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Trigger Point Guide Theory

Karri Koivula

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Legal notices
Disclaimer

Huge effort is made that this book represents generally accepted medical practises and that
this information doesn’t pose a risks for anybody who uses it.

But it is very important that you realize that you read this book at your own risk.

All material provided in this e-book is for informational and educational purposes only, and not
to be construed as medical advice.

No action should be taken solely based on this e-book

Absolutely consult you physician before you take any actions related to your you health

By downloading/reading this book

You understand and agree that in no event shall the author nor the publisher of this e-book be liable
to you or any other user of this e-book for the use of the information.

Statements mentioned within this e-book are not intended to diagnose, treat, cure or prevent
any disease.

The statements made within this e-book have not been evaluated by the Food and Drug
Administration.

If you don’t understand or agree these terms then please quit reading this book right now and
delete this book from your computer.

Thanks.

Copyright notice

It’s illegal to copy any material from this book and distribute it.

I regularly search the internet for illegal copies.

And I will press criminal charges against those who illegally distribute it.

Copyright. 2004 Karri Koivula

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Start here
Foreword

The focus here is in practical advice.

The bottom line,

And all that matters,

Is that trigger points cause referred pain,

And that they “relax” trough massage.

And that the pain symptoms they cause will vanish along them…

Call to action

Read some theory below then go to the pain patterns section and…

Look at the body part pictures and try to pin point your pain, then look at the muscle pain index and
see which muscles are generally involved.

Then go to work, use the side menu to easily jump to what ever muscles you need to massage, and
use the pictures and written guidelines if any to get the job done.

Theory section starts


Trigger points are hyper contracted bundles of muscle cells. Also because of this contraction there
are taut bands of stretched muscle attached to these contraction knots that run to both directions and
end up in the muscles attachments points.

Putting pressure on the trigger point will eventually make them relax.

Even pressing at the taut band can make this happen as it forces a stretch to the contracted knots
that are in the center.

But for best effect you want to aim center.

you’ll locate the center/trigger point by its pressure tenderness, pressing it moderate/hard force
should cause noticeable pain both ate the spot and in the pain referral zone.

You can test this by pressing a spot few centimetres of the spot, and see that you can barely feel the
pressing.

Normal muscle tissue can take a lot of force applied to it; until you start to feel even slight
discomfort.

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Trigger point identification -important
Pressure tender spot

Spot that hurts to press

Twitch reaction

When you press the spot or taut band you can feel the taut band to twitch violently.

It’s good indicator from trigger points, but it doesn’t happen, or you can’t always feel it.

Reappearing of referred pain symptom

When you press the tp you feel something on the actual pain zone were the symptom that bothers
you exists.

Sometimes it’s the exact feeling of the pain but most cases you just feel some weird sensations in
the general area of you pain zone.

Brief massage guide lines

Find the spot and the direction of applying pressure massage that hurts the most.

Massage multiple short session though out the day.

As long as it takes for the spots to become none-tender, or as long as it takes to get relief.

This will in most cases take weeks.

Ways to massage

Repetitive stroke massage or continuous pressure

Il like the best from continuous pressure applied by tool and using bodyweight for applying the
pressure. It’s the lazy person’s way to do it and works just perfect.

Continuous pressure

Hold 8-15 seconds pressure move to another spot come back later repeat about 2-3 per spot 2-5
times per day

Massage

Massage 10 strokes move to another spot come back repeat 2-3 times per spot 6-10 times per day

There are no rules once you get the hang of it youll make you own system.

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Case example
Acute pain phase

Massages points in many sessions a day for two weeks

Holy smoke I am full of these buggers it seems that every inc of my body is is a tender spot.

Pain symptoms regress backwards old injuries start to feel again maybe resulting in more pain.

My muscles are twitching like there no tomorrow.

Where is this all going to lead..

Then every other day for couple of weeks

Things start to normalize

I got to tell everybody about this.

This is pretty cool, why the doctors didn’t tell me about this.

Upkeep/ maintenance

Then once a week, or when needed.

Massage is getting boring but some of the points are still a bit tender, although generally it gets
harder and harder to find them

Then once a moth, one session holding for 5 seconds,per spot.

I’m so lazy I should do the massage more often.

Some spots may get tender but they don’t seem to cause those old referred pain symptoms,
strange…

Where I ever in pain? It seems so distant…

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Pain shift - important
What you get is a pain shift or the pain gets worse.

You can aggravate the current tp and your pain symptom worsens this is common although it
doesn’t seem to postpone the relaxation of the tp.

