UE/LE CS points

Question 1

Tensor fascia latae tender point

where and how treat

Answer 1

inferior to the crest of the ilium in the body of the TFL M

f ABD
ABduct hip/thigh, flex

Question 2

lateral trochanter iliotibial band

Answer 2

along the iliotibial band distal to the greater trochanter

fABD
patient supine, doc standing on ipsi side
moderate ABduction of the hip+knee, slight flexion until pain relieved by 70%
might require slight IR of the hip

Question 3

lateral hamstring

biceps femoris

Answer 3

in the posterior thigh lateral to the midline, approx halfway down the shaft of the femur, near attachment to posterolateral surface of the fibular head

F ER Abd
pt supine, doc sitting ipsi
flexion of the knee with external rotation and slight ABduction of the tibia and plantar flexion of the ankle by compression on the calcaneus, foot resting on doc leg

patient prone, doc standing on episo side, with knee on table so that you can extend the ipsi hip and rest it on the knee. use cephalad had to monitor the TP in the popliteal , use caudad hand on ankle to ER and slightly ABduct.
compress on the calcaneus with cauded hand to add plant flexion of the ankle

Question 4

lateral meniscus

lateral collateral ligament

Answer 4

lateral aspect of the meniscus on the joint line

F Abd ir/er
pt supine, doc seated on ipsi side. thigh ABducted so leg is off table resting over the pt’s knee.
moderate knee flexion, slight abduction, internal or external rotation of the tibia. may require ankle dorsiflexion and eversion until T>70% reduction

Question 5

medial hamstring semimembranosus

semitendinosus

Answer 5

in the posterior thigh medial to the midline appox halfway down the shaft of the femur

F IR Add
pt prone, patient on contra side: cephalad hand is monitoring the distal attachment of the m (in the popliteal fossa)
caudad hand is holding ankle and flexing knee up 90 degress
internal rotation and slight adduction of the tibia and plantar flexion of the ankle by compression on the calcaneus

pt supine, doc ipsilateral to the TP misogynist lumberjack style. grasp the lateral ankle/foot to control the lower leg, flex the knee and hip 90 so that their foot is resting in/hooked into your popliteal fossa. internally rotate tibia with slight ADduction, compress on the calcaenous to plantar flex

Question 6

medial meniscus

MCL

Answer 6

anteromedial aspect of the meniscus on the joint line

F IR Add
pt supine, doc is ipsilateral and seated.
thigh ABducted so the leg is off the table and resting on the doc’s leg. moderate knee flexion. internal rotation, and slight ADduction of the tibia so that T>70% reduced

Question 7

anterior cruciate

Answer 7

superior aspect of the popliteal fossa on the hamstring tendons, either medially or laterally

pt supine, doc standing on ipsi side as the TP.
place an object/pillow under the distal femur to create a fulcrum. apply a shearing force by moving the proximal tibia posteriorly on the femur so that T>70% reduced

Question 8

posterior cruciate

Answer 8

in the center or slightly below the center of the popliteal fossa

patient supine, doc standing on ipsi side
place an object/pillow under the distal femur to create a fulcrum. apply a shearing force by moving the distal femur posteriorly on the proximal tibia so that T>70% reduced

Question 9

popliteus

Answer 9

in the belly of the popliteus M just inferior to the popliteal space

F IR
patient prone, doc is standing on the ipsi side, monitor TP with cephalad hand, manipulate the leg with the caudad hand manipulating the leg via the ankle.
slight flexion of the knee with internal rotation of the tibia until T>70% reduced

Question 10

extension ankle gastrocnemius

Answer 10

within the proximal gastrocnemius muscles distal to the popliteal margin

patient prone, doc standing on ipsi side, misogynistic lumberjack style. cephalad hand monitoring the TP, caudad hand monitor through the ankle, pt’s knee flexed and resting the ankle on the lumberjack leg.
marked plantar flexion of the ankle, add compression force through calcaneus so that T>70% reduced

Question 11

medial ankle, tibialis anterior

Answer 11

inferior to the medial malleolus along the deltoid L

INV ir
pt lateral recumbent with pillow under affected leg.
place a pillow under the calf to make the ankle lifted up. apply inversion force with slight shear/internal rotation of the foot so that T>70% reduced

Question 12

lateral ankle fibularis/peroneus longus, brevis, tertius

Answer 12

inferior and anterior to the lateral malleolus in the sinus tarsi (talocalcaneal sulcus)

EV er
pt is lateral recumbent with pillow under effected leg apply an eversion force with slight shear/external rotation of foot so that T>70% reduced

Question 13

flexion calcaneus quadratus plantae

Answer 13

anterior aspect of the calcaneus on the plantar surface of the foot at the attachment of the plantar fascia

patient prone, doc on ipsi side with misogynist, lumberjack leg to flex their knee and rest their ankle on your leg.
marked flexion of the forefoot approximating the forefoot to the calcaneus so that T>70% reduced

Question 14

navicular

Answer 14

in the big toe side, at the insertion of tibialis anterior
patient

patient prone, doc on ipsi side with misogynist, lumberjack leg to flex their knee and rest the DORSUM OF THEIR FOOT on the doc’s thigh, plantar flexion of subtalar joint, supination of the forefoot so that so that T>70% reduced

Question 15

supraspinatus TP

where and how treat

Answer 15

in the belly of the suptraspinatus M

F ABD ER
patient supine, doc sitting ipsilateral to TP monitor at the TP w cephalad hand, manipulate movement through elbow with caudad hand
45 degree flexion of the shoulder, 45 degree abduction, with marked ER so that T>70% reduced

