Tender Points UE/LE Flashcards
PASS!
What are the seven steps to counterstain?
- 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.)
Tensor Fascia Lata Tenderpoint Trt position
The patient’s knee is ABducted and slightly flexed
Tensor Fascia Lata Tenderpoint location
in body of TFL inferior to the iliac crest
Lateral Trochanter (Iliotibial Band) Trt position
patient’s hip/thigh is abducted and slightly flexed, may require slight internal/external rotation of hip
Note: prone or supine positions work
Lateral hamstring tender point location
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
Lateral hamstring tender point Trt
knee is flexed and the tibia is externally rotated with slight abduction; compression on the calcaneus is added to plantar flex the ankle
MEdial Hamstring TP Location
distal aspect of the medial hamstring tendons near their attachment to the posterior medial surface of the tibial condyle
MEdial Hamstring TP Trt
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
Lateral Meniscus
Lateral (Fibular) Collateral Ligament Trt
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
Medial Meniscus
Medial (Tibular) Collateral Ligament TRt
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
ACL Trt
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
PCL Trt
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
ACL Location
superior aspect of popliteal fossa adjacent to the hamstring tendons
PCL location
slightly below center or
popliteal fossa
Popliteal Trt
pt’s knee flexed and tibia is internally rotated until the tenderness is ≥70% reduction
Gastrocnemius Location
within the proximal gast. distal to the popliteal margin
(Ankle Extension) Gastrocnemius Trt
pt’s knee flexed and dorsum of foot on doc’s thigh, add
compressive force through calcaneus until the tenderness is ≥70% reduction
Medial Ankle (Tibialis Anterior) Location
anterior and inferior to the medial malleolus along deltoid ligament.
Note more than 1, only trt mention this 0ne
Lateral Ankle Fibularis (Peroneus)
Longus, Brevis, Tertius Trt
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
Flexion Calcaneus (Quadratus Plantae) Trt
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
Flexion Calcaneus (Quadratus Plantae) Location
anterior aspect of plantar surface of calcaneus at attachment of plantar fascia
Lateral Ankle Fibularis (Peroneus)
Longus, Brevis, Tertius Location
Anterior and inferior to the lateral malleolus in the sinus
tarsi (talocalcaneal sulcus)
Navicular: F Trt
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
Suprspinatus Trt
Supine,
patient’s arm is flexed 45 degrees, abducted 45 degrees, and externally rotated until the
tenderness
Location of Infraspinatous Tp (2)
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
Trt of Infraspinatous Tp Upper
Supine,
patient’s arm is flexed ~90-120 degrees and abducted, may require er/ir (upper)
Trt of Infraspinatous Tp Lower
Lat. Recumbant. patient’s arm is flexed ~135-150 degrees, abducted, and er to fine tune
Levator Scapula Trt
Prone; IR pt’s shoulder, add mild-mod traction with minimal abduction
Rhomboids Minor/Major M. Trt
Seat or supine; pt’s shoulder extended adducted by pulling elbow posterior and medially
Location Subscapularis Pt.
Anterolateral border of the scapula on the subscapularis
muscle
Trt Subscapularis M.
Supine; pt’s shoulder extended and internal rotated,
traction can help, push posterior and medially
Trt Biceps Branchi Long Head
Supine
elbow and shoulder flexed, arm is minimally aBDucted
and internally rotated
Trt Biceps Brachi Short head (corticobrachialis)
Supine;
elbow and shoulder flexed, arm is minimally aDDucted
and internally rotated
Trt Pectoralis Minor
Supine
pt’s arm across chest, shoulder/scapula pulled anterior,
inferior and medial to shorten fibers
Trt Radial Head
Supine
pt’s elbow in full Extension, forearm markedly supinated, fine tune with vaLgus Forcr
Trt Medial Epicondyle (Pronator Teres)
Supine
pt’s elbow Flexed, marked pronation, forearm slightly
aDducted
Location Dorsal Wrist Extensor Carpi Radialis
Surpine
dorsal surface of second metacarpal associated with
extensor carpi radialis muscle (may also be in any extensor muscle)
Treatment Dorsal Wrist Extensor Carpi Radialis
Flexor?
pt’s wrist passively Extended and aBducted
pt’s wrist passively Flexed and aBducted
Trt Dorsal Wrist (Extensor Carpi Ulnaris)
pt’s wrist passively Extended and aDducted
Trt Palmar Wrist (Flexor Carpi Ulnaris)
pt’s wrist passively Flexed and aDducted
Trt Abductor Pollicis Brevis
ABDuct and flex the thumb
