Chapter 011 Unwinding the Soft Tissue of the Forearm: Dimensional Massage

Chapter 011 Unwinding the Soft Tissue of the Forearm: Dimensional Massage...

True / False Questions

1. The entire kinetic chain of the upper extremity provides the body with the mechanism to utilize the hand and wrist to their maximum capacities.
True False

2. An adhesion is a type of band aid used in first aid.
True False

3. There is always inflammation present at the injury site for tendonosis.
True False

4. A wrist ganglion is a cyst that usually protrudes on the dorsal side of the wrist.
True False

5. The median nerve can be entrapped by the supinator and be a causal factor of carpal tunnel syndrome.
True False

6. Entrapment of the radial nerve in the triceps can translate to decreased innervation, inadequate ability to apply pressure between the thumb and the index finger, and painful sensations.
True False

7. Posture and sleep positions have no affect on nerve complaints in the distal upper extremities.
True False

8. Subluxated vertebrae called by chiropractors to be articular surfaces that are out of alignment.
True False

9. If the massage therapist suspects any cervical involvement and or nerve/compression, it is appropriate to refer to appropriate health professional.
True False

10. Muscles that may be involved in the lateral epicondyle problem area would be the triceps brachii, brachioradialis, pronator teres, flexor carpi radialis, and anconeus.
True False

Multiple Choice Questions

11. The carpal tunnel provides a way for __________ tendons to reach the hand and fingers.
A. 8
B. 6
C. 10
D. 11

12. Injuries that tear tissue, ligaments, and bruise nerves are called ____________.
A. strains
B. sprains
C. hernias
D. fractures

13. An inflammation of a tendon sheath can cause
A. strains.
B. sprains.
C. tendonosis.
D. tenosynovitis.

14. Dupuytren's contracture is a debilitating hand condition that
A. goes away easily.
B. can inhibit normal hand and finger function.
C. limits only the first finger.
D. is guaranteed to be fixed by massage therapy.

15. Dupuytren's contracture is a pathological condition that involves the palmar aponeurosis or fascia and nodules that develop in the fibrous tissue that can cause permanent flexion in
A. 4th or 5th fingers in one or both hands.
B. 1st finger in one or both hands.
C. the knuckles.
D. 2nd finger in one or both hands.

16. Conservative measures for carpal tunnel syndrome include
A. surgery of the flexor retinaculum.
B. releasing soft-tissue entrapment, bracing, and correcting sleep postures.
C. corticosteroids.
D. removal of the first rib.

17. Inflammation of a joint common in the aging process is called
A. spurs.
B. strains.
C. arthritis.
D. sprains.

18. Osteoarthritis is
A. a degenerative joint disease.
B. a sprained ankle.
C. a torn tissue.
D. not an aging problem.

19. Bony growths on the sides of the vertebrae are called
A. sprains.
B. strains.
C. subluxations.
D. spurs.

20. Sleeping with the upper extremity above the head can help the _________ entrap the brachial plexus.
A. serratus anterior
B. coracobrachialis
C. pectoralis minor
D. pectoralis major

21. Thin connective tissue that surrounds a group of tendons is called a
A. ganglion
B. tendon sheath
C. tendonitis
D. tenosynovitis

22. Collagen is made up of mostly
A. protein.
B. cytoplasm.
C. adipose tissue.
D. unsaturated fatty acids.

23. Injuries to soft tissue such as a stretch or tear of a tendon or muscle is called a
A. sprain.
B. fracture.
C. strain.
D. tenosynovitis.

24. An injury where there is a "fray" in the white fibers of collagen is called
A. tendonitis.
B. tenosynovitis.
C. sprain.
D. tendonosis.

25. In ulnar nerve transposition, the
A. massage therapist treats the ulnar nerve.
B. surgeon reroutes the ulnar nerve.
C. physical therapist exercises the ulnar nerve.
D. acupuncturist needles the ulnar nerve.

26. The depletion of the space between the vertebrae is called
A. herniated disk.
B. slipped disk.
C. degenerative disk disease.
D. vertebral disk.

