Needling technique Flashcards

position, grip/technique, needle

1
Q

Infraspinatus

A

s/l or prone
flat - down to scapula
40-50 size

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2
Q

deltoid

A

prone, supine, or s/l
flat (but don’t go too medially)
40-50mm

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3
Q

Biceps

A

supine
pincer - and needle lateral to medial
40-50mm

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4
Q

brachialis

A

supine
Flat - lateral to medial (Do not pass mid line)
40-50mm

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5
Q

Triceps

A

prone, can do s/l or supine too
Pincer - lat/long head
flat - Medial head (lat to med direction)
40-50mm

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6
Q

Upper Trap

A

prone, sidelying, or supine
pincer grip
30-40mm

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7
Q

SCM

A

upper - prone
Most of it - supine

Upper - toward occiput in btwn mastoid and occiput
OR – small window in s/l off mastoid process
Supine - with pincer with findings vessels

Needle 30mm

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8
Q

Lat

A

Prone for trunk portion
Supine, s/l, prone for axillary

Trunk = rib lock
Axillary - Pincer

Trunk 40mm

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9
Q

Pec Major

A

Supine

Clavicular - flat lateral clavicle create window and tangential parallel with clavicle
Axillary - pincer
Sternal - rib block with whole hand flat

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10
Q

Subscapularis

A

Axillary - Supine
Medial - prone

Axillary 90deg abd ER and go perp into scapular
Medial - hammerlock position with shelf mm and go into scapular area. Do not use support in front of shoulder**

Medial 50mm needle

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11
Q

Wrist extensors

A

Supine in slight flex

Flat - tangential tech
Pincer - Extensor longus/brevis
Flat - digitorum/ulnaris
For ulnaris come from the side to stay more horizontal

Needle 30mm

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12
Q

Brachioradialis

A

supine with slight flexion

Pincer grip

Needle 30-50mm

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13
Q

Supinator

A

Supine

Flat -start at radius and only fan inf/sup direction. needle radius towards ulna
Go off radius and below radial head towards ulna

Needle 40mm

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14
Q

Anconeus

A

Prone - forearm flexed ~45deg

Flat (thin muscle so insert just prox to TrP and hit bone)

Needle 30mm

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15
Q

QL

A

sidelying / prone

Flat - need to open up QL (Pillow under, arm overhead), find mid line and go just posterior to mid line.

Posterior approach - L3 middle, up and over past p/s and slight ankle to belly button.

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16
Q

Psoas major

A

side lying, supine, prone

Flat palpation -
Lateral approach - like QL but 10-30deg ant to belly button. (Avoid abdominal cavity)
Posterior - same as QL but deeper

Supine - Iliopsoas approach - lateral to femoral canal (flat)

75mm
50mm if anterior?

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17
Q

Glute max

A

prone or s/l

flat

60-75mm

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18
Q

Glute med

A

sidelying

flat

50-60mm

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19
Q

Glute min

A

prone or s/l

flat

50-60mm

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20
Q

Adductor longus/brevis
Gracilis
Adductor magnus

A

supine :
with leg out to the side in ER - pincer/OK grip
Magnus - flat palpation (if you needle magnus you typically go through gracilis)

sidelying - pincer (longus/brevis)

*stay away from big groove (adductor canal)

Needle - 50-60mm

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21
Q

Pectineus

A

supine - slight ER

Flat -Femoral Triangle (inguinal ligament, sartorius, adductor longus) locate artery. Middle finger on it. Other rest down for nerve (lateral), vein Medial). Needle AP only

Needle 50-60mm. Only down about an inch.

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22
Q

Rectus femoris

A

supine

Flat

40mm fine. Longer for deeper quad.

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23
Q

Vastus lateralis

A

supine or sidelying

Flat - do AP or PA. Painful to go to fascia/ITB.
big muscle need to do both sides.

50-60mm

24
Q

Vastus medialis

A

supine

flat - lower 2/3rd of femur under rectus and goes medial. Keep in mind adductor canal (have them quad set)

Needle 50-60mm.

