OMM Combined 1
Torsion: Produced by? Axis? Rotate in ___ directions aroud their axis. Temporals move with the ___. Named by?
Produced by; Blows directed from above or below on an anterior or posterior quadrant of the cranium. Axis; Anterioposterior (AP) from the nasion to the opisthion (midpoint on the posterior border of the foramen magnum). Motion; Rotate in opposite directions around their axis. TEMPORALS MOVE WITH THE OCCIPUT. Named; Superior great wing of the sphenoid.
Torsion: Produced by? Axis? Rotate in ___ directions aroud their axis. Temporals move with the ___. Named by?
Produced by; Blows directed from above or below on an anterior or posterior quadrant of the cranium. Axis; Anterioposterior from the nasion to the opisthion (midpoint on the posterior border of the foramen magnum). Motion; Rotate in opposite directions around their axis. TEMPORALS MOVE WITH THE OCCIPUT. Named; Superior great wing of the sphenoid.
Sidebending Rotation: Produced by? Axis of Sidbending and Rotation? Motion: Sidbending? Rotation? Named?
Produced by; Lateral force directed exactly at the level of the SBS. Axis (there are 2 types); Sidebending; 2 vertical axis (through the foramen magnum of occiput, body of sphenoid). Rotation; Anterioposterior (AP) from nasion to opisthion. Motion (there are 2); Sidebending; Moving around the 2 vertical axes in opposite directions. Rotation; Moving along the AP axis in the same direction (inferiorly on the side of the convexity). Locked together so there is NO 'stripping of the gears'. Named; By the rotation (side of convexity) OR the side that drops inferiorly. This is always on the same side.
Sidebending Rotation: Sidebending Rotation: Produced by? Axis of Sidbending and Rotation? Motion: Sidbending? Rotation? Named?
Produced by; Lateral force directed exactly at the level of the SBS. Axis (there are 2 types); Sidebending; 2 vertical axis (through the foramen magnum of occiput, body of sphenoid). Rotation; Anterioposterior (AP) from nasion to opisthion. Motion (there are 2); Sidebending; Moving around the 2 vertical axes in opposite directions. Rotation; Moving along the AP axis in the same direction (inferiorly on the side of the convexity). Locked together so there is NO 'stripping of the gears'. Named; By the rotation (side of convexity) OR the side that drops inferiorly. This is always on the same side.
Guiding Principle of Respiratory-Circulatory Model
Progression from central to distal -*Beginning point = thoracic inlet, then the thoracic cage* allows tissues of thoracic cage to respond to respiratory effort and the pumping action of the diaphragm to receive the fluids trapped in the peripheral tissues >thoracic cage > L-spine > Pelvis/Sacrum > Lower extremity
Peripheral weakness in the context of LBP always indicates the presence of a neural compression. What are the etiologies of this weakness?
Spinal cord, nerve root, or peripheral nerve with Grade 3 to 4 muscle weakenss
What are three examples of synovial joints?
Spinal facet joints, the sacroiliac joints and the uncovertebral joints in the cervical spine
What does the accompanying picture show?
Spondylolysis
Dominant hemisphere lesions in the cerebral cortex causes what defects?
Speech and language deficits
Naming of SBS strain patterns
Sphenobasilar symphysis (SBS) is the central reference point of naming function and dysfunction in the Primary Respiratory Mechanism (PRM) The occiput controls how the vault moves and the sphenoid how the face moves - Therefore, a strain of the SBS will affect the entire cranial mechanism
What are some congenital predispositions of spondylolisthesis?
Spina Bifida Occulta Genetically weak or thin pars interarticularis Sacralization of L5 High pelvic index for age
What is the activating force for an articulatory technique?
Springing motion or repetitive concentric movement of the joint through its restrictive barrier
extend, rotate head toward involved side, apply downward force
Spurling's maneuver instructions
Which type of MET to treat muscle tightness? Weakness?
Tightness = isometric Weakness = isotonic
How is nerve functions determined for T2-T12?
Via combination of motor and sensory testing
How is nerve function determined for T1?
Via motor testing of interossei muscles
MC/PIP
Vibration
viscero-somatic reflex
Visceral inflammatory disease causes palpatory paraspinal soft tissue abnormalities at segmentally related levels
Treatment - approach to dx
Visual cues Light gentle touch Observe, by palpation, inherent motion and motion patterns as they emerge Motion test - Motion is initiated/encouraged during the phase of the PRM that most closely resembles it and followed to endpoint
Nondominant hemisphere in the cerebral cortex causes what defects?
Visuospatial deficitis
cartilaginous end plates
anchors the intervertebral discs to the vertebral body
Mechanics of ribs due to
angle of costovertebral and costotransverse joints
low
bone relative concentration of nociceptors
C6
brachioradialis reflex nerve root
posterior
does a fall on outstretched hand injury typically cause an anterior or posterior radial head dysfunction?
What is a normal physiologic change in UA during pregnancy
glucose in urine
24 hours
how much time is allotted between each level test for return to play?
anterior/posterior
is the elbow less stable in the anterior/posterior or medial/lateral direction?
protrusion
mandible movement in cranial extension
retrusion
mandible movement in cranial flexion
how does the mandible and the temporal bones relate?
mandible will move in the same direction as the top of the temporal bone (Right temp. bone externally rotated/L. temp. bone internal rotated = Right deviated mandible)
describe the movement of the kidneys during inspiration
move inferiorly and externally rotate
adduction
movement of distal ulna in a decreased carrying angle
abduction
movement of distal ulna in an increased carrying angle
posteromedial
movement of greater wings of sphenoid in cranial extension
anterolateral
movement of greater wings of sphenoid in cranial flexion
lateral
movement of olecranon in a decreased carrying angle
medial
movement of olecranon in an increased carrying angle
midline bones flex, paired bones externally rotate
movement of other bones in cranial inhalation
anterosuperomedial
movement of pterygoid processes of sphenoid in cranial extension
posteroinferolateral
movement of pterygoid processes of sphenoid in cranial flexion
base moves anteroinferior, nutation
movement of sacrum in craniosacral extension (exhalation)
base moves posterosuperior, counternutation
movement of sacrum in craniosacral flexion (inhalation)
abduction
movement of wrist in a decreased carrying angle
adduction
movement of wrist in an increased carrying angle
move wrist into barrier
muscle energy general principles for treating an increased/decreased carrying angle
tibialis anterior
muscles tested with ankle dorsiflexion
peroneus longus, brevis
muscles tested with ankle eversion
gastrocnemius, soleus
muscles tested with ankle plantar flexion
triceps
muscles tested with elbow extension
brachialis, biceps
muscles tested with elbow flexion
dorsal/palmar interossei
muscles tested with finger abduction/adduction
extensor hallucis longus
muscles tested with great toe dorsiflexion
flexor digitorum
muscles tested with hand grip strength
gluteus medius
muscles tested with hip abduction
adductor longus
muscles tested with hip adduction
gluteus maximus
muscles tested with hip extension
iliopsoas
muscles tested with hip flexion
quadriceps
muscles tested with knee extension
hamstrings
muscles tested with knee flexion
deltoid
muscles tested with shoulder abduction
pectoralis major, latissimus dorsi
muscles tested with shoulder adduction
extensor carpi radialis
muscles tested with wrist extension
flexor carpi radialis
muscles tested with wrist flexion
suboccipital muscles fuse with spinal dura from C1-C3
myo-dural bridge (headache fascial triggers)
decreased radial pulse, neurologic sx reproduction
positive Adson's test clinical findings
decreased radial pulse, neurologic sx reproduction
positive costoclavicular maneuver clinical findings
decreased radial pulse, neurologic sx reproduction
positive hyperabduction test clinical findings
what are contraindications to OMM treatment of headaches?
possibility of non benign etiology, cut fractures to skull or cervical vertebrae, neoplastic bone disease in cervical spine, acute trauma
sx that persist for long period of time
post concussive syndrome
symptomatic
post concussive syndrome treatment
whatre the attachments of the ACL
posterio medial side of lateral condyle of femur antero-medial side of tibia
describe the position of the fibular head with an inversion ankle sprain
posterior (because typically coupled with plantar flexion) this can lead to compression of peroneal nerve
dorsiflexion of the foot causes what in the fibula and talus?
posterior glide of talus (more secure) and external rotation of the fibula
internal occipital protuberance
posterior pole
what happens to the radial head when you fall forward on a pronated arm
posterior radial head
falling on an outstretched hand causes what disfunction of the radial head? How to tx it?
posterior radial head tx- supination with resisted pronation
Ideal/neutral posture of spine
posture that requires least effort and minimizes the stresses on ligaments, joint etc
what is colic?
predictable inconsolable crying episodes for more than 3 hours a day, more than 3 times a week for 3 weeks or more
what type of babies are more susceptible to somatic dysfunction
premature babies - smaller and softer
inherent CNS motility, CSF fluctuation, intracranial/spinal membrane movement, cranial bone mobility, involuntary mobility of sacrum between ilia
primary respiratory mechanism
recommendation 5 of the clinical guidelines from the ACP and APS
provide pts with evidenced based info on lbp with regards to their expected course advise to remain active and provide info about self care options
what is the function of compression/distraction/torsion in FPR
provide soft tissue relaxation
Ileocecal area (R) and Sigmoid colon (L)
proximal thigh
describe the result of the study by Radjieski, LUmley, and Cantieri
pts with pancreatitis assigned to either: receiev standard care alone or standard care plus OMT results: pts who received OMT averaged significantly fewer days in the hospital before discharge. no significant differences in time to food intake or in use of pain meds "You went to a rad party last night and put too much alcohol into your lumen and now your on the can"
Type of motion ribs 1-4
pump handle
allow parietal bone to move freely, internally rotate parietal bones
purpose of technique
assess motion of anterior, posterior portion of cranium
purpose of technique
temporal bones move more freely, release restricted temporal bone
purpose of technique
Lumbosacral lordotic angle
quantification of lumbar lordosis
inherent tensile strength, guides, protects CNS, influences CSF, coordinates movement of cranial bones
reciprocal tension membrane function
what is Van Buskirk associated with
rediscovered Still Technique
what is indicative of cervicogenic headache in association with muscles?
reduced range of motion
what happens to the volume of central blood after OMT
reduced suggesting improved peripheral circulation
Reflector of pathophysiological process
referred pain or dysfunction
Somato-somatic
reflexes
what kind of problems can occur with plagiocephaly?
reflux, recurrent otitis media, strabismus, learning problems
low
skeletal muscle relative concentration of nociceptors
what occurs in the skull at age 1
skull doubles in size, temporal fuses, mandible ossifies, OA patterns "set"
describe Class 2 Ney York Heart Association Functional Classification for CHF
slight mild limitation of activity comfortable with rest or mild exertion
which is more sensitive: SLR or slump
slump used as PE tool if herniation is suspected
what is the MOA of T4/T5 palpatory findings in those with coronary artery occlusion
small visceral affarents form heart send input to WDR neurons in spinal cord which send signal to brain and ventral horn WDR also receive somatic input from chest wall therefore brain and ventral horn cannot tell if pain is coming form vicera or somatic source
T1, rib 1, manubrium
thoracic inlet borders
describe the lymphatic protocal for uper and lower extremities
thoracic inlet left then right, thoracic diaphragm LE: pelvic diaphragm, LE UE: pectoral traction, UE Cervical drainage pump
everything that goes through thoracic inlet
thoracic outlet
where is the axis for the frontal bone?
through the center of orbital plate
cerebellum
tip of coracoid process
Creep
tissue under sustained load will extend in response to load
what is the goal of the start stretch
to reduce sympathetic tone: 10-30 seconds
levoscoliosis
to the left
Dextroscoliosis
to the right
Pharynx
top of 1st rib,where it meets manubrium (pharyngitis)
Middle Ear
top of clavicle, (otitis media)
how can an IS/SI dysfunction cause bladder issues
torque pelvic diaphragm
Dorsal/Posterior Columnar Medial Lemniscal Pathway
touch, vibration, tactile pressure, stereognosis, recognition of texture, 2 point discrimination, proprioceptive
Most common area of somatic dysfunction
transition areas in the spine
what can be some causes of cranial dysfunction?
trauma (dental and concussion), postural habits, compensatory patterns, mind/body relationships, allergies
Antagonist inhibition
treat the antagonist muscle instead of directly treating the target muscle
how can OMM effects post concussion syndrome?
treat the neck - it can cause a lot of dysfunction
what are posterior chapman points used for
treatment only
C7
triceps reflex nerve root
TTP over greater trochanter, worse with walking
trochanteric bursitis clinical presentation
dull, prolonged
type of pain transmitted by C fibers
somatic, visceral, neuropathic
types of pain
internal/exernal rotation
typical axis of motion of paired bones
transverse
typical axis of motion of unpaired/midline bones
what is trigeminal neuralgia?
unilateral disorder characterized by brief electric shock like pains, abrupt in onset and termination
what are the characteristics of a migraine?
unilateral, pulsatile, moderate to severe, aggravated by physical activity, during the HA have either N/V or photophobia/phonophobia
ethmoid, occiput, sphenoid, vomer, sacrum
unpaired craniosacral bones
what counterstrain point is often associated with diffuse medial knee pain
untreated AL5 on the ipsilateral side
is gallbladder uppper or middle GI or lower?
upper (along with liver and spleen) - all coming off of the celiac trunk
describe the viscerosomatics of T5-9
upper GI through liver/gall bladder *greater splanchnic*
describe the viscerosomatics of T2-5
upper extremity
which chapman point is located third intercostal space on the sternum
upper lung upper limb
What is the MC predisposing factor leading to acute OM?
upper respiratory tract infection
GAGs
uptake water, maintain distance between collagen fibers, allow for some crosslinking
describe the viscerosomatics of T111-L2
ureter, bladder, hindgut, prostate, LE
what is the treatment for chapman points
use firm pressure with finger pad in circular motion 30 seconds per point per day max
describe the viscerosomatics of T12 - L1
uterus
OMT focused on the upper cspine affects what cranial nerve
vagus - measured by HR variability
what is cubitus varus? valgus?
varus - adducted elbow valgus - abducted elbow
cold, swelling, cyanosis
vascular symptoms that indicate Thoracic outlet syndrome
which is more vulnerable to shifts in dural tension arteries or veins?
veins
what tx for sinus headaches?
venous sinus drainage - cranial tx
ligamentous instability
what does the sulcus test indicate?
condylar decompression
what does this part of venous sinus drainage technique treat?
confluence of sinuses
what does this part of venous sinus drainage technique treat?
metopic suture
what does this part of venous sinus drainage technique treat?
occipital sinus
what does this part of venous sinus drainage technique treat?
sagittal sinus
what does this part of venous sinus drainage technique treat?
straight sinus
what does this part of venous sinus drainage technique treat?
transverse sinus
what does this part of venous sinus drainage technique treat?
IT band hypertonicity
what does what does Ober's test indicate?
hip pathology
what does what does Patrick's test indicate?
hip joint inflammation
what does what does the hip compression test indicate?
CN III, IV, V1, V2, VI
what is found in close proximity to the cavernous sinus?
CN I
what is found within the cribriform plate of the ethmoid?
CN V3
what is found within the foramen ovale?
CN V2
what is found within the foramen rotundum?
middle meningeal branches, meningeal branches of CN V3
what is found within the foramen spinosum?
CN V2
what is found within the inferior orbital fissure?
CN II
what is found within the optic canal of the sphenoid?
pituitary gland, optic chiasm
what is found within the sella turcica of the sphenoid?
CN III, IV, VI, V1
what is found within the superior orbital fissure of the sphenoid?
biceps long head
what is this counterstraining?
subdeltoid bursa
what is this counterstraining?
lateral epicondylitis
what is this testing for?
ATF tear
what ligament does the anterior ankle drawer test indicate?
MCL, LCL, articular disc
what ligaments are involved in the TMJ "terrible triad"
tibialis posterior
what muscle supports the longitudinal arch of the foot?
fibularis longus
what muscle supports the transverse arch of the foot?
Liver
What organ is it?
Viscerosomatics of prostate
L1-L2
Viscerosomatics of uterus
T10-L1 (symp)
Viscerosomatics of urinary bladder
T10-L1 (symp) S2-S4 (para)
Viscerosomatics of kidneys and ureters
T10-L1 (symp) Vagus
Spine levels innervation of the lower legs?
T10-L2
what is the sympathetic innervation of the uterus
T10-L2
viscerosomatic reflex of the testicles?
T10-T11 (midgut range)
Viscerosomatics of the legs
T11 - L2
What two bony landmarks are used to determine apparent (functional) leg length?
Umbilicus and medial malleolus
Pancreas
What organ is it?
1
What step is this in venous sinus drainage technique (1-7)?
2
What step is this in venous sinus drainage technique (1-7)?
3
What step is this in venous sinus drainage technique (1-7)?
4
What step is this in venous sinus drainage technique (1-7)?
5
What step is this in venous sinus drainage technique (1-7)?
6
What step is this in venous sinus drainage technique (1-7)?
7
What step is this in venous sinus drainage technique (1-7)?
C5
biceps reflex nerve root
low
cartilage relative concentration of nociceptors
what are emotional signs of concussion?
irritable, sad, more emotional than usual, anxiety
female
is Thoracic outlet syndrome more common in males or females?
abnormal
is neuropathic pain associated with normal or abnormal pain processing?
normal
is nociceptive pain associated with normal or abnormal pain processing?
females
is the carrying angle greater in males or females?
Sibson's Fascia
"Thoracic inlet". Superior border of the thoracic cavity. Attachments: Transverse process of C7, anterior internal border of 1st rib
what is the definition of osteopathic reserach used by the AOA bureau of research
"the investigator seeking funding needs to explain how the hypothesis and expected findings of his or her proposed research would be *relevant to the theory, mechanisms, of practice of osteopathic med*
What muscle does ureter run on top of and can cause irritation if UTI etc?
- Iliopsoas;
Iliopsoas tightness causes what change in lumbar curvature?
- Increased lordosis
Chapman point for upper limbs?
- Inferior portion of T3 while superior portion of T3 is upper lung
Tenderpoint below occiput?
- Inion (Posterior C1): treat with only F
what is the neck joint that is/are rotation?
(c1-c2 )AA
Rule involving Champan's reflex on thigh
(cut in ½) flip over the colon on top of thigh (look at image, transverse colon is more distal than flexures
Left half of transverse colon and right half of transverse colon
(most) distal thigh
High vs low Median n. palsy?
- High: lesion in elbow/forearm - Low: lesion in wrist
How often to increase heel lift?
- Every 1-2 wks
S/CS for LBP
*Anterior tender points* correlated with -FLEXED SD's, require flexion *Posterior* tender points correlate with -EXTENDED SD's, require extension
SECONDARY causes of rib pain?
*Cardiovascular* (MI, angina, aneurysm etc) *GI* (peptic ulcer, GERD, pancreatitis, gallbladder dz), *Pulmonary* (PE, PTX, Pneumonia, pleuritis), *Other*: (Psych, tumors, infection, breast dz, fibromyalgia
Thoracolumbar shift CCP?
*Lower* thorax shifts with ease
Quadratus Lumborum
*O*: Posterior iliac crest, Iliolumbar ligament *I*: 12th rib, Transverse process of L1-L4 *A*: Fixation of 12th rib during respiration, laterally flexes (side-bends) trunk
Pump Handle Rib Motion
*Ribs 1-5* With inhalation, anterior of ribs moves cephalad -AP diameter increases
Caliper Rib Motion
*Ribs 11 & 12* -With inhalation, ribs move *around* the single articulation, analagous to internal and external rotation with a bit of "bucket and pump handle" motion
Bucket Handle Rib Motion
*Ribs 6-10* With inhalation the lateral aspect moves cephalad -Transverse diameter increases
Symptoms, pain and referral in *quadratus lumborum*
*Symptoms*: -Pain w/ turning over in bed -Unable to bear standing upright or walking -Cough/sneeze very painful -Easily mistaken for radicular pain of lumbar origin *Pain referral* -SI & buttock -Hip & greater trochanter -Abdomen -Groin
describe the results of the MOPSE study
*reduction in LOS, duration of IV abx, respiratory failure, or death* no significant intention to treat differences
describe the grading for edema
+1: less than 2 mm +2: 2-4 mm +3: 4-6 mm +4: 6-8 mm
Gluteus medius tender point? Treatment position for counterstrain?
- 2/3 between PSIS and IT band (L3) and posterior end of IT band (L4) - Hip extension with ER
What rules are given as part of the patient education component of treatment?
- 3-6 hours of instruction in back mechanics and proper use of the back - No high heels - Weight loss - Avoid vocations requiring heavy lifting or strenuous activity - Avoid contact sports - Avoid gymnastics - Avoid diving
What location of the lumbar spine is most commonly affected in a degenerative spondylolisthesis?
- 6-9 times more common at L4 - Sacralization of L5 is 4x more common than the incidence in the general population - Not seen before age 40 and rare between 40 and 50 - Slippage is 30%
Tietze Syndrome
- A primary cause of rib pain -Usually within 1 or 2 costochondral joints (often 2nd/3rd) -*Swelling (palpable) is associated* with pain and inflammation -Labs: May have elevated ESR and/or CRP
What is Hawkin's test use for?
- AC joint impingement/supraspinatous tendon tear
Attachments of Inguinal ligament? Causes what SD if tense?
- ASIS and pubic tubercle - Causes Anterior inominate and superior pubic shear
Where is Iliacus tenderpoint? Counterstrain treatment position?
- ASIS to midline 1/3 way - Supine, BL hip flexion with external rotation ("frog leg")
Only mm. in thenar emminence innervated by ulnar n. and will be damaged in ulnar n. palsy?
- Adductor pollicis longis (adduction of thumb action lost); other thenar mm. innervated by median n.
What medications are used to treat spondylolisthesis?
- Analgesics: as needed - Muscle relaxants: no help - Vapo-coolant spray and stretch trigger point techniques with local anesthetics helps with secondary myofascial pain
Most commonly injured ligament in ankle sprain? At what ankle position is it torn?
- Anterior Talofibular ligament - Injury when plantarflexion
Where is the tenderpoint for masseter? Tenderpoint for medial pterygoid?
- Anterior to mandible rami - Posterior to ascending rami of mandible and above jaw angle
Treatment of plantar fasciitis?
- Arch support inserts and OMT, anti-inflammatory, ice
What is Speed's test?
- Arm flexed, elbow extended and supinated; push downwards while patient keeps arms flexed; pain = biceps tendon issue
What are the tenets of osteopathic med?
- Body mind and spirt unity - inherent regulatory and healing capacity - rational treatment based on the previous three including OMM
Treatment of Scheulerman's kyphosis?
- Bracing (if young before they are mature) - OMT and PT
Anterior cervical tender points? - Treatments?
- C1 (posterior part of ascending ramus of mandible), C2-C6 (all on TP), C7 (Clavicle portion where SCM attaches), C8 (sternal attachment of SCM) - Treat: C1 (RA), C2-C6 (FSARA), C7 (FSTRA), C8 (FSARA)
What is arthrogryposis?
- Congenital curved joints and potential for lumbosacral agensis - Multiple joint contractures - UL adducted and internally rotated - Diamond shaped LL - Skin is very smooth and lacks creases - Etiology is unknown
Hammer toe?
- Deformity of PIP, but none in DIP or MTP
What is Sever disease? Treatment?
- Dorsiflexion causes pain b/c of calcaneous bone apophysis near the Achilles tendon insertion (usually in children) - NSAIDs, heel fat, cushion; but usually resolves on its own by 2-8 wks
IR vs ER of jaw and type of deviation it causes?
- ER of temporal bone causes ipsilateral mandibular deviation - IR of temporal bone causes contralateral jaw problem
How much heel lift to begin with for short leg?
- Elderly to start with 1.5 mm (1/16th) - Young to start with 3.2 mm (1/8th)
What is Jobes' test?
- Empty can test; test for supraspinatus tear
What type of braces can be used to treat spondylolisthesis?
- Everything from soft elastic supports to body casts extending from the knee to nipple - The lumbar spine is never fully immobilized - still move under the influence of the psoas muscles with walking - There is no evidence that bracing in any form is an effective management strategy for chronic spondylolisthesis
What is the function of a levitor?
- Exerts pressure between the pubic symphysis and the sacral apex - Transfers weight bearing off the posterior elements forward into the vertebral bodies - By reducing the chronic strain on those tissues, symptomatic relief is obtained
Posterior cervical tender point treatments?
- Extend SARA, except C1 and C3 midline which is Flexion
Sequence of SPENCER's?
- Extension, Flexion, Circum with compression, Circum with traction, ABduction, IR, pump
Action of Piriformis? Counterstrain treatment?
- External rotates when hip flexed, abduct - Prone, leg off the table, flex hip/abduct/ER
Gluteus maximus action? Origin/Insertion?
- External rotation, Hip extension - Ilium to Gluteal tuberosity of femur/IT band
Still's technique?
- First into ease then compression, then into barrier
What thoracic dysfunction can cause tachyarrhythmia under stress?
- Flattened kyphosis in upper thoracics
Treatment for posterior Rib tenderpoint?
- Flexion, SB away, R away
What is Gluteus medius tender point associated with?
- Forward sacral torsion on ipsilateral side
Which carpal bones does flexor retinaculum attach to?
