL and GV
* Vertebral segements T3/T4 & T6/7, interspinous process (GV), facet joint, erecor spinae, rib angles, intercostal spaces near the sternum and the sternum
45
What is the Jin Jing of the neck?
LI = Trapezius
SJ = Levator scapulae
SI = Rhomboids, contralateral splenius cervicus and capitis
ST = Swallowing muscles, jaw and mouth muscles
GB = Sternocleidomastoid
BL = Erector spine, sub occipital muscles, occipital-frontalis
46
When to refer headaches?
Amnesia
Prolonged
Loss of conscious
Personality changes
Post concussion
Prolonged pain
Blurred vision
Sudden dizziness > 3 mins
Sudden tinnitus > 3 mins
47
What are some distal points for the torso?
SI3 Upper Back Pain
SP4 abdominal pain below the umbilicus
GB39, GB40, GB43 lateral costal pain
22.01 (Chong Zi), 22.02 (Chong Xian) – Upper back especially Rhomboid area, scapular, neck pain and lung related back pain (coughing)
48
What branch innervates the deep paraspinal muscles?
The medial posterior branch innervates the deep paraspinal muscles located at the HJJ points
The lateral posterior branch innervates the erector spinae muscles located on the inner and out Bladder points
49
What is the agonist muscle?
The agonist muscle is defined as the prime mover and the muscle/ tendon in the injury.
50
What is the antagonist muscle?
The antagonist is the opposing muscle group involved in the neural reflex arc.
51
What do the HJJ points do?
The HJJ points to increase the blood flow to different areas of the body. Especially when used with electroacupuncture.
T1-T5 – will regulate the influence the blood flow to the head, neck and upper extremity. As well as organs in the upper jiao.
T6-10 – will regulate the blood flow of the Internal organs (Celiac ganglion).
T10 – L2 will regulate the blood flow of the lower back, hip, lower extremity and lower jiao organs.
52
What muscles of the torso are prone to trigger points?
Pectoralis Major – (Accessed LU1, LU2, PC1, ST14-16)
* Pectoralis Minor Important in Thoracic Outlet Syndrome Covered in Shoulder
* The Serratus Posterior Superior (SPS) (Classical SI15)
* The Latissimus Dorsi (Nerve accessed at GB22)
* The Serratus Anterior (Nerve Accessed at GB23). Also, you may need to include manual work here, Massage and or gua sha to break up the adhesions
53
What is the shoulder complex comprised of?
Three bones, four joints and at least 20 different muscles and 7 channel sinews
54
What does the shoulder structure provide?
It provides maximum flexibility and minimal stability – great for athletic performance but prone to many problems
55
What are the channel sinews of the shoulder?
* Large Intestine * San Jiao
* Small Intestine * Lung
* Pericardium
* Heart
* Bladder
56
What is LI15?
Glenohumeral (GH) joint and supraspinatus tendon
57
What is LI16?
A/C joint and supraspinatus tendon and the superior articular branch suprascapular nerve
58
What is TE14?
Supraspinatus / infraspinatus tendon
59
What is SI9?
Axillary nerve (true shoulder)
60
What is SI10?
Inferior branches articular nerves of GH, post deltoid, GH capsule
61
What is SI11?
Infraspinatus branch of suprascapular nerve
62
What is SI12?
Supraspinatus branch of the suprascapular nerve
63
What is SI13?
Rhomboids
64
What is SI14?
Levator scap
65
What is SI15?
Serratus posterior superior
66
What is BL43?
Rhomboids
67
What is LU1/LU2?
Pectoralis major
68
What is KI27/ST13?
Subclavius (drops the clavicle bone and rotates it during shoulder extension)
69
What are some extra points of the shoulder?
Dajiazhen - halfway between LU2 & LI15
Taijian – 1 cun above Jianneiling
Jianneiling – Halfway between LI15 and axillar crease
Jubi – 1 cun below Jianneiling (coracobrachialis)
Jianhou – halfway between SI9 & SI10
Jiantongdian – lateral border of scapular border (teres Major)
Naoshang – tip of equilateral triangle LI15 &
TE14
70
What is the rotator cuff? And its movements / acupuncture points?
