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TUINA IV - Coggle Diagram
TUINA IV
limping with weakness in thigh muscles
insidious pain or soreness in heel, sole of foot; worse w activity, better w rest
palpation: plantar fascia, calcaneus, triceps surae, gastrocs, soleus, achilles
plantar fasciitis/heel spur
warm-up: rolling, press-kneading, grasping, finger pressing, rubbing; specific: pushing towards toes, flick-poking, passive dorsiflexion, passive dorsiflexion + pushing; finishing: patting, rubbing
tests
Stretching Test of Plantar Fascia
(+) pain in plantar fascia
Resisted Plantar Flexion of Forefoot
(+) pain at posterior ankle
Achilles Tendonitis
(-)
swelling, visible gap in thigh muscle fibers
pain in thigh muscles
palpation: tenderness, swelling, ropey mass in thigh
tests
adductor longus
adductor brevis
pectineus
adductor strain
warm-up: rolling, rubbing, kneading, pressing, grasping; specific: flick-poking, 1-finger meditation, hold shaking
stretches: passive abduction with and without external rotation; pulling with external rotation (FABER)
adductor magnus
pain, swelling at knee joint
palpation: MCL/LCL, rupture, avulsion fracture
exams
Varus Test
LCL sprain/tear
Anterior Drawer Test
ACL sprain/tear
warm-up: kneading, 1-finger meditation w side of thumb, grasping pushing/pressing, rolling along GB/ST/SP; specific: scraping, flick-poking, 1-finger meditation in eyes of knee; finishing: scrubbing w medicated oil
Posterior Drawer Test
PCL sprain/tear
Valgus Test
MCL sprain/tear
atrophy of thenar eminence (chronic)
Hx of overuse
Hx of overuse of elbow
Hx of trauma to elbow
Cozen's Test (+) pain at lateral epicondyle
RROM: pronation & supination, wrist flexion & extension in neutral & ulnar deviation, finger flexion & extension
Medial Epicondylitis
warm-up: rolling, pressing, kneading, flick-poking, 1 finger meditation; specific: rotating & flick-poking, scrubbing w oil
swelling and radiation towards wrist
weakness or inability to flex/extend knee
hamstrings exams
Resisted Knee Flexion
Hamstrings Strain
warm-up: rolling, rubbing, kneading, grasping; specific: pulling w pushing (supine), pushing along hamstrings w extension (prone), bending w pushing (standing), flick-poking, 1-finger meditation; finishing: scrubbing, patting, hold-shaking
palpation: tender, swollen, ropey, weak, atrophy
quadriceps exams
Resisted Knee Extension
Thomas Test
Quadriceps Strain
warm-up: rolling, rubbing, kneading, grasping; specific: prone/lateral recumbent - pulling/stretching for upper and lower fibers, flick-poking, 1-finger meditation; finishing: scrubbing, patting, hold-shaking
iliopsoas strain indicated by thigh lifted off of table, external rotation of thigh
Active Straight Leg Raise
depression in tendons/ligaments of knee joint
weak, cold knees
pain underneath patella
Apley's Grinding Test/Patella Pressing Test
Patellar Chondromalacia
warm-up: rolling, grasping, pressing along SP/ST channels and patella, flick-poking, press-kneading on quads; specific: scraping under patella, pumping patella; finishing: scrubbing
Palpation: pressing pain around and underneath patella, patella may be off-center, possible atrophy of quadriceps femoris
Hx of Patellar Femoral Tracking Disorder
deep knee pain
temporary locking of knee joint or clicking in knee joint
palpation: pressing pain
Exams
Lateral Meniscus Test
Meniscus Tear
warm-up: rubbing, press kneading, grasping, kneading over the joint space, fossa, flick-poking; specific: scraping along knee joint, 1-finger meditation; traction, traction w rotation; finishing: scrubbing w medicated oil
Apley's Grinding Test/Patella Pressing Test
Meniscus Traction/Distractino
Medial Meniscus Test
gait change
swelling & dislocation of local & adjacent ankle areas
Hx of acute ankle injury