- Hamate, pisiform, trapezium, scaphoid
Shoe lift vs heel lift?
- Heel lift is for up to 10-12 mm difference; for larger length discrepancy, use shoe lift
What type of orthotics are used to treat spondylolisthesis?
- Heel lifts to level the sacral base - Cushioned shoe insoles to absorb some of the shock of walking - Levitor orthotic device
Heel pad syndrome vs plantarfasciitis?
- Heel pad syndrome has pain that occurs with over use while plantarfasciitis has pain that is worse in the morning, but gets better throughout the day
Origin/Insertion Biceps femoris? Tender point?
- Ischial tuberosity to femoral head - Posterior thigh/lateral to midline
Only pelvic organs to be innervated by Cervical for Parasympathetic? Which segment?
- Kidney and proximal ureter - C1-2
Posterior colon chapman points?
- L2 to L4 TP
Nerve root for patellar reflex? Achilles?
- L4 - S1
What do S2, S3, and S4 innervate parasympathetically?
- Left 1/2 of colon - Lower ureter - Bladder detrusor - Uterine Body - Prostate - Cavernous tissues of the genitalia
Chapman point for rectum?
- Lesser trochanter of femur
Medial knee injury but with clicking/popping sensation?
- Medial meniscus
Four muscles of mastication? Which ones open and close jaw?
- Medial pterygoid, lateral pterygoid, masseter, temporalis - Only lateral pterygoid opens jaw; all others closes it
Tenderpoint for inguinal ligament? Treatment position?
- Medial side of inguinal ligament - Flex hips, Adduction, IR
L4 nerve root sensory/fxn?
- Medial/anterior thigh, leg, ankle - Dorsiflexion, inversion ankle, knee extension, patellar reflex
Musculoskelatal Assessment of HA: Asst artery? Sphenoid? Temporal bone: HA usually due to restriction in? Tx? Flexion vs Extionsion HAs?
- Middle meningeal artery: supplies dura and calvaria - Greater wing is LOW on side of HA pan. Patient with right sided HA will have a left torsion. - Restriction in internal rotation. Tx with temporal rocking -Flexion heads. Associated with milder headaches. Sinusitis/allergies. -Extension heads. Associated with more severe headaches - migraines
Tender point of Piriformis? Treatment position for counterstrain? Symptom of sciatic n. impingement by piriformis?
- Midpoint between ILA sacrum and greater trochanter - Prone or supine, hip flex and abduction, ER - Pain, tingling down hip/back of thigh (no further than knee)
What is Heel Lift Therapy?
- Must be tailored to the individual - In some patients, the entire lift can be placed at one time, while in others, the lift needs to be applied in small increments as small as 1/16" over months to years
When is a fusion surgery performed as a form of treatment for spondylolisthesis?
- Neurologic deficits - Grade III or greater displacement - Progression of spondylolisthesis in an adult - Significant postural deformity - Symptomatic Grade I or II unrelieved by good conservative care
What are the goals of manipulation in patients with spondylolisthesis?
- Normalize lumbar lordosis - Restore normal motion to all areas related to the segment - Stretch tight hamstrings - Improve respiratory motion of diaphragm and pelvic floor
What did the study by Degenhardt and Kuchera show?
- OMT weekly x 3 wks (7-35 month yo) w/ recurrent OM and followed them for a year - 62.5% had no recurrent symptoms
In short leg syndrome, what is position of sacral base? Other SD found?
- On side of short leg, sacrum base is lower, the shorter side has Anterior Inominate and lumbar is SB away and Rotate toward short leg, contralateral leg IR and pronated foot
What is Kuskokwim Disease?
- Only occurs in native Eskimos living in the Kuskokwim Delta region of Alaska - Genetic autosomal recessive disorder - Similar to arthrogryposis
Reflex of morley?
- Pain transmitted to somatic from viscera through A-delta fibers; eg pain stimulated when palpating visceral organs
What are the characteristics of a spinal cord disorder?
- Pain, numbness, tingling, sensations proximal to distal - Dermatomal pattern followed - Weakness localized to affected muscles - Bowel, bladder, sexual function compromise - Positive Romberg, Babinski, ankle clonus
What is Travell trigger point?
- Point in R Pec Major that can trigger SVT
Most likely shoulder dislocation in seizure?
- Posterior dislocation
Rule of 3's? T7-9: SP's are where?
At the level of the transverse process one level below.
Chapman point for prostate? Broad ligament in female? Colon?
- Prostate and broad ligament: lateral IT band - Colon: anterior IT band
What is reciprocal barrier?
- Pt taken to their barrier and Pt asked to go further into their barrier
What is sulcus sign?
- Pull humerus inferior and there is dislocation/sulcus formed; indicates GH joint laxity (eg. in gymnast)
What is the progression of subtype A isthmic spondylolisthesis?
- Rapid progression from age 9-15 - Rarely is there progression beyond age 20 unless degenerative changes supervene
Pedal pump contraindicated in?
- Recent abdominal surgery, DVT, fracture of LE
What is the management of children with leg length inequality and scoliosis?
- Reevaluated annually, unless they are in a growth spurt - During rapid growth, the child is reevaluated for every inch of increased height
If epiphyses are still open, how can the patient be treated for non-structural scoliosis?
- Repetitive compression stimulates bone growth - Have patient jump rope, or hop around on short leg only - If inequality is severe, can surgically staple epiphyses closed in the long leg to allow short leg to catch up
When do thoracic scoliosis compromise lung and heart fxn?
- Respiratory (>50%) - Cardiac (>75% curve)
What ribs do Lats attach to? QL? What Lumbar segments do QL attach to?
- Rib 9-12 - QL to lower portion of Rib 12; L1-4
What are Jone's tender point?
- SD in body that are treated with counterstrain but does not have any relation to visceral component
Action of sympathetic vs PSN on bronchi?
- SNS dilate bronchi
What anatomic level is used to determine anatomic short leg secondary to scoliosis?
- Sacral base
What technique to use in dysmenorrhea? why?
- Sacral inhibition b/c pelvic organs (except ovaries/testes innervated by S2-S4)
Bladder and lower ureter parasympathetic nerve supply?
- Sacral splanchnic (S2-4)
Palpation finding on cranial vault for SB-rotation cranial SD?
- Sense of fullness on SB side (where egg is opened)
How are winged scapula different for serratius weakness vs trapezius?
- Serratius weakness leads to medial scapula winging - Trap = lateral scapula winging
What is Morton's toe?
- Shortened first metatarsal so most of the weight on second metatarsal and forms callus under 2nd/3rd metatarsal; Causes pronation/Internal rotation of Hip and fxnl shortened leg; treated with orthotics or pad
Schmorl's nodules?
- Small IV disc bulges that occur in Sheureman kyphosis
Describe the research by Drs. Sergueef, Nelson and Glonek
-created visual representation of how the NS is altered by CV4
What area should be stimulated/OMT performed to cause thin nasal mucus secretions?
- Sphenopalatine ganglion (aka pterygopalatine); innerverated by parasympathetic nervous system via CNV2 (maxillary)
Superficial vs deep peroneal n.?
- Superficial (eversion), Deep (dorsiflexion)
Anterior Thoracic tender points? - Treatments?
- T1 - 6 found on sternum; treated with Flexion - T7-9 above umbilicus - T10 (1/4 between umbilicus and pubic symp) - T11 (1/2 between umbilicus and pubic symp) - T12 (Top of iliac crest/mid-axillary line) *T7-12 treated with FSTRA
Viscerosomatic reflex for esophagus is? Stomach?
- T3 - 6 on R - T 5-10 on L
Sympathetic n for upper GI, middle GI, lower GI?
- T5-9 - T9-12 - T12-L2
McMurray test?
- Testing for medial and lateral meniscus tear
Chapman for upper lung? Lower lung?
- Third intercostal (Ant), between TP and spinous of T3 (posterior) - Fourth intercostal (Ant), between TP and spinous of T4 (posterior)
Most common scoliosis?
- Thoracic R convex (90%)
Up to what Leg length difference can it be treated with shoe lift?
- Up to 2 cm
Direction of thrust for HVLA of upper, middle, lower cervicals?
- Upper: toward eye - Middle: toward neck - Lower: toward chest
When is surgery done for short leg syndrome?
- Usually if > 5 cm
When to give heel lifts for short leg syndrome?
- When femoral head difference is >5mm;
What is Ulnar Claw hand?
- When ulnar n. damage occurs and 4th/5th digit has extended MCP and flexed DIP/PIP b/c damage to lumbricals 3 and 4 (which flex MCP and extend DIP/PIP)
Who first did mandibular manipulation? and what did this do?
- William Galbreath - Causes eustation tube to open and close in a pumping motion that allows it to drain more effectively
What is needed to diagnose acute OM?
- confirm hx of acute onset - ID signs of ME effusion - Evaluate for ME effusion
What is the OCF studies show in regards to OM?
- improvement in health measured by fewer ear tubes, improved tympanography assessment, and generally reduced need for abx in kids w/ recurrent OM
S1?
- lateral leg/small toe/achille's reflex/gastroc mm strength
Origin/Insertion of Iliopsoas? Tender point? Counterstrain position? What else can occur with tight Iliopsoas? Action of Iliopsoas?
- lumbar and iliac fossa to lesser trochanter - Medial to ASIS (treat: Flex, ER, SB toward) - Ipsilateral Iliopsoas hypertonicity can cause piriformis hypertonicity in contralateral Leg - Hip F, ER
what are the actions of tensor veli palatini?
- opens the eustation tube with contraction - tenses the soft palate
What is a somatovisceral reflex?
- presents as objective, measurable change in visceral function d/t somatic injury/nociception - mediated through spinal cord
Concentric muscle movement?
- shortening of muscle while making force (bicep exercise)
What did Mills study show?
- showed efficacy of OMT as an adjunctive treatment in recurrent OM - randomized, blinded and controlled clinical trail - fewer OM episodes, fewer ENT surgeries, more surgery free months, more normal tympanograms over 6 months "you need Mills if your ear Fills with fluid"
Cranial II
--
Look at Cranial Review tables.
--
Red Flag Screening
->50 or <18 years of age -No improvement in 4-6 weeks with rest -Pain at rest or night pain -Low energy trauma in high risk patient -High energy trauma -H/o CA -Fever >38C or 100.4F > 48 hrs -H/o drug/alcohol abuse -Neuromotor deficits -unexplained weight loss
Costochondral Separation
-A primary cause of rib pain -Caused by blunt trauma, violent coughing, landing hard on your feet -Physical exam reveals TTP over costochondral junction -Often associated with *rib fracture*
Costochondritis
-A primary cause of rib pain -Pain and inflammation within the costochondral or chondrosternal joints -*Swelling is usually NOT associated* -Typically *multiple joints* involved
How to treat herniated disc asa DO?
-Appropriate diagnosis -Decrease biomechanical forces/fascial strains acting on the vertebral unit by: 1. Treating *segmental hypomobility* above/below disc 2. *Decreasing tension on muscles* which when tight compress the L-spine -Provide education on body mechanics, lifestyle changes, rehab
Iliolumbar ligament
-Binds L4-L5 transverse processes to ilium -Develops in the 3rd decade from immature fibers of the quadratus lumborum -undergoes fibrous metaplasia with age -Degenerative changes from 4th decade > Actions: Resists forward sliding,lateral bending, and axial rotation of L5 on the sacrum
Spondylolisthesis
-Classically forward slipping of the superior vertebrae on the inferior -In situations of sponylolysis, whether a listhesis develops depends on the ability of the *ALL and Iliolumbar ligaments* to resists any applied forces
Anterior rib articulations?
-Costochondral joints -Chondrosternal joints
Diagnosis of Locked Up Rib SD
-Diagnosed with pt *exhales* -part of rib cage doesn't completely collapse vs rest of ribs -treat the "key rib" (inferior rib) *Complete diagnosis = "Locked up Ribs 1-8 Left, Key Rib 8"*
Diagnosis of Locked Down Rib SD
-Diagnosed with pt *inhales* -part of rib cage doesn't completely rise vs rest of ribs -treat the "key rib" (superior rib) *Complete diagnosis = "Locked Down Ribs 4-10 Right, Key Rib 4"*
Primary and Secondary Respiration: Primary respiration? Secondary? You cannot? You can? How? As the motion of the cranial bones is changed it will feel like.... but?
-Dr. Sutherland described the Primary respiration as that starting with the inherent motility of the CNS and Secondary respiration as that associated with the lungs. -Tidal; you cannot consciously change your primary mechanism. -You can 'force' the Secondary to influence the Primary.Techniques of exaggerated inhalation/exhalation to assist in moving the cranial bones.It is not truly the respiration that changes it; it is the collaborative effort of the muscles involved in respiration that will influence the motion of the cranial bones but it will return to its motion once the forced secondary respiration ceases.As the motion of the cranial bones is changed it will feel like the primary respiration has been 'changed'...you are just feeling the true primary that was being held back by the cranial dysfunction!
"Locked Down" Ribs?
-Ease of motion with exhalation -Will not come up during inhalation compared to other side
"Locked Up" Ribs?
-Ease of motion with inhalation -Will not go down during exhalation compared to other side
The T-spine has a constant tendency for spinal flexion. Why?
-Effects of gravity -Tendency of the back muscles (extensors) to become inhibited while flexors tend toward contraction
Posterior Costocervical Articulations
-Either complete facets or demifacets -One demifacet on the inferior and one on the superior aspect of the vertebrae
Locked down ribs aka?
-Exhalation SD -Inhalation restriction
Diagnosis of Rib SD
-First diagnose by group -Find *key rib* -In locked up, key rib is most inferior -in locked down, ky rib is most superior
Diagnosing Type II SD:
-Flexed/extended spine -Rotation/sidebending on *same side* -One vertebrae -Short restrictors involved -Causes: trauma, exceeding nl ROM
Most common PAIN reasons we treat ribs:
-Headaches -Neck pain -Shoulder pain -Arm pain -Upper back pain -low back pain -Hip/pelvis pain -Knee (or lower) pain
Consider imaging for the T-spine if?
-Hx of trauma -Pt is extremely sensitive to palpation during the structural exam -There is significant pain with ROM -Abnormal neurologic evaluation
Thoracic Spine Diaphragms
-Inferior border of the thoracic cavity -Attachments: Xiphoid, internal surface of inferior 6 ribs, left crus>L2, R crus> L3. -Main muscle of respiration by changing the *negative intrathoracic pressure on inhalation* -Major "pump" of the venous and lymphatic systems
Locked up ribs aka?
-Inhalation SD -Exhalation restriction
Principle III
-Initiating motion of a vertebral segment in any plane of motion will *modify the movement* of that segment in other planes of motion. -Useful when isolating to a specific vertebra during treatment
Posterior elements of L-spine?
-Lamina -Facet joints -Spinous/transverse processes
L-spine Sidebending (lateral flexion)
-Minor motion -Permitted as the inferior facets of a vertebrae slide down on one side and up on the other
Facet Tropism
-Most common congenital dysfucntion -30% of patients -Articular pillars on one side may be twisted, thus asymmetric -Asymmetric joints may be associated with asymmetric muscle tension and altered spinal motions
Tissues that generate pain in the lower back?
-Muscle (spasm, trigger points) -Supporting ligaments -Nerve fibers -Fascia -Facet joints: capsule and synovium -Disc: annulus fibrosis (outer fibers)
Diagnosing Type I SD:
-Neutral Spine -Rotation/sidebending *opposite* sides -3+ vertebrae -Long restrictors involved -Causes: postural, unleveled sacral base,
OMT uses for patients with LBP (per AOA)?
-OMT significantly reduces pain and improves functional status in patients with: -Non-specific acute and chronic LBP -Pregnant/postpartum women with LBP -Pt's with LBP should be treated with OMT given the high level of evidence that supports its efficacy
Venous Sinus Drainage.:Treatment techniques: Ociput Sinus (3), Transverse Sinus?
-Occipital sinus. 2 middle fingers tip to tip on the inion. Hold until feel softening. Keep fingers in same position and move one finger's width down towards foramen magnum. When reaching as close to the foramen magnum as possible, approximate the wrists. Wait for a softening and/or warmth. This decompresses the occipital condylar parts from the facets of the atlas. This last part is very important when treating colic in children! -Transverse sinus. Pads of little fingers on inion, other fingers spread out along superior nuchal line. Don't move or squeeze...it is the weight of the head on your fingers that completes this. Wait for a softening and/or warmth.
4 transitional areas of axial skeleton
-Occipitoatlantal jxn -Cervicothoracic jxn -Thoracolumbar jxn -Lumbosacral jxn
Physiologic vs Pathologic
-Occurs as a twisting effect around the anatomic axis. vs -Shearing force that causes the anatomic axis to be disrupted (gears get stripped).
Significance of Rotatores, Intertransversarii and Multifidi in T-spine?
-Often responsible for maintaining non-neutral SD of the vertebral units -Osteopathic theory: these muscles are involved in VS and SS reflexes through *type II* SD's -Can be reflexively affected by organ dysfunction
QL1 tenderpoint location
-On attachment of the QL to the 12th rib, in the superior lateral portion of the muscle
Bio-mechanical model (aka Postural Structural Model)
-Osseous skeleton is viewed as a series of building blocks -Alteration of the system is viewed from: 1. Balance of muscles as movers and stabilizers of the skeleton 2. Integrity of the continuous bands of fascia 3. The alignment of the bones and joints
Sponylolysis
-Pars interarticularis defect (or fx) may be congenital, but most commonly a chronic overload injury (repetitive traumatic stress) -Seen commonly in athletic teenagers
Middle elements of L-spine?
-Pedicles -Foramen/spinal canal
Disparent compensatory findings
-Pelvis and thorax rotated in same direction which does not allow for torsion-like movements of the pelvis and thorax during locomotion -Patients may be acutely ill, or have suffered significant trauma and will often present to you with pain
Type I Motion of L-spine
-Physiologic motion of the T or L-spine resulting from a neutral spinal position -Type I SD occurs when the spine gets stuck in that position, and it is maintained by *long restrictor muscles*
Type II SD of L-spine
-Physiologic motion of the T or L-spine resulting from a non-neutral spinal position -Occurs when the spine gets stuck in that position. -Maintained by *short restrictor muscles*
Diagnosis of Caliper Ribs 11-12
-Place hands laterally on lower rib cage in mid-axillary line to check motions of ribs 11 and 12 with breathing -No need to determine the key rib
Rib Somatic Dysfunctions
-Primary causes of rib pain Different types: *Respiratory Rib S.D.* - Locked up/down *Rib Counterstrain T.P.'s* (anterior/posterior) *Structural Rib S.D.* - Posterior/anterior rib, anterior-posterior rib compression, lateral rib compression
Anterior-Posterior Rib Compression
-Rib SD -*Named by (and secondary to) A-P rib trauma* -Complaint of chest wall pain -Mimics a rib fracture (*negative CXR*) -*Affected rib shaft(s) will be prominent and tender in the mid-axillary line* -May have decreased respiratory motion of ribs
Lateral Rib Compression
-Rib SD -*Named by (and secondary to) lateral rib trauma* -*Affected rib shaft(s) will be prominent and tender both anteriorly AND posteriorly* -Mimics a rib fracture (*negative CXR*) -Complaints of chest wall pain -May have decreased respiratory motion of ribs
Flexion/extension are the main motions of the L-spine because of . . .
-Sagittal orientation of the facet joints -The wedge-shaped thickness of the discs and bodies -The posterior direction of the spinous processes
Rib Treatment Protocol?
-Seated diagnosis -Find correlating TP -Treat key rib TP using S/CS -Re-evaluate respiratory rib motion - if abnormal, use ME to treat SD - re-evaluate again. -If motion is abnormal after ME, use HV/LA (or LV/MA) for key rib
Sources of T-spine dysfunction?
-Trauma -Poor posture standing/sitting/lying down -Degeneration -Osteoporosis -Intrinsic mechanical asymmetries -Visceral disease -Neurologic (Myelopathy, Radiculopathy)
Clinical Considerations Integrating the T-spine?
-Upper thoracics -Upper ribs -Inlet -Neck -Head If ABOVE the diaphragm - treat only structures above the diaphragm If below, treat the following structures located above the diaphragm: -T-L junction -L-S junction -Innominates -Upslips -Sacrum
L-spine Rotation
-Varies among individuals -Very limited in the lumbar spine because the articular processes lock together -Permitted by the large disc size (*coupled movements*)
Anterior elements of L-spine?
-Vertebral body -IV discs
Rule of 3's? T1-3: SP's are where?
At the same level of the transverse process
Caliper Ribs
-floating ribs -no anterior attachment -increase transverse diameter -analogous to internal and external rotation
Other reasons to evaluate and treat the L-spine
-improve fx of viscera -tx of LBP -address the base of the trunk to treat dysfunction/pain
In a SD, the top vertebra is described as it is . .
-sidebent -rotated -flexed or extended
When to address body regions? 4 basic concerns:
1. Viscerosomatic concerns 2. Dermatomal and myotomal concerns 3. Mechanical concerns 4. Respiratory and circulatory concerns
Cranial III
...
What is the scale for reflex grading?
0 - Absent 1 - Decreased 2 - Normal 3 - Increased 4 - Clonus
What are the increments of years used for D in the Heilig Formula?
0-10 years = 1 10-30 years = 2 Over 30 years = 3
What is the Pelvic Index (PI) in patients with spondylolisthesis?
0.8-1.15
what is the Wagner wound classification
0: no ulcer in a high risk foot 1: superficial ulcer. involve *full skin thickness* but NOT underlying tissue 2: deep ulcer. penetrates down to ligaments and muscle but *no bone involvement or abscess formation* 3: deep ulcer with *cellulitis or abscess* formation often with *osteomyelitis* 4: localized gangrene 5: extensive gangrene with whole foot
where is the ant L5 TP?
1 cm lateral to the pubic symphysis
What percentage of spondylolisthesis does traumatic account for?
1%
True ribs (vertebrocostal)
1-7
Where is the Chapman's piont for upper lung?
3rd intercostal space, along the sternal border
what ribs move in pump handle motion?
1-3
OMM for Thoracic Rib Cage: Used to improve . . .?
1. ANS balance (decrease sympathetic tone) 2. Spinal & Rib Mechanics (increase ROM) 3. Diaphragm function (restore motion, free diaphragm for better excursion) 4. Vascular & Lymph Flow (assist immune system)
How to increase arterial supply?
1. Arteries must be free flowing without any bony or soft tissue obstruction to the area that needs the supply. 2. The nerves that control that arterial supply need to be free from obstructions 3. Compression of a nerve also decreases its perineural arterial supply and venous drainage, so those compressions need to be removed. 4. The drainage by veins and lymphatics need to be very ative to remove congestion that can decrease the arterial supply.
What are the sequences of events for osteoarthritis of a synovial joint?
1. Articular somatic dysfunction 2. Facet Synovitis 3. Cartilage degenerates 4. Capsular laxity 5. Facet subluxation 6. Osteophyte formation 7. Facet and laminar enlargement
1. HA in region of eyebrows or sinuses, tic doulourex, tingling in the cheek (buccal). 2. infants with poor suckling, failure to thrive from inability to swallow
1. CN V. 2. vagus. DECOMPRESS THE CONDYLAR PARTS!!!
Primary CAUSES of rib pain?
1. Costochondral separation 2. Costochondritis 3. Somatic dysfunction -Also: fracture, contusion, arthritis, ankylosing spondylitis, bone cancer metastasis (PbKTL)
What is congestion in arterial supply due to?
1. Direct compression of veins and lymphatics by bone or soft tissue 2. Poor diaphragmatic action which decreases the pressuer differentials needed to promote venous return and lymphatic return
What are the sequences of events for disc degeneration?
1. Disc is weakened by circumferential microtears in the annulus fibrosus 2. Microtears coalesce to form a radial tear 3. Focal disc bulge 3a. Disc herniation 4. Circumferential bulging 5. Disc narrowing 6. Osteophyte formation 7. Vertebral body enlargement
Eye tx (3)? Ear? Nose and sinuses (3)? Throat (5)?
1. Efflurage over eyelid, ME, Glaucoma 2. Balance Temporal, Hyoid, Mandibular drainage 3. Adress para and sympathetics, Cranial tech, Mandibular drainage 4. Open the inlet. Hyoid technique. Sphenopalatine ganglion. Effleurage of the neck. Submandibular soft tissue.
Adequate respiration is responsible for
1. Movement of air 2. Venous/lymphatic circulation 3. Prevention of complications ( HAI, poor healing, impaired fluid regulation (CHF), prolonged hospital stay
PRIMARY RESPIRATORY MECHANISM (PRM)******** TEST QUESTION (5)
1. Inherent MOTILITY of the CNS. 2. FLUCTUATION of the CSF. 3. The MOBILITY of the reciprocal tension membrane (RTM). 4..Articular MOBILITY of the cranial bones. 5. The articular MOBILITY of the sacrum between the ilia.
