UE/LE CS points Flashcards
shit
Tensor fascia latae tender point
where and how treat
inferior to the crest of the ilium in the body of the TFL M
f ABD
ABduct hip/thigh, flex
lateral trochanter iliotibial band
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
lateral hamstring
biceps femoris
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
lateral meniscus
lateral collateral ligament
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
medial hamstring semimembranosus
semitendinosus
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
medial meniscus
MCL
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
anterior cruciate
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
posterior cruciate
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
popliteus
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
extension ankle gastrocnemius
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
medial ankle, tibialis anterior
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
lateral ankle fibularis/peroneus longus, brevis, tertius
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
flexion calcaneus quadratus plantae
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
navicular
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
supraspinatus TP
where and how treat
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
infraspinatus TP
where and how treat
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
rhomboid minor/major
where and how treat
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
levator scapulae
where and how treat
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
subscapularis
where and how treat
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
long head of biceps
where and how treat
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
short head or biceps/coracobrachialis
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
pectoralis minor
where and how treat
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)
radial head lateral
where and how treat
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
medial epicondyle
where and how treat
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
dorsal wrist
where and how treat
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.
palmar wrist (2-5)
where and how treat
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.
palmar wrist 1st carpometacarpal
where and how treat
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
what is wartenberg syndrome and how you treat
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
describe arm unwinding
=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.
- place cephalad hand near patient’s shoulder
- flex and ABduct patient’s arm and rest their forearm on your antecubital fossa
- slide caudad hand under the scapula and hook hand on to medial scapular border
- place cephalad hand on anterior shoulder/pectoral fascia
- pull shoulder girdle laterally and superiorly until fascia pulls easy.
- 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
- continue external fascial unwinding all the way to the wrist
- add traction and articulate the wrist
- finish with soft tissue on thenar/hypothenar eminences and finger pull
what are the deep fascia of the UE
deltoid fascia pectoral fascia brachial fascia bicipital aponeurosis antebrachial fascia tendon of palmaris longus palmar carpal ligament palmar aponeurois superficial transverse metacarpal L
