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OPP Flashcards

1
Q

Thoracic midline and lateral tenderpoints

A
  • T1-9 Spinous processes
  • 1/2 inch bilateral on either side
  • example: posterior midline T5 TP
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2
Q

T1-9 Lateral thoracic CS

A
  • Patient prone

- Stand opposite and pull shoulder towards you on same side of TP

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3
Q

T1-9 Midline thoracic CS

A
  • Locate TP; have patient twist their arms in front of them lying face down and put their palms together; lift their arms
  • locate TP; have patient twist arms and put palms together while seated; extend patient’s back and lean them forward
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4
Q

Lower thoracic and lumbar midline and lateral TP and additional

A

T10-L5: spinous processes and 1/2 inch bilateral
UPL5: superior PSIS
LPL5: inferior PSIS
Gluteus medius L4: iliac crest in posterior axillary line
Gluteus medius L3: gluteus between UPL5 and gluteus medius L4

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5
Q

Posterior T10-L5 midline and lateral, UPL5, gluteus medius TPs CS

A
  • Have patient lie prone
  • locate TP
  • extend leg on same side
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6
Q

LPL5 CS

A
  • Have patient lie prone
  • Flex hip and knee to 90
  • Slight adduction
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7
Q

Evaluation of UE

A
  • Levator scapulae
  • Supraspinatus (belly and insertion)
  • Acromioclavicular
  • Long head biceps
  • Short head biceps
  • Subscapularis
  • Radial head (anterior and posterior)
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8
Q

Evaluation of hip

A
  • Flexion/extension
  • Internal/external rotation
  • Abduction/adduction
  • Lateral trochanter TPs
  • Piriformis TP
  • Biceps femoris TP
  • Semimembranosus TP
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9
Q

Evaluation of knee

A
  • Anterior/posterior glide
  • Medial/lateral glide
  • Internal/external rotation
  • Fibular head motion
  • Medial meniscus TPs
  • Lateral meniscus TPs
  • Patella tendon TPs
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10
Q

Evaluation of ankle

A
  • Ankle swing test
  • Plantarflexion/dorsiflexion
  • Inversion/eversion
  • Internal/external rotation of interosseus membrane
  • Lateral ankle TPs
  • Medial ankle TPs
  • Ankle extension
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11
Q

Evaluation of foot

A
  • Inversion/eversion
  • Superior/inferior joint glide restriction
  • Calcaneus TP
  • Phalanges joint glide (circumduction)
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12
Q

Evaluation of anterior thoracic

A
  • T1-12 Fryette’s
  • Anterior thoracic TP from T1-8
  • Cervicothoracic diaphragm
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13
Q

Evaluation of posterior thoracic

A
  • T1-12 Fryette’s
  • Posterior thoracic TP T1-9
  • Thoracolumbar diaphragm
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14
Q

Evaluation of anterior lumbar

A
  • L1-5 Fryette’s
  • T9-L5 TP
  • Iliopsoas TP
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15
Q

Evaluation of posterior lumbar

A
  • L1-5 Fryette’s

- T10-L5 posterior TP

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16
Q

Evaluation of ribs

A
  • 2-10 for respiratory motion and subluxation

- ribs 1-10 for anterior and posterior TP

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17
Q

Supraspinatus CS

A
  • Abduct arm 45 degrees

- Fine tune with external rotation

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18
Q

Levator scapulae CS

A
  • Locate TP with opposite hand of TP (for left TP use right hand)
  • weave opposite hand under patient’s arm to hold the inferior scapula
  • Extend shoulder
  • Elevate and retract scapula
  • Fine tune using 6 motions of scapula or compression
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19
Q

AC CS

A
  • Stand opposite of TP
  • Flex and adduct shoulder
  • Fine tune with slight traction and adduction
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20
Q

Biceps long head CS

A
  • Flex elbow and shoulder
  • Minimally abduct shoulder
  • Internally rotate shoulder
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21
Q

Biceps short head CS

A
  • Flex elbow and shoulder
  • Minimally adduct and internally rotate shoulder
  • Fine tune with adduction
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22
Q

Subscapularis CS

A
  • Patient at edge of bed to allow shoulder extension
  • Extend, interally rotate, and slightly abduct the shoulder
  • Fine tune with traction
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23
Q

Radial head CS

A
  • Extend elbow fully
  • Supinate forearm fully
  • Fine tune with ulna abduction or adduction
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24
Q

Interosseus membrane MFR (indirect)

A
  • Hold proximal leg with one hand and distal leg with other
  • Rotate hands in opposite directions to determine torsional laxity vs. restriction (name for hand closest to foot)
  • Slowly rotate leg into position of laxity and apply compression or traction
  • Hold until tissue release is completed
  • Retest
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25
Q

Hip MFR (indirect)

A
  • Hold ankles with arms relaxed
  • Slowly move both legs to identify positions of laxity
  • Lean backwards to apply traction
  • Follow tissue release
  • Retest
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26
Q

