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In the Preface, I state that: “The neuro-reflexogenic relationship of muscles, _________, and joints is at the heart of Myoskeletal Alignment Techniques.”
Tip: When stretching myofascia, you’re also stretching these sensitive structures
The hand can grasp with forces exceeding _________ pounds.
Tip: The grip is stronger than one might think
Tension, trauma and _________ movements can alter he position and function off associated joints.
Tip: Commonly seen in carpal tunnel cases
Active movement psychologically reinforces clients to move the arm through a greater range of motion. This is called _____ ______
Tip: Pain-free stretching teaches the brain that it’s OK to move into that range of motion.
Myoskeletal Techniques utilize _______ and _________.
Tip: Neurologically turning muscles on and off
Fiber tearing with inflammation is termed tendinitis, while fiber tearing without inflammation is called_________.
Tip: Tendon tearing typically does not result in long-term inflammation
A technique is a formal expression of _____ to affect the body.
Tip: Keep a clear intent on the desired therapeutic goal
One question therapists should ask themselves during the evaluation process is “What type of tissue am I working…. hypermobile, fibrotic, fibrosed or _________?”
Tip: Muscle guarding is neurologically tightened tissue, that is also called what?
Is it appropriate to perform the same techniques with ______ muscles as with _____ muscles?
Tip: Think length- strength imbalances
Pain is a ____ of the brain.
Tip: Pain lives in the brain, not in the tissue
The force applied should not create ________pain.
Tip: Neuropathic pain falls under the category of this type of peripheral and central pain
Effective deep tissue work requires low shoulders, locked-in lumbar lordosis and force coming from the _________.
Tip: let the force come through the body from below
Thoracic outlet syndrome is usually compression of the lower trunk of the ________plexus.
Tip: The name of the neurovascular structure coming through the clavicle
During the day as the clavicle and scapula drop they begin to compress the _____ branch of the brachial plexus.
Tip: Think ulnar nerve distribution.
Nerve root compression can cause pain while it’s being pinched, but nerve trunk compression causes more problems ________.
Tip: Pins and needles when the pressure is taken off the nerve trunk.
How do you determine if it is a shoulder or neck problem?
Tip: Perform a thorough exam including referring physicians
At the shoulder (not scapular rotation), there should be _______ degrees of abduction.
Tip: Other structures are involved once the humerus reaches shoulder height
There also should be approximately _______ degrees of medial and lateral horizontal humeral rotation
Tip: Sometimes internal humeral rotation is less
In the intertransversarii routine, the therapist’s goal is to relieve ________ compression.
Tip: These tissue bundle to form the brachial plexus
Which tiny neck muscles are often the first to occlude nerve roots forming the brachial plexus?
Tip: These muscles run from transverse process to transverse process
When rotating the head to the right, the therapist is stretching the intertransversarii on the _______side.
When you lift client’s right rotated head, which muscles are underneath?
Soft finger pads slide down under the clavicle making sure you’re not on the transverse process of______
The 1st rib attaches to this vertebra
Soft finger pads evaluate to see if the 1st rib on one side is more ______ than the other.
Tip: What are you pushing down?
Tight/short anterior scalenes can bind down the first rib leading to a_____ _____ posture.
What is an Upper Crossed posture?
When subclavius muscle is fibrotic, it can rub on a very sensitive________.
What neurovascular structure traverses under the clavicle?
What will break down before the nerve root itself?
What are the vascular structures that surround the brachial plexus?
Double and triple crush syndromes start proximally but we often feel them_______?
Tip: Often leads to a misdiagnosis of carpal tunnel
In the pec minor release, the therapist’s flat forearm pins the pec minor attachment just below the ________process
Tip: Where are the proximal pec minor attachments
Ida Rolf used to say_____the front and _____the back.
Tip: Move the pectorals up
When accessing the pec minor with the axillary finger release, the therapist’s soft finger pads scoop under ________ to contact the rib attachments of pec minor.
