Look for areas of hypersensitivity and tenderness that are likely to have a direct relationship to a somatic dysfunction of a nearby area. They are primarily based on the neuromuscular basis of somatic dysfunction in general. They come from an imbalance in the proprioceptive activity leading to a reflex tenderpoint and a secondary somatic dysfunction. Most of these are specifically located in a muscle body or near to the area of the body affected. There are several of them located along the sternocleidomastoid muscle that correspond to C2 to C6 spinal segments. Look also for tenderpoints linked to the supraspinatus muscle, the subscapularis muscle, the biceps brachii muscle, the rectus femoris muscle, and the gastrocnemius muscle, usually within the muscle belly or along one of the tendons. In looking for Jones CS tenderpoints, seek out dime-sized, tense, and fibrotic tender areas with much more tenderness perceived by the patient than can be explained by the pressure actually applied to the site. These tenderpoints will be consistent from one person to the next and are much like CRPs because the pain will not radiate. In treating these areas, place the patient in the position of greatest comfort. Use counterstrain in order to reduce the degree of tenderness by about two-thirds of the original tenderness. The patient is entirely passive during this treatment and is then returned to a neutral position.
MUSCULOSKELETAL TESTING You should know about the different musculoskeletal testing done in osteopathic manipulative medicine because these are commonly referred to during the Comlex-USA Level 3 examination. Some of these involve the upper extremities, while others involve the lower extremities. These are listed as follows: •
Adson Test—In the test, the radial pulse is palpated while the patient is asked to rotate and extend their head away from the side of their complaint. The patient then inhales and holds his breath. The test is repeated with the patient rotating and extending his head toward the side of the complaint. A positive finding
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