ankle pain
palpation
front of ankle ~GB40 = anterior talofibular ligament
ankle sprain
warm-up: rubbing, press-kneading, pushing; specific: flick-poking, 1 finger meditation, stretching with distraction, manipulatin of joint; finishing: scrubbing, patting
posterolateral side ~ BL 61 = posterior talofibular ligament
lateral side ~BL62 = calcaneofibular ligament
medial ~KI6 = medial collateral ligament
pain with inversion/eversion (+)
excessive ROM (+) for severed ligaments
X-ray will show fractures, dislocations, ligament sprains
limited ankle ROM secondary to pain
abnormal sensation, numbness, stabbing pain in thumb, index, middle and radial side of ring finger; worse at night and with increased hand temp; overwork will aggravate pain and cause radiation into arm (early stages)
hand/forearm parasthesia or pain, worse with wrist flexion and better with swinging the hand
cold sensation, purple color, difficulty with movement in hands & fingers
Phalen's Test (+) shooting pain/paresthesia
Reverse Phalen's Test (+) shooting pain/paresthesia
Tinel Test (+) shooting pain when tapping over carpal tunnel
Roos Test
(+) color change, pain, movement difficulty
(-) no change
Carpal Tunnel Syndrome
rolling, 1-finger meditation, pressing, press-kneading along PC channel, Traction w rotation, hold shaking, flexor digitorum stretch; scrubbing with oil
Eden's/Chest Thrust
(+) pulse change
(-) no change
Doorbell/Scalene pressing
(-) no change
(+) pain, shooting pain
Thoracic Outlet Syndrome
Wright's Test
(+) pulse change
(-) no change
Addson's/Reverse Addson's
(+) pulse change
(-) no change
Tinel's/Tapping on coracoid
(+) pain, radiating pain
(-) no pain
palpation
paresthesia
atrophy along median nerve
visual
atrophy
discoloratino of fingers
swelling at palmar wrist/palm
atrophy of greater thenar eminence, paralysis, decreased myodynamia, loss of sensation in thumb, index, middle and radial side of ring finger (late stages)
pain or swelling of palm
pain and/or difficulty w movement of wrist
median nerve compression
visual: depression at TB 4 when making a fist
Lunate Bone Subluxation
specific: rolling, pushing, press-kneading, grasping along forearm; stretches: traction with pressing supinated and pronated, NO hold shaking; finishing: scrubbing with oil
palpation: depression at TB 4, possible paresthesia
Longitudinal Tapping of 3rd Metacarpal Test (+) pain, weakness
depression or pain at TB 4
history of FOOSH injury
radial styloid process - tender & sore (acute)
thumb pain, radiating to elbows, weak, difficult to move (acute)
palpable firm mass over styloid process (chronic)
Finklestein's Test (+) pain
De Quervain's Tenosynovitis
warm-up: rolling, pressing, pushing, kneading, 1-finger meditation; specific: flick-poking on muscles, tendons, hard masses; finishing: scrubbing with oil
crepitus & swelling (chronic)
tender & sore at palmar MP & interphalangeal joints (acute)
stiff movement, worse in AM or after work (acute)
palpable, firm, masses over IP joints (chronic)
test: palpate for clicking at locations with masses, with extension & flexion
Trigger Finger
warm-up: rolling, pressing, pushing, kneading, 1-finger meditation; specific: flick-poking over muscles, tendons, hard masses, pulling finger, hold-twisting finger; finish: scrubbing w oil
fingers may lock or click (chronic)
pain around lateral epicondyle, worse w extension, lifting, pushing
pain around medial epidcondyle, worse w wrist flexion
Reverse Cozen's Test (+) pain at medial epicondyle
RROM: pronation & supination, wrist flexion & extension in neutral & ulnar deviation, finger flexion & extension
Lateral Epicondylitis
warm-up: rolling, pressing, kneading, flick-poking, 1-finger meditation; specific: rotating & flick-poking, scrubbing w oil
possible swelling at medial epicondyle