Hip MFR (direct)

A
  • Flex hip and knee at 90
  • internally and externally rotate to test restriction
  • Move into restriction and hold through tissue release
  • Retest
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27
Q

Lateral trochanter CS

A
  • Anywhere along IT band
  • Stand on same side of TP with patient supine
  • Hold leg proximal to ankle
  • Abduct and slightly externally rotate the leg
28
Q

Piriformis CS

A
  • TP in mid-buttock between top of greater trochanter and mid-line of sacrum
  • Patient prone with affected side at very edge
  • Flex hip @ 90
  • Abduct and externally rotate
29
Q

Patella tendon CS

A
  • TP along patella tendon
  • Place knee on table under patient’s ankle
  • Push down on distal femur to extend knee
  • Cup patella with thumb web-space and push down towards tibia
  • Fine tune with slight internal or external rotation of tibia
30
Q

Medial meniscus CS

A
  • Hold ankle
  • Flex knee 60
  • Fine tune with slight tibial internal rotation and adduction
31
Q

Lateral meniscus CS

A
  • Hold ankle
  • Flex knee 60
  • Fine tune with tibia external rotation and abduction
32
Q

Extension ankle CS

A
  • TP on proximal gastrocnemius heads
  • Patient prone
  • Flex patient’s knee and place your foot on the table
  • Rest patient foot on your thigh
  • Push on heel to extend and plantar flex
  • Fine tune with slight ankle eversion or inversion
33
Q

Lateral ankle CS

A
  • TP inferior and anterior to lateral malleolus
  • Have patient lie on affected side so their affected ankle is bent towards you beneath their top leg
  • Induce eversion of foot and push calcaneus towards the floor
  • Fine tune with more or less eversion
34
Q

Medial ankle CS

A
  • TP along inferior to medial malleolus
  • Have patient lie on opposite of affected side with their affected leg straight out
  • Induce inversion of the foot and push calcaneus towards the floor
  • Fine tune with more or less inversion
35
Q

Ankle myofascial release

A
  • Direct: move ankle into position of restriction in ALL planes; apply constant force until tissue give stops
  • Indirect: move ankle to positions of laxity; apply compression and follow tissue release
  • Retest
36
Q

Forefoot MFR

A
  • Grasp calcaneus and forefoot at level of proximal tarsal-metatarsal joints; test inversion/eversion
  • Direct: move forefoot into restriction and maintain constant force until tissue give stops
  • Indirect: Move forefoot into laxity and apply compression
  • Retest
37
Q

Calcaneus CS

A
  • Identify TP on distal calcaneus
  • Position with plantar flexion by placing patient’s foot on your leg (with your foot on the table) and grasping the forefoot and plantar flexing
  • Fine-tune with compression of calcaneus toward point (grab ankle and direct up) and with forefoot inversion/eversion
  • Hold for 90
  • Slowly return
38
Q

Semimembranosus CS

A
  • Locate TP medial to midline halfway down shaft of femur
  • Label 10/10
  • Flex knee (with patient prone) with slight internal rotation and adduction of tibia
  • Reach 3/10 or less
  • Hold for 90 seconds
  • slowly return to neutral
  • Recheck
39
Q

Biceps femoris CS

A
  • Locate TP lateral to midline halfway down shaft of femur
  • Label 10/10
  • Flex knee (with patient prone) with slight external rotation and abduction of tibia
  • Reach 3/10 or less
  • Hold for 90 seconds
  • slowly return to neutral
  • Recheck
40
Q

Hip ME positions

A

-Flexion: patient supine with their leg flexed on your shoulder while you sit on the table; contract against shoulder
-Extension: patient @ end of table with unaffected leg up towards their chin while you compress the opposite leg
-Abduction: stand inside patient’s leg with your hand on their ASIS
-Adduction: stand opposite patient and have them contract against your hand at their ankle
-Internal rotation
External rotation

41
Q

Fibular head ME

A
  • Identify position of restriction
  • Put patient’s fibular head in that position and dorsiflex their foot
  • Have them push against it like a gas pedal for 3-5 seconds at a time
  • After each contraction, allow 3-5 seconds for full relaxation before moving into new barrier
  • Repeat 3-5 times
  • Final stretch at the end
  • Retest
42
Q

Ankle ME

A
  • Move ankle into restrictive barrier

- Patient pushes away

43
Q

Foot articulatory

A
  • Check for superior/inferior glide restrictions of metatarsals
  • Treat with circumduction (3-5 times clockwise then counterclockwise)
44
Q

Interphalangeal articulatory

A
  • Check for flexion/extension restriction
  • Treat with circumduction (clockwise and counterclockwise)
  • Can apply traction/compression
45
Q

Anterior thoracic TP

A
  • AT1: suprasternal notch
  • AT2: middle of manubrium
  • AT3/4: midline sternum @ level of same rib
  • AT5: midline - 1” about xiphoid process; lateral - cartilage of 5th rib
  • AT6: midline - sternal-xiphoid junction; lateral - cartilage of 6th rib
  • AT7: midline - tip of xiphoid; lateral - cartilage of 7th rib
  • AT8: midline - 1.5” below xiphoid; lateral - @ chondral mass
46
Q

