med massage
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| 4 other names for thoracic outlet syndrome | brachial neuralgia, pectoralis minor syndrome, scalenus anticus, hyperabduction syndrome
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| definition of.. | neurovascular entrapment of brachial plexus
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| definition of.. | blood vessels running to or from arm are inpinged or impaired at thoracic outlet
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| location of.. | area behind clavicle between the insertion of trapezius and SCM
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| 3 causes of.. | drooping shoulders in poor posture, extra cervical rib, abnormal configuration of scalenus medius or anticus
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| 3 causes of.. | carcinoma of upper lobe of lung (pancoast's tumor), full abduction of upper extremity, hypertonic pectoralis minor or anterior & medial scalenes
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| 3 signs & symptoms | shooting pains, numbness, weakness
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| 3 signs & symptoms | tingling, pins & needles, coldness
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| worse during... | night, when lifts arm over head, after activities
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| treatment | massage to release hypertonic musculature & trigger points & strengthen weakened musculature. METs to stretch & strengthen where necessary
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| muscles involved | rotator cuff, erector spinae, pectoralis major & minor, scalenes
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| rotator cuff muscles-SITS | supraspinatus, infraspinatus, teres minor, subscapularis
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| supraspinatus-origin | supraspinous fossa of scapula
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| supraspinatus-insertion | greater tubercle of humerus (superior facet)
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| supraspinatus-action | initiates abduction of humerus, stabilizes head of humerus
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| infraspinatus-origin | infraspinous fossa of scapula
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| infraspinatus-insertion | greater tubercle of humerus (lateral side, middle facet)
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| infraspinatus-action | lateral rotation, extension of humerus
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| teres minor-origin | upper 2/3 of axillary border of scapula
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| teres minor-insertion | greater tubercle of humerus(inferior facet)
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| teres minor-action | lateral rotation, extension of humerus
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| subscapularis-origin | subscapular fossa of scapula
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| subscapularis-insertion | lesser tubercle of humerus
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| subscapularis-action | medial rotation & adduction of humerus
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| erector spinae muscles (3) | iliocostalis, longissimus, spinalis
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| iliocostalis-origin | lateral layer, thoracolumbar aponeurosis, posterior ribs
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| iliocostalis-insertion | posterior ribs, cervical transverse processes
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| iliocostalis-action bilaterally | extension of spine
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| iliocostalis-action unilaterally | lateral flexion of spine
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| longissimus-origin | middle layer, thoracolumbar aponeurosis, lumbar & thoracic transverse processes
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| longissimus-insertion | cervical & thoracic transverse processes, mastoid process
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| longissimus-action bilaterally | extension of spine
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| longissimus-action unilaterally | lateral flexion of spine
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| spinalis-origin | medial layer, ligamentum nuchae, cervical & thoracic spinous processes
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| spinalis-insertion | cervical & thoracic spinous processes, occipital bone
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| spinalis-action bilaterally | extension of spine
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| spinalis-action unilaterally | lateral flexion of spine
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| pectoralis major-origin clavicular head | medial half of clavicle
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| pectoralis major-origin sternal head | sternum, cartilages of upper 6 ribs
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| pectoralis major-insertion | lateral lip of bicipital (intertubercular) groove of humerus
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| pectoralis major-action | adduction, horizontal adduction & medial rotation of humerus
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| pectoralis major-action clavicular head | flexion of humerus
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| pectoralis major-action sternal head | extension of humerus from a flexed position
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| 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
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| palpation of supraspinatus | have client's arm by their side, have them abduct against resistance & feel supraspinatus contract
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| 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
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| 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
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| 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
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| palpation of teres minor | check position, ask client to laterally rotate their shoulder
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| palpation of subscapularis | supine-cradle arm in flexed position, slowly sink your thumbpad onto subscapular fossa, adjust arm & scapula as you progress
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| palpation of subscapularis | check position, ask client to medially rotate arm
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| 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
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| 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
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| 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
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| 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
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| 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
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| palpation of pectoralis minor | check position, ask client to depress scapula, bring shoulder down toward hip
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| 1 special test | hyperabduction test
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| hyperabduction test | reason:numbness, tingling down arm- position:sitting- procedure:client abducts & externally rotates arms & holds this position for one minute
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| hyperabduction test | positive results: pain, numbness, tingling down arm- indicates: possible thoracic outlet syndrome (pressure on brachial plexus)
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| scalenes | (blank)
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| scalenes-origin anterior | transverse processes of cervical vertebrae C3-C6
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| scalenes-origin medius | transverse processes of cervical vertebrae C2-C7
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| scalenes-origin posterior | transverse processes of cervical vertebrae C4-C6
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| scalenes-insertion anterior & medius | to 1st rib
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| scalenes-insertion posterior | to 2nd rib
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| scalenes-action bilaterally | raise first 2 ribs during forced inspiration "or" assist neck flexion
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| scalenes-action unilaterally | assists in lateral flexion of head to same side
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| scalenes | brachial plexus passes between the anterior scalenus & middle scalenus
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| 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
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| palpation of scalenes | with the flat of your hand, use gentle pressure to palpate stringy superficial muscle bellies in this triangle
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| strokes & techniques | static compression, longitudinal stripping, sustained pulling, holding, release trigger points, myofascial release
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| METs | contract relax: relax hypertonic muscle- pulse muscle energy: relaxation of hypertonic muscle- proprioceptive neuromuscular facilitation: strengthen weaken muscle
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| contract relax MET | pects -
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| pulse muscle energy MET | (blank)
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| proprioceptive neuromuscular facilitation MET | (blank)
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