Which is bit odd, but that’s the practice of things.

And thus some use very rough methods from the beginning to get things handled as quickly as
possible and suffer a little extra pain.

Pain shift can be like going back in time.

Pain shift happens when the pull of the muscles changes and it flares old latent trigger points.

For example if you hurt you foot and got longstanding knee pain that eventually settled in you hip.

You can experience the same knee pain again as the trigger point will flare upp again as the balance
between the pull of the muscles changes as you massage tps.

But at this point don’t call me and get angry at me but continue to massage the points that are
responsible of this newly appeared symptom.

They should vanish eventually.

I don’t know a case where this pain shift or regression back to old symptoms haven’t vanished-

I don’t see any logic reasons for this but realize that there is a risk for this.

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Trigger Point Guide Pain patterns

Karri Koivula

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Index

1. Head and neck pain

2. Upper back, shoulder, upper arm pain

3. Middle back, lower back ,hip and buttock pain

4. Chest, abdominal and groin pain ,

5. hip, thigh, knee pain

6. Leg and ankle pain

7. Foot pain

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Head and Neck pain

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Eye area pain

Sternocleidomastoid
Temporalis
I pain/muscle index slpenius cervicis
massater
occipitalis
Top of head orbicularis oculi
sternocleidomastoid suboccipital group
splenius capitis trapezius

Back of head pain Ear and chin joint pain


Trapezius sternocleidomastoid
sternocleidomastoid massater
semispinalis capitis lateral pterygoid
semispinalis cervicis trapezius
splenius cervicis buccinator
suboccipital group Platysma
occipitalis orbicularis oculi
digastric zygomataticus major
temporalis digastric
medial pterygoid
Side of head
Trapezius Tooth pain
sternocleidomastoid temporalis
temporalis massater
splenius cervicis digastric
suboccipital group
semispinalis capitis
Back of neck
Trapezius
Front of head multifidi
sternocleidomastoid levator scapulae
Frontalis splenius cervicsis
zygomaticus major
semispinalis capitis Front of neck
sternocleidomastoid
digastric
korva ja leuka nivel medial pterygoid
särky
lateral pterygoid
massater
sternocleidomastoid
medial pterygoid

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Trapezius

Use Stick and tennis ball against the wall.

Picture:

For trigger points, lower down in the trapezius, lye down in the floor and use
tennis ball and use it to apply the pressure and find the right spots.

picture:

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Sternocleidomastoid

Just grab the muscle like in I am doing, bend the head to the side you are
pinching the muscle to give it some slack and make it easier to grab.

Just go trough the whole muscle pinch gripping it and find the trigger points.

The muscle two branches on top of each others, you can see them divide in the
lower attachment point.

But for the most part of the muscle you don’t have to distinguish them.

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Temporalis

Use your knuckles or some hard tool to locate temporal trigger points.

But go easy on them.

Its really spooky kind of pain that they can make and reappear when pressed.

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massater

I find it helpful to press little towards ears to hit the muscle in right direction.

Use fingers, knuckles or tool

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Splenius Capitis Splenius Cervcis

Tool against wall or against floor.

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Semispinalis Capitis

Tool against wall or against floor.

10

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multifidi , rotatores

Tennis ball is too big to hit the trigger points but some tool that is smaller
works fine.

Be little extra careful when applying pressure near vertebrae, use common
sense.

To be extra cautious use tool with your hands not against floor or wall-

Buccinator

11

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It refers pain to the teeth near the muscle
Use your fingers for pressure

Lateral pterygoid

12

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The x is the trigger point spot and grey areas on both side it the referred pain
areas.

use fingers to locate and hit the spot.

Medial pterygoid

To reach this muscle you need to press it from below your chin.
It is on the x spot
orbicularis oculi

13

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No it’s not the Frankenstein’s bride wearing an eye patch, even thou it kind of
a looks like it.

The pain pattern is the grey shadow that seems to sculpt the nose and the
trigger point is the small x just in the eye brow line or little below, like it is in
this case.

Just track down the bones around the eye looking for tender points.

The black patch describes the muscle.

zygomaticus, levator labii

14

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Indian war painting, or maybe not.

Use fingers to locate and aply pressure

15

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digastric

Again you need to venture to the underneath of the chin.

Use fingers an to search tender spots and referred pain.

16

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frontalis occipital

Move your eyebrows and try to wiggle your ear can you feel the occipital
muscle in the back of your head.

