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Principals

• Tmm involved - Diagnose muscles


• Diagnose Primary channels involved
• Tmm – Jing Well Point
• Guiding needle Primary channel – Shu Stream Point
• Tmm – Ashi Points, Triger Points, Cupping, EA
• Tmm - Tonify Yang – 77.02, 77.18
• Distal Needling - 3 zones – Anterior, Lateral, Posterior
• Local Blood letting.
• Local Cupping.

Supraspinatus
Action:
• Abduction of the humerus.
• The muscle is the main mover until
about 20–30° of abduction.

source: Joseph E. Muscolino The Muscle


and Bone Palpation

3 source: Jing Jin David Legge

1
Supraspinatus Clinical Features

• Pain often radiates to the deltoid region of


the shoulder, and distally down the arm.
• Tenderness with palpation in the in the
region of SI 12, Li-16, Li-15.
• Sudden sharp pain are diagnosed as
shoulder impingement syndrome.

Common Patient Complaints:


• Pain is commonly experienced when
putting arm into the sleeve of a coat or
reaching to the back seat of a car.
• Pain at night, especially while sleeping on
the affected.

Supraspinatus Injury

Characterized by:
• inflammation of the tendon
• possible strain or muscle tears at the
attachment to the humerus

Compression weakness
A lesion of the C5 root leads to weakness of
the supraspinatus and all the other shoulder
abductors

source: Joseph E. Muscolino The Muscle


and Bone Palpation

Shoulder Impingement Syndrome

• Sudden, sharp pain is due to shoulder


impingement syndrome.
• Occurs when the tendons of the rotator
cuff, along with the subacromial bursa,
become compressed against the acromion.

The "arch of pain“ Test


• patient stand with their arms adducted to
the side.
• The patient then slowly abducts the arm of
the injured shoulder.
• If pain occurs with active abduction during
the "arch" from approximately 70 to 110
degrees, the test is positive.

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Supraspinatus Test
• Length test - asked the patient to reach behind his back to touch the
opposite hip with to palm facing the back
• The abduction of the arm to 30%
• Champagne Toast Test - neutralizes the deltoid muscle - 30
degrees of flexion 30 degrees of abduction and external rotation
• Empty & Full Can Tests
• Palpating Supraspinatus Tendon – Hand behind the back

7 source: Hans Garten The Muscle Test Handbook. Functional Assessment,


Myofascial Trigger Points and Meridian Relationships-Churchill Livingstone
(2013)

Supraspinatus Triger Points

• Si-12
• Li-16
• Li-15

source: myofascial pain and dysfunction the trigger point manual

‫הספה של סרט וידאו‬

3
Local Blood letting

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Supraspinatus Treatment

• Tw-1 (Tmm)
• 77.24, 77.25
• 77.22, 77.23
• 77.18
• 88-01
• Jiān Níng + San Jian
• 11.06 (Piān Jiān - Divate shoulder)
• 44.06
• 22.04, Si-3 (guiding needle)
• Local Blood letting

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77.24 Foot Thousand Metal Zu Qian Jin 足千金穴


77.25 Foot Five Metal Zu Wu Jin 足五金穴
Location:
77.24 - ½ Cun lateral (posterior) and 2 Cun
inferior to CeXiaSanLi (77.23)
77.25 - Two Cun directly inferior to ZuQianJin
(77.24).

Indications:
• Acute enteritis, fish bone stuck in the
throat, pain in the shoulder and back,
• abscess in the throat, pharyngitis, tonsillitis
and thyroid enlargement.

Innervation:
Lung, Kidney and lateral side of the throat.

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77.18 Shen Guan - Kidney Gate

Location:
1.5 Cun inferior to Tian Huang (77.17).

Indications:
• Hyperchlorhydria, regurgitation, deviation of
the eyeball, astigmatism, anemia,
• epilepsy, neuropathy, pain in the
supraorbital bone, pain of the nasal bone
and dizziness.

Innervation:
Six Fu

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77.22 Ce San Li (Beside Three Mile) 侧三里穴


77.23 Ce Xia San Li (Beside Lower Three Mile) 侧下三里穴
Location:
77.22 - 1.5 Cun lateral to SiHuaShang (77.08).
77.23 - 2 Cun inferior to CeSanLi (77.22).

Indications:
• Toothache
• Facial paralysis.

Innervation:
Lung, Teeth

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88-01 Passing Through the Kidney Three Needles

Reaction Area: Kidney.

