| ___________ daily headaches tend to have accompanying shoulder &
periscapular pain. | Chronic daily |
| ___________ headaches may have associated neck & shoulder pain. | Cerviogenic & spinally mediated |
| In tension tension headaches, if the ___________ muscle is affected with trigger points, client may experience nausea, vertigo & tinnitus.
This can happen at the same time as characteristic muscle tenderness & stiffness, hypertonicity in the affected muscles& loss of appetite. | Sternocleidomastoid (SCM) |
| What are 3 causes of Tension headaches? | Stress, fatigue, common cold, hypoglycemia (low blood sugar) & poor
posture or decease in ROM of the head & neck.
Infections such as herpes simplex (shingles) or sinusitus can perpetuate trigger points, as well. |
| What's typically the best course of action for a tension headache, when applied to the shoulder muscles (for relief):
- Stretching and applied heat
- Resting the muscle and using cold
- There is no reason to treat the shoulders in a tension headache. | Stretching or heat applied to the shoulder muscles may help |
| Can a tension headache cause temporomandibular (TMJ) dysfunction? If so, why? | Yes. This is simply because many people clench their jaw and/or grind their teeth (usually when sleeping) when under stress (physical or mental). |
| True or False:
Only migraine-type headaches can cause postural dysfunction, not tension headaches. | False: tension headaches can cause postural dysfunction.
Migraine-type headaches were not discussed, in this regard, in this class. |
| True or false:
Long axis traction of the cervical spine is not recommended for tension headache treatments. | False. It is recommended, as it is a gentile technique. |
| Which is best when treating a headache sufferer, when applying directly to affected muscles:
a) Increasing blood flow via energizing active techniques, to increase blood flow and heartrate.
b) Relaxing soft tissue techniques, with light stretching of tendons. | B.
'A' may make it worse. |
| Is recommending massage, as a complimentary technique to your osteopathy, wise?
a) no, you may lose a patient.
b) yes, because it will help them relax.
c) no, you only ever need osteopathy. | B.
While osteopathy is wonderful, our #1 concern is our patient's wellness, not their money. Treating patients frequently, even with various practitioners helping, will help them get better more quickly, and reduce long term damage, in many cases. A tension headache often requires both physical and mental relaxation to improve most effectively. |
| What's my name?:
A group of disorders that occur when blood vessels or nerves in the space between your collarbone and your first rib (thoracic outlet) are compressed. This can cause pain in your shoulders and neck and numbness in your fingers. | Thoracic Outlet Syndrome (TOS) |
| The brachial plexus is composed of nerve roots _________ and provides
innervation to the entire upper limb. | C5-C8 & T1 |
| The syndrome causes neuropraxia, which is the loss of conduction at the
compression site. Symptoms include localized pain, sensory loss & motor
weakness. Vascular compression results in trophic (cellular health) changes in tissue | Thoracic Outlet Syndrome. |
| On your own body, point to the general area of the Thoracic Outlet. | Finger should be BELOW the collar bone, around the middle of a clavicle. |
| What's the most likely reason that this person develops thoracic outlet syndrome? | The thoracic outlet is possibly being compressed by the external pressure of the crutches under their armpits. |
| Can the sublaxation of a joint in the cervical spine cause thoracic outlet syndrome? | Yes, especially in whiplash cases. |
| What's one reason pregnancy may cause thoracic outlet syndrome? | Pregnancy causes a combination of 1) increased fluid retention &
2) postural changes, which can cause TOS. |
| In a patient with thoracic outlet syndrome, what are some physical indicators that you might notice, WITHOUT PALPATION? Name 2. | - drooping shoulders
- head forward-posture
- hyperkyphosis
- scoliosis.
- Finger flexors (Muscle wasting; various muscles in lower arm)
- Muscle Wasting in hands: Interossei muscles, Thenar, Hypothenar |
| In a patient with Thoracic Outlet Syndrome, will their fine motor functions be affected? | Yes |
| Thoracic outlet syndrome mainly affects what:
a) nerves
b) veins and arteries
c) both
d) all answers are correct | D) Technically, it can be any of these combinations, but C is also correct. |
| In Thoracic Outlet Syndrome, which is basically caused by nerve and/or blood supply restriction, is it likely that you will be able to palpate and trigger points, or to find muscle tenderness? | Most likely, yes. |
| Where might a Thoracic Outlet Syndrom Patient have fascial restrictions? | Anterolateral neck (mainly the neck muscles connected to the sternum and clavicle) , shoulder & upper arm.
These areas are pretty much all touching/part of the thoracic outlet. |
| Name 1 of the tests for Thoracic Outlet Syndrom. | Adosns test, Travells Variation, Scalene Cramp Test, Costoclavicular & Edens test, Wrights abduction, Pectoralis minor length test, Upper limb tension tests |
| Name a dfferentiating condition with arm conditions that might be confused with Thoracic Outlet Syndrome | Cervical spine spondylosis, cervical radiculopathy & cervical tumours.
Raynauds disease
Carpal Tunnel
Ulnar nerve compression at the elbow or at guyons canal at the wrist
Tendinitis of the rotator cuff and forearm muscles
Osteoarthritis in the glenohumeral joint |
| What's the main area you treat in Thoracic Outlet Syndrome? Name more than 1. | Treat the entire shoulder girdle & neck. Anterior & middle scalenes, Pectoralis major.
Bonus: Any postural contributors, and contributing structures. |
| Is it wise to increase circulation in the area of the Thoracic Outlet Syndrome? | Yes, in fact, it's necessary. |
| Name 1 thing to recommend to a Thoracic Outlet Syndrome patient that they should be doing on their own, during their treatment period. | • Stretch shortened muscles (SCM, scalenes, Pec Minor)
• Encourage relaxation
• Strengthen weak muscles – upper traps if shoulders drooping, rhomboids |
| Do not place _________ over neck or anterior chest if client has
hypertension or artherosclerosis in the neck vascular. Do not perform
muscle stripping or aggressive techniques in these circumstances | deep moist heat |
| True or False:
If a patient is taking Naproxen or Ibuprofen, because these are over the counter anti-inflammatories, it's okay to do frictions. | False: you should avoid frictions in this case. |
| In Thoracic Outlet Syndrome, when should you be particularly gentile? Name 1 reason. | Avoid aggressive mobilizations if degenerative disc disease, rheumatoid
arthritis or a cervical rib is present |
