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OS3 Exam II > Tender Points > Flashcards

Tender Points Flashcards

1
Q

AC1 location

A

-high on posterior edge of ascending ramus at earlobe

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2
Q

AC1 treatment

A

-rotate away with fine tuning

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3
Q

AC2-6 location

A

-anterolateral aspect of the TP of affected vertebra

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4
Q

AC2-6 treatment

A
  • flex, side bend away, rotate away

- F SARA

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5
Q

AC7 location

A

-posterosuperior surface of proximal clavicle where SCM muscle inserts (lateral to AC8 TP)

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6
Q

AC7 treatment

A

F STRA

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7
Q

AC8 location

A

-on the medial end of the clavicle at the sternal attachment of the SCM

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8
Q

AC8 treatment

A

-F SARA

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9
Q

AT1

A

-midline in suprasternal notch

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10
Q

AT2

A

midline on the manubrium

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11
Q

AT3-4

A

At the level of the costal cartilage related to the named vertebrae

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12
Q

AT5

A

about an inch above the xiphoid junction

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13
Q

AT6

A

at the sternal-xiphoid junction

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14
Q

AT7

A

at the tip of the xiphoid

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15
Q

AT8 location

A

midline 1.5 inches inferior to xiphoid

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16
Q

AT1-8 treatment

A
  • Dr places knee under patient’s head/neck or trunk to use as a wedge to flex patient to involved vertebrae.
  • Doc’s operating hand supports upper back and fine tunes flexion
  • more flexion needed the lower the TP’s
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17
Q

AT9 location

A

midline 1-2 cm superior to umbilicus

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18
Q

AT10 location

A

midline 1-2 cm inferior to umbilicus

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19
Q

AT11 location

A

midline 3-4 cm below umbilicus

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20
Q

AT12 location

A

mid-axillary line on the supermodel surface of iliac crest (bilateral)

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21
Q

AT9-12 treatment

A
  • Patient supine, doc on same side of TP with foot on table.
  • Doc uses patient’s legs to cause flexion. Patient’s hips and knees bent to 90 degrees with fine tuning by adding rotation towards Dr.
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22
Q

AL 5-6T location

A

-At the costosternal joint at the affected level

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23
Q

AL5-6T treatment

A
  • patient seated

- Doc behind patient with leg on table under patient’s arm on unaffected side; F STRA

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24
Q

AL7-8T location

A

-on inferior medial surface of costal cartilages, 1 and 2 inches inferolaterally from xiphoid

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25
Q

AL7-8T treatment

A

-patient seated, doc behind patient with leg on table under patient’s arm on unaffected side; F STRA

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26
Q

An anterior rib tender point usually indicates

A

a depressed rib

-ribs depress with exhalation

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27
Q

A posterior rib tender point usually indicates

A

an elevated rib

-ribs elevate with inhalation

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28
Q

AR1 location

A

-below clavicle on rib 1, lateral to manubrium

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29
Q

AR1 treatment

A
  • patient supine
  • Flex neck up, F STRT
  • treats a depressed rib, inhalation restriction)
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30
Q

AR2 location

A

-1.5 inches lateral to manubrium on rib 2, at mid-clavicular line

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31
Q

AR2 treatment

A
  • F STRT at the neck

- treats a depressed rib, inhalation restriction

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32
Q

AR3-6 location

A

-anterior axillary line on ribs 3-6 (slightly anterior to mid-axillary line)

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33
Q

AR3-6 treatment

A
  • patient seated, Doc behind patient with foot on table and knee under arm on unaffected side
  • F STRT at the neck and torso
  • treats a depressed rib, inhalation restriction
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34
Q

AL1 location

A

-medial to ASIS

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35
Q

AL1 treatment

A

-patient supine, doc on same side as TP with foot on table; flex knees/hips to greater than 90 degrees, knees and ankles pulled toward the doc and the TP (equivalent to the upper body RA from the TP)

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36
Q

AL2 location

A

-medial to AIIS

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37
Q

AL2 treatment

A
  • patient supine, doc opposite side of TP with foot on table; flex knees/hips 90 degrees, knees and ankles away from the TP and towards doc (F SARA)
  • treatment requires significant rotation of flexed hip away form tender point side
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38
Q

AL3-4 location

A
  • AL3 lateral to AIIS

- AL4 inferior aspect of AIIS

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39
Q

AL3-4 treatment

A

-patient supine, doc opposite TP with foot on table; flex knees/hips to 90 degrees, ankles away from the TP and towards the doc, knees pushed toward the TP and away from the doc (F SART)