* The rotator cuff is a group of muscles and tendons that hold the shoulder joint in place and help move the shoulder
* Supraspinatus (abduction) (Local SI12)
* The infraspinatus (external rotation) (Local Si11)
* The subscapularis (internal rotation) (local HT1)
* The teres minor (external rotation) (local SI9)
71
What are the symptoms of rotator cuff injury?
Pain in the lateral upper arm
Worse in active motion of problem muscle/tendon (abduction, internal rotation, external rotation) especially when stressed through that movement.
Pain may be worse when sleeping on affected or unaffected shoulder.
72
What is the painful arc?
Pain occurring between 80 and 100 of abduction is characteristic of impingement of the supraspinatus tendon
73
What are the tests for rotator cuff injuries?
Primary tests:
Hawkins Kennedy Test,
Neers Test,
Apleys Scratch, - Included in Normal Upper body scan Supraspinatus tests,
Included in Normal Upper body scan Lift Off Test,
Teres Minor strength test
74
What is a SMART treatment for rotator cuff injuries?
SMART treatment for rotator cuff
Sensory: Channel Sinew distal point (SI 3)
Motor: Suprascapular nerve (SI-11 and SI-12) Autonomic: HT-6, Vasomotor Segments: T5-T7 (HJJ) Radiculopathy: C5-C7 (HJJ)
Trigger/Ashi:
* Subscapularis (HT-1)
* Teres Minor MP (Jian Hou)
* Infraspinatus Tendon & TP (SI-11)
* Supraspinatus Tendon & TP (Adjacent to LI-15 & LI- 16 to promote perfusion to tendon)
Scapular stabilizers: Weakness of Serratus Anterior may contribute to a loss of posterior tilt and upward rotation of the scapula. Consider weakness in Rhomboids and shortened Levator scapula. Discoordination of the Upper and Lower of Trapezius will also disrupt scapulo-humeral rhythm.
75
What is frozen shoulder?
* Retrograde disease aggravated by long-term sprain and attack of cold
* Usually a chronic presentation but can have acute flare ups
* Traumatic injury that leads to chronic inflammation of the joint capsule and the soft tissues around the joint
* Worse when abduction and external rotation
76
What is the diagnosis for frozen shoulder?
* Frozen shoulder diagnosis: wind, cold, damp > blood stasis > bi syndrome > freezing phase, frozen phase, thawing phase
77
What is legges treatment for frozen shoulder?
Legge treatment
* Use of local shoulder points with techniques such as the green tortoise seeks the point
* Needling in multiple directions and not retaining needles
* Distal points ST38 & GB39
* Cupping over shoulder joint area
* Heat/Moxa/laser. Remember is frozen
* Some electro from Si10 – LU1/2 at 2hz
78
What is Thoracic outlet syndrome? (TOS)
TOS involves an abnormal level of compression of the neurovascular bundle by bony ligamentous and to soft tissues.
This area is bordered approximately by ST11, ST12 and ST13
79
What are the symptoms of TOS?
Depending on what is impinged the patient may complain of numbness tingling, swelling, cold limb down the neck, chest, limb and will often fatigue easily.
Also, pain in the rhomboid area, levator scapular or upper trap area often occurs during sleep or prolonged overhead activities or stress.
Often occurs in the inter scalene triangle, costoclavicular approximation and the thoraco-coraco-pectoral (TCP tunnel)
80
What is the elbow?
* The elbow is a modified hinge joint with three bones. It is considered a stable joint with good ligamentous and muscular support
* The elbow flexes and extends but also pronates and supines
81
What are the contributing symptoms of elbow pain?
* Neck/Shoulder conditions such as TOS, cervical degeneration, nerve entrapments can all refer to the elbow
* Trigger points of rotator cuff muscles and other muscles such as coracobrachialis, serratus posterior superior, serratus anterior and latissimus dorsi are capable of presenting with elbow pain.
82
What is LI12?
Brachioradialis motor point, radial nerve (branch to ECRL)
83
What is LI11?
ECRL motor point (radial nerve) brachioradialis
84
What is LI10?
Supinator (deeper insertion)
85
What is LI9?