Degenerative Cascade Model of Spine
1. Injury/dysfunction 2. Facet joints ^^ weight bearing 3. Stabilizing ligaments (ALL, PLL) are put on slack 4. ^^ motion = instability 5. Form follows function; (Wolf's law) osteophytes (bone spurs) are laid down in the direction of pull
Clinical pearls for segmental SD's
1. Make sure Type II's are completely treated (assoc. w/ more severe symptoms/conditions) 2. May be a hidden type II within a type I 3. Type I SD's can be compensatory
Ribcage Functions
1. Protection of vital organs of respiration and circulation 2. Respiration by creation of negative intrathoracic pressure 3. Circulation (venous and lymphatic) - creation of *negative intrathoracic pressure* assists with venous and lymphatic return
Diagnostic notation of segmental SD's
1. Vertebral levels (L2, or L1-4) 2. F=flexed, E=extended, N=neutral 3. R=rotated, S=sidebent -lower case "r" and "l" for right/left Ex: L3 F RrSr
Diagnosis of Bucket Handles Ribs 6-10
1. Pt seated, physician behind 2. Get permission 3. Fingers spread out so as to be in contact with as many ribs as possible along the mid-axillary line 4. Patient breathes deeply in and out 5. Identify locked up or down group 6. Identify key rib
Diagnosis of Pump Handles Ribs 1-5
1. Pt seats, physician behind 2. Get permission 3. Fingers along the sternal border of 1-5th ribs 4. Patient breathes deeply in and out 5. Identify locked up or down group 6. Identify key rib
Example of steps to comprehensive medical diagnosis, integration with OMT
1. Reach medical Dx 2. Correlating SD's related to the diagnosis 3. Considering other areas that help with venous and lymphatic return, improve arterial circulation 4 Performing sympathetic/parasympathetic stimulation or inhibition as appropriate
Given the goal of respiratory-circulatory OMT, it is important that the....
1. Restriction to terminal drainage at the *thoracic inlet* must be removed 2. *T-spine* and *ribs* must be functionally flexible 3. *L-spine* must be flexible enough to change its anterior curvature for breathing 4. *Pelvic diaphragm* should be balanced and nonrestrictive
Diagnostic procedure for specific segmental SD's
1. Spinal sweep 2. Assess paired transverse processes in 3 positions (neutral/flexed/extended) using *static and motion* palpation 3. Diagnostic interpretation - positional diagnosis will describe the SD
Radial head dysfunction supination and pronation correlate with what? - Mech of injury for pronation dysfunction? - Supination dysfunction?
1. Supination = Anterior Radial head 2. Pronation = Posterior Radial head - Fall forward on pronation - Fall backward on extended hand
Fibular head dysfunction?
1. Supination = Posterior Fibular 2. Pronation = Anterior Fibular
Structural exam of the T-spine
1. Sweep 2. Localize to the specific vertebral level using landmarks 3. Localize to the specific transverse processes with the Rule of 3's 4. Finalize the diagnosis by assessing for either Type I or type II SD
Ottowa Ankle Rules? What do they indicate?
1. Tenderness to palpation on posterior medial/lateral malleolus 2. Unable to bear weight immediately post injury 3. Midfoot pain plus pain in navicular/5th metatarsal *Indicate ankle fracture; if not present, do RICE
What occurs with Increased sypathetic tone? (8)
1. Vasoconstriction. Decreased nutrition to tissue. 2. Thickened secretions.Tissue congestion. 3. Decreased Drainage. 4.Dilation of the pupils. 5. Thyroid glandular secretions. 6. Slight vertigo. 7.Tinnitus 8. Increased fatigue
What are the 5 models?
1. biopsychosocial 2. structural 3. neuro 4. cv/resp 5. metabolic
describe the three broad categories of lbp as described by the AOA guidlines
1. non specific lbp 2. back pain potentially associated with radiculopathy or spinal stenosis 3. back pain potentially associated with another specific spinal causes
HA TX (4)
1.#1; eliminate the cause. 2.Avoid triggers. 3.Treat attacks. Indirect techniques best when patient presents for treatment while experiencing a headache. 4.Prophylaxis.
DDX New onset HA? (read)
1.Acute angle closure glaucoma. Prominent eye pain, dilated pupils, narrow anterior chamber, ocular HTN (>40), increased cup/disc ratio. 2.Temporal arteritis. Tenderness over the temporal region. 3.Meningitis. Nucal rigidity, fever, + Kernig's (if flex the hip, can't extend at the knee), + Brudzinsky's (flexion of neck causes flexion at hips and knees) 4. CVA: Subarachnoid hemorrhage; 'thunderclap' HA (explosive, severe headache of sudden onset), worst HA ever. LOC, stiff neck, N, V, photophobia, seizures, pupillary dilation. Time of onset to maximum intensity < 5 minutes. 5.Mass lesion/tumor/abscess. Increased intracranial pressure, PAPILLEDEMA, altered mental status, neurologic deficits. 6.Malignant HTN. 7.Pheochromocytoma. 8.Toxic exposure. 9.HIV. Cryptococcal meningitis, progressive multifocal leukoencephalopathy, encephalitis, generalized sepsis. 10.Metabolic causes. Hyponatremia, uremia, hypoglycemia, carbon monoxide poisoning, hypercapnia/COPD/sleep apnea.
Specific HA tx? (4)
1.Cranial: VSD., Parietal/frontal lifts., CV4, Treat temporal bones, V-spread (of O-M suture) facilitates venous drainage through the jugular foramen. 2.Cervical spine-especially OA-AA. Frees suboccipital region to relieve muscle tension. 3. Hypertonic (tight) suboccipital muscles. Soft tissue, muscle energy, myofascial release, facilitated positional release. 4. Thoracic inlet - sympathetic involvement.
!!! DANGER SIGNS !!!: 1. During exertion/straining? 2. Fever or neck stiffnesss 3. Drowsy or confused? 4. With abnormal physical exam (pupil size, fundus, extraoculomotor [EOM] activity, facial symmetry, reflexes); Think subdural, stroke.
1.Think leaking aneurysm, increased intracranial pressure (ICP). 2. Meningitis, encephalitis 3.Think increased ICP secondary to encephalitis, meningitis, metabolic (electrolytes or sepsis). 4. Think subdural, stroke.
Increased parasympathetic tone? (3)
1.Thinning of secretions. 2.Tear production. 3.Nasopharyngeal and sinus secretions are profuse, clear, and thin.
Hand position to imitate a temporal bone** WILL BE A QUESTION ON: (3) With external rotation: Temporalis rotates ____, squama ____,mastoids move _____.
1.Tips of middle fingers together at an angle (axes through petrous ridges). Thumbs represent the temporal squama. Little fingers represent the mastoid processes. External Rotation (what you will feel under your hands in either a vault or temporal hold). The temporals rotate anteriorly. The squama widen. Mastoids move posteriomedially.
Temporal Rocking: Use (3)
1.To temporarily reduce (or less frequently to increase) the frequency of the CRI. 2.To restore the balance of the cranial mechanism when it has been disturbed for any reason. 3.Has a calming effect - good at the conclusion to a treatment.
How short can one's leg be without having any symptoms throughout life if no other deformities are present?
1/2" shorter on one leg
How short can one's leg be without having any symptoms throughout life if other deformities are present?
1/8" shorter can cause the back to become symptomatic
normal CRI frequency
10-14
what is the number of cycles for a normal cranial rhythmic impulse?
10-14
what is the normal carrying angle
10-15 in women 5-10 in men
describe the angle of the eustachian tube in a kid and an adult
10-30 degrees in kid 40-50 degrees in adult
Floating Ribs (free)
11,12
what ribs are caliper motion?
11,12
In sacral base unleveling, most curves measure less than how many degrees?
15 degrees
how long does a cluster headache or a trigeminal HA last for?
15-180 minutes
Lumbar extension
15-30 degrees
Intestinal peristalsis
1in bellow ASIS
torsion, sidebending rotation, vertical strain, lateral strain, compression
Abnormal SBS mechanisms (common cranial strain patterns)
HI location? Treatment?
2 cm lateral to PSIS E ABD ER
What can the hand detect?
2 pt discrimination, texture, conture/structure, friction/moisture, compliance, temp, stereognosis
What percentage do pathologic spondylolisthesis account for?
2%
Evidence of what implies restriction of the AC joint?
Absence of gapping
Lumbar rotation
20-30 degrees
Recommended amount of fiber?
20-35g daily
What cobb angle of scoliosis require surgery?
20-40 degrees
What percentage of spondylolistheses are dysplastic?
21% F:M = 2:1
when does the SBS fuse?
25 y/o
What percentage of spondylolisthesis are degenerative?
25% F:M = 4:1 Black:White = 3:1
Lumbar sidebending
25-35 degrees
Where is the Chapman's point for bronchus?
2nd intercostal space along the sternal border
chapman pt for the heart?
2nd intercostal space near the sternum
Neck pain
2nd only to back pain as a cc
Larynx
2nd rib
Tongue
2nd rib @ costosternal joint.
Sinuses
2nd rib, top, midcl.
at birth how many parts of the sphenoid do you have?
3
describe the sympathetic innervation to the detrusor mm and internal sphincter
L1-L2
Viscerosomatics of descending colon and rectum
L1-L2 (symp) S2-S4 (para) runs on *LEFT*
Lumbar Fascial Dx
3 areas need to be examined and named for a full diagnosis of the lumbar fascial restrictions -T/L shift -L/P roll -Iliac Crest Height (landmark)
superficial, deep, visceral
3 types of fascia
when does the metopic close?
3 years old
Pneumonia Anterior Chapman's Points
3,4 ICS Lung
What is the plane of the proximal tib-fib joint?
30 degrees from lateral to medial
What position isolates the AC joint when diagnosing and treating?
30 degrees of horizontal flexion
how long does a tension headache last for?
30 minutes to 7 days
What vertebral levels does the diaphragm attach?
L1-L3
how many parts of the occiput are there at birth?
4
what ribs move with both pump and bucket handle motion?
4,5
how long does a migraine typically last for?
4-72 hours
S5 location? Treatment?
Medial and superior to ILA Push on opposite base
AL2 tenderpoint location
Medial aspect of AIIS
AL1 tenderpoint location
Medial aspect of ASIS
Low Back pain
49-70% adults have had low back pain 2nd most common reason for visits cost more than 100B per year
Where is the Chapman's point for lower lung?
4th intercostal space, along the sternal border
migraines without aura must have how many attacks?
5
How much motion is available in the sacroiliac joint?
5 degrees each for flexion and extension
At the age of 20, the incidence of spondylolisthesis in the population goes up to what percent?
5%
Lumbar flexion
50-70 degrees
What percentage of spondylolistheses are isthmic?
51% almost all at L5
Iliolumbar Ligament Tender Point?
Along iliac crest on posterior
What is the definition of clonus?
Alternating muscle contraction and relaxation in rapid succession. Disconnect between upper and lower motor neurons
when is the cranial bases its adult size?
6 years old
what ribs move in bucket handle motion?
6-10
At what age does spondylolysis develop?
6-8 years
If abx are used to treat OM, what do you choose?
Amoxicillin
MPSI location? Treatment?
7-10 cm below PSIS F AB ER
when do parts of the occiput and atlas fuse?
7-9 years old
what cobb angle is great enough to affect cardiac function
75 degrees
False ribs (vertebrochondral)
8-10
Describe the research by Drs. Oleski, Smith and Crow
91.6% of patients had difference in measurement in 3 or more angles, thus proving movement in the cranium can be measured by XR
Cranial Somatic dysfunction in newborns
88% have it, most asymptomatic
complex of neuro sx that occurs just before onset of migraine
Aura (migraines)
fatigue, difficulty concentrating, neck stiffness, photo/phonophobia, nausea, blurred vision, yawning, pallor
Aura clinical presentation (migraines)
Migraine: Usually starts? which side? Lasts? ____ in nature? Asst with? M vs F? Two types? May be triggered by? (2) Vasoconstrictor? Vasodilator?
=unilateral (usually left first) and may progress to bilateral. -Lasts hours to days. -Vascular in nature. -Associated with nausea, vomiting, photophobia, phonophobia. More common in females.. 2 types: Classic= with an aura.10-90 minutes beore a headache.Light flashes. Common= no aura
Which subtype isthmic spondylolisthesis is the most common form in patients under 50?
A
If the medical problem is the T-spine itself?
A *spinal evaluation* needs to be done. -Joint Exam -Neurologic exam
What maintains a somatic dysfunction of the sacroiliac joint?
A true joint subluxation locking mechanism due to ligamentous tension
large size, rapid conducting
A fibers (afferent pain neurons) characteristics
What is spondylolisthesis?
A forward slippage of one vertebrae on the segment below it
What is the definition of articulatory technique?
A low velocity/moderate to high amplitude technique where a joint is carried through its full range of motion with the therapeutic goal of increased freedom and range of movement
A moderately or severely strained rib may exhibit?
A rib angle point and mid-axillary tender point - *special kind of key rib* - difficult to find with the respiratory diagnosis because it cannot move well into inhalation or exhalation
Rib tender points may easily diagnose?
A significantly strained rib - not necessarily the key rib
Compression of the SBS - affect on PRM? Causes?
A strain in which the sphenoid and occiput have been forced together to such a degree that physiologic flexion-extension is impaired. Compression varies from mild to moderate to severe The PRM is dampened, demonstrating less amplitude and power With severe compression the cranium feels rigid Occurs from a force to the back of the head, to the front of the head, or from a circumferential compression (as during a difficult birth) that exceeds the resiliency of the tissues#$https://o.quizlet.com/abkeSG33lt6PjV0IKjKZKA_m.png
Why are sacral dysfunctions considered to be torsion dysfunctions?
A torsion is two parts of an object rotating in opposite directions about a single axis Since L5 is tightly anchored to the iliac crests by the iliolumbar ligaments, L5 tends to move with the ilia When you compare L5 to the position of the sacrum, it appears that the two have rotated in opposite directions about a vertical axis
What is a possible reaction after treatment?
A transient increase in patient symptoms following manipulative treatment (happens to about 1/3 of patients)
LATERAL STRAINS: Cause? Axes? Movement direction? Named based on? Head feels like?
A traumatic blow on the side of the head anterior/posterior to the SBS. Axes; 2 vertical. Movement; Same direction around the axes. Named; Base of the sphenoid. Left or right. Head feels like a parallelogram.
Interoceptors
Internal environment
respond to strong stimuli, rapid, localized
A-delta fibers (afferent pain neurons) characteristics
Stereogenesis
Ability to recognize 3D shape based on touch
What two vertebrae have the highest percentage of spondylolisthesis occurrence?
L5 on S1 (75%)
What are the three subtypes of an isthmic spondylolisthesis?
A: Lytic-fatigue fracture of the pars B: elongated but intact pars C: acutely fractured pars
On an X-ray what is the difference between subtype A and B in appearance?
A: broken neck of the Scotty dog B: greyhound (spondylolysis - the scotty dog wears a collar)
C2
AA, C2, C3 spinal root innervation
is the ACL or PCL weaker
ACL
What are the four unilateral flexed and extended sacral dysfunctions?
AKA sacral shears Flexed Sacrum Right and Left Extended Sacrum Right and Left
Chapman point for intestine?
ASIS (anterior/peristalsis), Rib space (8-10)
What two bony landmarks are used to determine actual (anatomic) length length?
ASIS and medial malleolus
What is the principal asymmetry of an inflare innominate dysfunction?
ASIS closer to midline --------- Secondary: PSIS farther from midline and sacral sulcus is wider
What is the primary asymmetry for an outflare innominate dysfunction?
ASIS farther from midline ---------- PSIS closer to midline and sacral sulcus is narrower
What are the three anterior landmarks that need to be palpated for asymmetry?
ASIS, pubic tubercles, and pubic symphysis
Left sympathetic fibers predominately influence what in the heart? Can cause what?
AV node PVCs and other ventricular arrhythmias
Motions of SC joint?
Abduction Horizontal flexion
Motions of AC joint?
Abduction, adduction External rotation, internal rotation
When testing adduction of the hip, what muscles are tested?
Abductors- gluteus medius and minimus, tensor fascia lata
S1
Achilles tendon reflex nerve root
Thompson test?
Achilles tendon rupture; calf squeeze which should cause plantarflexion
Stomach
Acidity: Between ribs 5-6 (L) Peristalsis: Ribs 6-7 (L)
What are the characteristics of Chronic Pain?
Acute and subacute syndrome due to tissue injury with nociceptive activation
Considering Dr. Zink's Focus on the Respiratory-Circulatory Model, which technique style do you think he relied upon most? A) Cranial osteopathy B) HVLA C) Soft tissue/lymphatic pump D) S/CS E) Myofascial release
Answer: B) HV/LA
When testing abduction of the hip, what muscles are tested?
Adductors
rotator cuff inflammation with scarring
Adhesive capsulitis
extend arm posteriorly, palpate pulse, turn head towards/away
Adson's test instruction
What is the normal disc aging percentages?
Age 14 to 34 90% Normal Discs 10% Degenerative Age 35 to 45 25% Normal Discs 75% Degenerative Age 46 to 59 25% Normal at L3/L4 0% Normal at L5/S1 Age 60 and up 0% Normal at L5/S1 2% Normal at L4/L5 3% Normal at L3/L4
What are the demographics for people with spinal osteoarthritis?
Age 25+ (most cases appearing beyond age 40) Obese
What is the relationship of the pelvic index?
Age dependent relationship PI increases with age
Patterns of Motion in the Cranium
All motion of cranial bones are interdependent No cranial bones move independently Restrictions in any one part of the cranium will affect the rest of the cranial mechanism The sphenobasilar junction, also known as the sphenobasilar synchondrosis (or symphysis a.k.a. SBS) is the reference point around which cranial motion patterns are described
Cobb Angle
Angle of scoliotic curvature
You perform the RSS on yuor patient and find that the rib cage moves freely and symmetrically into exhalation. Upon inhalation, the right side moves freely but the left side does not inhale fully. Where should you look for the key rib and tenderpoint associated with it? A) L side, lowest rib, mid-axillary line B) L side, lowest rib, rib angle C) L side, top rib, mid-axillary line D) L side, top rib, rib angle E) R side, lowest rib, mid-axillary line F) R side, lowest rib, rib angle
Answer: C) L side, top rib, mid-axillary line
A 27 y/o F presents for OMT 2 days after vaginal delivery of her full-term baby with prolonged labor. She reports significant soreness and swelling int he pelvis region, especially with walking. In electing to provide OMT from a respiratory-circulatory approach, where would you begin the treatment? A) LP diaphragm B) Lymphatic pumps (LE) C) Thoracic inlet D) TL diaphragm E) urogenital pelvic diaphragm (pelvic floor)
Answer: C) Thoracic inlet
Which treatment style fits best with the Biomechanical Model? A) HVLA B) Muscle Energy C) S/CS D) Facilitated Positional Release E) Any of the above
Answer: E) Any of the above
When passively moving the patient, you are testing which muscle group?
Antagonistic muscle group
Flexion
Anterior aspects of the spine approximate
Location of AL5? Treatment?
Anterior pubic rami F SARA
What are four axis dysfunctions?
Anterior rotation, posterior rotation, superior pubic shear, and inferior pubic shear
Patient with short leg syndrome can have what sacral finding on the side of dysfunction?
Anterior sacral base (forward torsion)
Most common ligament injured in an ankle sprain?
Anterior talofibular ligament
What are the four unilateral torsion sacral dysfunctions?
Anterior torsion on right oblique axis (right on right sacral torsion) Anterior torsion on left oblique axis (left on left sacral torsion) Posterior torsion on right oblique axis (left on right sacral torsion) Posterior torsion on left oblique axis (right on left sacral torsion)
Which side of the cardiac wall is especially rich in sympathetic fibers? Levels of ventricles/atria?
Anterior wall Ventricles = T1-3 Atria = T4-6
What ligaments suspend sacrum between inominates
Anterior/posterior SI, interosseous SI ligaments
Kidneys
Anterior: 1" superior and 1" lateral to umbilicus Posterior: btw spinous and transverse processes of T12-L1
Adrenals
Anterior: 2" superior and 1" lateral to umbilicus Posterior: btw spinous and transverse processes of T11-12
How should the radial head move in supination?
Anteriorly
Where is the middle transverse axis located?
Anteriorly at the level of S2 near the junction of the long and short arms of the sacroiliac joint
Which manipulative techniques can be used to treat spondylolisthesis?
Any technique which does not increase the lumbar lordosis, or extend the lumbosacral junction may be used
Where is the inferior transverse axis located?
At the level of the inferior lateral angle
What are some known consequences of >1/2" leg length inequality?
Arch collapse: Long leg side Osteoarthritis - Hip: Long leg side Trochanteric Bursitis: Long leg side Premature spinal osteoarthritis Piriformis Syndrome: Long leg side Ovarian cyst: Short leg side Infertility/Chronic fetal wastage
Superior Articular Facets of T-spine
Articulate with the vertebrae directly above it. *Backward, upward, lateral*
Superior Articular Facets of C-spine
Articulate with the vertebrae directly above it. *Backward, upward, medial*
Posterior Costotransverse Articulations
Articulation of the rib tubercle with the transverse process of the corresponding vertebra
Why is it important to treat the L-spine?
As part of a comprehensive evaluation and tx for a patient's medical diagnosis. The attachments of the thoracolumbar diaphragm are to the L-spine - may improve/increase venous/lymphatic return/arterial flow
What is circumferential bulging?
As the disc architecture deteriorates, the annulus further weakens and begins to bulge circumferentially.
junction of parietomastoic, occipitomastoid, lambdoid sutures
Asterion
What are three false positives for a standing flexion test?
Asymmetric hamstring tension, sacral dysfunction, and severe L4 or L5 dysfunction
When is articulatory technique contraindicated?
Avoid simultaneous hyperextension and rotation of the occiput and upper cervical segments as this can damage or occlude the vertebral arteries. Avoid articulating an acutely inflamed joint. Avoid articulating an acutely infected joint. Avoid articulating joints that are acutely sprained or strained.
Temporal bones: Axis of rotation is through the? The axes?
Axis of rotation is through the petrous ridge. The axes converge anteriorly.
Which subtype isthmic spondylolisthesis is due to repetitive microfracturing with elongation occurring with healing?
B
Pneuomonic for remembering patterns (5)
B = B ones Show the motions of the bones utilizing a sphenoid and occiput. A = A xis AP, transverse, vertical D = D irection the bones are moving Same, opposite N = N amed by Base of sphenoid, side of convexity/side that drops inferiorly, SBS rises/falls, greater wing of the sphenoid F = F ingers Show motions utilizing hands
intermediate size, speed
B fibers (afferent pain neurons) characteristics
What causes spondylolysis?
Lytic defect in the pars interarticularis
What axes do the sphenoid and occiput rotate about in vertical strains? A. Vertical B. Anteroposterior C. Transverse D. Petrous ridge E. Oblique
C. Transverse
Right vagus predominately acts on what in the heart? Left?
SA node AV node
In a SBS torsion strain the sphenoid and occiput rotate in the same direction A. True B. False
B. False
Eccentric contraction
Contraction of a muscle against resistance while forcing the muscle to lengthen
recent trauma/CVA/neurosurgery, infection, elevated ICP/edema, tumor, congenital malformation
Contraindications to venous sinus drainage technique
Lesions in the cerebral cortex cause what defects?
Contralateral motor/sensory defects
Describe what your hands will feel when palpating a patient's head with a right SBS torsion? A. Left index finger will be higher B. Right index finger will be higher C. Left little finger will be higher D. Right little finger will be lower
B. Right index finger will be higher - finger, on the greater wing of the sphenoid, will be higher
Which of the following is a non-physiologic SBS strain? A. Left torsion B. Right lateral strain C. Left side-bending and rotation D. Flexion E. Extension
B. Right lateral strain
Superior Vertical Strain - axis & mechanism of force
Basisphenoid shifts superiorly Basiocciput shifts inferiorly Spheniod and occiput rotate in same directions, about their respective transverse axes This could be caused by - Traumatic vector of force inferiorly on the anterior vertex - Or superiorly at the base of the occiput#$https://o.quizlet.com/BMfa73y8v46DMK17a1dFpg_m.png
What is the function of the cerebellum?
Controls muscles during movement to ensure smooth motor transitions and to maintain posture and balance
Inferior Vertical Strain - axis & mechanism of force
Basisphenoid shifts inferiorly Basiocciput shifts superiorly Sphenoid and occiput rotate in same directions, about their respective transverse axes - In this picture, both are clockwise) This could be caused by a traumatic vector of force in inferiorly on the posterior top of the head (midline) = Large red arrow in picture#$https://o.quizlet.com/s1XguD1GAH5ddWsWYs69yA_m.png
A level of Grade 0-2 usually means there is what type of existing problem?
CNS problem
LEFT LATERAL STRAIN: Base of sphenoid? Wings of sphenoid? Index fingers? Little fingers?
Base of the sphenoid goes to the left. Wings of the sphenoid rotate towards the right. Index fingers move to the right. Little fingers move to the left.
RIGHT LATERAL STRAIN: Base of sphenoid? Wings of sphenoid? Index fingers? Little fingers?
Base of the sphenoid goes to the right. Wings of the sphenoid rotate towards the left. Index fingers move to the left. Little fingers move to the right.
balanced membranous tension
BMT
Thoracic facet orientation
BUL- posteriorly/laterally
lumbar facet orientation
BUM
orientation of the facets of the vertebrae?