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40
Q

AL5 location

A

-anterior aspect of pubic bone about 1 cm lateral to pubic symphysis (near pubic tubercle)

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41
Q

AL5 treatment

A

-patient supine, doc same side of TP with foot on table; flex hip 90-135 degrees, push ankle away from TP and doc, and rotate knees slightly toward the TP and doc (F SART)

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42
Q

Iliacus TP

A

-in lower quadrant, 1-2 inches medial to ASIS deep in iliac fossa (iliacus muscle)

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43
Q

Iliacus TP Treatment

A

patient supine, doc same side as TP with foot on table; flex knees/hips 90 degrees, ankle crossed on doc’s knee with knees separated, marked ER of both hips
-frog legged

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44
Q

Low Ilium TP location

A

-superior aspect of lateral ramus, where psoas muscle crosses pelvic rim

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45
Q

Low Ilium TP treatment

A

patient supine; doc same side of TP

-flex knee/hip 90 degrees, slight ER hip, fine tune with AD/AB (only one leg)

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46
Q

Inguinal Ligament TP

A

-Lateral surface of pubic bone near attachment of inguinal ligament

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47
Q

Inguinal Ligament TP treatment

A
  • patient supine; doc same side of TP with foot on table
  • flex knees/hips 90 degrees and rest on Doc’s knee, cross opposite ankle over the leg on side of doc, ankles toward Doc (IR hip on side of TP)
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48
Q

Sartorius TP

A
  • near the attachment of the sartorius muscle to the ASIS

- palpate from about 2-3 cm ciudad to the ASIS by pushing toward the inferior aspect of the ASIS

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49
Q

PC1 inion location

A

about 1-2 cm inferior to external occipital protuberance, slightly lateral, on insertion of the semispinalis capitis

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50
Q

PC1 inion treatment

A
  • cradle head in monitoring head. Place non-monitoring hand on patient’s forehead, and flex the patient’s neck (with fine tuning) to reach the position of comfort
  • This is a maverick point
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51
Q

Treatment of a maverick point calls for

A

lengthening the patient’s tissues around the tender point rather than shortening/wrapping around them

52
Q

PC1 location

A

-about 3 cm below inion, and 1 cm medial to occipitomastoid sure; press anteromedially

53
Q

PC2 location

A

in main muscle mass about 2-3 cm lateral to midline and just below occiput

54
Q

PC1 and 2 treatment

A

ESARA

55
Q

PC3 location

A

inferolateral aspects of C2 spinous process

56
Q

PC3 treatment

A
  • FSARA–flex to 45 degrees, sidebend away and rotate away

- may require you to STRA instead

57
Q

PC4-7 location

A

-on inferolateral aspect of spinous processes, named for spinal nerves which exit below vertebrae (e.g., PC5 point on C4 SP)

58
Q

PC4-7 treatment

A

-ESARA

59
Q

PC8 location

A

-same as PC4-7

60
Q

PC8 treatment

A

FSARA or ESARA, depending on patient

61
Q

PT1-12 location

A

-on spinous process of respective vertebra

62
Q

PT1-3 treatment

A
  • patient prone, with arms draped over side of table
  • Doc stands at head of table and cups patients chin with one hand, using the other hand to monitor the tender point
  • slowly and passively extend patient’s neck, fine-tuning with rotation and side bending away from TP
63
Q

PT4-6 treatment

A
  • patient prone, with arms draped over top of table
  • Doc stands at head of table and cups patient’s chin with one hand, using the other hand to monitor the TP
  • slowly and passively extend the patient’s neck, fine-tuning with rotation and side bending “away” from the TP (may be to either side)
64
Q

PT7-9 treatment

A
  • Patient is prone, with arms draped over top of table with a pillow under his/her chest to further extend the thoracic spine.
  • Doc stands at head of table and cups patient’s chin with one hand, using the other hand to monitor the TP
  • slowly and passively extend the patient’s neck, fine-tuning with rotation and side bending “away” from the TP (may be to either side
65
Q

PT10-12 Treatment

A
  • Patient is prone, with arms draped over top of table with a pillow under his/her chest to further extend the thoracic spine
  • Doc stands at side of table, and grasps the patient’s ASIS not he side opposite the dysfunction, raising the patient’s hip and inducing extension of the lower T spine
66
Q

PR1 location

A

-posterior margin of rib head beneath margin of trapezius

67
Q

PR1 treatment

A
  • patient seated, doc standing behind/to the side
  • Doc places patient’s arm on side of dysfunction on doc’s knee
  • Doc sidebends and rotates Patient’s head toward the dysfunction, as well as slightly extends
  • Hold for 120 seconds
68
Q