27. The worse case scenario for tendonitis might be a _______________.
A. periosteal tear or avulsion
B. simple lesion in the tendon
C. fracture
D. lesion in the muscle tissue

28. An inappropriate technique to start treatment with on the forearm would be ________.
A. effleurage
B. compression
C. stripping
D. elliptical movement

29. A technique that will mobilize the radioulnar joint and affect muscles attaching to the interosseus membrane is
A. effleurage.
B. compressive effleurage.
C. petrissage.
D. elliptical movement.

30. What area of the body should you begin treatment for a forearm, hand, and wrist problem?
A. Start on the trunk.
B. Start on the shoulder girdle region.
C. Start on the lower extremities first.
D. Start on the problem forearm muscles.

31. A large muscle on the forearm that should be treated first in a sequence for forearm issues is the
A. flexor carpi radialis.
B. extensor carpi radialis.
C. brachioradialis.
D. extensor digitorum.

Fill in the Blank Questions

32. ____________________ techniques increase the neuromuscular mechanisms in the tissues and reinforce movement patterns.
________________________________________

33. Be careful of the ____________ muscles when you are stripping tendons on the dorsal side of the forearm.
________________________________________

34. Do not _____________ sore areas.
________________________________________

35. _________________ muscles whenever possible with techniques to decrease tension.
________________________________________

36. To jostle the brachioradialis, slightly _________ the elbow joint, pick the muscle tissue up and jostle it toward the ______________.
________________________________________

37. For compressive effleurage of the forearm muscles the therapist must use his _____________ and ____________ with soft compressive hands and stroke toward the elbow joint.
________________________________________

38. A dual hand distraction technique for the medial epicondyle muscles is the ____________ twist.
________________________________________

39. The structure that covers the extensor and flexor tendons entering the hand and wrist is the ____________.
________________________________________

40. It is ______________ to work over the flexor retinaculum with a client who has a diagnosis of carpal tunnel syndrome.
________________________________________

41. Dupuytren's contracture is named for the French surgeon, __________________.
________________________________________

42. Some of the causes of carpal tunnel syndrome include _____________, ___________, and _________________. (Give at least three.)
________________________________________

43. Muscles that might be included in a medial epicondyle pathology or condition are ____________________, ______________, and ________________. (Name three.)
________________________________________

44. Muscles that might be included in a lateral epicondyle pathology or condition are ___________, ____________, and __________________. (Name three.)
________________________________________

45. If attachments of tendons in the medial or lateral epicondyle areas are too acute or subacute, the therapist might need to use ___________ first.
________________________________________

46. The _____________ nerve could be entrapped by the supinator or by triceps brachii.
________________________________________

47. When appropriate techniques that could be used at tendon attachments include ____________, _____________, and ______________. (Name three.)
________________________________________

48. Active engagement techniques include broadening while _________________ the muscles.
________________________________________

49. Active engagement techniques include ________________ while lengthening the tissues.
________________________________________

50. The therapist's purpose is to _________________, ________________, and ______________. (Name three.)
________________________________________

51. It is better to use _________ hands and __________ into tissues instead of _______ into them.
________________________________________

11-1

Chapter 011 Unwinding the Soft Tissue of the Forearm: Dimensional Massage... Key

True / False Questions

1. The entire kinetic chain of the upper extremity provides the body with the mechanism to utilize the hand and wrist to their maximum capacities.
TRUE

Bloom's: Application
Bloom's: Comprehension
Bloom's: Knowledge
Difficulty: Medium
Learning Outcome: 11-10

2. An adhesion is a type of band aid used in first aid.
FALSE

An adhesion is scar tissue that may or may not be painful.

Bloom's: Knowledge
Difficulty: Easy
Learning Outcome: 11-1

3. There is always inflammation present at the injury site for tendonosis.
FALSE

Inflammation is unlikely to be present at the injury site if the condition is tendonosis.

