Precise knowledge of clinical anatomy and kinesiology, and orthopedic/myofascial palpation and inspection, and movement analysis skills, are all essential foundations for diagnosis, and for determining where--and where not--to needle.

This unique class prepares students to get the most from the Shoulder Arm Hand module & Review/Practicum Lab.

Clinical anatomy and the jing-jin ("sinew meridians" or myofascial tracts)

• We will improve our abilities to accurately locate key bony landmarks, muscles, tendons, joints, neural and vascular tissues, through palpation on ourselves and each other, and through review of clinical anatomy.
• Through palpation, observation and movement exercises, we will explore functions of key muscles and their jing-jin associations, as well as functional vs. dysfunctional movement patterns.
• We will review safety considerations, including needling angle and depth, to avoid injuring the many critical structures in this body region.

Enhanced orthopedic palpation and inspection skills

• We will enhance our abilities to feel different tissue types and layers: skin, fascia, muscle, nerve, blood vessel, and bone, with both our hands and needle-tip sensation.
• We will practice inspection and palpation for tissue abnormalities including myofascial trigger points, tendinopathies and joint disorders.

Review of anatomical structure and kinesiologic function

Shoulder Girdle

• Bony landmarks: be able to locate by palpation; know which muscles attach to them, if applicable
  • Clavicle
  • Scapula
    • Medial and lateral borders
    • Scapular spine and supraspinous fossa
    • Acromion
    • Coracoid process
  • Head and neck of humerus
    • Greater tubercle
    • Lesser tubercle
    • Deltoid tubercle
    • Bicipital groove
    • Radial sulcus
• 3 true synovial joints: be able to find the joint lines and ligaments by palpation
  • Gleno-humeral (GH): the shoulder joint proper.
    • Joint line: anterior, superior, posterior
  • Sterno-clavicular (SC): the sole point of attachment of the arm to the axial skeleton.
    • Joint line: anterior, superior
  • Acromio-clavicular (SC): attaches the clavicle to the scapula, and allows for rotation of the clavicle during scapular motion.
    • Joint line: anterior, lateral, superior
    • Be able to distinguish AC joint line from the superior aspect of the GH jointline by palpation
    • Coraco-clavicular ligaments
  • (The “scapulo-thoracic joint:” the scapula moves on the thorax and functions like a joint, but is a structurally a myofascial tissue plane, not a true joint.)

• Myofascial structures that move and stabilize the scapula and humerus, extending from the thoraco-lumbar fascia, lower trapezius, and latissimus dorsi, to cervical spine and occiput, to sternum, clavi-pectoral fascia and upper ribs, to the elbow joint and proximal forearm. Be able to locate by palpation; know attachments and primary functions
  • Rotator cuff
    • Core: supraspinatus, infraspinatus, teres minor, subscapularis
    • Accessory: long heads of biceps and triceps
  • Scapular movers and stabilizers
    • Pectoralis minor
    • Serratus anterior
    • Rhomboids
    • Trapezius: all three divisions
  • Arm movers
    • Biceps brachii, including bicipital tendon and transverse humeral ligament
    • Triceps brachii
    • Coracobrachialis
    • Pectoralis major divisions
    • Latissimus dorsi
    • Teres major
    • Deltoids: anterior, medial, posterior

• Neurovascular tracts and critical structures. Be able to locate by palpation

• • Subclavian artery
  • Brachial artery
  • Brachial plexus
  • (Lungs, relative to above structures; obviously, we don’t palpate these!)

Upper Arm and Elbow

• Bony landmarks: be able to locate by palpation; know which muscles attach to them, if applicable
  • Medial epicondyle
  • Olecranon
  • Lateral epicondyle
  • Radial head

• Joints: be able to find the joint lines and ligaments by palpation
  • Radio-humeral and radio-capitellar joints
  • Ulnar-humeral joint

• Myofascial structures that move and stabilize the elbow. Be able to locate by palpation; know attachments and primary functions

• • • Elbow flexors and extensors
      • Biceps brachii and aponeurosis
      • Brachialis
      • Brachioradialis
      • Triceps heads

• Neurovascular tracts and critical structures. Know pathways and be able to locate by palpation where superficial

• • Brachial neurovascular bundle (medial upper arm)

Forearm, Wrist, Hand, and Fingers

• Bony landmarks: be able to locate by palpation; know which muscles attach to them, if applicable
  • Radial styloid
    • Ulnar styloid
• Joints: be able to find the joint lines and ligaments by palpation
  • Wrist
    • Radio-carpal joint
    • Ulnar-carpal joint
    • Distal radio-ulnar joint
    • 1st carpo-metacarpal joint

• • Fingers
    • Metacarpo-phalangeal joint
    • Proximal interphalangeal joints
    • Distal interphalangeal joints

• Myofascial structures that move and stabilize the forearm, wrist and fingers. Be able to locate by palpation; know attachments and primary functions; know which are mono- vs. poly-articular muscles
  • Forearm
    • Supinator
    • Pronators teres and quadratus

• • Wrist and finger extensors
    • Extensors carpi radialis longus and brevis
    • Extensor digitorum
    • Extensors carpi ulnaris

• • Wrist and finger flexors
    • Flexors carpi ulnaris, radialis
    • Flexor digitorum superficialis and profundus
    • Flexor pollicis longus
    • Palmaris longus

• • Thumb
    • Abductor, adductor and opponens pollicis

• Neurovascular tracts and critical structures. Know pathways and be able to locate by palpation where superficial
  • Median nerve
  • Ulnar nerve
  • Radial nerve
  • Radial artery

Address root causes of musculoskeletal pain and disability with classically-based needling of joints and ligaments. This hands-on class provides essential knowledge, skills and protocols to treat a wide range of orthopedic conditions by stabilizing and mobilizing joints with acupuncture.

Joint dysfunctions are common but sometimes hidden causes of chronic pain and disability. Learn to integrate acupuncture techniques with contemporary orthopedic examination to decrease pain and restore normal functioning of the joints of the spine and extremities. Take home practical methods and strategies, including:

• Understanding Yin and Yang of joint anatomy, kinesiology, and the adverse effects of joint injuries on muscles, tendons, and the nervous system
• Learn history and physical exam techniques to identify joint mobility/stability dysfunctions, including:
  • Specialized inspection and palpation techniques for joints and ligaments
  • Joint active and passive range-of-motion and end-feel examinations
• Understand mechanisms and therapeutic effects of orthopedic acupuncture for joints
  
• Practice needling safety and techniques for hyPERmobile and hyPOmobile joints, including;
  
  • Shoulder, arm and hand: acromio- and sterno- clavicular, glenhumeral, ulnar- and radio- carpal; radio-ulnar; thumb CMC, MCP joints
  • Lower leg: knee ACL, MCL, LCL, meniscii, superior tib-fib; ankle anterior talofibular and calcaneofibular joints
  • Spine: cervical and lumbar facets; supraspinous, interspinous, iliolumbar, sacroiliac, and sacrotuberous ligaments
• Practice post-treatment joint re-assessment for immediate assessment of outcomes