Upper limb counterstrain
Page created: March 04, 2021
Upper limb counterstrain
Chronic Week 1
Chronic Week 1
Down syndrome (Trisomy 21)
Galactosemia
Tay-Sachs disease (NORD)
Mucopolysaccharide storage disease type 1 (Hurler syndrome) (NORD)
Phenylketonuria (NORD)
Phenylketonuria (NORD): Year of the Zebra
Classical homocystinuria (NORD)
Homocystinuria
Glycogen storage disease type II (NORD)
Hypertrophic cardiomyopathy
Abnormal heart sounds
Normal heart sounds
Development of the cardiovascular system
Fetal circulation
Aortic valve disease
Mitral valve disease
Pulmonary valve disease
Tricuspid valve disease
Valvular heart disease: Pathology review
Cyanotic congenital heart defects: Pathology review
Acyanotic congenital heart defects: Pathology review
Atrial septal defect
Ventricular septal defect
Patent ductus arteriosus
Coarctation of the aorta
Cardiomyopathies: Pathology review
Approach to cyanosis (newborn): Clinical sciences
Aortic dissections and aneurysms: Pathology review
Peripheral artery disease
Peripheral artery disease: Pathology review
Vasculitis
Vasculitis: Pathology review
Deep vein thrombosis and pulmonary embolism: Pathology review
Raynaud phenomenon
Fryette laws
Diagnosing cervical somatic dysfunction
Spurling test
Cervical spine counterstrain
Cervical spine facilitated positional release
Cervical spine HVLA
Cervical muscle energy treatment
Cervical spine myofascial release
Other cervical spine treatments
Diagnosing lower limb somatic dysfunction
Special tests for the lower limb
Lower limb counterstrain
Lower limb HVLA
Lower limb muscle energy treatment
Lower limb myofascial release
Other lower limb treatments
Diagnosing lumbar spine somatic dysfunction
Lumbar muscle energy treatment
Lumbar spine counterstrain
Lumbar spine facilitated positional release
Lumbar spine HVLA
Lumbar spine myofascial release
Other lumbar spine treatments
Cranial osteopathy: Cranial nerves
Primary respiratory mechanism
Diagnosing cranial somatic dysfunction
Cranial treatments
Diagnosing pelvis somatic dysfunction
Pelvis counterstrain
Pelvis muscle energy treatment
Other pelvis treatments
Diagnosing rib somatic dysfunction
Rib counterstrain
Rib HVLA
Muscle energy for rib somatic dysfunction
Other rib treatments
Diagnosing sacral somatic dysfunction
Sacrum counterstrain
Sacrum muscle energy treatment
Sacrum myofascial release
Diagnosing thoracic spine somatic dysfunction
Thoracic spine counterstrain
Thoracic spine facilitated positional release
Thoracic spine HVLA
Thoracic muscle energy treatment
Thoracic spine myofascial release
Other thoracic spine treatments
Diagnosing upper limb somatic dysfunction
Special tests for the upper limb
Upper limb counterstrain
Upper limb HVLA
Upper limb muscle energy treatment
Upper limb myofascial release
Other upper limb treatments
Angina pectoris
Stable angina
Coronary artery disease: Clinical sciences
Coronary artery disease: Pathology review
Heart failure
Heart failure: Pathology review
Congestive heart failure: Clinical sciences
Dilated cardiomyopathy
Restrictive cardiomyopathy
ACE inhibitors, ARBs and direct renin inhibitors
Adrenergic antagonists: Beta blockers
Calcium channel blockers
Thiazide and thiazide-like diuretics
Loop diuretics
Potassium sparing diuretics
cGMP mediated smooth muscle vasodilators
Lipid-lowering medications: Statins
Cardiac conduction velocity
Cardiac conduction system
ECG basics
ECG normal sinus rhythm
ECG intervals
ECG QRS transition
ECG axis
ECG rate and rhythm
ECG cardiac infarction and ischemia
ECG cardiac hypertrophy and enlargement
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.