Clinical Massage 1 Final

Why memorize trigger points when you can memorize this stack of flashcards?

Describe a referral pattern

When or how pain radiates from a trigger point.

What is a latent trigger point?

It doesn't fire on its own and can become an active trigger point

What is an active trigger point?

It fires on its own and has a referral pattern

What are the main 5 posterior neck muscles?

1. Trapezius,

2. Splenius Capitis,

3. Posterior Cervical Muscles,

4. Suboccipitals,

5. Splenius Cervicis

List the four suboccipital muscles. 

1. Rectus capitis posterior minor

2. Rectus capitis posterior major

3. Obliquus Capitis Superior

4. Obliquus Capitis Inferior 

List some muscles whose referral pattern could duplicate the symptoms of a headache. 5 total

Traps

Suboccipitals

Posterior cervical muscles

Splenius Capitis

Splenius Cervicis

What’s “our” definition of a trigger point?

A Hyperirritable spot within a soft tissue structure that is associated with a hypersensitive palpable nodule surrounded by tight fibers.

What are some soft tissue structures that can form trigger points? 7 total

1. Muscles

2. Tendons

3. Ligaments

4. Fascia

5. Periosteum

6. Scars

7. Joint capsules

4 factors of TP formation

1. Formed when soft tissue is abused in some way (injury, compensation, overuse)

2. Age

3. Tissue health

4. Overall health

What’s the definition of a referral?

Any type of a sensation that the client feels somewhere in the body. Is often familiar to the client.

What is a central trigger point?

Located in the center of muscle fibers, the muscle belly

What is an attachment TP?

Located at the attachment of the muscle to the tendon, or the attachment of the tendon to the bone

What is a key TP?

Responsible for the formation of other TPs

What is a satellite TP?

TPs that form in response to key TPs. Located in the referral zone of the key TP

4 perpetuating Factors of Trigger Point Formation

1. Nutritional inadequacies

2. Metabolic/endocrine inadequacies

3. Physiological factors

4. Illness

How does a trigger point relate to the client’s symptoms?

1. The referral pattern is familiar to the client and matches the description of the client’s symptoms

2. When we press the trigger point, we duplicate the client’s symptoms

3. As the trigger point melts away the client’s symptoms diminish.

Treatments of Trigger Points:

1. Trigger point pressure release

2. Spray and stretch: Vapocoolant sprayed unilaterally while passively stretching the area

3. Injection: Local anesthetic, procaine, saline, lidocaine

Describe the difference between a Trigger Point and a Tender Point

Trigger point has a referral pattern, which is usually in a distal direction

Tender point does not have a referral pattern, but it is tender for the client when pressed.

What’s our range for Optimal Tolerance?

5-5.5/10

What type of tissue does CFF address most effectively?

Areas of tissue that feel “too stuck together.” Thick, matted, dense

What is tenosynovitis?

Inflammation of a tendon with a sheath

What are some soft tissues we will address?

1. Muscles

2. Tendons

3. Ligaments

4. Fascia-connective tissue

5. Periosteum

What are some differences between acute, sub-acute, and chronic

Acute: Last for a short duration of time. Sharp, severe, intense. Occasionally felt.

Sub-acute: Continues to diminish as tissues heal, transitions from sharp to dull

Chronic: Dull, mild or severe, present for over 3-6 months

What is a syndrome?

A collection of symptoms

What are some of the main muscles in the upper shoulder and back?

1. Trapezius,

2. Rhomboids,

3. Serratus Posterior Superior,

4. Levator Scapula,

5. Paraspinals,

6. Subscapularis,

7. Supraspinatus,

8. Infraspinatus,

9. Teres Minor,

10. Deltoid

Trapezius functions

Elevates shoulders

Rotates glenoid fossa upward

Draws clavicle backwards and upwards

Scapula adduction

Stabilizes scapula for glenoid fossa to rotate upward

The 4 trapezius sections

Cervical fibers

Upper fibers

Middle fibers

Lower fibers

Rhomboid sections

Rhomboid major and minor

Rhomboid functions

Adduction of scapula

Downward rotation of glenoid fossa

Assists with adduction and extension of arm by stabilizing scapula against rib cage

Rhomboid functions

Adduction of scapula

Downward rotation of glenoid fossa

Assists with adduction and extension of arm by stabilizing scapula against rib cage

Serratus Posterior Superior function

Raises the ribs and helps the chest to expand

Levator scapula functions

Rotates glenoid fossa downward

Elevates scapula

Assists in rotation of the neck to the same side

BL neck extension

Paraspinals/Erector Spinae Superficial to Deep

Semispinalis

Multifidi

Rotatores

Paraspinal/Erector Spinae Muscles functions

Extend the spine

Assist with rotation of the spine

Stabilize the spine

Subscapularis functions

Medial rotation of arm at the shoulder

Adduction of the arm at the shoulder

Stabilizes the head of the humerus within the glenoid fossa

Supraspinatus function

Stabilizes the humerus head within the glenoid fossa

Abducts the arm

Infraspinatus function

Lateral rotation of the arm at the shoulder

Stabilizes the humeral head in the glenoid fossa during arm movement

Teres minor function

Lateral rotation of the arm at the shoulder

Stabilize the humeral head during movement

The deltoid has __ groups of muscle fibers. What are they?