Anterior T1-8 CS

A
  • Stand @ head of table and locate TP with patient supine
  • Internally rotate arms (both for midline; ipsilateral for lateral)
  • Flex neck and upper back until tenderness reduced and retest
  • Fine tune with more or less flexion
  • Hold for 90 seconds
  • Slow return to neutral and retest
47
Q

Cervicothoracic MFR

A
  • Sit @ head of table and place hands across top of shoulders with fingertips on upper ribs and thumbs overlying scapulae
  • Indirect: rotate cervicothoracic fascia to its position of laxity; add compression and follow tissue release
  • Direct: rotate cervicothoracic fascia to its restriction and apply force until tissue give done
48
Q

Thoracolumbar MFR

A
  • Place one hand across chondral masses of the lower ribs and your other hand across the thoracolumbar spinous processes
  • Indirect: gently rotate the fascia under your hands to the position of laxity; add slight compression; follow tissue release
  • Direct: move fascia to its restriction barrier and apply steady force until tissue give done
49
Q

Thoracic MFR

A
  • Sit @ head of table, place your fingertips on transverse processes of restricted segment
  • Indirect: use your fingertips to gently move the segment to position of rotation, sidebending, and flexion/extension laxity
  • Direct: move segment into rotation, sidebending, and flexion/extension restrictions
50
Q

-Anterior rib TPs

A
  • Rib 1: inferior to medial clavicle, lateral to sternum
  • Rib 2: rib shaft in mid-clavicular line
  • Ribs 3-10: rib shafts in anterior axillary line
51
Q

Anterior ribs 1-2 CS

A
  • Flex head

- Rotate and sidebend towards TP

52
Q

Anterior ribs 3-10 CS

A
  • Stand on opposite side
  • Lean patient on thigh to depress rib
  • Sidebend/rotate towards TP
53
Q

Posterior rib TPs

A
  • Rib 1: lateral shaft anterior to trapezius muscle
  • Ribs 2-10: rib angles
  • MAKE SURE TO HAVE PATIENT GIVE THEMSELVES A HUG
54
Q

Posterior rib 1 CS

A
  • Stand on same side
  • Place patient’s arm on thigh
  • Slightly extend neck
  • Sidebend head away and rotate towards
55
Q

Posterior ribs 2-10 CS

A
  • Stand on same side
  • Lean patient on thigh to elevate rib
  • Sidebend/rotate away from TP
56
Q

Rib 1 motion testing

A

-Place thumb webbing around patients neck and test elevation or depression with respiration

57
Q

Ribs 2-5 motion testing

A

-Place hypothenar eminence between patients chest @ upper ribs to test elevation or depression with respiration

58
Q

Ribs 6-10 motion testing

A

-Place hands @ lateral lower ribs to test lateral vs medial movement with respiration

59
Q

Indirect rib MFR

A
  • Hold entire rib and gently compress front to back with fingertips
  • Pull compressed rib laterally
  • Follow tissue give
60
Q

Rib MFR direct

A
  • Pull subluxed or key rib angle superior and maintain pull
  • Move arm into plane into restrictions:
    - Abduct and internally rotate until tissue give stops
    - Then externally rotate from abducted position until give stops
    - Then adduct externally rotated arm until give stops
  • Return arm to side
  • Repeatedly compress shoulder toward rib angle to achieve motion in rib
61
Q

Checking for rib subluxations

A
  • Run your fingers down your patient’s back
  • Pot holes = anterior subluxation
  • Speed bumbs = posterior subluxations
62
Q

Anterior lumbar TPs

A
  • AT9: 1/2-1” superior to umbilicus
  • AT10: 1” below umbilicus
  • AT11: 2” below umbilicus
  • AT12: inner aspect of iliac crest in mid-axillary line
  • L1: 1/2” medial to ASIS
  • AL2: medial surface of AIIS
  • AL3: lateral surface of AIIS
  • AL4: inferior surface of AIIS
  • AL5: pubic ramus 1/2” lateral to pubic symphysis on either side
  • Iliacus: 1” medial and slightly inferior to ASIS
  • Psoas: 2” medial and slightly inferior to ASIS
63
Q

T9-L5 anterior CS

A
  • Passively flex the knees and hips to 90

- Fine tune with increased hip flexion and slight rotation or sidebending

64
Q

Iliopsoas CS

A
  • Cross ankles and flex knees and hips to 90 allowing knees to open and hips to externally rotate
  • Fine tune with increased hip flexion
65
Q

Lumbar MFR

A
  • Sit at side of patient
  • Place fingertips on transverse processes of restricted segment
  • Indirect: move rotation, sidebending, flexion/extension into laxity
  • Direct: move rotation, sidebending, flexion/extension into restriction

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