Hand placement for Stills for OA somatic dysfunction, supine.
Describe compression.
Index or middle finger on side of OA side bending in the occipital sulcus. Side bend and Rotate it to where it likes to live.
Compress through top of head.
Hand placement for Stills for AA somatic dysfunction, supine.
Describe compression.
Index or middle finger on transverse process of the atlas, on the side of rotation. Rotate it to where it likes to live.
Compress through top of head.
Hand placement for Stills for typical cervical somatic dysfunction, supine.
Describe compression.
Index or middle finger on articular pillar at level of dysfunction, ON THE SIDE OF ROTATION.
Compress through top of head.
Hand placement of a type 2 somatic dysfunction for (all seated): T1
T1 - Doc faces seated pt and monitors PTP. Other hand manipulates head.
Hand placement of a type 2 somatic dysfunction for (all seated): T3 (upper thoracics)
T3 - Doc faces seated patient. Forearms on patient’s shoulders and pushes shoulder posterior to induce rotation.
Hand placement of a type 2 somatic dysfunction for (all seated): T6
T6 - Doc stands behind patient. Patient uses ipsilateral hand to hold contralateral shoulder. Doc places axilla on contralateral shoulder, reaches around front to ipsilateral shoulder, and induces SB/rot.
Hand placement of a type 1 thoracic somatic dysfunction for (all seated)
Doc faces seated patient. Forearms on patient’s shoulders and induce side bending and rotation.
Describe levator scapulae action. Describe ME treatment (supine)
Action - Elevates scapula and tilts its glenoid cavity inferiorly by rotating scapula.
Contact tender point on levator scapulae with thumb and rest other fingers on anterior shoulder. Flex, sb, rotate neck AWAY from affected side for stretch.
Supine technique (Modified Kirksville Crunch)
Ex. T1-3 NRlSr – apex at T2
- Patient: Supine
- Physician: Standing at the side of the table opposite the PTP
- Patient places clasped hands behind neck and approximates elbows.
- Physician places thrusting hand on the elbows and chest over the dorsum of the hand. Palpates the PTP with fulcrum hand and rests the PTP on the thenar eminence of the fulcrum hand.
- With the other hand, physicians grasps the patient’s elbows and rolls the patient slightly toward his feet so the PTP more firmly rests upon the physician’s thenar eminence.
- Patient inhales deeply and exhales completely.
- At the end of exhalation, the physician exerts a rapid anteroposterior thrust through the patient’s arms onto the transverse process restingon his thenar eminence.
- Reassess.
Chin-pivot for T1-4
(Ex. T3 N SrRl)
Rotate away,
- Patient: Prone with pillow placed under patient’s chest
- Physician: Standing at head of table
- Patient lies prone with head and neck sidebent and rotated into the barrier (SB left and rotated right here).
- Physician uses right hand to palpate the right PTP of T3 and places the palm of the left hand over the right parietooccipital region of the patient’s head.
- Using the left hand, the physician carefully ROTATE the patient’s head to the RIGHT until the physician’s right hand sense this motion over the right T3 TP.
- Patient inhales and exhales, and on exhalation, a thrust is made by the physician’s right thenar eminence onto the patient’s right T4 TP in an anterior and caudad direction while holding the head and upper thoracic spine sidebent left and rotated right.
- Reassess.
Muscles for rib: Rib 1 pump v bucket
pump - anterior scalenes
bucket - middle scalenes
Muscles for rib: Rib 2-10 PUMP (2-5) –> v. BUCKET(7-10)
Pump - pectoralis and serratus anterior
Bucket - lateral part of serratus anterior
Muscles for rib: Rib 11-12
latissimus dorsi and quadratus lumborum
Symptoms of what syndrome and what nerve?
Tingling and numbness in the outer (lateral) part of your thigh, hyperesthesia to the point of not putting anything in pockets, trophic skin changes later on, + tinel’s sign 1cm medial and inferior to ASIS
Meralgia paresthetics, lateral femoral cutaneous nerve (L2,3) under the inguinal ligament in the inguinal canal — which supplies sensation to the surface of your outer thigh — becomes compressed, or “pinched.
Due to: ● Very intense athletics ● Obesity ● Tight girdle/belt, clothing ● Seat belt misplacement or post accident ● Anatomic anomaly (runs thru sartorius)
Symptoms of what syndrome and what nerve?
● Pain along proximal third of lateral leg
● Foot drop= inverted and plantarflexed at rest, loss of eversion and dorsiflexion = “Steppage/slapping gait”.
● Loss of sensation on the dorsum of foot
● Sx exacerbated during plantarflexion and inversion of the foot
Common Fibular Nerve Compression. L4-S2
d/t trauma or compression of lateral aspect of leg, fibular neck fracture, leg hooked over rail (bedridden, comatose, post op), strawberry pickers palsy (time spent in squatting position), ankle sprains or trauma to fib head, new meditators (due to lotus position), lithotomy position during childbirth
treatment of common fibular nerve compression - name four
posterior fibular head HVLA or ME, ME of gastroc and soleus, ME of hypertonic hamstrings/biceps femoris (flex Hip and fully E knee, extend against resistance)
Position of ease in posterior fibular head
Foot inversion, plantarflexion, and LE internal rotation
Symptoms of what syndrome and what nerve?
● Pain over dorsomedial aspect of foot and worst ar rest
● Weakness of extensor digitorum brevis
● Tingling, numbness, or burning in the foot between the first and second toes and occasionally in the upper outer foot by the ankle.
Anterior Tarsal Tunnel Syndrome.
Deep peroneal/fibular nerve compression (L2-4) at the inferior extensor retinaculum. often occurs in the foot between the first and second toes or the upper outer foot by the ankle
Caused by: caused by trauma (recurrent ankle sprains, soccer players), talonavicular dysfunction, prolonged plantar flexion, compression from shoes
Treatment of anterior tarsal tunnel syndrome
remove compressive forces, MFR of extensor retinaculum, traction tug of talonavicular joint, hiss whip for cuboid, navicular, cuneiforms, 1st and 2nd metatarsal
Symptoms of what syndrome and what nerve?
● Shooting pain, burning, numbness and tingling, and loss of sensation on sole of foot
● Gait is not affected
Tarsal Tunnel Syndrome
compression of posterior tibial nerve (L4-S2) in the tarsal tunnel behind the medial malleolus with the overlying flexor retinaculum
two treatments of tarsal tunnel syndrome
MFR of FLEXOR retinaculum, HVLA for eversion SD of ankle
piriformis tender point
In piriformis, 7cm medial to and slightly cephalad to greater trochanter.
Tx - prone, H and K flexed. Thigh abducted and ER.
