Upper limb counterstrain
Notes
Upper limbs
Upper limb counterstrain
| SHOULDER | ||
| TENDER POINT | ANATOMICAL POSITION | TREATMENT POSITION |
| Levator scapulae | On the superomedial border of the scapula, at the attachment of levator scapulae | Abduct slightly, internally rotate, and add traction (Abd IR traction) |
| Supraspinatus | In the muscle belly of supraspinatus | Flex to ~90º, abduct and internally rotate the shoulder (F Abd IR) |
| Infraspinatus | Upper: posteromedial aspect of glenohumeral joint Lower: in the middle of the muscle belly of infraspinatus | Flex to ~120º, abduct and externally rotate (can also internally rotate for upper point) (F Abd IR) |
| Subscapularis | Anterolateral border of the scapula (in the anterior axilla), push posteriorly and medially to locate it | Extend and internally rotate the shoulder (E IR) |
ELBOW | ||
| TENDER POINT | ANATOMICAL POSITION | TREATMENT POSITION |
| Radial head (Supinator) | Anterolateral aspect of radial head | Place patient’s elbow over knee (palm up) to induce extension and supination, then add valgus stress (E Sup Val) |
| Medial epicondyle (Pronator teres) | At medial epicondyle | Flex elbow, pronate and adduct forearm (F Pro Add) |
Figure 1. Upper limb counterstrain tender points. On left: posterior view of the right shoulder. On right: anterior view of the left forearm.
HAND AND WRIST | ||
| TENDER POINT | ANATOMICAL POSITION | TREATMENT POSITION |
| Dorsal wrist (Extensor carpi radialis) | Dorsal surface of 2nd metacarpal | Extend and abduct wrist |
| Dorsal wrist (Extensor carpi ulnaris) | Dorsal surface of 5th metacarpal | Extend and adduct wrist |
| Palmar wrist (Flexor carpi radialis) | Palmar base of 2nd / 3rd metacarpal | Flex and abduct wrist |
| Palmar wrist (Flexor carpi ulnaris) | Palmar base of 5th metacarpal | Flex and adduct wrist |
| First metacarpal (Abductor pollicis brevis) | Palmar base of 1st metacarpal | Flex wrist and abduct thumb |
Author: Arman Israelyan, OMS-III
Editor: Matt Lipinski, DO
Illustrator: Aileen Lin, MScBMC
Editor: Robyn Hughes, MScBMC
Key Takeaways
Upper limb counterstain is a manual therapy technique used to alleviate pain and dysfunction in the upper extremities, including the shoulder, elbow, wrist, and hand. It involves gentle manipulation of the affected area, intending to reduce muscle tension and restore normal joint motion.