Tip: Under the big chest muscle and on to the ribs
The _____________ is one of the most overlooked joints in therapy.
Tip: It attaches to the sternum
Sternoclavicular (SC) is the only shoulder joint containing a ____________.
Tip: It resembles cartilage
How many movements are available at the SC joint?
Tip: Think scapular elevation and retraction.
In arm abduction and shoulder shrugging, the medial head of the clavicle should __________.
Tip: When the lateral clavicle elevates the medial head does what?
How high does the arm abduct before the SC joint comes into play?
Tip: The SC joint comes into play when the scapula stops moving
If there is restriction in the SC joint, it is found in the last ____ degrees of shoulder abduction.
Tip: The SC joint is only active at the end range of arm abduction
When shrugging the shoulders, the medial head of the _______ should
Tip: The lateral heads go up and medial go down during shrugging
If the medial head of the clavicle does not drop down while shrugging, the _____ joint is dysfunctional
Tip: Think about which joint the medial head of the clavicle is part of
One of the Myoskeletal goals is to assess SC restriction in _________________
Tip: The medial clavicular heads drop down as the shoulders go up
When testing for SC forward flexion restriction therapist places _______ and _______ on medial clavicular heads.
Tip: You are operating in a very small space.
In horizontal adduction the medial heads should move _______________
Tip: Place fingers on the medial SC joint and feel the movement as the arms move forward
In treating SC joint elevation restriction, therapist places fingers on the ________ border of the clavicle
Tip: Remember, the medial clavicle drops down during arm abduction
To correct an (SC) joint elevation restriction, the therapist fingers firmly hold the sternal head of the clavicle while he brings client’s arm into _______________.
Tip: Bringing the arm back is called?
During SC forward flexion treatment, the therapist places his finger and thumb on the anterior clavicular heads and directs his finger pressure ____________.
Tip: The medial clavicular heads should drop back during forward shoulder flexion
Who said: “Roll the joints and they’ll come home”?
Tip: The founder of osteopathic medicine
To locate the AC joint, slide you fingers laterally along the clavicle until you palpate a ____ or ______.
Tip: The AC joint connects the clavicle with the scapula at the acromion
When the AC joint is dysfunctional, it can inhibit arm _______________
Tip: Moving the arm away from the midline of the body is?
When fingers are on the AC joint and you elevate your shoulder you should feel the acromion moving _____ in relation to the clavicle.
Tip: Which direction are your shoulders going?
Which shoulder joint provides the only true bone-on-bone connection to the axial skeleton?
Tip: Think about where the shoulder and clavicle meet
When the AC joint is dysfunctional, what arm motion is usually most affected?
Tip: Taking the client may have difficulty moving her arm away from the body
When treating internal rotation restriction at the AC joint, abduct the client’s arm to __ degrees then adduct an extra ___ degrees to isolate movement at the AC joint.
Tip: Bring the arm out to the side and toward the midline
How many degrees of motion do we want to achieve in external rotation?
Tip: Don’t try to get it all in one session
When treating an AC external rotation restriction, the client pushes against therapist’s hand with a ____ percent effort.
Tip: Heavy pressure engages too many muscles
What does the T stand for in the acronym ART?
Tip: We want to find palpable irregularities
The glenohumeral (GH) joint is a ___________ joint.
Tip: The glenohumeral is the most mobile joint in the body
Which of these is a movement of the GH joint?
Tip: There are many movements available at the GH joint
The GH joint has __ or ___ movements, depending on how you count them.
Tip: Think… most mobile joint in the body
The integrity of the GH joint comes from which structure?
Tip: Think of the group of core muscles surrounding the humerus
If there is a restriction in any range of GH motion, the Myoskeletal therapist applies ______ energy techniques to restore mobility?
Tip: The technique involves the client actively contracting and relaxing specific musculature to achieve greater joint mobility
What are the two most common problems at the GH joint?
Tip: You should have approximately 90 degrees of motion in both of these directions
During treatment of neutral GH external rotation, the therapist’s hand first braces the client’s _________ firmly against his body.