BUM BUL BM Cervical = backwards upwards medial Thoracics Backwards upwards and lateral Lumbar - backwards and medial
Cervical Facet orientation
BUM- posteriorly/superiorly at 45 degree angle
What are the symptoms for central canal stenosis?
Back pain or Neck Pain Bilateral or Unilateral Leg or Arm Pain, Numbness, Muscle Cramps, Paresthesias Neurogenic Claudication Loss of Balance
As the leg goes backward ________, the innominate rotates _________.
Backward Anteriorly
gastrocnemius-semimembranosus bursitis, located on medial side
Baker's cyst
Location of AR1? AR2? AR3-7?
Below medial end of clavicle at SC joint 2nd rib at midclavicular line Along anterior axillary line
Liver
Between ribs 5-6, 6-7 (R)
Gallbladder
Between ribs 6-7 (R)
Tension Headaches: Unilteral vs Bilateral? Feels like? Diff from migraine (2) Lasts? Cause?
Bilateral. Dull, achy pain, pressure feeling. No aura.Not worsened with physical activity. May be associated with stress, anxiety, depression. May be associated with photophobia, phonophobia. May last days to weeks. Poor biomechanics ('medical student posture'), bruxism, and fatigue may produce tension headaches. Palpation over trigger area may reproduce symptoms.
5 models of Osteopathic care
Biomechanical, Cardio/respiratory, neurologic, metabolic/energetic, behavioral/psychosocial
What are the main differences between neurogenic claudication and vascular claudication?
Both NC and VC are relieved by rest, but NC resolves rapidly, almost instantly, while VC can take five minutes or more to resolve NC improves walking uphill, VC gets worse with the same activity NC occurs when walking, but not when riding an exercycle due to the flexed posture. VC occurs both walking and riding the exercycle
Lateral Strain
Both sphenoid and occiput rotate in the *same* direction around two parallel *vertical* axes Basisphenoid and basiocciput veer in opposite directions, producing a shearing type motion is named for the direction the basisphenoid shifts, left or right#$https://o.quizlet.com/CxYizeZzVBXccVJ3zZ3XSg_m.png
Increase in right vagal tone on the heart can cause what? Left vagal tone?
Bradyarrhythmias AV block
Hysteresis
Breaking of cross links
junction of coronal, sagittal sutures
Bregma
Spleen
Btw 7-8 (L)
Pancreas
Btw 7-8 (R)
small intestine
Btw ribs 8-9-10-11
which osteopathic researcher was the first career osteopathic researcher
Burns
What is disc narrowing?
By this time of adulthood (about age 40), the nucleus pulposus is no longer gelatinous but has taken on a more fibrous consistency. Volume loss is produced by desiccation and the loss of mucopolysaccharides. Measurements at this stage also show a reduced intradiscal pressure. Disc narrowing per se is not painful. However, disc narrowing results in 70% of all compressive forces being born by the facet joints. Normally the facet joints bear only 17% of the compressive load. Narrowing of the discs also changes the relationship of the pedicles to the nerve roots. The pedicles drop caudad, narrow the neural foramen and may stretch or rub against the nerve roots passing adjacent to them.
Ribs In Hospitalized Patients?
COPD and CHF often in same patient, in acute exacerbation, BOTH can present with SOB crackles in the lung base, and changes on CXR
cranial rhythmic impulse
CRI
Which subtype isthmic spondylolisthesis is due to a history of severe trauma and may heal with immobilization or the use of a magnetic coil?
C
small size, slow conduction
C fibers (afferent pain neurons) characteristics
deviates toward one side, dysfunctional side
C shaped TMJ deviation
burning pain, allodynia, skin temp/color/texture changes
CRPS clinical presentation
what acts as support and buffer for the CNS
CSF
Which of the following is NOT drained by the Left Lymphatic Duct? A) Left knee B) Left Knee C) Left ventricle D) Left kidney E) Right leg
C) the heart is drained by the R lymphatic duct
which technique increase the central rhythmic impules?
CV 4
what cranial technique helps depression?
CV4
Describe the research by Drs. Gitlin and Wolf?
CV4 induced labor in 6 post-date female patients "Get him the wolf out of me!"
What are the discs weakened by in disc degeneration?
Circumferential (annular) microtears in the annulus fibrosus
Thoracic Duct Route?
Cisterna chyli (abdomen) > aortic hiatus> diaphragm > crosses from R - L at T4/5/6 *posterior to the esophagus* > drains into veins at the *junction of the L internal jugular and the L subclavian vein*
Tenderpoints: Frontal, Orbital HA:nerve? Location of TP? TX? Periorbital HA: Nerve? Location? TX? Occibipat HA: Nerve? Location? TX?
C1 - frontal, orbital headaches. Found on the posterior surface of the ramus of the jaw. Treat be rotating the head AWAY from the TP. C2 - periorbital headache. Found on the transverse process of C2. Treat by flexing the spine and rotating and sidebending AWAY from the TP. C4 - occipital headache. Found on the transverse process of C4. Treat same as C2.
Musculoskeletal Assessment for Headaches: Nerve name? Sensory vs Motor? Tx?
C1 - suboccipital nerve. MOTOR to suboccipital triangle. Headache is 'reproduced' by palpation of these muscles...(treat OA). C2 and C3 - greater and lesser occipital nerves. SENSORY to the cranial vault, back of the head, and suboccipital area. Headache is in the occipital region.
what three spinal segments are affected with HTN according to the johnston study
C2 T2 T6
where can you have referred pain from that could be interpreted as a headache?
C2-C3 zygapophyseal joint/intervertebral disc, alanto-occipital joint, lateral alanto-axial joint
C3
C3, C3 joint innervation
Lateral Strain - Mechanism of injury
Can follow a lateral force applied to the side of the head - anterior or posterior to SBS (large red arrows)#$https://o.quizlet.com/CxYizeZzVBXccVJ3zZ3XSg_m.png
what structure is implicated in carpel tunnel vs de quervaines?
Carpel tunnel: flexor retinaculum De Quervaines: extensor retinaculum?? or Abductor halacis longis
Upon neurologic examination of someone with spondylolisthesis, deficits in the pelvis and lower extremities suggest what?
Cauda equina involvement and warrant EMG/NCV evaluation
What causes an anterior torsion to occur?
Caused by truncal sidebending and rotational forces in extension coming down from the lumbar spine Also caused by exaggeration of the gait cycle Symptoms - backache, buttock ache
What causes a posterior torsion to occur?
Caused by truncal sidebending and rotational forces in flexion coming down from the lumbar spine NOT caused by the gait cycle Symptoms - intense LBP and hip pain, piriformis pain, pt walks with a limp
VERTICAL STRAIN.:Caused by? Axes? Movement direction? Bones? Named?
Caused by; Traumatic blow on the top of the head behind/in front of the plane of the SBS or from below through the mouth anterior/posterior to the plane of the SBS. Axes; 2 transverse. Movement; Same direction around the axes. One bone in flexion while the other is in extension. Named; Direction of the base of the sphenoid. Superior or inferior.
SBS COMPRESSION:Caused by? Axis? Movement? Sphenoid and occiput? Palpation?
Caused by; Traumatic blow to the nose directly in line with the SBS. Axis; A-P. Movement; Compression of the SBS along its line of axis. Sphenoid and occiput approximate and 'lock'. Prevents true flexion/extension, internal/external rotation. Little movement felt. Palpation; Fingers of both hands approximate. Distance between sphenoid wings and occipital lateral angles on both sides are reduced. Head will feel hard.
Short leg syndrome has what effect on the sacrum?
Causes sacral base unleveling
What are the joint distributions of spinal osteoarthritis?
Cervical and lumbar apophyseal, hip, knee, first metatorsophalangeal, first carpometacarpal and distal interphalangeal joints
Isotonic Contraction
Change in distance between origin and insertion w/o change in tension
What represents th somatic manifestation of a visceral dysfunction?
Chapman Point
pain with squatting
Childress' sign
ClusterM v W? Assst with? Pain: duration? Occurs in? Pain is described as? Cause? Asst sx?
Cluster also called 'suicide HA' because of pain intensity. More common in men with average age of onset in late 20's to 40's. May smoke and drink alcohol more than the 'average' person. Ocular/periocular pain lasts 30 minutes to 2 hours and occurs in clusters of days or weeks. May have 1-15 attacks/day. Pain is described as explosive onset and very sharp in intensity. -Thought to be caused by neurogenic inflammation affecting the vascular plexus of the CAVERNOUS SINUS, its tributaries, and its autonomic nerve supply. Associated symptoms; ipsilateral rhinorrhea, nasal congestion, lacrimation. May experience Horner's syndrome (miosis [pupil constriction], ptosis [drooping eyelid], anhidrosis [decreased facial sweating]) which is a disturbance of the sympathetics.
episodic attacks of periorbital pain, occur in 4-8 week cycles
Cluster cephalgia (headaches)
30-120 minutes
Cluster cephalgia (headaches) duration
M>F
Cluster cephalgia (headaches) gender distribution
unilateral, excruciating, explosive, deep, non-fluctuating
Cluster cephalgia (headaches) location/quality
lithium
Cluster cephalgia (headaches) treatment
20-50
Cluster cephalgia (headaches) typical age of onset
anterior coccyx displacement
Coccygodynia
HIFO location? Treatment?
Coccyx or ILA E ADD
FLUCTUATION OF CSF: Accomplished by? Fluctuation is NOT? Implies?
Coiling and uncoiling of the CNS is accomplished by changes in the sizes and volumes of the ventricles and occurs rhythmically. This movement causes the fluctuation of the cerebral spinal fluid. FLUCTUATION not circulation. Circulation implies around in circles like the cardiovascular system. Fluctuation implies ebb and flow like the tide.
distal radius displaced dorsal/posterior
Colles' fracture description of pathology
73 yo woman blood in still for 1 week. no hematemesis or dizziness. chronic LBP 15 yrs no other significant medical history or fhx. what is the most likely cause of her melena?
Colon CA
What are the colon symptoms of hyperparasympathecotonia?
Colonic cramping and pain, diarrhea, and irritable bowel syndrome
What is osteophyte formation?
Commonly called bone spurs, these outgrowths of bone were once believed to be nature's way of attempting to restabilize the joint. More likely they are due to traction on the periosteum where the joint capsule and ligaments attach into the bone (the enthesis - inflammation at this site is enthesitis, diseases and disorders at this site are enthesopathies). Remember that bone will remodel in accordance with the stresses placed on it (Wolff's Law).
What was the outcome of the Multicenter Osteopathic Pneumonia Study in the Elderly (MOPSE) clinical trial done bye Noll, Degenhardt, and Morley?
Compared to the conventional care only group, the OMT group had significant reductions in length of hospital stay, duration of IV antibiotics, respiratory failure and death "NULLmonia"
What is a dysplastic spondylolisthesis?
Congenital defect in neural arch of L5 or upper sacrum Insufficiency of the lumbosacral facets Plane of the facet joints approach horizontal
What is the treatment for spondylolisthesis?
Conservative management is successful 85-90% of the time in adults. If patient is a child, conservative management is successful only 50% of the time
Strain Patterns
Cranial dysfunctions are membranous articular dysfunctions (dural and bony aspects) They are a combination of membranous imbalance as well as articular restrictions It is important to realize that while one may be predominant in a given dysfunction, there are usually membranous and articular components to cranial dysfunctions
SBS descends, cranial-sacral extension
Cranial exhalation movement of SBS
SBS rises, cranial-sacral flexion
Cranial inhalation movement of SBS
What conveys impulses from head and face?
Cranial nerves V, VII, IX, and X and upper cervical nerve roots II and III convey impulses from the head and face. The brain itself has NO pain fibers!!!
RECIPROCAL TENSION MEMBRANE (aka dura): Two dural membranes?
Cranial reference of the dural membranes. -Falx cerebri. -Falx cerebelli.:Extends caudally from the straight sinus (Sutherland's fulcrum) make a connection with the intraspinal membrane that ultimately meets with the sacrum. -Tentorium cerebelli.:Another diaphragm. Part of the fascial system made up of the same kind of connective tissue one would find in a ligament. Very firm but malleable.
Cranial Technique: What does the tenchnique allow?
Cranial technique is a technique that allows the physiologic function within to manifest its unerring potential, rather than the application of blind force from without. -WHEN WE TREAT, WE APPROACH AND TREAT GENTLY...EASING THE TISSUES; NOT FORCING THEM INTO PLACE!!!
Describe the research by Dr. Frymann?
Created a device that contacted the parietal bones via probes, and transmitted any motion that occurred to a polygraph matching. There was strong evidence of motion separate to respiratory and cardiac activity
Describe the research by Dr. Sutherland?
Created an experimental helmet that he used to inhibit cranial motion. He noted sxs he experienced and then attempted to reverse the sxs by changing the inhibitory grasp of the helmet to enable motion.
Krause's end bulbs
Crude touch
How do you define dynamic lateral stenosis?
Entrapment of the nerve root in the area of the lateral recess (a "gutter" in the bone of the pedicle through which the nerve root travels) A transient entrapment Caused by facet subluxation and disc narrowing
SBS side-bending and rotation strain involves three axes. One is a vertical axis through the foramen magnum. Another is an A-P axis through the cranial vault. What is the third axis? A. A longitudinal axis along the parietals B. A transverse axis above the sphenoid C. A transverse axis at the junction of the basisphenoid and basiocciput D. A vertical axis through the body of the sphenoid E. An axis along the petrous ridge
D. A vertical axis through the body of the sphenoid
C5-C6 injury
Erb-Duchenne palsy etiology
Pectus excavatum
Most common congenital skeletal deformity
Principles of diagnosis and treatment of glenohumeral joint (4)?
Evaluate ROM Evaluate muscle strength Treat restricted ROM Treat muscle weakness
Pneumonia - Goals of OMM
Decrease sympathetic tone Decrease vasoconstriction Decrease thick secretions Decrease goblet cells Increase respiratory efficacy
Diverticulitis Sympathetic Goals
Decrease sympathetic tone Decrease vasoconstriction Decrease valve spasm Decrease constipation/ileus Decrease reflex ileus
What direction and axes of motion are involved in a patient with lateral SBS strain? A. Vertical - opposite directions B. Anteroposterior - opposite directions C. Transverse - same direction D. Vertical - same direction E. Transverse - opposite directions
D. Vertical - same direction
What has rib raising been shown to decrease as an articulatory technique?
Decreases the sympathetic nervous system activity
How is a disc herniation defined?
Defined as extrusion of the nucleus pulposus into the spinal canal (soft disc). Also refers to rupture and fragmentation of the annular cartilage with displacement of a fragment into the spinal canal with nerve entrapment (hard disc, or sequestered fragment)
Spondylosis
Degenerative condition (osteoarthritis) of the spine -Common cause of back pain in the elderly
Description of motion of one vertebrae
Described as it moves in relation to the vertebra *below*
Articular MOBILITY of the cranial bones.
Design of the articular surfaces in response to movement.
Pacinian Corpuscle
Detect deep pressure, vibration
8 essential steps to MET
Diagnose, engage barrier, unyielding counterforce, muscle contraction, relaxation, engage new barrier, final stretch, retest
What is the main use of Chapman points today?
Diagnosis
Anterior Rib
Diagnosis: Prominence and TTP of rib anteriorly -rib angle less prominent posteriorly, but rib angle can still be tender -Motion restriction of rib inhalation and exhalation -Often *key rib of respiratory SD*
Inspiratory Muscles
Diaphragm, External Intercostals, sternocostalis Accessory- SCM, scalenes, Pec major/minor
What causes Parkinson's Disease?
Dopaminergic synapses in corpus striatum deteriorate and causes tremors, bradykinesia, and muscular rigidity Decrease in neurons in substantia nigra
What is the symptom for an anterior innominate rotation dysfunction?
Diffuse low back pain radiating around the abdominal wall attachments to the iliac crest and following the inguinal ligament into the groin
What type of OMT is done to treat entrapment neuropathies?
Direct or indirect techniques ME, MFR, thrust, and functional techniques
Bio-Mechanical Model OMT
Directed toward: 1. Restoring maximal motion to all joints 2. Symmetry of length and strength to all muscles and ligaments 3. Symmetry of tension within fascial elements throughout the body
What is the challenge in diagnosing/treating a patient with spinal osteoarthritis?
Discovering the pain generator
If COPD exacerbation - ribs?
Dramatic limitation to exhalation and exhalation phase will be active (patient is working to get air out) - *LOCKED UP*
Pathologic Strain Patterns: due to? ex? (6)
Due to a traumatic event which causes a shearing of the SBS gear mechanism. Fall, blow, dental work, birth trauma (40#/square inch of pressure on baby's head), MVA, landing hard on your feet.
What is pathologic spondylolisthesis?
Due to bone disease: neoplasm, osteogenesis imperfecta, osteitis deformans, arthrogryposis, Kuskokwim disease, and tuberculous osteomyelitis
What is traumatic spondylolisthesis?
Due to fractures in other parts of the vertebra other than the pars interarticularis
What are the six types of spondylolisthesis?
Dysplastic, isthmic, degenerative, traumatic, pathologic, and iatrogenic
PL3 treatment?
E ABD ER
PL4 treatment?
E ABD ER
Treatment of PC2-8?
E SARA
Treatment of PL1-5?
E SARA
Treatment of PT1-12?
E SARA
Treatment of PR1?
E SART
About which axis do SBS torsions rotate? A. Transverse axis above the basiocciput B. Transverse axis above the basisphenoid C. Vertical axis in the occiput D. Vertical axis in the sphenoid E. Anteroposterior axis
E. Anteroposterior axis
What is the prostate symptom of hyperparasympathecotonia?
Engorgment and secretion (non-specific prostatitis)
When is a EMG/NCV or SSEP/DEP necessary to obtain?
EMG/NCV in the presence of neurologic deficits SSEP/DEP is there are sensory deficits and the EMG/NCV is normal
Treatment of lateral ankle?
EV ER (+/- plantarflexion)
What is iatrogenic spondylolisthesis?
Excessive removal of bone following spinal decompression surgery
What are the symptoms for dynamic lateral stenosis?
Excruciating nerve pain relieved by position Worst positions are extension and rotation Much easier to walk uphill or push a shopping cart Increased pain walking downhill and reaching overhead Neurogenic Claudication
Temporal Bone Motion - FLEXION
External rotates about an axis running along the petrous portion Squamous portion moves anteriorly, laterally, and inferiorly Mastoid portion moves medially, superiorly, and slightly posteriorly#$https://o.quizlet.com/QgaslvuHFX0YH9XJt.Jh6A_m.png
Tinnitus: .External rotation of temporal bone = ? Internal rotation of temporal bone =? Otitis media can be caused by? (4)
External rotation of temporal bone = low pitched roar. Internal rotation of temporal bone = high pitched whine 1.CN X dysfunction, 2.internal rotation of the temporal bones, 3.torsion of the SBS, 4.sidebending-rotation of the SBS.
When testing internal rotation of the hip, what muscles are tested?
External rotators- obturators, gemellus, quadratus femoris, piriformis
What are the characteristics of a bilaterally flexed sacrum?
Extra deep sacral sulci Increased lumbar lordosis
Treatment of PC1?
F
Treatment of TFL?
F AB
Treatment of IT band?
F AB (ER/IR)
PIR treatment?
F AB ER
Treatment of LCL?
F ABD ER
Treatment of MCL?
F ADD IR
Treatment of AT1-7?
F IR
Who demonstrated the mobility of the sacrum on the middle transverse axis radiographically?
F J Kottke in 1962
Treatment of AC2-6 and AC8?
F SARA
Treatment of PR2-10?
F SARA
Treatment of AC7?
F STAR
Treatment of AT7-12?
F STAR
Treatment of AR1-10?
F STRT
t/f uncompensated patterns alternate and are often symptomatic with a trauma onset
FALSE uncompensated patterns DO NOT alternate
What is posterior joint syndrome?
Facet + Circumferential Annular tears = PJS AKA facet syndrome
What does the Stage II of spinal degenerations represent?
Facet Capsular Laxity + Internal Disc rupture = dynamic lateral stenosis, degenerative spondylolisthesis, and degenerative retrolisthesis
True or False. The sacroiliac joints are smooth.
False even though they are totally congruent. They are filled with lumps and bumps that correspond to a depression on the opposite side of the joint.
True or False. Sacroiliac joint ligamentous pain is always present in an innominate dysfunction.
False. Pain may or may not be based on what ligamentous structures are involved.
Are pubic symphysis dysfunctions more common in males or females?
Females, especially ages 25-35 and during 3rd trimester of pregnancy
Treatment of PCL?
Femur posterior
diffuse aches, stiffness, fatigue
Fibromyalgia clinical presentation
11/18 tenderpoints for >3 months
Fibromyalgia diagnostic criteria
General counterstrain treatment principles (6)?
Find a significant tender point Position per palpation/standard treatment Find position of comfort to reduce pain by 70% Hold for 90 seconds Slow return to neutral Retest
What are the signs in somebody presenting with Parkinson's?
Flexed posture, head tilted forward, increased T-spine kyphosis Slow, shuffling gait Tripping and falling d/t decreased hip, knee and ankle flexion Loss of muscle strength Increased muscle tightness
What are the four bilateral sacral dysfunctions?
Flexed sacrum (sacral base anterior) Extended sacrum (Sacral base posterior) Posteriorly translated sacrum Anteriorly translated sacrum
Treatment of flexion calcaneous?
Flexion
Review of Cranial Bone Motion - Sphenoid FLEXION
Flexion Sphenoid rotates about a transverse axis through the center of the body at the level of the sella turcica The greater wings move forward, slightly laterally and inferiorly#$https://o.quizlet.com/Kh4fAbgLSsmGcTZwpEpmvA_m.png
Physiologic strains
Flexion and extension strains Torsions Side-bending and rotation - These strains are common and considered physiologic if they do not interfere with the flexion-extension motion of the mechanism
What type of exercise can be done as a part of the treatment process of spondylolisthesis?
Flexion type exercises ONLY NO extension exercises Swimming is good
Physiologic Strain Patterns. Which motions do you feel in an head with no dysfunction? Somatic dyfunctios of head are named by?
Flexion/extension, internal/external rotation are the physiologic motions of the cranium based on the primary respiratory mechanism. In a head with no dysfunctions this is all you would feel. Any trauma to the head will elicit a response of the cranium to that trauma. Because of the body acting as a unified whole, trauma to another part of the body may also elicit a dysfunction within the cranium. The somatic dysfunctions of the cranium are named by the motion of the bones.
Physiologic Strain Patterns> Pathologic strain patterns?
Flexion/extension, internal/external rotation are the physiologic motions of the cranium based on the primary respiratory mechanism. In a head with no dysfunctions this is all you would feel. Any trauma to the head will elicit a response of the cranium to that trauma. Because of the body acting as a unified whole, trauma to another part of the body may also elicit a dysfunction within the cranium. The somatic dysfunctions of the cranium are named by the motion of the bones. Torsion Sidebending-rotation
Respiratory-Circulatory Model
Focus on the importance of blood and lymph flow. Pumps: skeletal muscle and the thoracoabdominal diaphragm
As the leg comes __________, the innominate rotates ___________.
Forward Posteriorly
Contraindications for MET
Fracture, severe osteoporosis, infection/hematoma of the area, Metastatic disease of bone/muscle Relative- severe muscle cramps, open wound, uncooperative pt
Who discovered Chapman points?
Frank Chapman
Who first described MET in a teachable manner
Fred Mitchell Sr. DO
What happens if you have 1+ red flags present during screening?
Further evaluation and possibly medical/surgical treatment needed (CT scan, MRI, blood tests, X-rays etc)
Who presented a means of examining the whole body to interpret the status of the respiratory circulatory systems, and what was the method?
G. Zink - "Common Compensatory Pattern" -Pt evaluated in supine position -Physiologic, 'holographic' image presents the ideal (neutral) state -This 'ideal' physiologic pattern is best suited for locomotion (and health)
How does the Heel Loft Therapy change if high heel lifts need to be used?
Generally, a sole lift 1/2 the heel height is added, but when heel lifts are over 1" in height, the shoe gets built on top of a platform
Venous sinus technique
Gentle pressure and spread until softening over venous sinus. Know your anatomy and drainage.
Frontal Lift Technique
Gently bring palms together and lift head toward ceiling until softening
who is the author of the article: suboccipital decompression enhances HR variability indices of cardiac control in heatlhy subjects
Giles, Hensel
What does the Heilig Formula calculate?
Gives you the amount of the initial heel lift and the amount of subsequent incremental increases
What does S2 innervate?
Gluteus Maximus muscle Obturator Internus muscle Piriformis muscle Superior Gemellus muscle Hamstring muscles Gastroc-Soleus muscle Flexor Hallucis Longus muscle Intrinsic muscles of the foot External Sphincter Urethrae Pelvic Floor muscles
What does the muscle strength for spondylolisthesis show?
Good range of motion, but truncal muscle strength is decreased as is endurance
What is the scale for muscle strength?
Grade 0 - Flaccid paralysis Grade 1 - Can palpate muscle contraction, but muscle cannot move affected body part Grade 2 - Can only move body part with gravity eliminated Grade 3- Can only move body part against gravity Grade 4 - In between grades 3 and 5 Grade 5 - Full strength against full resistance
What is the Meyerding scale?
