Counterstrain: Anterior Trunk - Lab/OSCE Flashcards
(30 cards)
What do you treat first if there is more than one point of similar tenderness, in the thoracics and ribs?
Treat the most tender, most central/proximal, and thoracic first.
AC1 location and treatment position
- Tip of TP on C1, high on posterior edge of ascending ramus at earlobe.
- Tx - Pt supine, doc at head of table, RA
AC2-6, AC8 location and treatment position
- Anteriolateral aspect of transverse process of affected vertebra
- Tx - Pt supine, doc at head of table, FSARA
AC7 location and treatment position
- Posterosuperior surface of proximal clavicle where SCM inserts
- Pt supine, doc at head of table, FSTRA
What tenderpoint is lateral to AC8 tenderpoint?
What muscle do these two tenderpoints seem to be related to?
AC7
SCM insertions
AC8 requires the same flexion as what other anterior cervical?
AC3
AT1-AT8 Treatment
- Position - pt supine with feet flat on table, doc at head of table
- Doc places nee under upper back to wedge/flex pt to involved vertebra. Fine tune flexion with other hand.
AT9-AT12 Locations
AT9 - Midline 1-2 cm above umbilicus
**AT10 - Midline about 1-2 cm below umbilicus
AT11 - Midline about 3-4cm below umbilicus
AT12 - mid-axillary line on superior-medial surface of iliac crest
AT9-AL1Treatment
- Position - pt supine with doc on SAME SIDE as tenderpoint with FOOT ON TABLE
- Doc flexes pt’s leg/hip to 90degrees with fine tuning rotation toward doc. FSTRT
AL 5-6T Location
AL 7-8T Location
Treatment
- AL 5-6T: At costosternal joint at affected level
- AL 7-8T: On inferior medial surface of costasl cartilages, 1 and 2 inches inferolateral from xiphoid
- SAME TX - Pt SEATED, doc behind pt with leg on table under pt’s arm on unaffected side - FSTRA
What are anterior rib (1-6) tenderpoints usually indicative of?
What are posterior rib tenderpoints usually indicative of?
Anterior TP = Depressed rib = exhalation dysfunction
Posterior TP = Elevated rib = inhalation dysfunction
AR1 location
AR2 location
Treament
- AR1: Inferior to clavicle on rib1, lateral to manubrium (inf to SC joint)
- AR2: 1.5 in lateral to manubrium on rib 2 at mid-clavicular line
- SAME Tx - Pt supine, doc at head of table. FLEX NECK to 45. F-STRT the neck
What does AR1-2, AR3-6 counterstrain treat?
Treats a depressed rib, inhalation restriction.
AR3-6 location and treament
- Anterior axillary line on ribs 3-6
- Tx - Pt SEATED, doc behind with knee under arm of UNAFFECTED side. FSTRT to neck and torso.
AL1 location
Location - Medial to ASIS
AL2 location and treatment
Location - Medial and inferior to AIIS
Tx - pt supine, doc on OPPOSITE SIDE of the TP with foot on table. Flex pt’s knees/hips 90 degrees and rotate 60 toward doc. FSART
What is special about AL2 treatment?
- Requires significant rotation of flexed femurs away from tenderpoint side.
AL3 location
AL4 location
Treatment
- AL3 location - lateral to AIIS
- AL4 location - inferior aspect of AIIS
- Treatment - pt supine, ankles toward physician, minimal knee rotation toward doc. FSART.
AL5 location and treatment
- Location - anterior aspect of pubic bone, 1cm lateral to pubic symphysis
- Tx - pt supine, doc on SAME SIDE of TP with foot on table. Flex hip to 135 degrees and push ankles away/knees toward doc. FSTART
Iliacus (IL) location and treatment
- Location - in lower quadrant, 1-2 in medial to ASIS deep in iliac fossa
- Tx - pt supine, doc on SAME SIDE as TP with foot on table. Flex knees/hips to 90, ankles crossed on doc’s knees = ER of hips »_space; FROG LEGGED
Low ilium (LI) location and treatment
- Location - superior aspect of lateral ramus, where psoas m crosses pelvic rim.
- Tx - pt supine, doc on SAME SIDE of TP. Flex 1 knee/hip to 90, ER hip, fine tune with AD/AB.
Inguinal ligament (inlig) locatoon and treatment
- Location - lateral surface of pubic bone near attachment of inguinal ligament
- Tx - pt supine, doc SAME SIDE of TP with foot on table, F knees/hips to 90, rest on doc’s knee. Cross opposite ankle over leg on side of doc with ankles toward doc. (IR hip on side of TP).
If both thoracic TP and rib TP are present, which is treated first?
Thoracic.
AT1 location
Midline in suprasternal notch