Deep radial nerve
86
What is LI8?
ECRB
87
What is TE9?
Extensor digitorum communis
88
What is LU5?
Lateral ante brachial cutaneous nerve (superficial) radial nerve (deep)
89
What is PC3?
Median nerve trunk
90
What is HT3?
Medial antebrachial cutaneous nerve (anterior branch), pronator teres muscle
91
What is SI7?
Extensor carpi ulnaris
92
What is SI8?
Ulnar nerve
93
What is HT2?
Medial ante brachial cutaneous nerve (fascial exit)
94
What is LU3?
Musculocutaneous nerve bifurcation to bicep brachii
95
What is LU4?
Musculocutaneous nerve bifurcation to bicep brachii
96
What is TE11?
Medial head triceps
97
What is TE12?
Tricep lateral head
98
What is TE13?
Radial nerve (located in the triangular interval of triceps
99
What are some distal points for the elbow?
Distal points of the elbow
* Distal points on the affected arm channels such as xi cleft points (acute pain), luo connecting points.
* Jing well points affecting the entire sinew channel
* Use of the opposite elbow LU5 for LU11 and PC3 for TE10 pain
100
What is lateral epicondylitis?
Tennis elbow
* The most common presentation of elbow pain in and around the lateral epicondyle
* Pain that radiates from the epicondyle outside the elbow and into the forearm esp when straightening the arm, often a dull ache at rest
* Pain and weakness my cause difficulty grasping objects significantly when the arm Is extended
101
What tests can be used for lateral epicondylitis?
* Tests used such as Mills test, cozens test and extensor digitorum communis
102
What is the smart treatment for lateral Epicondylitis?
SMART treatment
Sensory: Distal Sensory point: (LU-7, LI-4) Superficial Branch of the Radial Nerve Motor: (LU-5) Radial Nerve
Autonomic: HT-6, Vasomotor Segments: T5-T7
Radiculopathy: C5-T1
Trigger/Ashi: Possible contributors of Lateral Epicondylitis include, most commonly, Extensor Carpi Radialis Brevis (LI-8), followed by Extensor Digitorum (TE-9) and, less commonly, Extensor Carpi Ulnaris (SI-7).
Additional points and considerations:
* Strictly speaking, Extensor Carpi Radialus Longus (LI 11) is not a lateral epicondylitis issue, as its origin is superior to the epicondyle. However, resisted radial deviation should always be tested to make sure ECRL is not also involved.
* Surround the Dragon at extensor origin (Tendo-periosteum), Needling at ECRB, EDC Tendon origin at Lateral Epicondyle.
* Asymptomatic side (Luo-connecting): (LU-7)
103
What is medial epicondylitis?
* Pain and tendinopathy on the inner side of the elbow, where the tendons of the forearm flexors attach to the medial epicondyle
* Relatively common overuse injury
* Symptoms: elbow stiffness and weakness of the hands and wrists, numbness or tingling which radiates into one or more fingers
104
What is a SMART treatment for epicondylitis?
SMART TREATMENT
Sensory: (PC-7/PC-6) Ulnar Nerve
Motor: Median nerve (PC-3)
Autonomic: HT-6, Vasomotor Segments: T5-T7 Radiculopathy: C5-T1
Trigger/Ashi: Possible contributors of Medial Epicondylitis include Pronator Teres (HT-3), Flexor Carpi Radialis (Xi Shang), Flexor Carpi Ulnaris, Flexor Digitorum Superficialis/Profundus (Bi Zhong), Palmaris longus (Xi Shang)
105
What are the active ROM for the neck?
Flexion 45-50 degrees
Extension 85 degrees
Lateral flexion 40 degrees
Rotation 90 degrees
106
When doing the Upper body scan of the shoulder, when the shoulder is flexed what movement is this and what muscles are involved?
Flexion, normal ROM is 180 degrees
The movement uses the anterior deltoid (LI sinew), pec major (HT/PC/BL) and the coracobrachialis (LU)
107
When extending and internally rotating the shoulder in the upper body scan, what muscles are involved?
Internal rotation of subscapularis (HT)
Shoulder extension (lats, BL, teres major/minor, posterior deltoid, SI)