Grade I = 0-25% slip Grade II = 26-50% Grade III = 51-75% Grade IV = 76-100%
What Meyerd grades respond to non-surgical/conservative treatment well?
Grades I and II Grade III becomes iffy And Grade III and IV usually require surgical fusion
What groups are at risk for developing spondylolysis?
Gymnasts, soldiers carrying backpacks, and paratroopers
what is the criteria for a secondary headache?
HA as a result of another disorder known to cause headaches, headache close timing to other disorder, headache greatly reduced or resolves within 3 months after successful treatment of disorder
what is a cervicogenic headache?
HA caused by something going on in the neck
How do you treat an inflare innominate dysfunction?
HVLA thrust Muscle energy uses adductor musculature of the hip
How do you treat a pubic symphysis compression dysfunction?
HVLA thrust Muscle energy using the adductor muscles
How do you treat an outflare innominate dysfunction?
HVLA thrust Muscle energy uses tensor fascia lata, gluteus minimus, and piriformis
Tenderpoints for LBP?
Half of the tenderpoints for backaches are on the *front* of the body where often there is no pain
Rule of 3's? T4-6: SP's are where?
Halfway between its transverse processes and the level below
lateral facing hallux
Hallux Valgus
Describe the research by Dr. Moskalenko
He determined that there are 2 well known processes in cranial motion: intracellular respiration and water balance. He did this by placing probes on the skull. The data showed 5-14 cycles per minute
Understand the ANS pain referral distibution.
Heart T1-T5 Stomach T5-T9 Liver & Gall Bladder T6-T9 Pancreas T5-T11 Small Intestine T9-T11 Colon & Rectum T8-L2 Kidney & Ureters T10-L1 Urinary Bladder T10-L1 Ovary & Fallopian Tube T9-T10 Testicle & Epididymus T9,10 & L1,2 Uterus T10-L1 Prostate L1-L2
What is the treatment for non-structural scoliosis if bone growth is complete?
Heel lift treatment in order to minimize the scoliosis
Iliac Crest heigh CCP?
High on the *left*
When testing hip flexion, what muscles are tested?
Hip extensors- hamstrings, gluteus maximus, adductor magnus (when hip flexed)
When testing hip extension, what muscles are tested?
Hip flexors- iliopsoas, rectus femoris
What are the causative agents in the nucleus pulposus that causes disc herniation pain?
Hydrogen ions Phospholipase A2 Immunoglobulin G (IgG) Stromelysins
What has been implicated as a postural fault responsible for spondylolysis and spondylolisthesis?
Hyperlordosis
Nerves and Foramina: Olfactory? Optic? Occulomotor, Trochlear, Opthalmic branch of trigeminal nerve, Abducent? Trigeminal nerve, maxillary branch? Trigeminal nerve, mandibular branch? Facial, Vestibulochoclear? Glossopharngyeal, vagus, accessory? Hypoglossal?
I (Olfactory) = cribiform plate.Ethmoid II (Optic) = optic canalSphenoid III (Oculomotor), IV (Trochlear), V1 (Trigeminal nerve, ophthalmic branch), VI (Abducent) = superior orbital fissure Sphenoid V2 (Trigeminal nerve, maxillary branch) = foramen rotundum Sphenoid V3 (Trigeminal nerve, mandibular branch) = foramen ovale Sphenoid VII (Facial), VIII (Vestibulocochlear) = internal acoustic meatus Temporal IX (Glossopharyngeal), X (Vagus), XI (Accessory) = jugular foramen Temporal/occiput XII (Hypoglossal) = hypoglossal canal Occiput
describe the grading for ankle sprains
I: mild streth of ligament II: incomplete tear of ligament III: complete tear of ligament
Abdominal pain improves with defecation and change in the frequency of her stool. No blood. What is the Dx?
IBS
The CCP of the T/L area presents as
ICH LEFT T/L Shift toward *same* side
The CCP of the L/P area presents as . . .
ICH Left L/P roll towards *opposite* side
Parasympathetic Cranial Nerves?
III, VII, IX, X
Treatment of medial ankle?
INV IR (+/- dorsiflexion)
Treatment of anterior fibular head?
INV, ER, and dorsiflex foot Patient tries to plantarflex and evert
Treatment of posterior fibular head?
INV, IR, and plantarflex foot Patient tries to dorsiflex and evert
What could a positive standing flexion test mean
IS dysfunction, contralateral hamstring tightness, carryover from seated flexion test
When is it a neutral SD of the L-spine?
If 3+ transverse processes are posterior on one side while the patient is on *all 3 positions*, then it is a neutral SD.
What is neural contiguity?
If a diseased structure is adjacent to a nerve, the pain will be felt in the distribution of that nerve. Ex: Apical lung tumor abutting the lower cord of the brachial plexus will cause pain which refers into an ulnar distribution in the forearm and hand
When is it a flexed SD of the L-spine?
If one transverse process is posterior on one side while the patient is in the *extended position* and then it become symmetric with the other transverse process in the flexed position -Rotated, side-bent toward the side of the posterior transverse process
When is it an extended SD of the L-spine?
If one transverse process is posterior on one side while the patient is in the *flexed position* and then it become symmetric with the other transverse process in the extended position
What is focal disc bulging?
If the annulus is weakened enough, localized bulging of the annulus can occur. If the bulge is large enough and in the right (or wrong depending on your point of view) location, it can rub against and irritate a nerve root. This gives rise to a radiculitis, nerve root distribution pain without identifiable neurologic deficits.
What is direct contiguity?
If the diseased organ is next to a musculoskeletal structure, that structure will respond Ex: Kidney stone passing down the ureter inflames the ureter which lies against the psoas muscle. The psoas muscle will become hypertonic and possibly go into spasm.
When testing external rotation of the hip, what muscles are tested?
Internal rotators- gluteus medius and minimus, tensor fascia lata
what is a positive seated flexion test indicative of ?
If torsion, then the second name is opposite: Ex: Positive right seated flexion test = ? on left sacral torsion. If unilateral sacral flexion/extension, then it will be on the same side of the dysfunction. Ex: positive right seated flexion test = right unilateral sacral ?
Order of anterior RIGHT colon Chapman's reflexes Proximal-->Distal
Ileocecal area, Ascending Colon, Hepatic flexure, right half of transverse colon
What is a dysfunction introduced from the lower extremity and causing restriction of motion between the ilium and sacrum called?
Iliosacral dysfunction
Diverticulitis Anterior Chapman's Reflexes
Iliotibial bands (bilaterally) 9th-12th ICD bilaterally
What three bones make up the innominate bone?
Ilium, Ischium, and pubic bone
Where is the superior transverse axis located?
In the posterior superior sacroiliac ligaments also at the level of S2, but being posteriorly positioned, ends up superior to the middle transverse axis
What is the lumbar spring test?
In the presence of sacral sulcus asymmetry, the prone patient is subjected to pressure directed anteriorly in the middle of the lumbar spine Absence of spring (stiffness) indicates a posteriorly going dysfunction (extension or posterior torsion) Presence of spring (softness) indicates an anteriorly going dysfunction (flexion or anterior torsion)
What is the sphinx test?
In the presence of sacral sulcus asymmetry, while continuing to palpate the sacral sulci, the patient is asked to assume the sphinx position (prop up on your elbows) This flexes the side of the sacrum that can move If a forward dysfunction is present (unilateral flexion or anterior torsion), the sacral sulci become more symmetric Is a backward going dysfunction is present (unilateral extension or posterior torsion), the sacral sulci become more assymmetric
Diverticulitis Parasympathetic Goals
Increase peristalsis
Cranial Vault Hold
Index finger contacts the greater wing of the sphenoid Long finger on temporal anterior to ear Ring finger on temporal posterior to ear (mastoid process) Little finger on occiput
VAULT HOLD? (3)
Index fingers on the greater wings of the sphenoid. Little fingers on the lateral angles of the occiput. Ears between the 3rd and 4th fingers.
Vault Hold: Position? What happens to your fingers in flexion? Extension?
Index fingers on the greater wings of the sphenoid. Little fingers on the lateral angles of the occiput. Ears between the 3rd and 4th fingers. With this hold...as the sphenobasilar synchondrosis (SBS) goes into flexion, your fingers move away from you and widen. In extension the SBS flattens and your fingers come towards you and come together.
headache, cranial strain, SBS compression, sinus congestion
Indicates to use venous sinus drainage technique
INFERIOR VERTICAL STRAIN: Cause? Base of sphenoid? Index finger? Sphenoid in? Little fingers? Occiput in? Temporlais in?
Induced by a blow on the vertex anterior to the plane of the SBS or from below through the heels or mandible posterior to the plane of the SBS. -Base of the sphenoid goes inferior relative to the occiput. -Index fingers move superiorly..Sphenoid in extension. -Little fingers move inferiorly.Occiput in flexion. Temporals in external rotation.
SUPERIOR VERTICAL STRAIN: Cause? Base of sphenoid moves? Index fingers move? Spehnoid in? Little fingers move? Occiput in? Temporalisi?
Induced by a blow on the vertex behind the plane of the SBS or from below through the mouth. Base of the sphenoid goes superior relative to the base of the occiput. Index fingers move inferiorly. Sphenoid in flexion. Little finger move superiorly. Occiput in extension. Temporals in internal rotation.
Contraindications for articulatory
Infection/inflammation in the body region to be treated. Patients taking antiplatelet/anticoagulant medications. Open wounds, Fracture, Joint instability, Excessive pain, patient objection,Severe Osteoporosis, Metastatic disease
What is a relatively uncommon dysfunction?
Inferior Innominate Shear (downslip)
AL4 tenderpoint location
Inferior aspect of AIIS
Cranial Torsions - mechanism of injury
Inferior or superior force vector directed on the outer anterior or posterior quadrant of the cranium (red arrows in picture)#$https://o.quizlet.com/6gvtVruiTL1bMltNTXNDsg_m.png
Location of AL4? Treatment?
Inferior to AIIS F SART (stand on opposite side)
LPL5 location? Treatment?
Inferior to PSIS F ADD IR
Spondylitis
Inflammatory condition of the spine
Sacral movement: Influeced by? Mobilitiy through?
Influenced by secondary respiration. Adjunct in sacral rocking and inhibition. Part of the pelvic diaphragm system. If the patient were to hold their breath, you would still be able to pick up its tidal movement. Mobility through primary respiration.
external occipital protuberance
Inion
What is the prolotherapy used to treat spondylolisthesis?
Injection of proliferant agents into fibro-osseous junction for the iliolumbar ligaments is helpful in cases with concomitant ligamentous laxity
LATERAL PHYSIOLOGIC MOTION: When the midline bones go into fleion, the paired bones go into? When the midline bones go into extension?
Internal/External Rotation Paired bones. As the head goes into flexion it also feels wider, fuller in your hands. When the midline bones go into FLEXION, the paired bones go into EXTERNAL ROTATION. When the midline bones go into EXTENSION, the paired bones go into INTERNAL ROTATION.
Treatment of abduction restriction of SC joint?
Internally rotate and extend arm
One of the most common sports injuries? Mechanism of injury?
Inversion ankle sprain Inversion and *plantarflexion*
Proximal tib-fib dysfunction often seen with what injury?
Inversion ankle sprains
What are the bladder symptoms of hyperparasympathecotonia?
Irritable bladder with increased bladder wall tone and stress incontinence with decreased internal urinary sphincter tone
Screening
Is there a problem? Screening exam, Asymmetry, Active ROM
Hemorrhoidal Plexus
Ischiopubic ramus, by obturator foramen.
Uterus
Ischiopubic ramus, by obturator foramen.
sidebend cervical spine to affected side, exert downward force
Jackson's test instruction
which osteopathic research was known for pioneering inter-examiner reliability and validity studies
Johnston
who is the author of the osteopathic approach to renal and urinary system
Kaufman
Which rib do you treat in MET
Key rib
3 cards with single digit numbers, increased time indicates concussion
King-Devick (KD) test
along femoral neck
Kline's line
C8-T1 injury
Klumpke's Palsy
arm supinated, wrist extended
Klumpke's palsy clinical presentation
Most common Alternaing Zink fascial pattern?
L-R-L-R (OA, cervicothoracic, thoracolumbar, lumbosacral)
Base of the Trunk
L-spine + sacrum + pelvis Important to keep in mind when treating patients with symptoms in other areas of the body.
CCP for the L-spine
L/P roll and IC height on opposite sides T/L shift and IC height on same side L/P roll and T/L on opposite sides
Where are the Anterior Lumbar tender points? Treatment by counterstrain?
L1 (medial to ASIS), L2 (Medial to AIIS), L3 (lateral to AIIS), L4 (inferior to AIIS), L5 (anterior/superior pubic rami) - STRA, SART, SART, SART, SARA (all F)
Discogenic pain refers to what areas of the spine?
L1 and L2 T1-T4
What lumbar segments do not have a reflex test?
L1, L2, L3, and L5
Posterior Lumbar Tender points?
L1-5 bilateral spinous processes L1-3 bilateral transverse processes L5 upper pole and lower pole
Dirty half dozen for back pain?
LIMPSS Lumbar non-neutral dysfunctions Innominate shear Muscle imbalance (of trunk and lower extremities) Pubic dysfunction Sacrum resisting anterior nutation Short leg/pelvic tilt
medial hip pain, painful ROM, locking joint
Labral tear clinical presentation
BIOMECHANICS OF CRANIAL: Articular surfaces? Reason why...? Shape of articular surface?
Landmarks Markedly important to know so that your hands are where they need to be to treat appropriately! Anatomy THE ARTICULAR SURFACES ARE NOT DESIGNED FOR MOTION...THEY ARE THE RESULT OF MOTION. The reason the sutures don't fuse...unless motion is impeded. The shape of the articular surfaces is based on the type of motion found there.
What are the Traube-Hering-Mayer Oscillation?
Laser Doppler Flowmetry and cranial palpation were used to find that oscillation (TH) and CRI are similar
Side-Bending and Rotation Dysfunction - Mechanism of injury
Lateral force vector directed at the level of and perpendicular to the sphenobasilar symphysis (larger red arrow in picture)#$https://o.quizlet.com/peS8ZQjcf1z9OeNZuAEi6w_m.png
Retina, conjuctiva
Lateral superior humerus
Location of AL3? Treatment?
Lateral to AIIS F SART (stand on opposite side)
Ovaries
Lateral to pubic symphysis
Urethra
Lateral to pubic symphysis
What are the common physical findings in people with spondylolisthesis?
Laterally flared ilia Back and abdomen thrust forward Short waist transverse abdominal crease at the level of the umbilicus Flattened heart shaped buttocks
Who first introduced Tenderpoints?
Lawrence Jones
What are the symptoms of fixed lateral stenosis?
Leg & Arm Symptoms Predominate Nerve Root Entrapment
idiopathic epiphyseal avascular necrosis
Legg-Calve-Perthes' disease
groin pain, radiates to knee, elevated sed rate, thomas test
Legg-Calve-Perthes' disease clincal presentation
Is the ASIS compression test a more or less accurate way of checking for an innominate dysfunction?
Less accurate
What does S4 innervate?
Levator ani muscle External Sphincter Urethrae Pelvic Floor muscles Coccygeus muscle
What does S3 innervate?
Levator ani muscle External Sphincter Urethrae Pelvic Floor muscles Intrinsic Muscles of the Foot
Intrinsic muscles of the pelvis
Levator ani, coccygeus (pelvic) deep transverse perineal, sphincter urethrae (UG)
Sympathetic Chain Ganglion
Lies *anterior* to the rib heads along the lateral aspects of the verterbal bodies. Originates from T1-L2. Provides sympathetic viscerosomatic reflexes to the body.
What is the Heilig Formula?
Lift = SBD/(D+C) where, SBD = sacral base declination D = duration C = compensation
Indications for MET
Limited range of motion Muscular shortening Musculoskeletal pain Segmental dysfunction To restore normal arthrokinematics
how is ME vs articulatory named
ME: named after position of ease "-ed" articulatory: named after motion into restriction "-ion"
Alpha motor neuron efferent acitivity decreases in
MET
What physical exam test has the highest sensitivity for assessing for DVT?
Lisker sign
What is the scale for C used in the Heilig Formula?
Little or no rotation = 0 Rotation = 1 Early Spondylosis = 2 Late Spondylosis = 3 Vertebral Wedging = 4
Tender point related to locked down key rib?
Located anteriorly or at the mid-axillary line
Tender point related to locked up key rib?
Located posteriorly at rib angle
Where is the location of the oblique axes?
Location of each axis is unknown and are probably not real axes, but an amalgamation of very complex multiaxial motion
Respiratory dysfunction is classified as either?
Locked UP or locked DOWN ribs
Allopathic literature view of LBP
Low back pain is often attributed to disc degeneration (however), muscular and ligamentous sources of pain may be equally important -Most common cause in every age group = soft tissue strain -Most lumbar injuries are due to *segmental dysfunction*
What are the symptoms of posterior joint syndrom?
Low back pain, neck pain Non-dermatomal radicular pain (does not extend below the knee or elbow)
What are the symptoms of a disc bulging?
Low back pain/neck pain May be dermatomal radicular pain usually no lower than the knee or elbow, if a nerve root is irritated. May be non-dermatomal radicular pain if pain emanates from the outer third of the annulus fibrosus
What are the symptoms of an inferior symphyseal shear dysfunction?
Lower abdominal pain just superior to the inguinal ligament.
What are the patterns of pelvic disproportion?
Lower line represents the femoral heads Upper line represents the sacral base plane
Bucket Handle Ribs?
Lower ribs except floating -Axis through costotransverse and costochondral articulations -Increase transverse diameter -Analogous to abduction/adduction
Compensation of short leg syndrome in the lumbar spine causes what? Which type of muscle tension may exist?
Lumbar curve to be convex on short side Psoas tension
INHERENT MOTILITY: Motility? Mobility? Overall?
MOTILITY = Moving on your own. MOBILITY = Moved by something else. The brain, brain stem, and spinal cord move in and of themselves. Proven and commented upon by neurosurgeons for years. 'Coiling and uncoiling of the ram's horn.' Accompanied by a constant rhythm of discharge and recharge and changes in glial cell size. Other structures with motility include the AV and SA nodes and visceral organs (gut).
Imaging of choice for a disc herniation?
MRI
How is the sacral base declination (SBD) measured in order to use in the Heilig Formula?
Measured by extending a line horizontally across the sacral base to lines projected vertically through the apex of each hip joint It is the vertical height difference between the sides
What are the causes of developing an entrapment neuropathy?
Mechanical effects of impinging adjacent tissues Compressive injury to nerve and circulation
Location of AL2? Treatment?
Medial side of AIIS F SART (stand on opposite side)
Location of AL1? Treatment?
Medial side of ASIS F STAR
Neck
Medial superior humerous (armpit side).
S1 location? Treatment?
Medial to PSIS at S1 Push on opposite ILA
What are the two grading systems for spondylolisthesis?
Meyerding and Taillard
What tests are done to diagnosis scoliosis?
Mid-gravity line and forward bending (Adam's Test)
What axis does the sacrum flex and extend in response to truncal motion?
Middle transverse axis
Pyloris
Midle of Sternum
Flexion/extension. Which type of bones involved? With flextion SBS ___, angle ___. Direction? Axis # and type? Fingers? Extension: SBS ___,angle ___. Direction?Axis? Fingers?
Midline bones. Sphenobasilar synchondrosis. -Flexion = SBS rises, angle decreases. Occurs in opposite directions. 2 transverse axes. Greater wings of the sphenoid and lateral angles of the occiput moves towards the patient's feet. The index and little fingers move away and widen. -Extension = SBS falls, angle increases. Occurs in opposite directions. 2 transverse axes. Greater wings of the sphenoid and lateral angles of the occiput moves towards the patient's head. The index and little fingers move towards you and come together.
Flexion/extension: Flexion/extension. Which type of bones involved? With flextion SBS ___, angle ___. Direction? Axis # and type? Fingers? Extension: SBS ___,angle ___. Direction?Axis? Fingers?
Midline bones. Sphenobasilar synchondrosis. Flexion = SBS rises, angle decreases. Occurs in opposite directions. 2 transverse axes. Greater wings of the sphenoid and lateral angles of the occiput moves towards the patient's feet. The index and little fingers move away and widen. Extension = SBS falls, angle increases. Occurs in opposite directions. 2 transverse axes. Greater wings of the sphenoid and lateral angles of the occiput moves towards the patient's head. The index and little fingers move towards you and come together.
FLEXION/EXTENSION: 4 mones? ______ and ______ move around each other at ________. Axis? Movement is the same or opposite? Base movement?
Midline, unpaired bones. Sphenoid, occiput, vomer, ethmoid. Sphenoid and occiput move around each other at the sphenobasilar synchondrosis (SBS). Act as gears--move in opposite direction around 2 transverse axes.*** Bases rise in flexion, descend in extension.***
episodic pulsating cephalgia associated with neurologic sx and/or aura in absence of primary disease
Migraine definition
direct action used to normalize bone contours
Molding membranous tension technique (BMT) procedure
remove shoes, support transverse arch
Morton's neuroma treatment
Parietal Bone Motion FLEXION
Move laterally around an axis connecting the anterior and posterior bevel changes The posterior aspect moves more laterally than the anterior aspect#$https://o.quizlet.com/oSVmEuMod7rB0QqhY2lR4A_m.png
SACRUM***: Where does movement occur? attachment? Axis? Moves in response to?
Movement occurs at the transverse axis of the sacrum at the level of S2. The dural attachment is on the anterior surface of the sacral canal. The sacrum can rotate around an A-P or a vertical axis if the SBS is doing so. Sacrum moves in response to the occiput.
Where is the caudad hand located when palpating passively induced iliosacral motion?
Moves the ipsilateral limb in internal and external rotation and hip flexion and extension.
What is vascular claudication?
Muscle Cramping, usually in the lower extremity, caused by insufficient arterial supply to the musculature. Most common cause is atherosclerotic vascular disease.
How do you treat a superior symphyseal shear dysfunction?
Muscle energy using adductor musculature
How do you treat an inferior symphyseal shear dysfunction?
Muscle energy using gluteus maximus
How do you treat a pubic symphysis gapping dysfunction?
Muscle energy using gluteus medius muscles
How do you treat an anteriorly rotated innominate?
Muscle energy using the gluteus maximus muscle and hamstring muscles HVLA thrust
How do you treat a posteriorly rotated innominate?
Muscle energy using the rectus femoris muscle HVLA thrust
How do you treat a superior innominate shear dysfunction?
Muscle energy with respiratory assistance HVLA thrust - leg pull
How do you treat an inferior innominate shear?
Muscle energy with respiratory assistance HVLA thrust - leg pull
Most of the Dirty Half Dozen for back pain caused by what?
Muscle imbalance of trunk and lower extremities
What are the signs of a LMN lesion?
Muscle weakness Flaccid paralysis Loss of reflexes Muscle atrophy
What are the signs of an UMN lesion?
Muscle weakness or paralysis No muscle atrophy early, but develops Increased muscle tone Increased tendon reflexes
What are the Williams Flexion exercise?
Must maintain a flattened lordosis at all times: Pelvic tilt Knee to chest Bent knee sit ups Seated forward bending Straight leg raises
Describe the research by Dr. Ueno
NASA study that helped develop a method of measuring ICP and oscillations in cranial diameter using transcranial US to prove the equation.
is a concussion structural damage?
NO it is dysfunction of brain metabolism no structural injury or damage
Is the vertical axis a true sacral axis?
NO. The sacrum does not rotate between the ilia It is an axis of pelvic rotation during the gait cycle, but it appears to be located posteriorly in the vicinity of the sacrum
What are the etiologies of spondylolisthesis?
NOT a congenital defect There are congenital predispositions that are genetically transmitted
What do visceral somatic reflexes cause?
NOT innominate or sacral somatic dysfunctions DO cause muscle hypertonicity in muscles that are innervated by S2-S4
How are sacroiliac dysfunctions named and diagnosed?
Named for the site of greatest motion restriction and asymmetry
How are the oblique axes named?
Named for their superior pole These helical axes shift position in space even as the sacrum moves on them
junction of frontonasal, internasal sutures
Nasion
Who demonstrated the mobility of the sacrum on the superior transverse axis radiographically?
Neil Pruzzo in 1971
What are the MRI findings of someone with spinal osteoarthritis?
Neural entrapment (nerve roots and spinal cord) Intervertebral disc (dessication, internal disruption, and protrusion)
What are the physical findings of fixed lateral stenosis?
Neurologic Exam may show single level neurologic deficits Reduced regional range of motion Reduced segmental range of motion
What are the physical findings for disc bulging?
Neurologic evaluation of the extremities is typically normal Pain increases in seated position Pain in lumbar spine increases with voluntary contraction of the psoas muscle Pain in the lumbar spine increases with truncal rotation Pain in the cervical spine increases with attempts at rotation or sidebending
What is a positive finding when palpating passively induced iliosacral motion?