Fingers, knuckles or a tool there aren’t any rules.

suboccipitalis

Use a tool to reach the muscle easily, against wall if necessary.

17

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Upper back, shoulder, upper arm

18

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teres minor
Index II subscapularis
serratus posterior superior
triceps brachii
Upper back pain trapezius
scaleni
Scaleni lats
levatorscapulae erector spinae
trapezius
multifidi Shoulder front
splenius cervicis
supraspinatus infraspinatus
rhombodei deltoid
triceps brachii scaleni
biceps brachii supraspinatus
pectoralis major
Back of shoulder pectoralis minor
biceps brachii
deltoid coracobrachialis
levator scapulae sternalis
supraspinatus subclavius
teres major
latissimus dorsi scaleni
biceps brachii
Back of upper arm triceps brachii
scaleni
teres major subclavius
triceps brachii supraspinatus
deltoid sternalis
subscapularis infraspinatus
supraspinatus Deltoid
teres minor brachialis
latissimus dorsi latissimus
serratus posterior superioir dorsi
coracobrachialis
scalenus minimus

Front of upper arm

19

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scalanes

Locate your collar bone use your fingers o pull to the collar bone.

20

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trapezius

Tennis ball or similar tool against the floor is the way to go, just lye on it and
move it to the tenderest spots and hold for awhile.

21

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Levator Scapulae

Tennis ball or similar tool against the floor is the way to go, just lye on it and
move it to the tenderest spots and hold for awhile.

22

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Latissimus Dorsi

Tennis ball or similar tool against the floor is the way to go, just lye on it and
move it to the tenderest spots and hold for awhile.

23

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Rhomboid

Tennis ball or similar tool against the floor is the way to go, just lye on it and
move it to the tenderest spots and hold for awhile.

Serratus posterior superior

24

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supraspinatus

Stick as a tool is great to reach this, tennis ball on the floor can
work also.

infraspinatus

Tennis ball or similar tool against the floor is the way to go, just lye on it and
move it to the tenderest spots and hold for awhile.

25

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Teres Minor

Teres Major

26

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Subscapularis

coracobrachialis

27

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deltoid

28

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Triceps

Biceps

29

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Middle back, lower back, hip and buttocks/sacral pain

30

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Index III hamstrings
soleus
Middle back pain
Buttock/sacral pain
spinae erectors
multifidi rotatores quadratus lumborum
rectus abdomis erector spinae
serratus anterior gluteus minimus
serratus posterior inferior gluteus medius
latissimus dorsi gluteus maximus
intercostals piriformis
hamstring
Lower back pain soleus

gluteus medius
gluteus maximus Hip pain
gluteus minimus
psoas quadreceps vastus lateralis
multifidi rotators (syvät gluteus minimus
elkälihakset) gluteus maximus.
spinae erectors ( piriformis
pinnalliset selkälihakset) quadratus lumborum
quadratus lumborum tensor fasciae latae
rectus abdomis
obiliques

31

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Gluteus maximus

32

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Gluteus medius

Gluteus minimus

33

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piriformis

Quadratus lumborum

34

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Spinae erectors & multifidi ja rotatores

Rectus abdomis

35

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liopsoas

obiliques

36

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Hamstring

37

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Chest, abdominal, genital pain

38

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latissimus dorsidiaphgram

Index IV Abdominal pain

Chest pain rectus abdomis


pectorals abdominal obliques
scalenes superficial spinal muscles
sternocleidomastoid deep spinal muscles
sternalis quadratus lumborum
intercostals
superficial spinal muscles Groin pain
subclavius
rectus abdomis Rectus abdomis
diaphgram Abdominal obiliques
intrapelvic muscles
Side pain adductor magnus
serratus anterior psoas
abdominal obiliques piriformis
intercostals

39

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Pectorals

40

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Serratus anterior

Latissimus Dorsi

41

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Rectus abdomis

Obiliques

42

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Hip, thigh, knee pain

43

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Index V rectus femoris
vastus medialis
abductor longus
Groin Pain
pectineus Inner knee
abductor longus vastus medialis
abductor magnus gracilis
rectus abdominis rectus femoris
abdominal obiliques sartorius
psoap intrapelvi muscles adductor longus
Outer knee
vastus lateralis
Hip pain
gluteus minimus
Back of thigh
gluteus minimus
vastus lateralis
semitendinosus
piriformis
biceps femoris
qiadratus lumborum
piriformis
tensor fasciae latae
intrapelvi muscles
vastus intermedialis
gluteus maximus Inner thigh
pectineus
vastus medialis
grazilis
Front thigh pain adductor magnus
Abductor longus
Back of knee
psoas
gastrocnemius
abducto magnus
biceps femoris
vastus intermedialis popliteus
pectineus semiteninosus
sartorius
semimembranus
quadratus lumborum soleus
rectus abdominis plantaris