25
Q

Vastus intermedius

A

supine

Flat AP - need a longer needle. Go anywhere

50-60mm

26
Q

Genu articularis

A

supine

flat - 1-2 inch above patella and go 45-60deg from aponeurosis. Angle towards femur and *Need to hit femur. Nothing else is there.

Needle 40-50mm

27
Q

Hamstrings

A

prone

flat - do not go mid line (sciatic)
- biceps femoris - cannot separate short/long head. Needle away from mid line. Very easy to treat besides upper 1/3. Pillow under feet.

50-60mm needle

28
Q

Gastroc

A

Prone

Flat - Prox - stay very superficial and needle away from mid line.

  • lower - pincer palpation.
  • Medial head typically more TrPs.

Needle 50 should be fine.

29
Q

Soleus

A

If someone has TrPs and you have them do eccentric work it will flare up the TrPs**(tendonitis rehab)

Prone or s/l

Flat - fingers on tibia, come posterior to tibia. Stop before mid line with needle. Lower 1/4 wouldn’t do. Can do straight AP 1/4 to 1/2in but you don’t know what is under in mid/low section.

30
Q

Teres Major

A

Prone with slight abd, or sidelying

pincer - needle ventral lateral (no precautions)

Needle 30-50mm

31
Q

Teres Minor

A

Prone arm abd 90. or in s/l. Resist ER to make it pop.

Pincer - needle ventral lateral (no precautions)

Needle 30-50mm

32
Q

Coracobrachialis

A

Supine with Abd and ER. Sit superior to the arm and next to the person.

Flat - find biceps first (make a muscle) and drop off. Then have them adduct Needling into bone only about 1 cm. Do not go posterior due to neurovascular bundle** Muscle will contract. If it does not, then don’t needle it!

Needle - 30 typically good. 40 for more space.

33
Q

Pronator teres

A

supine with forearm supinated and arm slight flex (pronator comes about halfway down radius)

Flat - Needle directed to med epicondyl or the radius. (Do not needle mid belly straight down. Median nerve runs between the two heads)

Needle - 30-40mm.

34
Q

Wrist flexors

A

Supine

From Ulna -> radius (Med -> Lat) FDP, FCU, FDS, palarmis, FCR, pronator teres

Flat - tangential techniques towards hand (up to elbow to stability hand) (Do not go medially for median nerve)

For Profundus - supine with larger needle (40-50). Elbow bent, prox 2/3. Pincer with thumb on radius and come between ulna and median nerve heading to radius. Palpate ulna and go just off it. Don’t hit radius (too far)

Needle 30-40mm

35
Q

Pec minor

A

supine with arm up in abd or “fainting position”

pincer and needle medial to lateral. Do the “hover over the ribs.” When you do the minor you also do the major.

Do not use smaller needles. Need 50-60 for flexible needle.

36
Q

Levator scap

A

Prone (lower), sidelying (upper or lower)

Prone - hammerlock position. Towel under. Rock climb grip. Flat into the scap (don’t have to)

Sidelying - C5/6 area posterior to the SCM. Thumb on spinous process, fold. Will also get neck mm. Pincer to thumb.

Needle 30-40 (C5/6 area)

37
Q

Supraspinatus

A

Prone, or sidelying with towel under shoulder

Rock climber grip - needle goes post/lat direction into fossa (deeper than you think)

Needle 40mm

38
Q

splenius capitus / cervicis

A

Cap - prone
Cervicis - sidelying (clump with semispinalis cap and cerv)

Cap - Flat
Cerv - Pincer/ fold technique. Have them lift head and go posterior to SCM and near spinous process. DO not go above C2.

Cap - 30mm
Cerv - 30-40mm.

39
Q

Semispinalis Capitus

A

s/l

Pincer - done together with semi cap, cerv, and splenius cerv.
Not above C2**

Needle 40mm.

40
Q

Oblique capitus inferior

A

prone (do not needle lat/cranially) -
Sit above the person (easier) or to the side.

Medial portion of muscle is all you can do. Lateral off limits due to artery
Palpate C1 transverse tubercle and C2 spinous process. Draw a line between. 1 finger SP C2 other half way. Only needle the medial half.