Indications
• Chronic nephritis, pyelonephritis, proteinuria,
cystitis, facial edema, systemic edema, edema
of the extremities.
• Kidney Depletion Dizzy Head’ (giddiness,
faintness, or lightheadedness), lumbalgia,
‘Kidney Viscus Nature Wind-Damp Disease’
(rheumatism), fatigue.
• diabetes mellitus, hypertension.
• impotence, premature ejaculation, strangury.
• metritis, reddish white leukorrhea.
• gastroenteritis, xerostomia, sore throat,
• shoulder pain.

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5
Sān Jiān (Stiff Shoulder) 三肩

Location:
3 points on the dorsal part of the hand, on
the Ulnar side of the first metacarpal bone.

Indications:
Frozen shoulder.
Shoulder blade pain.
Neck pain.

Jiān Níng 肩凝

Location:
On the radial side of the second
metatarsophalangeal joint

Indications:
Disorders of the Shoulder

11.06 Piān Jiān - Divate shoulder

Location:
On the ulnar side of the middle segment of the
ring finger, in the center between
the 2nd and 3rd finger creases

Indications:
Uterine pain, uterine tumor, metritis, irregular
menstruation, leucorrhea with reddish
discharge, tubal obstruction, retroversion of the
uterus, frequent urination, vaginal swelling,
frequent miscarriage.

Innervation:
Kidney, Liver

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44.06 Jian Zhong – Shoulder Center
Location:
On the lateral side of the humerus,
2.5 cun inferior to the acromion joint.

Indications:
• Knee pain (most effective)
• Dermatosis (most effective for skin
diseases in the neck region)
• Polio, hemiplegia
• Palpitations, arteriosclerosis
• Nose bleeding
• Shoulder pain

Innervation:
Heart
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Infraspinatus
Action:
• Lateral (external) rotation of the
humerus.
• Together with the teres minor it is
one of the few dorsally oriented
stabilizers of the head of the
humerus.

source: Joseph E. Muscolino The Muscle


and Bone Palpation

20 source: Jing Jin David Legge

Infraspinatus Clinical Features


• Pain often radiates to the deltoid region of
the shoulder, and distally down the arm.
• Tenderness with palpation in the in the
region of Si-11, or at the muscle-tendon
junction at Si-10, attachment of the tendon
near Tw-14.
• Pain and/or weakness with resisted
external rotation.
• The infraspinatus often accompanies other
rotator cuff injuries.

Common Patient Complaints:


Patient may report the feeling pain in the source:The Muscle Test Handbook
shoulder joint.

21

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Infraspinatus Test

• Hornblower’s Test
• Gunslinger Test - 45⁰

source: Hans Garten The Muscle Test Handbook. Functional Assessment,


Myofascial Trigger Points and Meridian Relationships-Churchill Livingstone
(2013)

22

Infraspinatus Triger Points

• Si-11 working the way


down with the fibers.
• Upper fibers below the
spine of scapula.
• Electrical stimulation:
Si-11, Si-10, Tw-14

source: myofascial pain and dysfunction the trigger point manual

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Infraspinatus Distal Points

• Si-1 (Tmm) the scapular aspect of the infraspinatus.


• Tw-1 the area of attachment to the humerus (Tw-14).
• 22.01,02
• 77.04, 77.03 (Bl-57).
• 77.18
• Jiān Níng
• 44-03L
• Local Blood letting
guiding needle
• Si-3.
• Tw-3 (the area of attachment to the humerus Tw-14).
24

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Teres minor
Action:
• Primarily a lateral rotation of the
humerus.
• A weak accessory effect of
adduction.

source: Joseph E. Muscolino The Muscle


and Bone Palpation

25 source: Jing Jin David Legge

Teres minor Clinical Features


• Pain often radiates to the later deltoid
region of the shoulder.
• Tenderness with palpation in the in the
region of Si-9.
• Pain and/or weakness with resisted
external rotation.

source:The Muscle Test Handbook


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Teres minor Test

• Hard to different between Infraspinatus and


Teres minor.
• Same test as Infraspinatus Test.

source: Hans Garten The Muscle Test Handbook. Functional Assessment,


Myofascial Trigger Points and Meridian Relationships-Churchill Livingstone
(2013)

27

9
Teres minor Triger Points

• Above Si-9.
• Electrical stimulation:
Si-9, Tw-14

source: myofascial pain and dysfunction the trigger point manual

28

Teres Major
Action:
Medial rotation, adduction and
extension of the humerus.

source: Joseph E. Muscolino The Muscle


and Bone Palpation

source: Jing Jin David Legge


29

Teres Major Clinical Features

• Involvement of the teres major muscle


is relatively uncommon.
• Trigger points in the teres major
muscle refer pain to the posterior
deltoid region.
• And over the long head of the triceps
brachii.

source:The Muscle Test Handbook


30

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Teres Major Test

source: Hans Garten The Muscle Test Handbook. Functional Assessment,


Myofascial Trigger Points and Meridian Relationships-Churchill Livingstone
(2013)