PR2 location

A

-superior surface of angles of ribs, at medial border of scapula, about 2 & 1/2 inches lateral to midline

69
Q

PR2 treatment

A
  • patient seated, doc standing behind/to the side
  • Doc places patient’s arm on side of dysfunction on doc’s knee
  • Doc flexes patient’s head and sidebands and rotates the trunk away form the dysfunction
  • Then rotate and sidebands neck away
  • hold for 120 seconds
70
Q

PR3-6 location

A

-superior surface of angles of ribs, at medial border of scapula, about 2 & 1/2 inches lateral to midline

71
Q

PR3-6 treatment

A
  • patient seated, doc standing behind/to the side. Doc places patient’s arm on side of dysfunction on doc’s knee, grasps patient’s shoulder (on side of dysfunction), and sidebands and rotates the trunk away at level of dysfunction
  • hold for 120 seconds
72
Q

PL1-5 SP location

A

-midline on the spinous processes

73
Q

PL1-5 SP treatment

A
  • patient prone, doc standing on same side of tender point (may stand on opposite side if more comfortable)
  • Doc extends patient’s hip ipsilateral to TP, fine tuning as necessary
74
Q

PL1-3 TP location

A

-on respective transverse process

75
Q

UPL5/PL5 location

A

superior medial edge of PSIS

76
Q

PL1-3 TP and UPL5 treatment

A
  • patient prone, doc standing on opposite side of TP (may stand on same side if more comfortable)
  • Doc extends patient’s hip ipsilateral to TP and rotates patient’s leg toward the TP, fine tuning as necessary
77
Q

LPL5 location

A

inferior aspect of PSIS

78
Q

LPL5 treatment

A
  • patient prone with thigh on dysfunctional side suspended over side of table
  • Doc flexes patient’s hip and knee to 90 degrees, then adds adduction and internal rotation of the hip
79
Q

PL3 Lat location

A
  • 2/3 lateral between PSIS and the tensor fascia latae

- associated with gluteus medius

80
Q

PL3 Lat treatment

A

patient prone, doc at side of table

-doc extends patient’s hip on same side of dysfunction and fine tunes as necessary

81
Q

PL4 lat location

A
  • posterior margin of tensor fascia latae

- associated with gluteus medius

82
Q

PL4 lat treatment

A
  • patient prone, doc at side of table

- Doc extends patient’s hip on same side of dysfunction and fine turns as necessary (may be less extension than for PL3)

83
Q

PS1 location

A

-1/2 inch medial to the inferior aspect of the PSIS bilaterally

84
Q

PS1 treatment

A
  • patient prone, doc standing beside patient.

- Doc applies posterior to anterior pressure diagonally opposite location of TP

85
Q

PS2-4 location

A

midline on sacrum between or below sacral spines

86
Q

PS2-4 treatment

A
  • patient prone, doc standing beside patient

- Doc applies pressure posterior to anterior on midline apex or base of sacrum to produce transverse axis rotation

87
Q

PS5 location

A

1/4 inch medial and superior to ILA bilaterally

88
Q

PS5 treatment

A
  • patient prone, doc standing beside patient.

- Doc applies posterior to anterior pressure diagonally opposite location of TP

89
Q

High Ilium (HI) location

A

-located by pressing against lateral aspect of PSIS

90
Q

HI treatment

A
  • patient prone, doc standing on same side as dysfunction

- While monitoring TP, doc extend’s patient hip and fine tunes as necessary with ab/adduction

91
Q

High Ilium flare-out (HIFO) location

A

-approximately 1 3/4 inches below and 1/4 inch medial to lower edge of PSIS

92
Q

HIFO treatment

A

patient prone, doc on whichever side of patient is more comfortable
-Doc extends patient’s leg ipsilateral to dysfunction, enough to clear the opposite leg, then induces moderate to marked adduction and slight external rotation

93
Q

Piriformis location

A

-about 1/2-2/3 of the distance from ILA to greater trochanter

94
Q

Piriformis treatment

A
  • patient prone, doc seated on same side of dysfunction
  • While monitoring TP, doc flexes patient’s leg over side of table to 135 degrees, abducting and externally rotating the patient’s hip
95
Q

Flare-in sacroiliac (FISI) location

A

-approximately 4 inches below PSIS, slightly lateral (related to gluteus maximus attachment)

