We're gonna talk about some osteopathic
manipulative interventions for the upper extremity
We're gonna start with some counterstrain
points which are easy ways
to treat dysfunction of the upper extremity.
A common one is the biceps and we're
gonna look at the counterstrain point
for the long head of the biceps which
comes up to the area of bicipital groove.
So if you can identify the bicipital
groove in the long head of the biceps,
you find out that there's an area
of tenderness or discomfort.
Does that hurt?
(it's okay) It's okay?
but we're gonna act out like it hurts
and treat this with a counterstrain point.
So what I'm gonna do is
take the point where it should be,
I'm gonna flex the elbow, supinate the
hand and then flex the shoulder as well.
Find where the pain goes away using some
internal rotation or external rotation
where the pain is gone, we'll hold it for 90 seconds.
Wait for the easing
and then we'll go ahead relax it
and see is it 70% better,
have we been effective.
That's the bicipital groove and
it's the long head of the biceps.
The next one is going to
be the superspinatous.
Just at the lateral aspect of the
scapula is the superspinatous
and the tender point is right over
here, sitting at the top groove.
And you find an area of tenderness
of laxity in the muscle.
And once you find that,
you can flex,
and externally rotate
in order to alleviate
that counterstrain point.
And again, once you have the point of
comfort, you have the pain going away,
the patient is much more comfortable,
you hold it for 90 seconds
and allow it to relax.
And the next counterstrain point
is going to be the radial head,
funny bone area.
So you wanna localize the area
and once you find the tender point of the radial head,
this is a hard once because you want to supinate
and extend it past baseline if you can.
Maybe somewhat tender but you wanna get
rid of the pain and that's gonna be hard.
So rotate, supinate and extend and
maybe even ABduct a little bit.
So that's gonna be over the radial
head, the lateral epicondyle.
Hold it for 90 seconds,
allow the pain to dissipate
and you're good.
If we're gonna look at
counterstrain points on the hand,
you're gonna have counterstrain points on
both the palmar and the dorsal aspect.
When you them on the palmar aspect,
you look at the wrist area,
you'll have four tender points along the
wrist, you'll have three right over here,
three on the thenar eminence
and then three along the
area along the hand.
You've got points along the base of the digits
and then two on each of
the digits as well.
If you find a tender point
and you wanna treat it,
you go ahead and when it's on the palmar
aspect of the hand, you're going to flex
and you can do some internal and external
deviation to get to point of comfort
and again you're gonna
hold it for 90 seconds,
waiting for the pain to ease and
the tender point to go away.
When you're dealing with
the dorsum of the hand,
again, four on the wrist area,
four at the base of the digits.
You're gonna go ahead and extend,
again with ulnar or radial deviation
until you get rid of the tender points,
holding it for 90 seconds,
waiting for the tender points to dissipate.
It's not uncommon to have
radial or ulnar deviation
and those can be treated with muscle energy.
Whereas if there is a radial
deviation, you're gonna go ahead and
push it in the area it wants to go
and then have the patient
push towards my hand.
Push for 3 seconds,
relax and then let it go a little bit further.
and relax until you get enhanced
motion and it does better
Those are some simple treatments
of the upper extremity.