Question 16

infraspinatus TP

where and how treat

Answer 16

upper: inferior and lateral to the spine of the scapula at the posterior medial aspect of the glenohumeral joint
patient supine, doc ipsi to TP with cephalad handing monitoring (reach under the shoulder), and caudad hand manipulate through the elbow
upper: flex shoulder to 90-120 and ABduction, may require ER or IR

lower: in the lower portion of the m inferior to the spine and lateral to the medial border of the scapula
patient lateral recumbent w TP up, doc in front, caudad hand is reached around to monitor the TP. cephalad hand is manipulating the arm. lower: flex shoulder to 135 with slight ABduction and ER/IR

F ABd ER/IR

Question 17

rhomboid minor/major

where and how treat

Answer 17

along the medial border of the scapula at the attachment of the rhomboid Ms

E ADD
pateint is seated or prone. doc is on either side and monitor the TP with the cephalad hand, manipulate the arm movement with caudad hand
shoulder extension with ADDuction by pulling arm posterior and medial

Question 18

levator scapulae

where and how treat

Answer 18

on the superior medial border of the scapula at the attachment of the levator scapulae

SCAP SUP, MED, IR ABD traction
patient is prone, with their head turned away. doc is on ipsi side, using cephalad hand to monitor TP, caudad hand manipulating arm , induce marked IR of the shoulder with traction and slight ABduction

Question 19

subscapularis

where and how treat

Answer 19

at the anterolateral border of the scapula on the subscap M pressing from an anterior lateral to posteromedial direction (aka medial border of armpit)

E IR
patient is supine, doc sitting on ipsilateral hand. use on hand to monitor the TP, other hand to manipulate the arm.
shoulder extension and IR

Question 20

long head of biceps

where and how treat

Answer 20

over the tendon of the biceps M in the bicipital groove

F ABD IR
patient is supine, doc is standing on ipsi side. cephalad hand monitor TP, caudad hand manipulate through the elbow.
flexion of the elbow, shoulder flexion, ABduction, IR

Question 21

short head or biceps/coracobrachialis

Answer 21

at the inferolateral aspect of the coracoid process

F ADD IR
patient is supine, doc is ipsi with cephalad hand monitoring the TP, caudad hand manipulate through the elbow.
flexion of elbow, shoulder flexion, ADDuction and IR

Question 22

pectoralis minor

where and how treat

Answer 22

inferior and medial to the coracoid process

f-F ADD
patient is supine and doc is standing on the ipsi side. cephalad monitor the TP, and caudad hand manipulate the shoulder/scap. move the patient’s arm across the chest (ADduction), protract scapula (medial and caudad pull)

Question 23

radial head lateral

where and how treat

Answer 23

on the anterolateral aspect of the radial head at the attachment of the supinator

E SUP VAL
patient supine, doc is sitting ipsilateral. patient’s elbow is in full extension, forearm markedly supinated,
elbow in full extension and resting on doc’s knee, forearm in marked supination, and slight vaLgus force if needed

Question 24

medial epicondyle

where and how treat

Answer 24

on the medial epicondyle of the humerus at the common flexor tendon and the attachment of pronator teres

F PRO ADD
patient is supine and doc is sitting ipsilateral. shoulder flexed. flexion, marked pronation, and slight ADDuction of the elbow with slight flexion of the wrist

Question 25

dorsal wrist

where and how treat

Answer 25

on the dorsal surface of the second metacarpal in the extensor carpi radialis M
-trx= wrist extension, w slight ABD

on the dorsal surface of the fifth metacarpal in the extensor carpi ulnaris M
-trx= wrist extension, w slight ADD

E ABD/ADD
patient supine. flex the elbow. grasp their hand with love handshake with caudad hand, monitor TP with cephalad hand.

Question 26

palmar wrist (2-5)

where and how treat

Answer 26

at the palmar base of the 2/3 metacarpal in the flexor carpi radialis M
-wrist flexion, with slight ABduction

at the palmar base of the 5th metacarpal in the flexor carpi ulnaris M
-wrist flexion, with slight ADDuction

F, ABD/ADD
patient sitting or supine. flex elbow and wrist with caudad hand, monitor TP with cephalad hand.

Question 27

palmar wrist 1st carpometacarpal

where and how treat

Answer 27

at the palmar base (radial aspect) of the first metacarpal in ABDuctor pollicis brevis M

F ABd

patient sitting or supine. flex elbow and wrist with caudad hand, monitor TP with cephalad hand.
wrist flexion with ABduction of the thumb

Question 28

what is wartenberg syndrome and how you treat

Answer 28

impingement of the superficial branch of radial N
= numbness and tingling in the left posterolateral hand

trx w CS of radial head- lateral E Sup Val

Question 29

describe arm unwinding

Answer 29

=direct MFR

great place to start with a new patient and with any UE/upper thoracic, head/neck complaints.
working w deep muscle and deep fascia of the UE

patient is supine,doc is siting on ipsi side.

1. place cephalad hand near patient’s shoulder
2. flex and ABduct patient’s arm and rest their forearm on your antecubital fossa
3. slide caudad hand under the scapula and hook hand on to medial scapular border
4. place cephalad hand on anterior shoulder/pectoral fascia
5. pull shoulder girdle laterally and superiorly until fascia pulls easy.
6. slowly, externally rotate deep fascia in circular motion. pause on areas of greater fascial bind, take care not to ER the shoulder just the fascia
7. continue external fascial unwinding all the way to the wrist
8. add traction and articulate the wrist
9. finish with soft tissue on thenar/hypothenar eminences and finger pull

Question 30

what are the deep fascia of the UE

Answer 30

deltoid fascia
pectoral fascia
brachial fascia
bicipital aponeurosis
antebrachial fascia
tendon of palmaris longus
palmar carpal ligament
palmar aponeurois
superficial transverse metacarpal L