No palpable motion
Non-physiologic dysfunction
Non-physiologic dysfunction is commonly associated with trauma that causes the displacement of a structure beyond its normal and physiologic range of movement - This leads to loss of mobility Non-physiological strains can be induced by systemic visceral disease as well as by trauma They vary from mild to severe Vertical and lateral strains are non-physiologic and can occur alone or be superimposed on physiologic strains Compression of SBS affects the entire cranial mechanism and is also non-physiologic Dysfunctions of the facial bones are relevant but beyond the scope of this lecture
What are the requirements for imaging in the case of a disc bulge?
Not necessary during the first four to six weeks of pain, but often obtained if the patient is not showing evidence of recovery X-ray: Lumbar - may reveal minimal disc narrowing. Cervical - frequently a segmental reversal of lordotic curve MRI: Clearly delineates size and extent of bulge
RECIPROCAL TENSION MEMBRANE: Role? Other system that has a similar role?
Not only protective in dividing the brain into separate hemispheres but also perform a function of motion. Limiting motion of the cranial bones so that they form an internal ligament for this system. Once the system starts moving it is not allowed to just keep going. This system, and the articular surfaces of the cranial bones to which they are attached, slows down the movement and stops it.
The articular MOBILITY of the sacrum between the ilia: Where is the motion around? Moves in response to? Why? With cranial flexion which way dose the sacral base move? Opposite of?
Note that this is MOBILITY because the sacrum is moving in response to something moving it. Motion around TRANSVERSE AXIS A THE SECOND SACRAL SEGMENT. Sacrum moves in response to the pull of the reciprocal tension membrane. Thus the inference of craniosacral. -Moves in response to the occiput because of its dural attachment. Flexion of occiput causes the dura to pull the sacrum up towards patient's head and the base to move back (DURA ATTACHES ON THE ANTERIOR SURFACE OF THE SACRAL CANAL AT THE LEVEL OF S2). Base comes posterior. OPPOSITE OF ANATOMIC FLEXION!!!
Red flags of spinal pain / neurological symptoms which contraindicate treating the L-spine
Numbness, tingling, weakness, bowel or bladder incontinence, urinary retention
Pneumonia Parasympathetic Treatment
OA Decompression Suboccipital release V spread
what are OMM targets in babies?
OA and condyles are usually the most dyfunctional
give me an example of the OA dx?
OA flexed SrRl
C1
OA joint spinal root innervation
T1-4 with synapses between the pre and postganglionic fibers occurring in the superior sympathetic ganglion at the level of? Asst viscerosomatics? (4)
OA/AA -Thyroid (T1-4 BL). -Lung and visceral pleura (T1-6 BL). -Heart (T1-5 Lt). -Arms (T2-8 BL).
what diagnoses are seen in common compensatory mechanism
OA: SRRL AA: RL T1: SRRR T12: SLRL L5: SLRR Innominate: Right anterior rotation Sacrum: L/L sacral torsion Leg: short right
what is the "ideal" therapy for the shoulder according to the Bergman article
OMM for shoulder girdle + usual medical care --> accelerates recovery
acute fx, hx of trauma, neoplastic/metabolic bone disease, primary muscle/joint disease, vertebral/carotid artery dissection
OMT contraindications for neck pain/cervicogenic headache
Right Lymphatic Duct
ONLY drains R head/neck/UE/thorax, heart, all lobes of both lungs EXCEPT left upper lobe
what is the most common compensatory pattern
Oa rotated left cervicothoracic junction rotated right thoracolumbar rotated left lumbosacral rotated right
what is the test for the IT band/muscle?
Ober's test (lay on contralateral side, abduct leg, extend, see if patient's leg will allow for lowering)
What are the physical findings of someone with spinal osteoarthritis?
Observation (joint enlargement, abnormal body carriage) Palpation (tenderness, muscle hypertonicity and fibrosis, joint enlargement, and joint swelling) Range of motion is restricted Strength testing (weakness of muscles crossing the affected joints) Neurologic examination (nerve root findings and spinal cord findings)
What are four somatic dysfunctions that affect the vagus nerve?
Occipito-mastoid suture Occipito-Atlantal (facets innervated by C1) Atlanto-axial (facets innervated by C1 and C2) C2 (facets innervated by C2 and C3)
Review of Cranial Bone Motion - Occiput FLEXION
Occiput rotates about a transverse axis superior to foramen magnum Basilar part and condyles move anteriorly and superiorly Squama moves posteriorly and slightly laterally#$https://o.quizlet.com/Kh4fAbgLSsmGcTZwpEpmvA_m.png
What is the normal motion for an oblique axis?
Occurs during the gait cycle - the sacrum alternates between anterior torsional movements with walking As the leg comes forward, the sacral sulcus on that side swings forward and the contralateral inferior lateral angle moves posteriorly and inferiorly
What are the physical findings of central canal stenosis?
Often severely limited range of motion Symptom reproduction by spinal extension Patchy neurologic exam - both extremities involved - Lumbar - deficits present in more than one nerve root, but often sensory disturbances in one root level, reflex loss in another and motor loss in a third. - Cervical - Same as lumbar unless spinal cord compression occurs, then get presence of Babinski responses, clonus and other signs of spinal cord compression.
What are the symptoms of an inferior innominate shear?
Often very painful Pain overlying the posterior sacroiliac ligaments with a more intense pain in the buttock overlying the sacrotuberous and sacrospinous ligaments
AL5 tenderpoint location
On the anterior, *superior* aspect of the pubic ramus just lateral to the symphysis
QL2 tenderpoint location
On the tips of the transverse processes of the lumbar vertebrae palpating from a lateral>medial direction
Torsion
One AP axis Rotation in opposite directions Named for greater wing of sphenoid that is high Physiologic
Torsion: Palpatory experience
One hand seems to rotate posteriorly; forefinger comes superiorly while little finger goes inferiorly while the other hand does the opposite. Described as; holding a pencil between your palms and turning your splayed hands like wheels. PLEASE remember this is NOT the axis. The hands will return to neutral and go into the same direction again; they will not twist past the midline in the opposite direction.
What is facet and laminar enlargement?
One of the reasons arthritic finger and knee joints bulge so much is enlargement of the bone. It is not all soft tissue swelling or fluid in the joint. This enlargement, while not painful in and of itself, may encroach on neighboring pain sensitive structures. Sometimes these pain sensitive structures are the nerve roots themselves, resulting in pain which follows a nerve root distribution (a radiculitis).
What is disc herniation?
One of the two possible pathways for disc degeneration. If sufficient stress is placed on the disc, the annulus can rupture. This allows displacement of the nucleus pulposus into the spinal canal, usually adjacent to one or more nerve roots. Nucleus pulposus has about the consistency of rubber cement. While liquid in consistency it is very viscous and does not just evaporate or absorb into the surrounding tissues. Given sufficient time (usually about 3 to 6 months) it will desiccate and shrink away from the nerve. It is also a very chemically irritating substance that enflames the nerve and surrounding tissues. This is usually accompanied by radiculopathy, nerve root distribution pain with neurologic deficits.
Side Bending Rotation Phantom Hands
One side will feel more fullness
hip clicks with flexion, abduction, extenal rotation
Ortolani's sign
pain/swelling of infrapatellar tendon during growth spurt
Osgood-Schlatter disease
What is degenerative spondylolisthesis?
Osteoarthritic changes at apophyseal joints due to long standing segmental instability
What is facet synovitis?
Osteoarthritis is considered a non-inflammatory arthropathy compared with the inflammation of Rheumatoid Arthritis, Systemic Lupus Erythematosis, Ankylosing Spondylitis and others. None the less, there is a small amount of joint inflammation which occurs and which can be more painful than very advanced arthritic changes in the cartilage proper.
How do you manage posterior joint syndrome?
Osteopathic Manipulative Treatment - Direct & Indirect Techniques Non-Steroidal Anti-inflammatory Drugs (NSAIDs) - High Dose Systemic Corticosteroids - 2 to 4 weeks - High Dose Facet Injection - Anesthetic and Corticosteroids - Should be done w/ fluoroscopic/US guidance Radiofrequency Facet Rhizotomy Open Surgical Rhizotomy
How do you manage dynamic lateral stenosis?
Osteopathic Manipulative Treatment - Treat accompanying dysfunction in flexed position - This applies to both cervical and lumbar regions Activity: Avoid Extension NSAIDs Systemic Corticosteroids Transforaminal Steroid Injection Facet Injection Traction in Flexion Exercise: Flexion Exercise series and avoid McKenzie Prolotherapy Spinal Fusion Surgery If only a single spinal level is involved in a patient younger than 50 years-of-age, implantation of a replacement artificial disc is a possibility
How is a disc bulge managed?
Osteopathic Manipulative Treatment Cervical: Traction techniques - Avoid flexion and excessive rotation Lumbar: Avoid Flexion, No Rotation, Use Sidebending Techniques, and Sidebend away from the side of pain Activity Avoid Cantilevered Forward Position Avoid Sitting Exercise Extension Exercises Lower Intradiscal Pressure McKenzie Exercises Bracing Elastic corset helps limit truncal rotation in the acute phase NSAIDs High Dose, Short Acting Traction Traction in a position of extension provides symptomatic relief. Whether it changes the time course of recovery is unknown Steroids Systemic - High Dose 4 to 6 weeks Epidural - Works extremely well for radicular pain For unremitting pain APLD - Automated Percutaneous Lumbar Discectomy Radiofrequency Disc Denervation
How do you manage disc herniations?
Osteopathic Manipulative Treatment Cervical: Traction techniques and Avoid flexion and excessive rotation Lumbar: Avoid Flexion, No Rotation, Sidebending Techniques Only, Sidebend away from the side of pain In addition to epidural steroids, transforaminal steroid injections often provide significant relief from radicular pain Again, surgery is reserved for those who have progressive neurologic deficits or those in whom intolerable pain persists beyond three months despite everyone's best efforts at conservative care
How do you manage retrolisthesis?
Osteopathic Manipulative Treatment Exercise: Williams Flexion Exercises Medications as for prior root irritation discussions Prolotherapy
How do you manage both fixed lateral and central canal stenosis?
Osteopathic Manipulative Treatment (not successful) Exercise: Williams Flexion Exercises and Aerobic Conditioning (exercycle) NSAIDs Systemic Corticosteroids Injectable Corticosteroids: - Lateral Stenosis - Transforaminal injection - Central Canal Stenosis - Epidural injection Surgical Decompression
How do you manage facet subluxations?
Osteopathic Manipulative Treatment: Combination of Direct and Indirect Techniques Exercise: Mixed Program to Strengthen Spinal and Abdominal muscles, and Increase Aerobic Capacity Bracing: Usually limited to Elastic Wrap Corset No bracing without exercise Prolotherapy: 50% Dextrose, P5G, Morrhuate Sodium - Injected at the fibro-osseous junction of the ligaments and facet joint capsule Rest of Treatment same as Posterior Joint Syndrome for element of synovitis
What are the radiographic findings of someone with spinal osteoarthritis?
Osteophyte formation (bone spurs) Asymmetric joint space narrowing Subchondral sclerosis Subchondral cyst formation Chondrocalcinosis
What does stage III of spinal degeneration consist of in terms of dysfunctions?
Osteophyte formation + bony enlargement + ligamentous and facet capsule hypertrophy = Fixed Lateral stenosis and/or Central Canal stenosis
what is the most common reason that a child is brought to the pediatrician
Otitis media
XR for malleolar zone pain + posterior edge of lateral/medial malleolus
Ottawa Ankle Rules: rule 1
XR for midfoot zone pain + 5th metatarsal/navicular pain, unable to bear weight
Ottawa Ankle Rules: rule 2
Where is the cephalad hand placed when palpating passively induced iliosacral motion?
Over the posterior sacroiliac ligaments approximately one centimeter inferior and medial to the PSIS
pressure, pain with passive movement, paralysis, paresthesia, pulselessness/pallor
P's of compartment syndrome
What are the primary asymmetries for a posteriorly rotated innominate?
PSIS caudad and sacral sulcus is deeper ---------- Secondary: ASIS cephalad, relative short leg, external rotation of the thigh, and restricted straight leg raising
What are the primary asymmetries of an inferior innominate shear dysfunction?
PSIS caudad, ischial tuberosity caudad, exquisitely tender over sacrotuberosus ligament, and taught sacrotuberous ligament --------- Secondary: ASIS caudad and ipsilateral long leg
What are the primary asymmetries for an anteriorly rotated innominate?
PSIS cephalad and sacral sulcus is shallow ----------- Secondary: ASIS caudad, relative long leg, internally rotated thigh, and no restriction of straight leg raises
What are the primary asymmetries of a superior innominate shear dysfunction?
PSIS cephalad, ischial tuberosity cephalad, and sacrotuberous ligament is lax ---------- Secondary: ASIS cephalad and apparent ipsilateral short leg
What are the four posterior landmarks that need to be palpated for asymmetry?
PSIS, sacral sulci, ischial tuberosities, and sacrotuberous ligament tension
Any organ innervated by the vagus nerve can refer pain to what part of the body?
Pain (C2) or muscle hypertonicity (C1 and C2) to the occipital region Interpreted as a muscle contraction headache
What is the symptom of an outflare innominate dysfunction?
Pain along the ipsilateral inguinal ligament
What is the symptom of a pubic symphysis compression dysfunction?
Pain at the pubic symphysis
What are the symptoms of a pubic symphysis gapping dysfunction?
Pain at the pubic symphysis with urinary urgency, frequency, and dysuria (urine is sterile)
What is the symptom for a posterior innominate rotation dysfunction?
Pain located at the ipsilateral PSIS
What is the symptom of an inflare innominate dysfunction?
Pain medial to the PSIS
What are the symptoms of spinal osteoarthritis?
Pain of insidious onset: - Local and/or radicular (pain and numbness with nerve root compression) - Mild to moderate intensity (1-6 on pain scale) - Pain worse with use, better with rest - Weather sensitivity Stiffness after periods of rest - Gel phenomenon Morning stiffness less than 30 minutes Crepitance with motion Joint enlargement Weakness
What is the symptom for a superior innominate shear (upslip)?
Pain overlying the posterior sacroiliac ligaments
Internal/External Rotation
Paired bones. As the head goes into flexion it also feels wider, fuller in your hands. When the midline bones go into FLEXION, the paired bones go into EXTERNAL ROTATION. When the midline bones go into EXTENSION, the paired bones go into INTERNAL ROTATION.
Internal/External Rotation: Which type of bones involved? When midline bones go into flexion, paired bones....?? When midline bones go into extension, paired bones?
Paired bones. As the head goes into flexion it also feels wider, fuller in your hands. When the midline bones go into FLEXION, the paired bones go into EXTERNAL ROTATION. When the midline bones go into EXTENSION, the paired bones go into INTERNAL ROTATION.
Torsion: Palpatory experience
Palpatory experience; One hand seems to rotate posteriorly; forefinger comes superiorly while little finger goes inferiorly while the other hand does the opposite. Described as; holding a pencil between your palms and turning your splayed hands like wheels. PLEASE remember this is NOT the axis. The hands will return to neutral and go into the same direction again; they will not twist past the midline in the opposite direction.
Diverticulitis Sympathetic Treatment
Paraspinal Inhibition Rib raising Collateral ganglia
imbalance between medial/lateral quadriceps
Patellofemoral pain syndrome (PFPS)
facet tenderness, abnormal patella glide
Patellofemoral pain syndrome (PFPS) clinical presentation
palpate for plica bands
Patellofemoral pain syndrome (PFPS) diagnosis
What are the gait changes that occur in spondylolisthesis?
Pathognomic stiff-legged, short stride, waddling gait in which the pelvis rotates with each step
What is Beevor's sign?
Patient does 1/4 sit up. Look for umbilicus being pulled Negative - no movement Positive - opposite muscles denervated
What are some examples of conservative treatment?
Patient education, exercise, manipulation, orthotics and braces, and medication
Treatment of .. L/P roll RIGHT ICH LEFT
Patient lies on *left* side, pelvis rolled to left and right IC is brought superiorly
Treatment of . . T/L shift LEFT ICH LEFT
Patient lies on *right* side, lower thorax is brought to the right, and left IC is brought inferiorly
How to test horizontal flexion of SC joint?
Patient reaches towards ceiling with both arms, clavicle should move posteriorly
How to test abduction of SC joint?
Patient shrugs shoulders, clavicle should move inferiorly
Pelvic diaphragm Release
Pelvic diaphragm should have motion similar to the thoracoabdominal diaphragm (moves inferiorly with inhalation and superiorly with exhalation)
Treatment order for low back pain?
Pelvic shears (*pubic* then innominate) Lumbar Sacrum Pelvic rotations
Adaptation
Perceptors stop responding after a while
What are the symptoms common in spondylolisthesis?
Persistent low bak pain for more than four weeks Sciatica may be present Dull ache in buttocks
Direct treatment of the specific segmental SD's of the L-spine?
Physician reverses the diagnostic formula. *Ex: L4FRlSl > L4ERrSr* -Muscle energy technique
Strain Patterns of the SBS
Physiologic strain patterns - Exaggerated flexion or extension - Torsions - Side-bending and rotation Non-physiologic strain patterns - Vertical strains - Lateral strains - Compression of SBS#$https://o.quizlet.com/vkYXUBGcxDREvQWZt37PoQ_m.png
Physiologic vs Pathologic
Physiologic-Occurs as a twisting effect around the anatomic axis. Pathologic-Shearing force that causes the anatomic axis to be disrupted (gears get stripped).
Paraspinal inhibition
Place fingerpads on one side of the erector spinae and thenar/hypothanar on the other Pull muscles toward midline Balance pressure and hold until tissues relax
FRONTAL LIFT. Treatment
Place hypothenar eminences on the lateral angles of the frontal and interlace the fingers over, but not in contact with, the forehead. Attempt to draw the fingers of one hand from the fingers of the other. The hypothenar eminences exert an influence of internal rotation on the lateral angles of the frontal. Coordinate this action with the lifting of the frontal bones anteriorly (towards the ceiling), until you feel the lateral angles moving into external rotation. Each side may not release at the same time. Gently release your hands.
V spread
Place index and long finger along the restricted suture forming a V, with fingers on each side of restricted suture Using palm of hand or combination of fingers on the opposite side of the head (longest diagonal), direct a fluid wave toward the involved suture until softening is appreciated
CV-IV. Technique (via the occiput).
Place one hand in the palm of the other so that the thenar eminences lie uppermost and parallel to each other (volleyball hold). Slide them under the head allowing the lateral angles of the occiput (medial to the occipitomastoid suture) to rest on them. Follow the CRI into extension (pull your hands back towards you just a little bit...you will see the chin tuck slightly...and hold it there; do NOT continue to pull). Wait for the Still point. Temporary cessation of the rhythmic motion of the PRM. It occurs when a point of balanced membranous or ligamentous tension is achieved. DO NOT remove your hands. When the CRI starts again (and it should feel more robust; bigger motions on your hands), gently remove your hands.
V-Spread technique
Place the index and middle fingers on either side of the (occipitomastoid) suture. Palm of other hand on the longest diameter from the suture. Countrecoup. (Newton's cradle) Spread 2 fingers apart. Palm will feel impulse. This directs fluid back to the suture to help open it. So long as the suture is restricted you will feel the fluid bounce back between your 2 hands. When released, a gentle easy motion will be felt between the 2 hands.
Treatment of EXA/gastrocnemius?
Plantarflexion
What landmarks do you check for asymmetry in a non-structural scoliosis diagnosis?
Popliteal creases, greater trochanters, gluteal folds, iliac crests, and PSIS
Proprioceptors
Position of Body
What are the results from an abnormal standing flexion test?
Positive on the side in which the PSIS rises highest at the end of forward bending
What are the two common findings associated with bilateral sacral dysfunctions?
Positive sacral rock test and very deep or very shallow sulci compared to their normal position
Stage one of spinal degeneration includes what types of dysfunctions and pathological findings?
Posterior Joint Syndrome Facet Subluxation Disc bulging Disc herniation
Extension
Posterior aspects of the spine approximate
What is the most common pelvic dysfunction?
Posterior innominate rotation
Which side of the cardiac wall is especially rich in parasympathetic fibers?
Posterior-inferior walls
How should the radial head move in pronation?
Posteriorly
What types of patients receive articulatory techniques?
Postoperative patients and older patients suffering from arthritis or osteopenia often find this type of treatment more acceptable than more vigorous forms of treatment
What did Licciradone study?
Potential benefits of OMT w/ LBP in third trimester - OMT lessens or faults the deterioration in back
causes coccygodynia
Pratt fall effects
chronic kneeling
Prepatellar bursitis etiology
What is the Babinksi sign?
Presence of a Babinski indicates a disconnect between the upper and lower motor neurons -> MS/AML OR Destruction of the upper motor neuron -> cerebrovascular accident/brain tumor
What is the cavernous tissue symptom of hyperparasympathecotonia?
Priapism - persistent engorgement of the erectile tissues in both genders
Expiratory muscles
Primary- internal intercostals Accessory- rectus abdominus, internal/external obliques
OA diagnosis
Pseudotype 1 Sidebending/rotation in opposite directions, flexion/extensionl, sidebending
What type of dysfunction common happens following childbirth?
Pubic symphysis gapping
What is the primary asymmetry of an inferior symphyseal shear dysfunction?
Pubic tubercle caudad --------- Secondary: ASIS caudad
What is the primary asymmetry of a superior symphyseal shear dysfunction?
Pubic tubercle cephalad ---------- Secondary: ASIS cephalad
Cranial Flexion & Extension Dysfunctions
Pure cranial flexion and extension dysfunction patterns are not commonly encountered It is more common to find one or the other in association with one of the bilaterally asymmetric dysfunctions discussed in the following slides
angle between ASIS-patella and tibia
Q angle
What are the five trigger points associated with spondylolisthesis?
Quadratus lumborum muscle Gluteal muscles Piriformis muscles Iliolumbar ligaments Posterior sacroiliac ligaments
describe the parasympathetic innervation to the detrusor mm and internal sphincter
S2-S4
Chapman point pancreas?
R Ribs 7-8
rest, ice, compression, elevation
RICE (acronym)
reciprocal tension membrane
RTM
Microtears coalesce to form what type of tears?
Radial tears. If the tear involves the outer 1/3 of the annulus fibrosus or the annular ligament, it can produce pain. The pain is presumed to be due to the leakage of nucleus pulposus into this pain sensitive area of the disc. The nucleus itself and the inner 2/3 of the annulus fibrosus contain no free nerve endings. This discogenic pain is often poorly localized and lacks the local tenderness to palpation of disease of the posterior elements of the spine. The back pain increases with coughing or sneezing. There will be a paraspinal muscle guarding reaction. The psoas strength test may also provoke discogenic pain.
What are the characteristics of a bilaterally extended sacrum?
Really shallow sacral sulci ILA's so far anterior that you feel like you will be going internal before you find them Flattening of the lumbar lordosis
What innervates the discs?
Recureent meningeal nerve innervates the posterior longitudinal ligament and outer one third of the annulus fibrosus posteriorly Visceral afferents from the sympathetic nervous system make up the sensory supply for the anterior longitudinal ligament and the outer one third of the annulus fibrosus anterolaterally
Sphenopalatine or pterygopalatine ganglia
Redness and engorgement of the mucous membranes, photophobia, tearing, and pain behind the eyeball, nose, neck, ear, or temple (headache). Worsens cases of asthma due to lowered resistance of the nasal mucosa to foreign protein and inadequate conditioning of air entering the lungs.
Locked-Up Ribs
Reduction of exhalation phase - may be due to *asthma or other obstructive disease*
Locked-Down Ribs
Reduction of inhalation phase - may be due to *consolidation from pneumonia, CHF*
Organs in proximity to the diaphragm refer to what region of the body?
Refer pain to the shoulder via the phrenic nerve (C3-C5)
What did Giamberardino, Affaitati and Costantini study?
Referred pain from internal organs - found that hyperalgesia can outlast symptoms - degree of decrement in pain was related to the number of episodes of symptomatic calculosis
What can innominate and sacral somatic dysfunctions cause?
Reflex visceral hyperparasympathecotonia
What are the uterus symptoms of hyperparasympathecotonia?
Relaxation of uterine muscle, vasodilation, decreased pain and threshold for cervix, and infertility
what is the PANS innervation of the cervix?
S2-S4
what are the rotator cuff mm
S: supraspinatus I: infraspinatus T: teres minor S: subscapularis
What is the ASIS compression test?
Resistance to posterior compression identifies the side of iliosacral dysfunction
What is often added to an articulatory technique to make it more effective?
Respiratory cooperation to contract and relax the musculature Active muscle contractions
Rib SD are designated as either?
Respiratory or structural
Most important element of Bio-Mechanical Model?
Restoration of maximal pelvic mechanics in walking cycle -Pelvis as 'cornerstone' -Influences from above or below must be considered to achieve symmetric movement of the osseous pelvis during walking -Standing Flexion Test
Goal of Bio-Mechanical Model OMT?
Restore maximal function of the MS system in postural balance (can start at feet and end with head, or vice versa)
Goal of Respiratory-Circulatory OMT?
Restoring the functional capacity of the MS system to assist *return circulation and the work of respiration*
Pneumonia Sympathetic treatment
Rib raising
Key Rib?