3, anterior, medial, and posterior

What is the scientific name of “Frozen Shoulder,” and what does it mean?

Adhesive capsulitis

Loss of ROM in all directions of shoulder movement

What’s the difference between an AC joint impingement and separation

Impingement: Inflammation of bursa, swelling of tendons

Separation: Tearing of ligaments

What boney landmark is the upper attachment for the short head biceps tendon?

Coracoid process

What is the main function of the brachialis?

Flexion of the forearm

List the three heads of the triceps.

Medial

Lateral

Long

Briefly explain why the biceps brachii is able to supinate the forearm.

The biceps' lower attachment is on the radius and ulna, allowing them to supinate the forearm

What are some forearm extensors?

Brachioradialis

Extensor Carpi Radialis Longus

Extensor Carpi Radialis Brevis

Extensor Digitorum

Extensor Carpi Ulnaris

Name the superficial forearm flexor muscles

pronator teres

flexor carpi ulnaris

palmaris longus

flexor carpi radialis 

What is the Diagnosis given for tendonitis of the elbow on the flexor side of the forearm?

medial epicondylitis 

What is the name of the attachment site at the medial epicondyle of the humerus?

common flexor tendon

What is the Diagnosis given for tendonitis of the elbow on the extensor side of the forearm?

lateral epicondylitis

What is the name of the attachment site at the lateral epicondyle of the humerus?

common extensor tendon

What are the attachments of the pectoralis minor?

Upper: Coracoid process

Lower: Ribs 3, 4, 5

List the four sections of the pectoralis major.

1: Sternal

2: Clavicular

3: Intercostal

4: Abdominal

List some functions of the pectoralis major.

Medial rotation of arm at shoulder

Adduction of arm at shoulder

Flexion of arm at shoulder

What is carpal tunnel syndrome?

A set of signs and symptoms resulting from entrapment of the Median Nerve at the Carpal Tunnel.

What four tendons and nerves are involved in the wrist? List them out

1. Palmaris longus tendon

2. Median nerve

3. Flexor carpi radialis tendon

4. Flexor pollicis longus tendon

What is the first site of entrapment for CTS?

Between 2 heads of the pronator teres

What’s the second site of entrapment for CTS?

Between flexor digitorum superficialis and profundus

What is the “true” site of entrapment for CTS?

At the carpal tunnel

Describe the difference between “tennis” elbow and “golfer’s” elbow.

TE: Involves the common extensor tendon and the lateral epicondylitis

GE: Involves the common flexor tendon and medial epicondylitis

Describe the difference between tendonitis and tendonosis

Tendonitis: Inflammation of a tendon caused by overuse or injury

Tendinosis: Damage to a tendon without inflammation present, involves microtears in the CT in and around the tendon

What happens during Thoracic Outlet Syndrome entrapment?

The brachial plexus exists the scalenes and passes deep to the pec minor tendon.

What is the scientific name for whiplash?

Cervical Acceleration/Deceleration

Brachioradialis’s function

Flexion of elbow in semi-pronated position

What are the functions of the extensor carpi radialis and brevis?

Assists in elbow flexion

Abduction of hand at the wrist

Assists in extension of the hand

Brevis: Extension of hand at wrist

Extensor digitorum function

Extends the digits/fingers

Assists in extension of the hand at the wrist

Extensor carpi ulnaris function

Adduction of hand

Extension of hand

What tendons form the Common Extensor Tendon?

Ext. carpi radialis and brevis

Ext digitorum

Ext carpi ulnaris

Pronator teres function

Assists in pronation of the forearm

Assists flexion at the elbow with resistance

Flexor carpi radialis

Flexion of hand at the wrist

Assists abduction of hand at wrist

T/F: Everyone has a palmaris longus tendon

False, it may be absent in some people.

Palmaris longus function

Cups the palm by tensing the palmar fascia

Assists in flexion of hand at the wrist

Flexor carpi ulnaris function

Flexes hand at the wrist

Strongly adducts hand at wrist (ulnar deviation)

What tendons attach to the Common Flexor Tendon?