96
Q

FISI Treatment

A
  • patient prone, doc on side of dysfunction. Doc abducts patient hip, flexing the hip only enough to allow the knee to clear the table.
  • Fine-tune with external rotation
97
Q

Medial Meniscus TP

A
  • located at the level of the lower edge of patella, at the medial meniscus
  • Push medial to lateral
98
Q

Knee Extender TPs

A

3 TPs: on patellar ligament/tendon, in front of medial meniscus, on front of medial surface of tibia
-push anterior to posterior

99
Q

Plantar Navicular (NAV) TP

A

-plantar surface of the navicular bone close to the cuboid

100
Q

Plantar Cuboid (CUB) TP

A
  • tuberosity of the cuboid bone

- about 2 cm posterior and medial to base of the 5th metatarsal

101
Q

Flexed Calcaneus (FCALC) TP

A

anteromedial plantar surface of calcaneus

102
Q

Infraspinatus TP

A
  • low: one cm from the medial margin and 5 cm inferior to the spine of the scapula
  • upper: 2-3 cm below the spine and 3 cm more lateral than the lower one
103
Q

Teres Minor TM TP

A
  • Lateral border of the scapula under the arm

- back of the head of the humerus

104
Q

Teres Major TP

A

-lateral and posterior surface of the scapula, at the inferior angle

105
Q

Medial Coracoid TP

A
  • superior medial surface of the front of the coracoid process
  • Pectoralis minor muscle
106
Q

Big 3 muscles to evaluate in Tension head ache

A
  • trapezius, levator scapulae, SCM

- if symptoms resolve with counterstain then do more comprehensive evaluation

107
Q

Headache/Neck Pain//TMJ tender points to evaluate:

A

-trapezius, levator scapulae, SCM, anterior and posterior cervical, cranial points

108
Q

Common offenders in anterior shoulder pain

A

-biceps, pec major and minor, infraspinatus, supraspinatus, deltoid, scalenes

109
Q

Common offenders in posterior shoulder pain

A

-levator scapulae, teres major and minor, supraspinatus, trapezius, subscapularis, serratus posterior superior (referral pattern is to the shoulder)

110
Q

Anterior Thoracic TPs

A
  • cardiopulmonary etiology is priority until proven otherwise
  • atypical chest pain often respond to treatment of counterstain points
  • common points: pectorals major, serratus anterior, T2-6 points
  • may include anterior rib points if pain is more lateral on anterior chest wall
111
Q

Common points in forearm/wrist/hand pain

A
  • often due to extension of a myofascial pain pattern from shoulder
  • triceps (long head most common)
  • medial elbow–pronator teres, flexor carpi radialis and ulnaris, palmaris longus (Pt4 and/or PR4)
  • Lateral elbow-supinator (radial head), extensor carpi radialis/anconeus/common extensor tendon (PT1 and/or PR1)
112
Q

AL1 in

A

internal oblique

113
Q

AL2 in

A

lower external oblique

114
Q

AL3 and 4 in

A

iliopsoas

115
Q

AL5 in

A

rectus abdominus and pyramidalis

116
Q

Tips related to GI conditions

A

-external oblique, lower rectus and iliacus

117
Q

Deep pelvic pain:

A

-obturator internus, and externus, adductor magnus, lower external abdominal oblique

118
Q

Anterior hip pain

A

-pectineus (inguinal ligament), lower external abdominal oblique

119
Q

TP associated with restless leg syndrome

A

-point on superior surface of symphysis

120
Q

Common muscles that refer to pelvis

A

-quadratus lumborum, longissimus thoracic, iliocostalis lumborum

121
Q

Anterior Knee common offenders

A

rectus femoris, vastus medialis

-adductor longus/brevis less commonly

122
Q

Lateral knee offenders

A

vastus lateralis, iliotibial band

123
Q

Posterior knee TP

A
  • gastrocnemius
  • pain when knee is extended and ankle dorsiflexed–extension ankle point
  • biceps femoris (athletes), soleus (more posterior calf pain), semimembranosus, semitendinosis, popliteus, and plantaris
124
Q

Ankle Muscle pain

A
  • fibularis longus and brevis (lateral)
  • tibialis anterior (medial)
  • soleus/posterior tibialis/gastrocnemius (posterior)
125
Q

Plantar heel pain

A

-quadratus plantae

126
Q

Foot (bunion region) pain

A

-flexor digitorum brevis, adductor hallicis, flexor hallicis brevis

127
Q

Dorsum of foot pain

A

-extensor digitorum brevis and extensor hallicis brevis

OS3 Exam II (10 decks)

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