Bloom's: Application
Bloom's: Comprehension
Bloom's: Knowledge
Difficulty: Medium
Learning Outcome: 11-6

4. A wrist ganglion is a cyst that usually protrudes on the dorsal side of the wrist.
TRUE

Bloom's: Knowledge
Difficulty: Easy
Learning Outcome: 11-1
Learning Outcome: 11-6

5. The median nerve can be entrapped by the supinator and be a causal factor of carpal tunnel syndrome.
FALSE

Bloom's: Application
Bloom's: Comprehension
Bloom's: Knowledge
Difficulty: Medium
Learning Outcome: 11-2
Learning Outcome: 11-4
Learning Outcome: 11-6

6. Entrapment of the radial nerve in the triceps can translate to decreased innervation, inadequate ability to apply pressure between the thumb and the index finger, and painful sensations.
TRUE

Bloom's: Application
Bloom's: Comprehension
Bloom's: Knowledge
Difficulty: Medium
Learning Outcome: 11-2
Learning Outcome: 11-6

7. Posture and sleep positions have no affect on nerve complaints in the distal upper extremities.
FALSE

Posture and sleep positions may contribute to nerve complaints and soft tissue problems in the forearms, hands, and wrists.

Bloom's: Application
Bloom's: Comprehension
Bloom's: Knowledge
Difficulty: Medium
Learning Outcome: 11-3
Learning Outcome: 11-6

8. Subluxated vertebrae called by chiropractors to be articular surfaces that are out of alignment.
TRUE

Bloom's: Application
Bloom's: Comprehension
Bloom's: Knowledge
Difficulty: Medium
Learning Outcome: 11-1
Learning Outcome: 11-2
Learning Outcome: 11-5
Learning Outcome: 11-6

9. If the massage therapist suspects any cervical involvement and or nerve/compression, it is appropriate to refer to appropriate health professional.
TRUE

Bloom's: Application
Bloom's: Comprehension
Bloom's: Knowledge
Difficulty: Medium
Learning Outcome: 11-2
Learning Outcome: 11-5
Learning Outcome: 11-6

10. Muscles that may be involved in the lateral epicondyle problem area would be the triceps brachii, brachioradialis, pronator teres, flexor carpi radialis, and anconeus.
FALSE

The pronator teres and flexor carpi radialis are medial epicondyle muscles.

Bloom's: Application
Bloom's: Comprehension
Bloom's: Knowledge
Difficulty: Medium
Learning Outcome: 11-6
Learning Outcome: 11-7

Multiple Choice Questions

11. The carpal tunnel provides a way for __________ tendons to reach the hand and fingers.
A. 8
B. 6
C. 10
D. 11

Flexors digitorum superficialis and profundus, abductor pollicis longus, and flexor carpi radialis add up to 10 tendons present in the carpal tunnel.

Bloom's: Application
Bloom's: Comprehension
Bloom's: Knowledge
Difficulty: Medium
Learning Outcome: 11-4
Learning Outcome: 11-6

12. Injuries that tear tissue, ligaments, and bruise nerves are called ____________.
A. strains
B. sprains
C. hernias
D. fractures

Sprains are injuries that tear tissue, damage ligaments, and bruise nerves. There are several levels of severity.

Bloom's: Application
Bloom's: Comprehension
Bloom's: Knowledge
Difficulty: Medium
Learning Outcome: 11-1
Learning Outcome: 11-6

13. An inflammation of a tendon sheath can cause
A. strains.
B. sprains.
C. tendonosis.
D. tenosynovitis.

Inflammation of the tendon sheath is defined as tenosynovitis.

Bloom's: Application
Bloom's: Comprehension
Bloom's: Knowledge
Difficulty: Medium
Learning Outcome: 11-1
Learning Outcome: 11-6

Dupuytren's contracture is a pathological condition that does inhibit normal hand and finger function. Often requiring surgery, it is not a soft tissue problem that massage therapy is a complete solution for. There are no guarantees.

Bloom's: Application
Bloom's: Comprehension
Bloom's: Knowledge
Difficulty: Medium
Learning Outcome: 11-1
Learning Outcome: 11-6

Dupuytren's contracture disables the ability of the client to extend the 4th and 5th fingers.

Bloom's: Application
Bloom's: Knowledge
Difficulty: Medium
Learning Outcome: 11-1
Learning Outcome: 11-6

Removal of the first rib is a surgical solution for thoracic outlet syndrome. Releasing soft-tissue entrapment, bracing, and correcting sleep postures are the only conservative measures in the list.

Bloom's: Application
Bloom's: Comprehension
Bloom's: Knowledge
Difficulty: Medium
Learning Outcome: 11-3
Learning Outcome: 11-4
Learning Outcome: 11-5
Learning Outcome: 11-6

17. Inflammation of a joint common in the aging process is called
A. spurs.
B. strains.
C. arthritis.
D. sprains.

Arthritis is inflammation of a joint.