The Pronator Teres,

Flexor Carpi Radialis,

Palmaris Longus

Flexor Carpi Ulnaris

The _____ is the deepest of the four tendons to the fingers

Flexor digitorum superficialis

Flexor digitorum superficialis’s functions

Flexion of middle and proximal phalanx of each finger

Flexes hand at wrist

Flexor digitorum profundus function

Flexion of distal phalanx of each finger

What tendon is considered to be an extension of the triceps muscle?

Anconeus

Anconeus’s function

Extension of forearm at the elbow

Supinator function

Primary supinator of the hand and forearm

Holds forearm in supination

Assists elbow flexion when arm is semipronated

What nerve lies within the supinator?

Radial

Subclavius function

Stabilizes the clavicle during shoulder movement

Draws clavicle toward the sternum

Intercostals function

Respiration

Rotation of thoracic spine

Serratus anterior function

Rotate glenoid fossa upward

Abduction of scapula

Elevation of scapula

Prevents winging of scapula

What nerve can become entrapped in the triceps?

Radial

What is a function of each deltoid head?

Ant: Flexion if arm at shoulder, horizontal adduction

Med: Abduction of arm at shoulder

Post: Extension of arm at shoulder

What are the biceps brachii’s attachments?

Upper: medial/short head of coracoid process

Lateral/long: Supraglenoid tuberosity of glenoid cavity at scapula

Lower: Common tendon at the radial tuberosity

What muscles contribute to an ache between the shoulder blades?

1. Trapezius

2. Rhomboid

3. Serratus Posterior Superior

(SPS)

4. Levator scapula

5. Paraspinal/Erector Spinae

6. Posterior cervical (PC)

7. Latissimus dorsi

What muscles cause symptoms in the anterior shoulder joint?

1. Supraspinatus

2. Deltoid

3. Biceps brachii

4. Brachialis

5. Coracobrachialis

6. Teres major

7. Subscapularis

8. Pectoralis major

9. Pectoralis minor

10. Subclavius

What muscles/tendons cause carpal tunnel syndrome?

1. SPS

2. Supraspinatus

3. Infraspinatus

4. Teres minor

5. Scalene

6. Deltoid

7. Biceps brachii

8. Brachialis

9. Coracobrachialis

10. Teres major

11. Latissimus dorsi

12. Subscapularis

13. Triceps

14. Brachioradialis

15. Extensor carpi radialis (long

and brevis)

16. Pronator teres

17. Flexor carpi radialis

18. Pectoralis major

19. Pectoralis minor

20. Subclavius

What muscles cause symptoms in the chest?

1. Serratus posterior superior

2. Paraspinals

3. Pectoralis major

4. Pectoralis minor

5. Subclavius

What muscles cause symptoms in the ear?

1. Masseter

2. Buccinator

3. Sternocleidomastoid

What muscles cause headaches?

1. Trapezius

2. Levator scapula

3. Splenius capitis

4. Splenius cervicis

5. Posterior cervical

6. Suboccipitals

7. Temporalis

8. Frontalis

9. Occipitalis

10. Buccinator

11. SCM

What muscles cause symptoms in the posterior shoulder joint?

1. SPS

2. Supraspinatus

3. Infraspinatus

4. Teres minor

5. PC

6. Deltoid

7. Teres major

8. Latissimus dorsi

9. Subscapularis

10. Triceps

What muscles cause a stiff neck?

Trapezius

PC

SCM

What muscles cause symptoms in the TMJ?

1. Temporalis

2. Lateral pterygoid

3. Buccinator

4. SCM

What muscles/tendons cause tendinitis of the elbow?

1. SPS

2. Supraspinatus (extensor side)

3. Infraspinatus

4. Teres minor (extensor side)

5. Biceps brachii (flexor)

6. Coracobrachialis (flexor)

7. Teres major (extensor side)

8. Lat dorsi (extensor)

9. Subscapularis (extensor and

flexor)

10. Triceps

11. Brachioradialis (extensor)

12. Extensor carpi radialis

long/brevis

13. Pronator teres (flexor)

14. Flexor carpi radialis

15. Anconeus

16. Pectoralis minor

17. Subclavius (extensor)

What muscles cause symptoms in the thumb?

1. Brachialis

2. Extensor carpi radialis longus

and brevis

3. Pronator teres

4. Subclavius

What muscles cause symptoms int he teeth/gums?

1. Traps(?)

2. Temporalis

3. Masseter

What muscles cause symptoms in the wrist and hand?

1. SPS (extensor)

2. Supraspinatus

3. Teres minor

4. Brachialis

5. Coracobrachialis

6. Teres major

(Wrist and hand continued)

7. Lat dorsi

8. Subscapularis

9. Triceps

10. Brachioradialis (thumb)

11. Extensor carpi radialis

(thumb)

12. Flexor carpi radialis

Clinical Massage 1: Common Conditions and Related Tr Pt Referrals

13. Pec minor

14. Subclavius