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ITM thoracic outlet
med massage
| Question | Answer |
|---|---|
| 4 other names for thoracic outlet syndrome | brachial neuralgia, pectoralis minor syndrome, scalenus anticus, hyperabduction syndrome |
| definition of.. | neurovascular entrapment of brachial plexus |
| definition of.. | blood vessels running to or from arm are inpinged or impaired at thoracic outlet |
| location of.. | area behind clavicle between the insertion of trapezius and SCM |
| 3 causes of.. | drooping shoulders in poor posture, extra cervical rib, abnormal configuration of scalenus medius or anticus |
| 3 causes of.. | carcinoma of upper lobe of lung (pancoast's tumor), full abduction of upper extremity, hypertonic pectoralis minor or anterior & medial scalenes |
| 3 signs & symptoms | shooting pains, numbness, weakness |
| 3 signs & symptoms | tingling, pins & needles, coldness |
| worse during... | night, when lifts arm over head, after activities |
| treatment | massage to release hypertonic musculature & trigger points & strengthen weakened musculature. METs to stretch & strengthen where necessary |
| muscles involved | rotator cuff, erector spinae, pectoralis major & minor, scalenes |
| rotator cuff muscles-SITS | supraspinatus, infraspinatus, teres minor, subscapularis |
| supraspinatus-origin | supraspinous fossa of scapula |
| supraspinatus-insertion | greater tubercle of humerus (superior facet) |
| supraspinatus-action | initiates abduction of humerus, stabilizes head of humerus |
| infraspinatus-origin | infraspinous fossa of scapula |
| infraspinatus-insertion | greater tubercle of humerus (lateral side, middle facet) |
| infraspinatus-action | lateral rotation, extension of humerus |
| teres minor-origin | upper 2/3 of axillary border of scapula |
| teres minor-insertion | greater tubercle of humerus(inferior facet) |
| teres minor-action | lateral rotation, extension of humerus |
| subscapularis-origin | subscapular fossa of scapula |
| subscapularis-insertion | lesser tubercle of humerus |
| subscapularis-action | medial rotation & adduction of humerus |
| erector spinae muscles (3) | iliocostalis, longissimus, spinalis |
| iliocostalis-origin | lateral layer, thoracolumbar aponeurosis, posterior ribs |
| iliocostalis-insertion | posterior ribs, cervical transverse processes |
| iliocostalis-action bilaterally | extension of spine |
| iliocostalis-action unilaterally | lateral flexion of spine |
| longissimus-origin | middle layer, thoracolumbar aponeurosis, lumbar & thoracic transverse processes |
| longissimus-insertion | cervical & thoracic transverse processes, mastoid process |
| longissimus-action bilaterally | extension of spine |
| longissimus-action unilaterally | lateral flexion of spine |
| spinalis-origin | medial layer, ligamentum nuchae, cervical & thoracic spinous processes |
| spinalis-insertion | cervical & thoracic spinous processes, occipital bone |
| spinalis-action bilaterally | extension of spine |
| spinalis-action unilaterally | lateral flexion of spine |
| pectoralis major-origin clavicular head | medial half of clavicle |
| pectoralis major-origin sternal head | sternum, cartilages of upper 6 ribs |
| pectoralis major-insertion | lateral lip of bicipital (intertubercular) groove of humerus |
| pectoralis major-action | adduction, horizontal adduction & medial rotation of humerus |
| pectoralis major-action clavicular head | flexion of humerus |
| pectoralis major-action sternal head | extension of humerus from a flexed position |
| palpation of supraspinatus | prone-locate spine of scapula, slide fingers up into supraspinous fossa, palpate thru trapezius onto fibers of supraspinatus,(fibers run parallel to spine), follow belly laterally until it tucks under acromion |
| palpation of supraspinatus | have client's arm by their side, have them abduct against resistance & feel supraspinatus contract |
| palpation of infraspinatus | prone-forearm off table, locate spine, axillary border & vertebral border of scapula,form a triangle around infraspinatus by laying a finger along each of these landmarks |
| palpation of infraspinatus | palpate in the triangle & strum across fibers, check position, with forearm off side of table, ask client to alternately raise their elbow one inch toward ceiling & relax, should feel muscle contract |
| palpation of teres minor | prone-arm off side of table, locate superior axillary border of scapula, slide off laterally onto teres minor, compress into & across its tube-shaped belly, reach up & grasp belly |
| palpation of teres minor | check position, ask client to laterally rotate their shoulder |
| palpation of subscapularis | supine-cradle arm in flexed position, slowly sink your thumbpad onto subscapular fossa, adjust arm & scapula as you progress |
| palpation of subscapularis | check position, ask client to medially rotate arm |
| palpation of erector spinae | prone-lay both hands along either side of lumbar vertebrae, locate region of lower erector spinae by having client alternately raise & lower their feet slightly, notice strong, round erector fibers tighten & relax |
| palpation of erector spinae | as your client continues this action palpate inferiorly onto sacrum & then superiorly along throacic vertebrae, with client relaxed, sink your fingers into erector fibers, feel their ropy texture & vertical fiber direction |
| palpation of pectoralis major | supine-arm abducted, sit facing client, locate medial shaft of clavicle & move inferiorly onto clavicular fibers, follow fibers laterally as they blend with deltoid & attach to greater tubercle |
| palpation of pectoralis major | grasp belly of muscle by sinking your thumb into axilla, ask client to medially rotate shoulder, note contraction of pectoralis major |
| palpation of pectoralis minor | supine- arm abducted & place thumb on lateral edge of pectoralis major, slowly & gently slide your thumb under pect. major along surface of ribs,, your will come in contact with the side of pectoralis minor |
| palpation of pectoralis minor | check position, ask client to depress scapula, bring shoulder down toward hip |
| 1 special test | hyperabduction test |
| hyperabduction test | reason:numbness, tingling down arm- position:sitting- procedure:client abducts & externally rotates arms & holds this position for one minute |
| hyperabduction test | positive results: pain, numbness, tingling down arm- indicates: possible thoracic outlet syndrome (pressure on brachial plexus) |
| scalenes | (blank) |
| scalenes-origin anterior | transverse processes of cervical vertebrae C3-C6 |
| scalenes-origin medius | transverse processes of cervical vertebrae C2-C7 |
| scalenes-origin posterior | transverse processes of cervical vertebrae C4-C6 |
| scalenes-insertion anterior & medius | to 1st rib |
| scalenes-insertion posterior | to 2nd rib |
| scalenes-action bilaterally | raise first 2 ribs during forced inspiration "or" assist neck flexion |
| scalenes-action unilaterally | assists in lateral flexion of head to same side |
| scalenes | brachial plexus passes between the anterior scalenus & middle scalenus |
| palpation of scalenes | supine-stand at the head of table, cradle head, passively flex it, lay your fingerpads along anterior & lateral sides of neck between SCM & trapezius |
| palpation of scalenes | with the flat of your hand, use gentle pressure to palpate stringy superficial muscle bellies in this triangle |
| strokes & techniques | static compression, longitudinal stripping, sustained pulling, holding, release trigger points, myofascial release |
| METs | contract relax: relax hypertonic muscle- pulse muscle energy: relaxation of hypertonic muscle- proprioceptive neuromuscular facilitation: strengthen weaken muscle |
| contract relax MET | pects - |
| pulse muscle energy MET | (blank) |
| proprioceptive neuromuscular facilitation MET | (blank) |
Created by:
mjjjmom
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