31

Teres minor Triger Points

• medial to Si-9.

source: myofascial pain and dysfunction the trigger point manual

source:The Muscle Test Handbook


32

Biceps Brachii

Action:
• Both divisions flex the elbow joint and
supinate the forearm.
• The long head aids in flexing the shoulder
joint and helps with abduction of the
humerus.
• the short head helps with adduction of the
humerus.

source: Joseph E. Muscolino The Muscle


and Bone Palpation

33 source: Jing Jin David Legge

11
Biceps Brachii Tendonitis Clinical Features

• Anterior shoulder pain


• Pain may radiate distally down the biceps
muscle toward the elbow
• Symptoms aggravated during exercise
• Symptoms relieved with rest
• May have "popping" or "snapping" in the
anterior shoulder
• Tendonitis is usually found at the bicepital
groove of the humerus
• Bicipital groove tenderness source: Everything You Need To Know - Dr. Nabil Ebraheim

• The groove is inferior and medial to the point


LI-15

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Biceps Brachii Test

Speed's Test

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Biceps Brachii Triger Points

• Long Head - Distal to Lu-4.

source:The Muscle Test Handbook source: myofascial pain and dysfunction the trigger point manual

36

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Biceps Brachii Points

• Lu-11 (Tmm)
• 77.09, 77.10
• 77.18
• Lu-5.
• Nei Jian + San Jian
• 11.08 Zhǐ Jīn
• 11.07 Zhǐ Sìmǎ
• 44-03L
guiding needle
• Lu-6.
• 22.04.
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77.09 Si Hua Zhong - Four Flowers Middle


Location:
Four and a half cun inferior to SiHuaShang
(77.08)

Indications:
• Asthma
• Eyeball problems
• Carditis, cardiovascular sclerosis, and
pain on both sides of the heart,
cardioplegia (feeling of suffocation and
discomfort)
• Acute gastric pain
• Swollen bones
• Shoulder pain

Innervation:
38
Lung, Heart

11.08 Zhi Wu Jin - Finger Five Metal

Location:
2 point group, evenly distributed on the
medial line of the dorsal proximal phalanx
of the index finger along the ulnar
margin of the phalangeal bone; on the
Large Intestine channel.

Indications:
• Enteritis
• Abdominal pain
• Fish bone stuck in the throat

Innervation:
Lung
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The tendon at the bicepital groove

• The bicepital groove usually lies between the


Lung and the Large Intestine meridians.
• This zone lies several centimeters distal and
slightly medial to LI-15.
• It may also be located several centimeters
superior and slightly lateral to Lu-3.
• Jian qian is the closest acupuncture point to
this injury site. (located halfway between the
anterior axillary fold and LI-15.

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Treatment of the tendon at the bicepital groove

• EA – two sets of paired points, inserted deeply


without piercing the ligament or the tendon and
its sheath.
• Cupping
• Blood letting
• Lu-1, Lu-2, Lu-3, Lu-4
• Li-15, Li-14, Jian qian.
• Pc-2

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Frozen Shoulder - Adhesive Capsulitis


• Inflammation and thickening of the shoulder capsule.
• May occur without any specific cause.
• May be triggered by a mild trauma to the shoulder.
• Loss of normal function occurs with both active and
passive movements.
• Dull, diffuse or aching pain in the shoulder

source: Everything You Need To Know - Dr. Nabil Ebraheim


The condition develops slowly:
1. Pain and freezing: pain worse at night, Increases with any movement, lasts
several months.
2. Stiffness or frozen: range of motion limited as pain is diminishing, may last up to 1
year.
3. Resolution: may begin to resolve over time, may last up to 3 years.

Conditions associated with frozen shoulder: diabetes, thyroid problems, auto immune
disease, stroke, rheumatoid arthritis, trauma, post surgery.

42

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Frozen Shoulder - Adhesive Capsulitis
Treatment
Li-1, Si-1, Tw-1 – blood letting - The TMM of the arm yang channels.

St-38
• Empirical Points
• The opposite side for acute symptoms, and the same side for chronic
symptoms. If results are not obtained, try the other side.
• Deep insertion towards Bl-57.

Zhong ping
1 cun distal and 1 cun lateral to St 36, between the Yang ming
and Shao yang channels.

TP – If necessary

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Frozen Shoulder - Adhesive Capsulitis


Treatment
• 77.09, 77.10.
• 77.18, 77.21
• 22-06
• San jian, Nei jian.
• Jian liu
• Blood letting local and Lu5 area
• cupping

44

Deltoid

45 source: myofascial pain and dysfunction the trigger point manual

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46

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