Tender Points UE/LE

Question 1

What are the seven steps to counterstain?

Answer 1

• Find a significant tenderpoint
• Establish pain/tenderness scale
• Shorten the local tissues while monitoring
• Reduce pain by at least 70% (pt in position of comfort)
• Maintain position for 90 seconds
• Passively return to neutral (Biggie)
• Recheck/reassess (tenderness, asymmetry, ROM, etc.)

Question 2

Tensor Fascia Lata Tenderpoint Trt position

Answer 2

The patient’s knee is ABducted and slightly flexed

Question 3

Tensor Fascia Lata Tenderpoint location

Answer 3

in body of TFL inferior to the iliac crest

Question 4

Lateral Trochanter (Iliotibial Band) Trt position

Answer 4

patient’s hip/thigh is abducted and slightly flexed, may require slight internal/external rotation of hip
Note: prone or supine positions work

Question 5

Lateral hamstring tender point location

Answer 5

distal aspect of the biceps femoris near attachment to the posterolateral surface of the fibular head

Note: there are TWO Dr. N. only went over above
Other middle of long head

Question 6

Lateral hamstring tender point Trt

Answer 6

knee is flexed and the tibia is externally rotated with slight abduction; compression on the calcaneus is added to plantar flex the ankle

Question 7

MEdial Hamstring TP Location

Answer 7

distal aspect of the medial hamstring tendons near their attachment to the posterior medial surface of the tibial condyle

Question 8

MEdial Hamstring TP Trt

Answer 8

patient’s knee is flexed and the tibia is Internally rotated with slight aDduction; compression on the calcaneus is added to plantar flex the ankle

Question 9

Lateral Meniscus

Lateral (Fibular) Collateral Ligament Trt

Answer 9

pt’s thigh abducted so leg is off table, flex knee~35-40 degrees, tibia is abducted and externally or
internally rotated until the tenderness is ≥70% reduction
• May require ankle dorsiflexion and
eversion of the ankle

Question 10

Medial Meniscus

Medial (Tibular) Collateral Ligament TRt

Answer 10

Same as the lateral, just hand placement changes !
pt’s thigh abducted so leg is off table, flex knee~35-40 degrees, tibia is abducted and externally or
internally rotated until the tenderness is ≥70% reduction
• May require ankle dorsiflexion and
eversion of the ankle

Question 11

ACL Trt

Answer 11

towel roll or pillow under distal femur for fulcrum, apply

force to proximal tibia to translate tibia posteriorly on distal femur until the tenderness is ≥70% reduction

Question 12

PCL Trt

Answer 12

towel roll or pillow under proximal tibia for fulcrum,

apply force to distal femur to translate femur posteriorly on proximal tibia until the tenderness is ≥70% reduction

Question 13

ACL Location

Answer 13

superior aspect of popliteal fossa adjacent to the hamstring tendons

Question 14

PCL location

Answer 14

slightly below center or

popliteal fossa

Question 15

Popliteal Trt

Answer 15

pt’s knee flexed and tibia is internally rotated until the tenderness is ≥70% reduction

Question 16

Gastrocnemius Location

Answer 16

within the proximal gast. distal to the popliteal margin

Question 17

(Ankle Extension) Gastrocnemius Trt

Answer 17

pt’s knee flexed and dorsum of foot on doc’s thigh, add

compressive force through calcaneus until the tenderness is ≥70% reduction

Question 18

Medial Ankle (Tibialis Anterior) Location

Answer 18

anterior and inferior to the medial malleolus along deltoid ligament.

Note more than 1, only trt mention this 0ne

Question 19

Lateral Ankle Fibularis (Peroneus)

Longus, Brevis, Tertius Trt

Answer 19

Pt. lateral recumbent with pillow under affected leg

Apply inversion force to foot and ankle with slight Internal rotation until the tenderness is ≥70% reduction

Question 20

Flexion Calcaneus (Quadratus Plantae) Trt

Answer 20

patient’s knee is flexed, dorsum of foot on doc’s thigh, marked flexion while translating calcaneus toward the forefoot until the tenderness is ≥70% reduction

Question 21

Flexion Calcaneus (Quadratus Plantae) Location

Answer 21

anterior aspect of plantar surface of calcaneus at attachment of plantar fascia

Question 22

Lateral Ankle Fibularis (Peroneus)

Longus, Brevis, Tertius Location

Answer 22

Anterior and inferior to the lateral malleolus in the sinus

tarsi (talocalcaneal sulcus)

Question 23

Navicular: F Trt

Answer 23

Flex their foot and push on Navicular Bone
patient’s knee is flexed, dorsum of foot on doc’s thigh, plantar flexion of subtalar joint, supination of forefoot until the tenderness is ≥70% reduction

Question 24

Suprspinatus Trt

Answer 24

Supine,
patient’s arm is flexed 45 degrees, abducted 45 degrees, and externally rotated until the
tenderness

Question 25

Location of Infraspinatous Tp (2)

Answer 25

Upper: inferior and lateral to the spine of scapula (posterior medial aspect of GH joint.
Lower: lower portion of muscle inferior to spine and
lateral to medial border

Question 26

Trt of Infraspinatous Tp Upper

Answer 26

Supine,

patient’s arm is flexed ~90-120 degrees and abducted, may require er/ir (upper)

Question 27

Trt of Infraspinatous Tp Lower

Answer 27

Lat. Recumbant. patient’s arm is flexed ~135-150 degrees, abducted, and er to fine tune

Question 28

Levator Scapula Trt

Answer 28

Prone; IR pt’s shoulder, add mild-mod traction with minimal abduction

Question 29

Rhomboids Minor/Major M. Trt

Answer 29

Seat or supine; pt’s shoulder extended adducted by pulling elbow posterior and medially

Question 30

Location Subscapularis Pt.

Answer 30

Anterolateral border of the scapula on the subscapularis

muscle

Question 31

Trt Subscapularis M.

Answer 31

Supine; pt’s shoulder extended and internal rotated,

traction can help, push posterior and medially

Question 32

Trt Biceps Branchi Long Head

Answer 32

Supine
elbow and shoulder flexed, arm is minimally aBDucted
and internally rotated

Question 33

Trt Biceps Brachi Short head (corticobrachialis)

Answer 33

Supine;
elbow and shoulder flexed, arm is minimally aDDucted
and internally rotated

Question 34

Trt Pectoralis Minor

Answer 34

Supine
pt’s arm across chest, shoulder/scapula pulled anterior,
inferior and medial to shorten fibers

Question 35

Trt Radial Head

Answer 35

Supine

pt’s elbow in full Extension, forearm markedly supinated, fine tune with vaLgus Forcr

Question 36

Trt Medial Epicondyle (Pronator Teres)

Answer 36

Supine
pt’s elbow Flexed, marked pronation, forearm slightly
aDducted

Question 37

Location Dorsal Wrist Extensor Carpi Radialis

Answer 37

Surpine
dorsal surface of second metacarpal associated with
extensor carpi radialis muscle (may also be in any extensor muscle)

Question 38

Treatment Dorsal Wrist Extensor Carpi Radialis

Flexor?

Answer 38

pt’s wrist passively Extended and aBducted

pt’s wrist passively Flexed and aBducted

Question 39

Trt Dorsal Wrist (Extensor Carpi Ulnaris)

Answer 39

pt’s wrist passively Extended and aDducted

Question 40

Trt Palmar Wrist (Flexor Carpi Ulnaris)

Answer 40

pt’s wrist passively Flexed and aDducted

Question 41

Trt Abductor Pollicis Brevis

Answer 41

ABDuct and flex the thumb