Tip: Leave room for a 1 liner
In GH horizontal abduction treatment, the client’s arm is held at __________ height with elbow extended.
Tip: Leave room for a 1 liner
How many degrees of GH abduction do we want?
Tip: The client should be able to abduct their arm straight up from a resting position
The scapulocostal joint should not move during the first _____ degrees of arm abduction.
Tip: It should start moving (approximately) as the arm reaches shoulder height
The therapist palpates the ______ border of the scapula as the client abducts the arm to test SC
Tip: The outermost landmark on the scapula
The scapulocostal joint should move from 90 degrees to approximately____ degrees.
Tip: It doesn’t stop moving until the last 30 degrees of arm abduction
In the presence of scapulocostal fixation, the therapist must work all the surrounding ___________ to restore length/strength balance.
Tip: Always seek to create length-strength shoulder girdle balance.
The whole purpose of the shoulder girdle is to make the ______ functional.
Tip: Which is the most distal structure?
Tendinosis is tearing without inflammation, and tendinitis is _________
Tip: Tendon tearing usually produces very little inflammation
The first 10-20 degrees of arm abduction are mainly caused by the ________ muscle contraction
Tip: This muscle moves the arm away from the body in abduction
The supraspinatus muscle grows out of the supraspinous _______.
Tip: Think proximal scapula
When working to lengthen the supraspinatus muscle, what activator can the client use to enhance the action?
Tip: What does the supraspinatus do to the humerus?
In _________tears, the therapist places their thumb in the “V” between the coracoid and acromion while rotating the client’s arm.
Tip: It’s under the acromion
The glenoid fossa is a ____shaped structure.
Tip: The top is narrower than the bottom
Therapist braces right elbow against his body and gently pushes with his ______ webbed hand while pulling with the ____ to create a counterforce.
Tip: The goal is to push the humeral head down in the glenoid fossa
As client inhales, she gently pulls her elbow toward her ____ to a count of 5 and relaxes.
Tip: Think post-isometric relaxation
The goal of this technique is to strip up to the ________junction of the supraspinatus muscle.
Tip: Scrum the tendon at the greater tubercle
Standing to clients back, therapist grasps client’s wrist and _____her arm.
Tip: The goal is to pull the humerus down in the bottom part of the capsule
Therapist uses his _____ to scrub the supraspinatus tendon at the greater tubercle.
Tip: Use a broad tool to help gate the mechanoreceptors
When working with subscapularis tendinosis, which is not one of our goals?
Tip: Work all the subscap attachments
Subscapularis is primarily an ___________ of the arm
Tip: Works with latissimus to roll the humerus forward
When working subscap in the armpit, reposition fingers if you feel a _____ or the client reports ____pain (zingers).
Tip: A heartbeat causes this sensation
During the day as the clavicle and scapula drop they begin to compress the _____ branch of the brachial plexus.
Tip: Two other rotator cuff muscles the externally rotate the humerus
When working on infraspinatus and teres minor, place the client’s arm ________ if possible.
Tip: Since they are external humeral rotators, placing them here exposes the tendons
To access many of the infraspinatus muscle fibers, the therapist’s fingers will have to come underneath the ________ muscle.
Tip: This muscle has three parts
In cases of bicipital tenosynovitis, it is often best to do_______frictioning.
Tip: We’re trying to separate the fibrotic sheath from the tendon
In cases of bicipital tenosynovitis it often hurts to extend the elbow and also to _________ the shoulder:
Tip: Pulling the arm back stretches this tendon sheath
If the tendon has slipped over the lesser tubercle and out of the groove medially, place the client’s elbow on the hip at ____ degrees, hook the tendon medially with curled fingers and pull up while you internally rotate the arm
Tip: This position allows best access to the tendon
The technical term for frozen shoulder is adhesive___________.
Tip: What ligamentous structure encloses the glenohumeral joint?
When assessing frozen shoulder, the therapist’s fingers monitor the _______________scapular border.