***Deep muscle. Go towards opposite eye. DO not go up to occiput.

50mm

41
Q

Multifidi (C, T, L-spine)

A

Technique is the same throughout.
**Scoliosis - T-spine off limits.
Fusions are fine. Laminectomy absolutely not. Discectomy ok.
Rule 1 - Lamina used to protect spine
Rule 2 - ALWAYS - caudal/medial
Rule 3 - 1 finger width off spinous process

Prone
Needle 40 C-spine prob ok.
50 T-spine
50-60 L-spine

42
Q

Longissimus Thoracis

A

Prone arm at side.

Flat palpation (sometimes can pincer). Shallow, deeper caudal/medial. We are outside of our safety window. 
*Do not do a rib lock. 

Needle 40mm.

43
Q

Iliocostalis Thoracis

A

Prone
RIB LOCK. Tangential. Do not move hand at all once satisfied you have the rib locked all the way down into the webbing of the hand.
Shallow, deeper

Needle 40mm.

44
Q

Iliocostalis Lumborum

A

Prone

Shelf - anywhere below the ribs. Reach across the body. Hook and pull. Needle straight across.

Needle 40mm.

45
Q

Iliacus (Prox and distal portion)

A

**Precautions. Viscera prox. Distal femoral artery, nerve.

Prox - Quarter roll with pillow under. Hook it, needle in to iliac fossa. Do not go medial. Needle 40-50mm

Distal (do with psoas just like pectineus) - Supine. Flat palpation. Find pulse, block artery medially, nerve laterally, other finger lat up to ASIS. Needle straight down (Do not go superior due to pelvic floor)

46
Q

TFL

A

supine or in sidelying with pillow between legs.

Flat

40-50mm
(No precautions)

47
Q

Obturator internus

A

Part of pelvic floor

(Medial side) Sidelying, Bottom leg straight, top leg up and over. Pull shorts up.
Find ischial tub, curl up and over. Needle flat palpation only within fingers. Go in about 1-1.5 cm towards fossa.

Lateral side - Prone all greater troch like other deep rotators.

48
Q

Obturator Externus,
Gemelli sup and inf.
Quadratus femoris

A

Prone
Find superior edge of greater troc to find the top. Stay away from mid section to avoid sciatic. Straight down into femur. Fan up/down.

Needle depends - 50-60 prob fine.

49
Q

Piriformis

A

Prone or sidelying (can treat anywhere in piriformis except for going straight down)
Find triangle - PSIS, greater troc, ischial tub.
Needle slightly towards troc or sacrum

*Can do tendon off the greater troc (40mm like cork board)

50
Q

Abdominal

abs, pyramidalis, obliques

A

Supine. Always lateral->medial.
Shelf palpation, 40mm shallow. Horz only

Obliques - Grab with pincer on same side. Have them lift head. Fan along your grip. 40mm

Prymidalis - Find pubic rami. Put towel over their privates. Need to be on the side and shelf into the bone 40mm

51
Q

Serratus anterior

A

Sidelying, their arm resting in front. Stand behind them. Have them hold their elbows. Protract to kick on SA. Start low and feel ribs 8-9th ribs.
RIB LOCK!
Shallow, deep, deeper - parallel to rib.
40mm.

52
Q

Lower trap

A

Prone 40mm, very superficial.
*if you can pick it up, pincer grip.
If not, RIB LOCK!! Same as iliocostalis (you go through low trap to get to those)

53
Q

Mid trap

A

Prone
50-60mm needle (MUST use bigger needle)
Flat palpation. Sit overhead, apex and “waterfall down” towards head. Tangential shallow, deep, deeper

*Also gets rhomboids and Serratus posterior superior.

54
Q

Serratus posterior superior (SPS)

A

Same as mid trap. Waterfall from apex to the head.
MUST use bigger needle 50-60mm.
Flat
Depth = mid trap, then rhomboids, SPS and the SPS sits over the erector spinae.

55
Q

Rhomboids

A

Same as mid trap. Waterfall from apex to the head.
MUST use bigger needle 50-60mm.
Flat
Depth = mid trap, then rhomboids, SPS and the SPS sits over the erector spinae.