Bloom's: Knowledge
Difficulty: Easy
Learning Outcome: 11-1
Learning Outcome: 11-6

18. Osteoarthritis is
A. a degenerative joint disease.
B. a sprained ankle.
C. a torn tissue.
D. not an aging problem.

Osteoarthritis is a degenerative joint disease that is often an aging issue.

Bloom's: Knowledge
Difficulty: Easy
Learning Outcome: 11-1
Learning Outcome: 11-6

19. Bony growths on the sides of the vertebrae are called
A. sprains.
B. strains.
C. subluxations.
D. spurs.

Spurs are osteoarthritis forming on the sides of the vertebrae. They are irregular and are often a response to an old injury.

Bloom's: Knowledge
Difficulty: Easy
Learning Outcome: 11-1
Learning Outcome: 11-2
Learning Outcome: 11-6

20. Sleeping with the upper extremity above the head can help the _________ entrap the brachial plexus.
A. serratus anterior
B. coracobrachialis
C. pectoralis minor
D. pectoralis major

Individuals who sleep with the upper extremity above his or her head often find that the extremity is so numb by morning it has to be brought down by the other extremity. The pectoralis minor can entrap the brachial plexus in this position above the head.

Bloom's: Application
Bloom's: Comprehension
Bloom's: Knowledge
Difficulty: Medium
Learning Outcome: 11-2
Learning Outcome: 11-3

21. Thin connective tissue that surrounds a group of tendons is called a
A. ganglion
B. tendon sheath
C. tendonitis
D. tenosynovitis

The thin sheath that surrounds tendons is called a tendon sheath.

Bloom's: Knowledge
Difficulty: Easy
Learning Outcome: 11-1
Learning Outcome: 11-6

22. Collagen is made up of mostly
A. protein.
B. cytoplasm.
C. adipose tissue.
D. unsaturated fatty acids.

Collagen fibers are made up of mostly protein.

Bloom's: Knowledge
Difficulty: Easy
Learning Outcome: 11-1
Learning Outcome: 11-6

23. Injuries to soft tissue such as a stretch or tear of a tendon or muscle is called a
A. sprain.
B. fracture.
C. strain.
D. tenosynovitis.

A strain is an injury to soft tissue, usually a tear or stretch to a tendon or to muscle tissue.

Bloom's: Knowledge
Difficulty: Easy
Learning Outcome: 11-1
Learning Outcome: 11-6

24. An injury where there is a "fray" in the white fibers of collagen is called
A. tendonitis.
B. tenosynovitis.
C. sprain.
D. tendonosis.

A tendonosis is a breakdown in the collagen fibers of the connective tissue.

Bloom's: Knowledge
Difficulty: Easy
Learning Outcome: 11-1
Learning Outcome: 11-6

Ulnar nerve transposition is a surgical procedure to reroute the ulnar nerve due to compression by its cubital tunnel.

Bloom's: Knowledge
Difficulty: Easy
Learning Outcome: 11-6

26. The depletion of the space between the vertebrae is called
A. herniated disk.
B. slipped disk.
C. degenerative disk disease.
D. vertebral disk.

Degenerative disk disease is the shrinking of the actual disk between the vertebrae.

Bloom's: Knowledge
Difficulty: Easy
Learning Outcome: 11-1
Learning Outcome: 11-6

27. The worse case scenario for tendonitis might be a _______________.
A. periosteal tear or avulsion
B. simple lesion in the tendon
C. fracture
D. lesion in the muscle tissue

From the above list a periosteal tear of the tendon from the bone needing diagnosis and appropriate clinical treatment.

Bloom's: Comprehension
Bloom's: Knowledge
Difficulty: Medium
Learning Outcome: 11-1
Learning Outcome: 11-6

28. An inappropriate technique to start treatment with on the forearm would be ________.
A. effleurage
B. compression
C. stripping
D. elliptical movement

Stripping is a specific treatment in a sequence used to push fluids. If the forearms muscles and tendons are too congested and hypertonic, the technique of stripping may be uncomfortable and not serve its purpose if used too soon in the treatment.