Rib responsible for maintaining that rib SD. Must be addressed to alleviate restriction
Example of cranial R torsion
Right greater wing of sphenoid will be elevated/anterior Right temporal and parietal will be in relative external rotation Right orbit wider Mandible shifts towards right side of midline#$https://o.quizlet.com/6gvtVruiTL1bMltNTXNDsg_m.png
Rectum
Right lesser trochanter (medial surface of femur)
Lumbo-Pelvic Roll CCP?
Rolls with ease to the *right*
arms at right angles, repeatedly open/close hands
Roos test instruction
Freyette's Type 1
Rotation and sidebending in opposite directions (neutral) Usually in segments, chronic involves long restrictor muscles
Fryette's Type 2
Rotation and sidebending in same direction (flexed or extended) usually by self, acute involve short restrictor muscles
Relationship between rotation, transverse process
Rotation is noted by the side of the *posterior transverse process*
Cranial Torsions
Rotation of the SBS along an *A-P axis* with the sphenoid and occiput rotating in *opposite * directions The torsion is named for the *superior* greater wing of the sphenoid, right or left That side of the head will favor external rotation#$https://o.quizlet.com/.VvkDJz8tOamDu.0Nh5GYw_m.png
jaw deviates toward dysfunctional side, then deviates toward other side
S shaped TMJ deviation
ligamentous instability
S shaped TMJ deviation indications
What is the level of innervation for the sacroiliac joints and their ligaments?
S1-S5 nerve roots
dural attachment at what segment synchronize the cranium and the sacrum?
S2
The ANS parasympathetics simplified. What does S2-S4 innervate? C1 and C2?
S2, 3, 4 Everything Innervated by T10-L2 Vagus (C1 & C2): Everything Else Except: CN III - Pupil of Eye CN VII - Salivary Glands CN IX - Parotid
What segments give rise to the sacral parasympathetics?
S2, S3, S4 Pelvic splanchnics
PANS innervation to the pelvic organs?
S2-S4
Right sympathetic fibers predominately influence what in the heart? Can cause what?
SA node Supraventricular tachyarrythmias
Treatment of AC1?
SARA
sphenobasilar symphysis
SBS
Extension Dysfunction
SBS moves freely into cranial extension but cannot move into cranial flexion The entire skull can be in a state of cranial extension-internal rotation with PRM facilitated in the expiratory phase - Head length increased, width narrowed - Forehead vertical - Paired bones internally rotated - Eyes receded - Ears close to head This is the equivalent of an "Bert Head"#$https://o.quizlet.com/nm-9LKGq.XwaHnqloSoUYA_m.png
Flexion Dysfunction
SBS moves freely into cranial flexion but is restricted moving into cranial extension The entire skull can be in a state of cranial flexion-external rotation with PRM facilitated in the inspiratory phase - Head width increased, length decreased - Forehead wide and sloping - Paired bones externally rotated - Eyes prominent - Ears protruding This is the equivalent of an "Ernie Head"/Hey Arnold
what is the sports concussion assessment tool?
SCAT3
what are OMM targets for torticollis?
SCM and other neck muscles
sacral coccygleal synchondrosis
SCS
posteroinferior
SCS movement in craniosacral extension
anterosuperior
SCS movement in craniosacral flexion
what is the theory behind somatic dysfunction of FPR
SD initiated/maintained by increased activity in the gamma motor neuron activity of that segment -> gamma motor neuron stimulates motor spindle -> result is increased tension in the mm even in neutral
What do you treat first, IS or SI?
SI
What is usually the first sign of short leg syndrome?
SI joint pain
Joints of the pelvis
SI/IS, pubic symphysis, acetabular
what do you rule out if you have painful hematuria
SITTT Stones, infection (#1), trauma, TB, tumors
which is more specific: SLR or slump
SLR - used for those with herniations to determine need for surgery
What does this standing X-ray reveal?
Sacral Base unleveling
What are two congenital anomalies that cause sacral base unleveling?
Sacral anomalies and 5th lumbar anomalies
dura exits foramen magnum, attaches to C2, attaches to S2
Sacral pole
Diverticulitis Parasympathetic Treatment
Sacral rock
What is a dysfunction introduced from the spine and causing restriction of motion between the sacrum and the ilium called?
Sacroiliac dysfunctions or Sacral dysfunctions
What structure serves as a universal joint to coordinate between the lower extremity and spinal motion?
Sacrum
What two structures form the sacroiliac joint?
Sacrum and innominate
In which direction does the AP axis translate?
Sacrum may translate anteriorly and posteriorly along this axis - may occur normally in relaxes recumbency, but when seen as a dysfunction, it is always traumatic
How does the lumbar oblique film present if spondylolisthesis is present?
Scotty dog has a broken neck
How does the lumbar oblique film present if spondylolysis is present?
Scotty dog is wearing a collar
The standing flexion test is part of the screening or scanning portion of a PE?
Screening
What is the purpose of the screening, regional and segmental portions of the osteopathic structural exam?
Screening = IS there a problem Regional = WHERE is the problem Segmental = WHAT is the problem
What position is the patient in for diagnosis of rib SD?
Seated
For a unilateral sacral dysfunction, how do you know which side is restricted?
Seated flexion test - primary test Secondary tests - lumbar spring test, sphinx test, and four digit contact
How do you know id you have a unilateral sacral dysfunction?
Seated flexion test will be positive There will be palpable asymmetry of the sacral sulci (one deeper and one shallower) There will be palpable asymmetry of the inferior lateral angles (one posterior and inferior/one anterior and superior) The sulci and ILA's are compared to each other, not to ideal normal
What is Napolean's hat sign?
Seen in the AP lumbar X-ray in the presence of severe (Grade III-IV) spondylolisthesis
What are the finding upon palpation of someone with spondylolisthesis?
Segmental hypermobility Anteriorly located spinous process or "drop off" sign posteriorly Rocking of the sacrum into flexion increases the symptoms Paraspinal muscles are slow to relax and feel boggy
What is the definition of viscerotome?
Segmental innervation of the internal organs
What is the definition of sclerotome?
Segmental innervation of the periosteum, ligaments and fascia
Basal ganglia inhibits what reflexes?
Segmental reflexes (resting muscles remain at rest)
Mechanoreceptors
Sensitive to distortion (bending, pressure, vibration, stretching) Meissner's Corpuscles, Pacinian Corpuscles, Merkels disk, hair root plexus, Ruffini's endings, Krause's end bulbs
Meissner's Corpuscles
Sensitive to light touch
Are screening tests sensitive, but not specific or specific, but not sensitive?
Sensitive, but not specific
What are two anatomic etiologies for sacral base unleveling?
Short leg or short hemi-pelvis
When patient continues with same complaints of low back pain despite treatment or continues to present with same postural findings/somatic dysfunction in the pelvis and lumbar spine, what should you suspect?
Short leg syndrome
Anatomical causes of short leg syndrome?
Short leg, scoliosis
Sidebending/Rotation Palpatory experience
Sidebending; Approximating the fingers of one hand on side of concavity (higher side), the other hand spreads and drops towards the patient's feet. Rotation; Represented by an inferior movement of the whole spread hand and superior movement of whole approximated hand.
Sidebending/rotation: palpatory experience
Sidebending; Approximating the fingers of one hand on side of concavity (higher side), the other hand spreads and drops towards the patient's feet. Rotation; Represented by an inferior movement of the whole spread hand and superior movement of whole approximated hand.
Order of anterior LEFT colon Chapman's reflexes Proximal-->Distal
Sigmoid colon, Descending Colon, Splenic flexure, left half of transverse colon
What is articular somatic dysfunction?
Simple joint immobility leads to thinning of the hyaline cartilage surface of the joint
What are the pain sensitive tissues in the spine?
Skin, fascia, ligament, muscle, synovial joints, discs, peripheral nerves, nerve roots and spinal cord
femoral head displaced from neck
Slipped Capital Femora Epiphysis
cox vara, antalgic gait
Slipped Capital Femora Epiphysis clinical presentation
obesity
Slipped Capital Femora Epiphysis risk factors
Arthrokinematics
Small movement of bone at joints normally involves concavity and convexity
distal radius displaced volar/anterior
Smith's fracture description of pathology
Somatic Dysfunction of the Cranium
Somatic dysfunction occurs in the cranial mechanism just as in the rest of the body Asymmetry Restriction of motion Tissue texture change Tenderness SD in the cranium is subtle, but palpable Takes practice and attention to detect and diagnose Treatment is helpful, at times profound
What is the indication for using an articulatory technique?
Somatic dysfunction where the application of a slow, gentle, and controlled movement is required
Functional causes of short leg syndrome?
Somatic dysfunction, muscle imbalance/hypertonicity
What are te four indications for OMT?
Somatic dysfunction, secondary symptoms, viscerosomatic reflexes, and prevent/treat complications d/t immobility
What are the stages of spinal degeneration?
Stage I - Stage of Dysfunction - OMT and exercise Stage II - Stage of Instability - OMT, exercise, bracing, pain management strategies, rhizotomy, fusion surgery and disc replacement surgery Stage III - Stage of Restabilization & Stenosis - OMT, exercise, pain management strategies, and surgical decompression
Treatment of horizontal flexion restriction of SC joint?
Stand on opposite site, one hand on SC joint and one hand behind scapula, patient grabs your shoulder as you stand taller to engage barrier
What type of imaging is a necessity for spondylolisthesis?
Standing lateral X-rays of lumbar spine are essential Lumbar oblique views are also needed
Venous Sinus Drainage: Straight sinus? superior sagittal sinus> metopic suture?
Straight sinus. 5th fingers on the inion and the thumbs on the bregma or as far up as you can reach. Hold until a feeling of softening and/or warmth. If you cannot reach the landmarks easily...don't force it! Superior sagittal sinus Start with crossed thumbs over the sagittal suture and spread the suture. Move one finger width at a time step by step until reaching the bregma. Hold until feel softening and/or warmth. Metopic suture (STILL treating the sagittal sinus!!!) Finger pads of both hands along each side of the metopic suture of the frontal bones. Hold until a feeling of softening and/or warmth.
What are the goals of treatment for someone with non-structural scoliosis?
Straighten the spine by leveling the sacral base
What is the third leading cause of death in the US?
Stroke
What two pelvic somatic dysfunctions can cause sacral base unleveling?
Superior and inferior innominate shear Anterior and posterior rotation of the innominate
Location of PR1-10?
Superior surface of rib angles
UPL5 location? Treatment?
Superior to PSIS E ADD IR/ER
What axis does the sacrum move upon with ventilation - extension with inhalation and flexion with exhalation?
Superior transverse axis
Which axis has motion of the sacrum during the cranial rhythmic impulse cycle?
Superior transverse axis With cranial base flexion, the sacrum moves into extension With cranial base extension, the sacrum moves into flexion
What innervates the facet joints?
Supplied by the posterior primary ramus of nerve root of both that segment, the segment above and the segment below
What type of treatment is given to those with Chronic Pain?
Supportive care
Merkel's Disk
Sustained pressure, texture, moisture, tactile discrimination, surface structure
Posterior Rib
Symptoms: Pain with inahalation Diagnosis: *prominent rib angle, TTP at rib angle* -May be secondary to cough, poor posture, increased kyphosis, excessive physical activity -Is *NOT* always associated with a thoracic SD at same level -Often *key rib of respiratory SD* - can restrict motion in inhalation and/or exhalation
Fascial patterns
Systems for classifying and recording the preferred directions of fascial motion throughout the body
Where do the sympathetics come from for the ear?
T 1 - T 4
Which to treat first: ribs or T-spine?
T spine
Treatment of. . . ICH Left
T/L soft tissue on the left
The ANS sympathetics simplified. What does T1-T4 refer to? T5-T9? T10-L2?
T1 to T4 Everything Above the Diaphragm T5 to T9 Gastrointestinal Tract to the level of mid-transverse colon. Liver, Gall Bladder, Pancreas Spleen (it's right next to the stomach) T10-L2 Mid-Transverse Colon to Anus Urinary Tract Adrenal Glands Reproductive Organs Vasomotor control of Lower Extremities
Costal facets
T1, T10-12 - one on upper edge for >> a rib head. T2-9 have 2 partial costal facets (or demifacets), >>rib heads T1-10 *transverse* facets on the anterolateral surface >>*rib tubercules*
Rule of 3's? T12 is the same as what?
T1-3
Somatic reflex of the head and neck?
T1-4
Sympathetic innervation of the heart via which levels? Which ganglia?
T1-4 (1-6) Cervical ganglia
Pneumonia - Sympathetics
T1-6 Lungs, esp T3-4
What spinal segments does thyroid disease affect?
T1-T4 (via sympathetic afferents) C3-C5 (via neural contiguity)
Diverticulitis Sympathetics
T10-11 jejumum, ileum, ascending colon T12-L2 pelvic viscera, descending colon Ganglia: Superior mesenteric (R), Inferior Mesenteric (L)
Superior Mesenteric Ganglion (SMG)
T10-11: small intestine BELOW duodenum, right colon, kidneys, adrenals
what spinal level supplies the distal 1/3 of the transverse colon to the rectum?
T12-L2
where is the viscerosomatic innervation to the prostate
T12-L2
Inferior mesenteric ganglion (IMG)
T12-L2: left colon, pelvis, rectum
Pneumonia Posterior Chapman's Points
T3 upper lung T4 lower lung
Viscerosomatic reflex/SNS for esophagus?
T3-6 R
What are the special sensory landmarks for T4, T7, T10, and T12?
T4 - nipple line T7 - xiphoid process T10 - umbilicus T12 - groin
Rule of 3's? T11 is the same as what?
T4-6
Celiac ganglia
T5-9: stomach, duodenum, liver, gallbladder, spleen, pancreas
Pt. w/ pancreatitis: where do the sympathetic nerve fibers originate?
T5-T9
Rule of 3's? T10 is the same as what?
T7-9
Diverticulitis Posterior Chapman's Reflexes
T9-12, lumbar region Rib head 11 Paraspinals T2-12
Viscerosomatics of testicle and epididymus
T9-T10, L1-L2 (symp) S2-S4 (para)
Clinical affects of increased sympathetics? (2)
THE BODY'S ABILITY TO MOUNT AN 1. 1.IMMUNE RESPONSE AND TO OBTAIN EFFECTIVE CONCENTRATIONS OF MEDICATIONS ARE REDUCED IN AREAS OF VASOCONSTRICTION AND TISSUE CONGESTION 2. Cataracts secondary to congestion
Anterior wall MI patient will present with which arrhythmia findings? Posterior-inferior wall MI?
Tachyarrhythmia (and increased tone at T1-6) Bradyarrhythmia (and increased tone at cranial base and C2)
Treatment of anterior radial head?
Take to pronation barrier, patient tries to supinate
Treatment of posterior radial head?
Take to supination barrier, patient tries to pronate
Tender point related to locked up or down caliper ribs?
Tender points at tips of ribs 11 and 12 can be addressed by treating tender points related to the latissimus dorsi
What are the symptoms of a superior symphyseal shear dysfunction?
Tenderness at pubic symphysis, pain in anterior and medial thigh inferior to the inguinal ligament, and pain may radiate into the labium or testicle.
What are the physical findings of a pubic symphysis compression dysfunction?
Tenderness at the pubic symphysis and anterior/superior bulging of the symphyseal cartilage
What are the physical findings for a pubic symphysis gapping dysfunction?
Tenderness at the pubic symphysis and sulcus is palpable where there is normally a slight bulge
What are the physical findings in posterior joint syndrome?
Tenderness overlying the facet joint (joints) Facet Joint capsules feel swollen and boggy to palpation Reproduction of radicular pain by palpation or needling Often temporary relief from OMT or injection of local anesthetics
These are small hypersensitive points in the myofascial tissues of the body used as diagnostic criteria and as a treatment monitor for counterstrain:
Tenderpoint
This does not refer pain when pressed:
Tenderpoint
origin of extraocular muscle attachment
Tendinous ring of Zin
MCC recurrent HA? Others? (5)
Tension-most common. Migraine. Cluster. Trigeminal neuralgia; tic douloureux. Severe pain over affected nerve branch. Acute exertional headache. Occurs suddenly related to coughing, sneezing, straining, running, or orgasm. Environmental exposure.
MOVEMENT: ____ cycles per minute? Called?
The Primary Respiratory Mechanism leads to the movement we feel under our hands. Felt to be between 6-12 cycles per minute. Depends on who you read; 6-10, 8-12, 10-14. This palpable, rhythmic fluctuation that results is called the Cranial Rhythmic Impulse (CRI). A term coined by Drs. John and Rachel Woods.
What is the function of the inferior transverse axis?
The axis on which the innominates rotate during the gate cycle
What is capsular laxity?
The capsule and ligaments retain their original length, even as the joint surfaces thin. No longer able to maintain normal apposition of the joint surfaces, hypermobility develops. This further stresses and stretches the ligaments and capsule. Thus the joint starts to become unstable.
What is cartilage degeneration?
The cartilage thins, it begins to fray, just like an old pair of blue jeans. The surface roughens. Microscopic pieces of cartilage break off into the joint and "sand away" at the joint surface. The inclusion of these tiny particles into the synovial membrane evokes a more intense inflammatory response.
In sacral base unleveling, what is the frequent cause of low back pain?
The compensatory curve
Uncompensated fascial pattern
The finding of fascial preferences that do not demonstrate alternating patterns of findings at transitional regions. Because they occur following stress or trauma, they tend to be symptomatic
Venous Sinus Drainage:Head feels like? Present with? What to do?
The head feels like a rigid bony box. Where do you start? How will your patient present? Sinusitis, allergic rhinitis, migraine, throbbing sensation. 1.Open up the sutures. 2.Drains the congested sinuses. No palpatory skills concerning the CRI are necessary.Works on the myofascial principles of softening of the tissues.
Side-Bending and Rotation Dysfunction
The occiput and sphenoid rotate in the opposite directions around *parallel vertical* axes (in body of the sphenoid and foramen magnum) - Causing side-bending At the same time both rotate in the *same* direction around the *A-P axis* - Causing rotation about an A-P axis, which is the same axis as torsions but with both rotating in the *same* direction *Named for the side of the convexity*#$https://o.quizlet.com/TZMHoplcXMHM1H2Z8b3w4Q_m.png
PRIMARY RESPIRATORY MECHANISM.(5)
The inherent MOTILITY of the CNS. The FLUCTUATION of the CSF. The reciprocal tension membrane. The inherent MOBILITY of the cranial bones. The MOBILITY of the sacrum between the ilia.
Review of Primary Respiration (5)
The inherent MOTILITY of the CNS. The FLUCTUATION of the CSF. The reciprocal tension membrane. The inherent MOBILITY of the cranial bones. The MOBILITY of the sacrum between the ilia.
Side-Bending and Rotation Dysfunction - motion of the axes
The motion about these axes cause a side-bending/rotation that is a compound movement similar to coupled motion of spinal segments Because the sphenobasilar symphysis (SBS) is slightly convex upward, as the two bones side-bend away from each other (about two parallel vertical axes) both bones rotate inferiorly on the convex side (around the AP axis) and superiorly to the concave side
How can transient treatment reactions be avoided or minimized?
The patient needs to remain thoroughly hydrated and can take NSAIDs
Rib raising
The patient should be lying in a supine position on the table and I will position myself so that I am seated at the patient's side. The hands are positioned so that the finger pads are placed at the position of the rib angles. In addition, the fingers are tractioned a small amount in the lateral position. This position is held while we wait for the soft tissues to release.
Suboccipital release
The patient should be positioned supine on the table with the operator seated at the head of the table. The finger pads should be placed over the suboccipital muscles bilaterally, just inferior to the superior nuchal line down to at approximately the level of C2. The patient's head should lifted so the weight of it is supported upon the pads of the fingers. Traction is then applied with the fingers in an anterior, lateral, and cephalad direction. The amount of traction that is used results in a force being applied to the tissues without producing significant movement of the structures. This position is then held until the tissues relax, which may take anywhere from 15 seconds to a minute.
In sacral base unleveling, what does the curve compensate?
The pelvic tilt
Sacrum
The reciprocal tension membrane system allows the sacrum to play a role in cranial dysfunction, either primary or secondary Trauma to the head can lead to low back pain A dysfunction in the head may be resistant to treatment because there is a sacral dysfunction Important to appreciate the cranio-sacral mechanism when dealing with recalcitrant dysfunctions of cranium or sacrum
Vertical Strains
The sphenoid and occiput rotate in the *same* direction around their own *transverse* axes This creates a superior or inferior strain at the SBS and disrupts normal flexion-extension Vertical strains are named by - Basilar process of the sphenoid relative to the - Basiocciput - Superior or inferior#$https://o.quizlet.com/TrzG6Ep4HmvNj89Smt5dfg_m.png
Hos do osteophytes form?
These form in response to the increased tension of the annular ligament on the periosteum of the bone. (Wolff's Law once again)
Which portion of the spine is most stable and least mobile? Why?
The thoracic spine, due to the rib cage and muscular attachments
How does vertebral enlargement occur?
The vertebral bodies enlarge with age alone, but this process is accelerated and worsened by degenerative disc disease
Describe the research by Drs. Heisy and Adams
They showed that the parietal bones move separate due to changes in CSF volume and ICP. This resulted in a change in the equation that determined ICP before and after surgery
Pneumonia parasympathetic goals
Thin secretions Decrease false sensitivity of alveoli so can continue to breathe deep
How do you determine the levels of multi-level spondylosis?
This can be accomplished by use of injections of local anesthetic and using symptom relief to guide the next step in treatment. Next determine which stage of degeneration the pain generating segment has and treat accordingly
Left Lateral Strain - hand model
This is the way the *little fingers* shift in a vault hold - not the index fingers little fingers go to LEFT in LEFT LATERAL STRAIN#$https://o.quizlet.com/t4jZfGb8B8JUjOAAMP5mQA_m.png
What is neurogenic claudication?
This leg pain and muscle cramping occurs with activities such as walking. It occurs in Dynamic Lateral Stenosis, Fixed Lateral Stenosis and Central Canal Stenosis
Primary respiratory mechanism definition: Primary =? Respiratory =? Mechanism?
This mechanism was first described by William Garner Sutherland, DO in 1939 in his self-published volume, "The Cranial Bowl". The mechanism is thought to affect cellular respiration and other body processes. In the original definition, the following descriptions were given: Primary, because it is directly concerned with the internal tissue respiration of the central nervous system. Respiratory, because it further concerns the physiological function of the interchange of fluids necessary for normal metabolism and biochemistry, not only of the central nervous system, but also of all body cells. Mechanism, because all the constituent parts work together as a unit carrying out this fundamental physiology.
whats the test for a tight Psoas m.?
Thomas sign - pull unaffected knee to chest, look for contralateral leg movement
what are the diaphragm associated with: C7, T1
Thoracic Inlet
Diverticulitis Lymphatics
Thoracic inlet Abdominal diaphragm Pelvic diaphragm Pedal pump
Pneumonia Lymphatics tx
Thoracic inlet Abdominal diaphragm Thoracic pump
condition that causes compression of subclavian neurovascular bundle
Thoracic outlet syndrome (definition)
numbness in ulnar nerve distribution
Thoracic outlet syndrome most common clinical presentation
What do you treat first, ribs or thoracics?
Thoracics
what are the diaphragm associated with: T12, L1
Thoracolumbar diaphragm
Side-bending Rotation
Three axes: two vertical, one AP Rotation in opposite directions around vertical axes, same direction around AP Named for convexity Physiologic
What are the seven axes of sacral motion?
Three transverse axes (superior, middle, and inferior) Two oblique axes (left and right) One vertical axis One antero-posterior axis
Parietal lift technique
Thumbs move apart, fingers lift toward operator. Feel for softening or "give"
Treatment of ACL?
Tibia posterior
Superior Vertical Strain - Hand model
Tipped fingers forward from a vault hold#$https://o.quizlet.com/jkTpcd.RzyFV5dD2vsHq-A_m.png
Main goal of OMM?
To increase arterial circulation to a diseased or injured organ or other tissue (spine, limb, etc.)
Primary goal of OMM (respiratory-circulatory model)?
To increase arterial circulation to a diseased or injured organ or tissue.
Nasal sinuses
Top of 1st rib, midclavicular line.
Temporal rocking. Treatment: hand position?
Treatment. Cup occiput with both hands with thumbs resting on the mastoid processes. With forearms resting on the table, gently rock from one forearm (red) to the other (yellow) rocking the temporal bones into external and internal rotation. Do at same rate as CRI. Takes 10 seconds to move from one forearm to the other.
What disorders are associated with the basal ganglia?
Tremors at rest, rigidity, loss of associated movements, posture disturbances
What disorders are associated with the cerebellum?
Tremors during movement, postural abnormalities, imbalance, ataxia
This is a hypersensitive focus, usually within a taut band of skeletal muscle that is painful upon compression and can give rise to characteristic referred pain, tenderness and autonomic phenomena:
Trigger Point
This represents the somatic manifestation of a vescero-somatic, somato-visceral or somato-somatic reflex:
Trigger Point
Spray and Stretch, Injecion with local anesthetic, ME, Myofascial release are examples of treamten for what?
Trigger Points
True or False. Direction of rotation of the sacrum is determined by the motion of the anterior most point of the sacral promontory.
True
True or False. Innominate bones rotate in response to leg motion.
True
True or False. When the innominate is carried beyond it's 5 degree range of motion, lumps on one side of the joint come into opposition with raised areas on the opposite side of the joint.