Front of knee

44

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Tensor latia fascae Vastus intermedialis

45

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Vastus medialis

46

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Rectus femoris

vastus lateralis

47

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Pectineus

48

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Abductor brevis Abductor longus

49

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Abductor magnus

Gracialis

50

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Hamstrings

51

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plantaris Popliteus

52

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Leg and ankle pain

53

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Side of leg
Index VI Gastrocnemius
gluteus minimus
peroneus longus
Front of leg
peroneus brevis
Tibialis anterior
vastus lateralis
adductor longus
inner ankle
Front of foot
Abductor hallucis
tibialis anterior
flexor digitorum lonngus
peroneus tertius
extensor digitorum longus
outer ankle
peroneus longus
Back of leg
peroneus brevis
Soleus
peroneus tertius
gluteus minimus
abductoe digiti minimi
gastronomicus
semitendinosus
semimembranus back of ankle
soleus
flexor digitorum longus tibialis posterior
tibialis posterior
Plantaris

54

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tibialis anterior

extensor hallucis longus & extensor digitorum

55

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peroneus longus & Peroneus brevis

peroneus tertius

56

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gastrocnemius

57

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soleus

tibialis posterior

58

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Flexor digitorum longus & flexor hallucis longus

59

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Foot pain

60

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Index VII

Top of foot Bottom of the foot Front


extensor digitorum brevis flexor hallucis brevis
extensor hallucis brevis flexor digitorum brevis
extensor digitorum longus adductor hallucis
extensor hallucis longus flexor hallucis longus
flexor hallucis brevis interosseus
interosseus abductor digiti minimi
tibialis anterior flexor digitorum longus
tibialis posterior
Big toe flexor digigti minimi brevis
top
tibialis anterior
extensor hallucis longus Bottom of the foot
flexor hallucis brevis middle
under gastrocnemius
flexor hallucis longus flexor digitorum longus
flexor hallucis brevis adductor hallucis
tibialis posterior soleus
interoseus
Other toes tibislis posterior
top
interosseus Heel pain
extensor digitorum longus soleus quadratus palnatae
under abductor hallucis
flexor digitorum longus tibialis posterior
tibialis posterior abductor digiti minimi

61

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Extensor digitorum brevis & extensor hallucis brevis

introsseus

Abductor hallucis

62

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abductor digiti minimi

flexor digitorum brevis

quadratus plantae

63

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Abductor hallucis & flexor hallucis brevi

Flexor digiti mininmi brevis

64

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Elbow, arm, wrist, hand pain

65

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Index VIII

Elbow Wrist outer arm


extensors
supinator subsscapulari
brachioradialis sascalenes
extensor latissimus dorsi
anconeus serratus posterior superior
triceps brachii coracobrachialis
supraspinatus
pectoralis major Wrist inner hand pain
serratus anterior
serratus posterior superior flexors
palmaris longus
Outer elbow pronator teres
opopnens pollicis
trticeps pectorals
scalanes latissimus dorsi
extensors serratus anterior
brachioradialis
brachialis Inner finger pain
flexors
infraspinatus flexores digitorum
teres major superficialis and profundus
cocabrachialis introssei abductor digiti
supraspinatus minimi
subclavius lats
serratus
Inner elbow pain subclavius

palmaris longus Top of finger pain


pronator teres
serratus anterior extensor digitorum
triceps brachii introssei
latissimus dorsi scalene
pectoralis major abductor digiti mininimi
serratus posterioer superior pectorals

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lats
subclavius
Thumb pain
supinator
scalene brachialis
brachioradialis
opponenns pollicis
abductor pollicis
extensor carpi radialis longus
first dorsal introsseus
flexor pollicis longus
subclavius
infraspinatus
brachialis

67

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extensor carpi radialis longus

brachioradialis

68

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supinator

extensor carpi radialis brevis

69

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extensor carpi ulnaris

anconeus

70

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extensor digitorum

Extensor indicis

71

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flexor carpi radialis

flexor carpi ulnaris

72

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palmaris longus

flexor digitorum

73

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pronator teres & pronator quadratus

flexor pollicis longus

74

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opponens pollicis & abductor pollicis

75

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introsseus

76

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