Tip: The scapula glides up and out during arm abduction…get down!
The lateral border of the scapula should not begin to move until ______ degrees of arm abduction.
Tip: When the arm reaches shoulder height, the scapula should move
In those with true frozen shoulders, the hard end-feel at end range of motion feels much like _____ on ______.
Tip: What does a bony end-feel feel like?
When you compress the joint and there is pain, the condition may be joint ______.
Tip: Think ulnar nerve distribution.
The therapist _______ and ______ humeral head during the muscle-guarding test.
Tip: Pain as the humerus is pulled away from the body indicates muscle guarding
Client places her left arm on therapist’s___________.
Tip: The technique is most effective when the therapist can maneuver the client using his body
In order to break up adhesions, the therapist’s hands compress, roll and ______ humeral head.
Therapist plungers the joint while slowly moving _____________.
Tip: The goal is to increase abduction so the arm should move in which direction?
During the lat release, therapist’s hands contact the client’s lateral _____________
Tip: Think lifting ribcage and lengthening lats
The therapist abducts client’s arm to pain-free barrier and rests her _________ on the therapy table.
Tip: Therapist must elevate client’s arm as high as possible (pain-free) so he can get on the ribcage and under the armpit.
The latissimus dorsi release helps increase humeral._________ rotation.
Tip: Since the lats are internal humeral rotators, lengthening causes what?
Therapist’s left hand contacts subscapularis and his right hand folds client’s _____ over his soft-cupped fingers.
Tip: The goal is to get soft finger pads onto the subscapularis muscle under the scapula
Subscapularis, like the latissimus dorsi, is an __________ rotator of the humerus.
Tip: The goal is to lengthen these muscles to allow more external humeral rotation
In the video, I’m attempting to get my thumb in the folds under the joint capsule which are preventing arm _____________.
Tip: Bringing the arm away from the midline is called what?
The primary goal of this technique is to move the humerus back down into the bottom of the ____________fossa.
Tip: The glenoid fossa is skinny at the top and widens at the bottom
Therapist’s left arm snakes under client’s elbow and grasps client’s _______.
Tip: Therapist and client hands need to grasp each other for this technique.
As the therapist steps onto his right foot, his soft __________hand loosens glenohumeral joint.
Tip: The goal is to press the humerus down in the pear-shaped glenoid fossa using a broad tool
How many joints comprise the elbow?
Tip: Think about the movements we see at the elbow: flexion/extension, pronation/supination, and radial/ulnar deviation
Which of these is not one of joints of the elbow?
Tip: The clavicle articulates with the sternum and the acromion.
What motion(s) is the elbow joint capable of?
Tip: The elbow is a hinge joint, but has some movement in other planes also
What is the best way to test elbow motion?
Tip: The elbow has to be stable in a controlled test of motion
When trying to create better supination, the therapist rotates the client’s arm up to the first restrictive barrier and asks them to gently turn the palm down or _________ .
Tip: What is the opposite movement?
When trying to improve elbow pronation, therapist rotates the client’s arm down to the first restrictive barrier and asks the client to turn the palm up or _________ .
Tip: Has UP in it
Which motion is usually most restricted?
Tip: You wouldn’t be prone to spill in this position
To test elbow extension restrictions, therapist extends client’s elbow to the 1st restrictive barrier and asks the client to contract the __________muscle to the count of 5, and relax.
Tip: What muscle (primarily) flexes the elbow
In the elbow extension test, the client flexes her biceps using a _____percent effort and relaxes.
Tip: It’s especially important during the elbow extension correction to instruct the client to use very little flexion effort
Tennis elbow is also known as _________?
Tip: Tennis elbow with inflammation is “itis” – no inflammation is “osis”
Extensor carpi radialis brevis and longus attach to the ______epicondyle.
Tip: Clients with true tennis elbow have pain on which side of the forearm?
Which of the wrist extensors is the most vulnerable to fiber tearing
Tip: It’s a long name, but a “short” muscle
The extensors and their fascial bags like to stick to which bone?
Tip: Which bone in the forearm is on the pinky side?
When we strip up the extensor muscles, the _________ is our finishing landmark.
Tip: At what bony prominence does the extensor muscle group originate
Extension of the wrist is known as ___________
Tip: It’s the same as with feet
While holding static pressure on extensor carpi radialis brevis tendon, we instruct the client to:
Tip: They have to go back and forth
Golfer’s elbow is more common than ______ elbow
Tip: Very different type swings
Which muscles get strained in golfer’s elbow?
Tip: Both attach to the medial epicondyle
When working the flexors therapist’s forearm strips up to the ________.
Tip: Make sure to follow all the way to the bony attachment at the elbow
The ______ you go, the ______ you go
Tip: Deep palpation requires patience
Ulnar nerve entrapment is often disguised as ____________
Where does it hurt when you hit your “funny” bone?
To assess for ulnar nerve entrapment, therapist’s fingers palpate between the ______ and _______
Tip: Think bones of the elbow
There are multiple _____ and ______ in the wrists and hands.
Tip: Carpals are what? Radiocarpal is what?
There is a small meniscus or ______ where the triquetrum and ulna bones meet.
Tip: The only meniscus or cartilage in the wrist
Hook of hamate is one of the attachments of the transverse_______ ligament attaches.
Tip: Bones of the wrist are called what?
Therapists work on the bony margins to keep from compressing the median nerve and inflamed _______ _________.
Tip: What tendons travel under the transverse carpal ligament?
The _________ membrane can restrict pronation and supination.
Tip: This ligamentous structure prevents shearing of the radius and ulnar bones
During wrist dorsiflexion, the goal is to increase palmar flexion, radial and _____ deviation.
Tip: A downward motion when shaking hands
To treat palmar flexion restriction, the therapist grasps client’s wrists with elbow flexed at _____ degrees.
Tip: The elbow must be flexed and pinned to client’s hip
To treat radial deviation restriction, client is asked to ulnar deviate _____ therapist’s resistance to a count of 5 and relax.
Tip: Contract-relax techniques always ask for this motion before bringing the body part to the next restrictive barrier
To treat ulnar deviation restriction, therapist shakes client’s hand and moves wrist _____ to 1st restrictive barrier.
Tip: The ulnar bone has the knot at the wrist
When spreading the _______ aponeurosis, therapist must stay off the median nerve in the carpal tunnel area.
Tip: Inside the hand, between the fingers and wrist
The hand and wrist _______ traverse through the carpal tunnel.
Tip: These muscles plantar flex the hand
What is a tendon that is sticking to the sheath?
Tip: How does a synovial sheath protect the tendon?
Which nerve usually gets compressed in the carpal tunnel?
Tip: Only one nerve goes through the carpal tunnel; the more lateral nerves do not
Therapist places client’s hand in _________ when stripping the flexors.
Tip: We want to put the flexors on a stretch
What bone does the flexor carpi ulnaris attach to?
Tip: Think pinky side
Where is the hook of the hamate in relation to the pisiform?
Tip: Closer to the midline and further from the main mass of the body
When working in the body we should always start in the spinal groove and work out way__________ to ____________.
Tip: Start nearer to the main mass of the body and then go further from it
When treating trigger fingers, the goal is to release swollen digital_____ tendons.
Tip: What do these muscles do to the palm when flexed?
Trigger fingers typically involve the ____ and ____ digits.
Tip: They typically run alongside one another
To work on most tenosynovitis cases, the client’s fingers should be _________
Tip: You want the related tissue to be lengthened
When treating DeQuervain’s Syndrome, the goal is to release swollen (fragmented) tendons of _____ longus and _____ pollicis from sheath.
Tip: Both have sheaths covering and protecting the tendon
To test for DeQuervain’s Syndrome, bring the thumb into flexion and resist
Tip: Cup the thumb with the fingers and try and pull it out while resisting
What type of condition is DeQuervain’s syndrome?
Tip: This is an inflammation of the fluid-filled sheath