True
True or False. You are 90 times more likely to die from NSAIDs than a C-spine manipulation.
True
True or Fasle. Degenerative disc disease of the spine may be asymptomatic.
True
True or False. A definitive motion test is palpation of passively induced iliosacral motion.
True.
True or False. A dysfunction in the sacroiliac joint occurs when the sacrum and innominate do not line up.
True.
True or False. A pubic symphysis dysfunction is still an innominate dysfunction.
True.
True or False. ASIS compression test is an alternate motion test.
True.
True or False. Bilateral innominate dysfunction is exceptionally rare.
True.
True or False. Inferior symphyseal shear dysfunction is more common than a superior symphyseal shear dysfunction.
True.
True or False. Reflex muscle hypertonicity may be caused by somato-somatic reflex activity.
True.
True or False. Normal discs do not herniate.
True. Some disc degeneration is required to permit disc herniation to occur.
True or False. The very old and very young respond well to articulatory technique.
True. They suffer less treatment reaction in terms of post-treatment discomfort and stiffness than when an HVLA technique is used
What is the seated flexion test?
Truncal flexion is carried out in the seated position - the side of the high riding PSIS is the side of the restriction
Vertebral Unit
Two adjacent vertebrae with their associated intervertebral disk
Flexion Extension
Two transverse axes Rotation in opposite directions Physiologic
Vertical Strain
Two transverse axes Rotation in same direction Named for direction of basisphenoid Non-physiologic
Lateral Strain
Two vertical axes Rotation in same direction Named for direction of basisphenoid Non-physiologic
C2-7 (Typical cervicals)
Type 2, rotation/sidebending in same direction flexion/extension/sidebending
In the thoracic and lumbar region, a somatic dysfunction caused by viscero-somatic reflex will cause what type of somatic dysfunction?
Type II - extended segmental dysfunction
What are the physical findings for degenerative spondylolisthesis and retrolisthesis?
Typically get segmental back or neck pain occ. radicular symptoms as well. Pressure over the spinous process of the segment worsens the symptoms of spondylolisthesis (remember there is no pars Interarticularis defect here) and improves the symptoms of retrolisthesis Neurologic examination is typically normal
What are three lower extremity deformities that cause sacral base unleveling?
Unilateral pes planus, knee deformities, and hip deformities
For how long does spondylolysis remain asymptomatic?
Until age 30
Pump handle ribs?
Upper ribs -Axis through costovertebral and costotransverse articulations -Increase A-P diameter -Analogous to flexion/extension
Lung
Upper: Btw 3-4 Lower: Btw 4-5
What is the ureter symptom of hyperparasympathecotonia?
Ureterospasm
FRONTAL LIFT: Use? Tx principles?
Use. Frontal sinus headaches. Treatment. Principles. Internally rotate the frontals to disengage them from their related bones. To lift them anteriorly. To permit them to externally rotate and widen the ethmoid notch.
V-SPREAD. Use?
Use. Release any peripheral suture. Patient may complain of headache or sinus pressure over a specific area of overriding or 'stuck' sutures.
CV-IV (Compression of the 4th ventricle): Use? (2) How? Mechanism? Contraindication?
Use. To stimulate the body's inherent therapeutic potency to overcome whatever dysfunction is present. To initiate labor in a female who is past her due date. Prostaglandins (f2alpha) assists in myometrial contractility. Oxytocin release from posterior pituitary. Mechanism. By inducing extension (or internal rotation) of the primary respiratory mechanism, the potency of the CSF is directed from the ventricular system to the periphery of the body. DO NOT USE THIS TECHNIQUE ON ACUTE HEAD TRAUMA PATIENTS.
PARIETAL LIFT: Use? Technique?
Use. Treating a headache at the vertex. Treatment. Place fingers at the superior edge of the suture line where temporal meets parietal (squamoparietal suture). Not above the superior temporal line. Thumbs should meet at the vertex but not be touching the patient's head. Cross thumbs and try to bring them apart; this will internally rotate the parietal bones. Then lift gently towards the head of the table. A release feels like your fingers are being pushed laterally (as the bones now go into external rotation). Each side may not release at the same time. Release head gently.
Degenerative spondylolisthesis is 2-3 times more likely to occur at what segment and in what race?
Usually at L4 in African Americans who are known to have greater L5-S2 stability and a lower incidence of posterior vertebral defects
palpate CRI, direct fluid wave from opposite hand to OM suture
V spread technique procedure
describe the VS and GA innervation for appendicitis
VS: T10-T11 via Lesser splanchnic GA Superior Mesenteric
describe the VS and GA innervation for GERD
VS: T5-T9 via Greater Splanchnic GA: Celiac Ganglion
describe the VS and GA innervation for diverticulitis
VS; T12-L2 via Least Splanchnic GA: inferior mesenteric
Parasympathetic innervation of the heart via which nerve(s)?
Vagus nerve (CN X)
Diverticulitis Parasympathics
Vagus nerve: OA/AA (R colon and small intestines) Pelvic splanchnic: S2-4 (L colon)
Pneumonia Parasympathetics
Vagus: OA/AA, C2 Occipitomastoid suture
Positional Diagnosis
We name the diagnosis by the actual position or direction of the *ease* of motion using static AND motion palpation
Uncovertable joints
What are the arrows pointing to?
Middle Transverse axis
What axis is represented in this picture?
Superior Transverse axis
What axis is represented in this picture?
Facet Joint synovitis
What do these pictures show?
psoas hypertonicity
What does the Thomas test indicate?
Posterior joint syndrome
What is the pain referral pattern associated with?
Segmental
What is the problem? Diagnosis
Bladder
What organ is it?
When does a non-compensated L5 occur?
When L5 is dysfunctional relative to the sacrum and thus rotates with the sacrum rather than the ilia
What is facet subluxation?
When the instability becomes severe enough, partial dislocation of the facet joints occurs
Lateral Strain - in new borns
When this occurs in utero or during the birth process - "Parallelogram head" Also seen with newborn torticollis
Scanning
Where is the problem? Palpation (Tissue texture, Temp, Tenderness), Passive ROM (Quality)
Where are the SI joints located?
Where the lower extremity ends and the spine begins
Inferior transverse axis
Which axis is represented by the picture?
Torsion Diagnosis in Vault Hold (hand models)
Which hand & pointer moves superior? Left pointer comes up = left torsion#$https://o.quizlet.com/HfpCo57NIGPFlv7I2uezew_m.png
Colon
Whole anterior IT band
Treatment types
Wide range of treatment techniques Indirect technique is more commonly used - Balanced membranous tension (the dural membrane equivalent of balanced ligamentous tension) Direct techniques are also used in a gentle, controlled fashion Disengagement - separating an articulation Direct the tide - using fluid fluctuations Respiratory assist - sometimes used to enhance response to treatment
If CHF exacerbation - ribs?
Will be restriction of lower thorax to inhalation- *LOCKED DOWN*
Who created the BLT technique?
Willima Sutherland
what are the common causes of post op complication (5Ws)
Wind: 24-48 hours. (atelectasis, PNA) Water: 48-72 hours (UTI) Walking: 72+ Wound: 72+ Wonder drug: 1 week (pseudomembranous colitis)
How is traumatic spondylolisthesis treated?
With immobilization
What is the normal motion for the middle transverse axis?
With slight truncal flexion or extension, the sacrum flexes and extends with the spine With further flexion, the sacrum moves into extension With further extension, the sacrum moves into flexion
Sacrum rock technique
With the patient in the prone position, apply gentle pressure at the sacral with rocking motion during inhalation and exhalation. The rocking motion augments flexion and extension phases associated with respiration or with the cranial rhythmic impulse
What type of imaging can be performed for fixed lateral stenosis?
X-ray MRI CT CT with myelogram
What imaging is done for central canal stenosis?
X-ray: Cervical - AP diameter of the spinal canal can be measured on lateral x-ray. Canal should measure not less than 13 mm. Lumbar - Just see lots of large osteophytes arising from degenerated discs MRI: Definitive CT
Are men more symptomatic if they present with a pubic symphysis dysfunction?
Yes.
When we are discussing the motion of the skull in regards to Cranial Osteopathy it is with the following rules in mind...: Nomenclature of axis? Terminology of base rising?
You as the Physician are sitting at the head of the table with the patient supine. The nomenclature of the axis does NOT correlate with the nomenclature utilized in the anatomic planes of motion (as that is done with the patient standing). The terminology of 'base rising' is in relation to you at the head of the table and thus the SBS coming up towards you; NOT towards the ceiling. The terminology of 'base falling/descending' is in relation to you at the head of the table and thus the SBS going down towards the patient's feet; NOT towards the floor.
short leg on the left will cause what type of scoliosis?
a levoscoliosis - convexity on the left - t spine side bending to the right
is the frontal bone considered a paired bone or a midline bone?
a paired bone - it has two ossification centers
Pedal pump
a venous and lymphatic drainage technique applied through the lower extremities; also called the pedal fascial pump or Dalrymple treatment.
elasticity
ability to return back to original state once stress is removed
what is the definition of flail chest
abnormal mvmt of ribs resulting from fracture due to blunt trauma in which several (3 or more) ribs are borken in 2 places and move in the opposite direction of rest of the rib cage during inspiration/expiration, fracture-dislocation
how long should you monitor after initial injury/possible concussion?
about 4 hours
what is the first line medication for pts with lbp
acetaminophen NSAIDs
what is the goal of the lengthening stretch
actin/myosin separation: 30-60 seconds
emergent surgery
acute closed lock treatment
pain <6 months
acute pain (definition)
which chapman point is located 2 cm superior to umbilicus and 1 cm lateral to umbilicus
adrenal
describe the viscerosomatics of T8-10
adrenal gland
what was the result on the study about OMT in shoulder dysfunction and pain
after 6 weeks: no difference between study groups after 12 weeks and 52 weeks: OMM > control reported full recovery
According to the AAP, which of the following is a criteria for initiation of antibacterial therapy for the treatment of acute OM
age < 2 years old
Left Lymphatic Duct
aka "Thoracic duct" -Largest lymphatic channel in the body -Receives lymphatic drainage from lower lumbs, pelvis, abdomen, left upper limb, and the left side of the thorax, neck and head
Neutral mechanics
aka Type 1 or principle 1 mechanics -result in coupled movements of sidebending and rotation to opposite sides -patient is in erect position with normal anteroposterior curves (not flexed/extended) -Rotation occurs toward the *convexity* of the sidebent curve in a *group of vertebrae*, technically 2 or more, but usually described as 3 or more
Non-Neutral Mechanics
aka Type 2 or principle 2 mechanics -Results in sidebending and rotation of a vertebra to the *same side* -Occurs when there is alteration to the anteroposterior curve into flexion/extension -L-spine is either flexed/extended -Rotation occurs into the side bending of the curve in a *single vertebral unit*
where are the anterior L2,3,4 TP?
all around the AIIS (2-medial, 3-lateral, 4-inferior)
Spondylogenic reflex syndrome
all of the muscles around an injury tighten to prevent further injury
what does the RTM do?
allows for shifting of the membranes and movements of cranial bones while maintaining constant tension throughout the whole system
Ferguson/lumbosacral angle
angle of the lumbosacral junction from inclination of the superior surface of the first sacral vertebra to the horizontal
what ligament is affected during a RH subluxation
annular ligament houses the RH joint strained/torn during subluxation
what are the attachments of the ACL
anterio lateral portion of medial condyle of the femur posterior interchondylar area of tibia
Appendix
anterior point: tip of 12th rib (Right) posterior point: tranverse process of T11 (Right)
what happens to the radial head when you fall backwards on a supinated arm
anterior radial head
tentorium cerebelli attachment to clinoid process (sphenoid)
anterior-inferior pole
falx cerebri attachment to ethmoid crista galli/frontal crest
anterior-superior pole
neck hyperextension, poor posture, pulmonary disease, exhaled 1st, 2nd rib
anterior/middle mechanisms of dysfunction that can cause Thoracic outlet syndrome
bilateral
are cervicogenic headaches typically unilteral or bilteral?
pathologic
are lateral strains physiologic or pathologic?
pathologic
are sibending rotations physiologic or pathologic?
both
are torsions physiologic or pathologic?
pathologic
are vertical strains physiologic or pathologic?
fluctuant movement of CSF is in response to what?
arterial pulse and respiration
what is the pterion?
articulation of 4 cranial bones - frontal, parietal, sphenoid, temporal
mnemonic for exhalation somatic dysfunctions
at 1 AM i had 2 Pee, b/c from 3-5 PM i had 6-9 Sam Adams then from 10-12 i had to Lay Down AM = anterior and Middle scalene P = Posterior scalene PM=Pec Minor Sam Adams = Serratus Anterior Lay Down = Latissimus Dorsi
the periosteum splits into two layers where?
at the suture
T1-T4
autonomic nerve roots to head and neck
what is the most common result of eversion of the ankle
avulsion fracture medial malleolus
which chapman point is located around the ubilicus
bladder
who is the author of the article: manipulative therapy in addition to usual medical care for patients with shoulder dysfunction and pain
bergman
where do veins exit the skull?
between bones
why does the front bone act like a paired bone?
because of the metric suture
what is a risk factor for somatic dysfunction in a newborn?
being the first baby born - tight squeeze
what is the definition of a concussion?
brain injury described as a pathophysiological process affecting the brain induced by biomechanical forces
Bronchus
btw ribs 2-3
Esophagus
btw ribs 2-3
Myocardium (heart)
btw ribs 2-3
Thyroid
btw ribs 2-3
Motion of ribs 8-10
bucket handle
Wolf's law
buildup of tissue in areas of stress (bone trabeculae)
which osteopathic researcher gathered medical records from osteopathic doctors nationwide
burns
which osteopathic research was known for demonstrating the effects of somatovisceral reflexes using an animal model
burns *touch something burning is a somatic condition but it burns you so bad it makes you sick to your stomach*
bilateral sensory, rectal sphincter tone, bowel/bladder function loss, saddle anesthesia, motor weakness
cauda equina syndrome clinical presentation
Motion of ribs 11 & 12
caliper
what does removing the natrual spinal curve achieve in FPR
can affect proprioceptive and nociceptive elements
what are the ottawa ankle rules
can't bear weight immediately after injury or for four steps at evaluation tenderness at posterior edge or tip of lateral/medial malleolus
which chapman point is located in the second intercostal sternal border
cardiac bronchitis thyroid
grip weakness, thenar atrophy
carpal tunnel syndrome complications
RICE, OMT, wrist splint, steroid injection, surgery
carpal tunnel syndrome treatment
decrease sympathetic tone, cervical somatic dysfunction, myofascial restriction, increase carpal tunnel space
carpal tunnel syndrome treatment (osteopathic goals)
what does the SNS cause in terms of vasoconstriction, GFR and urinary output
causes affarent vasoconstriction decrease in GFR decrease in urinary output
what is the likely mechanism for post concussive vulnerability?
cellular energy crisis due to hyper metabolism in the setting of diminished cerebral blood flow
what is between the two fibrous capsules covering sutures?
central zone containing weak fiber bundles and sinusoidal blood vessels
RECIPROCAL TENSION MEMBRANE.: Composed of (3) Which technique addresses?
cerebelli. Sutherland's fulcrum. Straight sinus. Constant tugging/relaxation occurring. Automatic, shifting suspension fulcrum. Correlates with the superior sagittal sinus (falx cerebri), the occipital sinus (falx cerebelli), the straight sinus (the three membranes come together), and the b/l transverse sinuses (tentorum cerebelli). What are addressed during a VSD technique.
pain referred to head from musculoskeletal dysfunction
cervicogenic headache
what can occur with cervicogenic headaches that is similar to post concussion syndrome?
cervicogenic vertigo
Isometric Contraction
change in muscle tension w/o changing distance between origin and insertion
what is the presentation of a radial head subluxation
child holding their arm in slight flexion and pronation against torso with RH tenderness
sidebend away, rotate toward dysfunction
chin pivot HVLA technique set up
pain >6 months
chronic pain (definition)
poor sleep, appetite changes, decreased libido, irritability, depression, fatigue
chronic signs/symptoms of chronic pain
movement of the CSF involves both what?
circulation and fluctuation
what are some etiologies of cervicogenic headaches?
circulatory consideration, lymphatic congestion, muscle tension, myodural bridge, irritation of joint capsules and other soft tissue structures, facets
in which steps can you not use ME in the Spencer technique
circumduction steps
pain, altered function, bruxism
classic triad of TMJ
what cranial nerve is associated with the occipital bones and poor suckling from infant?
cn XII
Dense
collagen fibers, regular/irregular support, connects structures
Ground substance
colloidal suspension (GAGs)
internal joint derangement, myofascial pain, degenerative joint disease
common disorders of the TMJ
dropped cuboid
common dysfunction of lateral longitudinal arch
dropped navicular
common dysfunction of medial longitudinal arch
cubital tunnel, handlebar neuropathy
common entrapment associations with ulnar nerve palsy
Psoas Major
common problem muscle thigh flexion/lateral flexion of vertebral column
Quadratus Lumborum
common problem muscle, attaches to inferior aspect of 12th rib
certain sx present, persistent cognitive impairment beyond 10 days, hx of previous concussions
complex concussion
burning pain at the sight of injury, joint stiffness, excessive growth of hair, edema,
complex regional pain sydnrome type 1
clawhand
complications of ulnar nerve entrapment/palsy
what is the theory behind FPR
compressing mm with a high gain set -> inverse spindle output, eliminating the affarent excitatory input to the spinal cord through the Ia and II fibers -> quieting of gamma motor gain to spindle, reduction of stretch stimuli, reset of the tension and hypertonicity of the extrafusal mm fibers
what is concentric and eccentric contractions?
concentric - approximation of the joint eccentric - elongation of the joint
what kind of somatic dysfunction is often found in babies with colic and infantile reflux?
condylar and OA restriction
asymmetric gluteal skin folds, short leg, limited abduction
congenital hip dysplasia clinical presentation
4th order
conscious awareness of the stimulus
the outer layer of the periosteum at the suture does what?
continues across the suture to unite
what is isolytic contraction?
contraction where the doctor breaks the contraction (like popping the pubes)
high
cornea relative concentration of nociceptors
inhaled 1st, 2nd rib, inferior sternoclavicular head, abnormal clavicle
costoclavicular region mechanisms of dysfunction that can cause Thoracic outlet syndrome
when craniosacral flexion occurs, what happens to the sacrum?
counternutation (extends from tension of the dura)
rotate away
counterstrain treatment for A1C tenderpoint
F SARA
counterstrain treatment for A2C tenderpoint
F STRAW
counterstrain treatment for A3C tenderpoint
F SARA
counterstrain treatment for A4C tenderpoint
F SARA
counterstrain treatment for A5-6C tenderpoint
F STRAW
counterstrain treatment for A7C tenderpoint (SCM)
E SARA
counterstrain treatment for P1C tenderpoint
E SARA
counterstrain treatment for P2C tenderpoint
F SARA
counterstrain treatment for P3C tenderpoint
E SARA
counterstrain treatment for P4C tenderpoint
E SARA
counterstrain treatment for P5-8C tenderpoint
increased femoral neck angle
cox valga
decreased femoral neck angle
cox vara
exhalation
cranial extension alternate name
inhalation
cranial flexion alternate name
strength of CRI
cranial rhythmic impulse amplitude
10-14
cranial rhythmic impulse normal rate
quality of movement
cranial rhythmic impulse vitality
CV4
cranial treatment - increases the CRI - CRI increased w/ infection and post-OMT - CRI decreased w/ depression
same as occiput, opposite of sphenoid
craniosacral movement of ethmoid
external rotation
craniosacral movement of palatine bones during flexion
external rotation
craniosacral movement of temporal bones during flexion
same as sphenoid, opposite of ethmoid
craniosacral movement of vomer
describe the location and function of extrinsic mm of hand and rist
cross hand and act on digits
describe the cruciate and collateral ligaments with lateral rotation of tibia on femur
cruciate ligaments relax collateral ligaments taut *collateral damage when you move laterally*
describe the cruciate and collateral ligaments with medial rotation of tibia on femur
cruciate ligaments taut collateral ligaments relax
recommendation 2 of the clinical guidelines from the ACP and APS
do not routinely obtain imagine or diagnostic tests for pt with non specific lbp
valgus
does Pes Planus result in a varus or valgus deformity?
What is one of the most significant risk factors that increase the prevalence of acute OM?
day care outside the home
Acute somatic dysfunction
days Vasodilation- warmth, edema, moist
what did sutherland contribute to cranial
decades of studying on disarticulated skulls; created experimental helmet
flexion does what to the AP diameter of the cranium
decreases the AP diameter
which osteopathic research was known for demonstrating the facilitated spinal cord segment
denslow and Korr
closing jaw
dental extension
opening jaw
dental flexion
after the brain's initial period of accelerated glucose metabolism the concussed brain goes into another period of what?
depressed metabolism
from what is a somite derved from and what does it turn into
derived from mesoderm turns into dermatome, myotome, sclerotome, and viscerotome
what kind of diagnosis is concussion?
diagnosis of exclusion
what causes a concussion?
direct blow to the head, face, neck or elsewhere in the body and impulsive force is transmitted to the head
force applied to direction of motion loss
direct membranous tension technique (BMT) procedure
force used to separate sutures at pivot area
disengagement membranous tension technique (BMT) procedure
Hepatic flexure (R) and splenic flexure (L)
distal thigh
what is plagiocephaly?
distortion of the circular shape of the head
Left lower abdominal pain, crampy in nature, what is it? (possible to have fever invovled)
diverticulitis
no
do concussions present with any radiographic changes?
describe talus movement with dorsiflexion and plantar flexion
dorsiflexion: posterior glide plantar flexion: anterior glide
what are some sleep related signs of a concussion?
drowsy, sleeping less or more than usual, trouble falling asleeo
Anterior/volar
during pronation, what direct does the radial head move?
posterior/dorsal
during supination, what direct does the distal radial move?
Posterior/dorsal
during supination, what direct does the distal radius move?
anterior/volar
during supination, what direct does the radial head move?
what is thought to be key dysfunction in infantile reflux?
dysfunction of vagus at the jugular foramen
scalene gap, costoclavicular region, pectoralis minor
entrapment points for the brachial plexus/subclavian A/V that can result in Thoracic outlet syndrome
what did C handy and harold Magouns Sr contribute to cranial
established the Sutherland Cranial Teaching Foundation
recommendation 4 of the clinical guidelines from the ACP and APS
evaluate pt with persistant lbp or s/s of radiculopathy or spinal stenosis with MRI or CT only if potetntial candidates for surgery or epidural spinal injection
what did Miller, Johnson and Seffinger find?
evaluated for the presence of entrainment (connection between operator and the subjects biorhythms) that may affect the results of CV4. They found that both operator and patient seemed to experience a Still Point, usually within the same time frame. This was shown by measuring blood flow velocity with laser doppler flow meter
what is the receding phase?
exhalation
what is the order for the spencer technique
extension flexion circumduction with compression circumduction with traction external rotation abduction internal rotation stretching of glenohumeral capsule
Exteroceptors
external environment
what are the two layers of the dura mater?
external layer and internal layer
motion of the frontal bone during flexion of the SBS
external rotation
what are the motions of the frontal bone?
external rotation/internal rotation
what are the motions of the parietal bones?
external rotation/internal rotation
what makes up the reciprocal tension membrane?
fall cerebri, tentorium cerebelli, falx cerebelli, continuous membrane of the dura
high
fascia relative concentration of nociceptors
what are some cognitive signs of a concussion?
feeling slow or foggy, can't remember or concentrate, confusion, answers questions slowly, repeats questions
Loose connective tissue
fibroblasts, fibrocytes, collagen, elastic fibers, reticular, fat cells and ground substance Lubrication/support
stress, cold, physical activity
fibromyalgia exacerbating factors
superior greater wing of sphenoid
findings that indicate a craniosacral torsion
*what is plagiocephaly*
flat head syndrome (1 side of skull flattened)
What is Obturator sign?
flex patient's right hip and knee to 90 degrees with internal rotation at the hip
whats going on: the spine is moving superior into the skull
flexion
thomas test
flexion of both knees, let one go, if knee cannot fully reach table or if there is excessive lordosis in the lumbar spine the test is positive
birth can commonly cause a sacral ________?
flexion of the base (anterior sacral base)
describe the paired motion of the cranial bones with flexion/extention/external and internal rotation
flexion with external rotation extension with internal rotation
what is the motion of the midline cranial bones?
flexion/extension
what are the driving forces of the primary respiratory mechanism?
fluctuations in CSF, inherent, rhythmic, involuntary motility of the CNS
direct/indirect, aids in disengagement
fluid membranous tension technique (BMT) procedure
viscous
fluid's internal resistance
eversion, abduction
foot pronation
inversion, adduction
foot supination
recommendation 7 of the clinical guidelines from the ACP and APS
for those that don't improve with self care physicians should incorporate non pharm therapy
facet arthritis encroaches on nerve roots
foraminal stenosis pathogenesis (low back pain)
what is the function of sutures?
forms a strong bond of union between adjacent bones while permitting slight movement
what does the inner layer of the periosteum do at the suture?
forms fibrous capsules covering the edges of bone
what did Viola Frymann contribute to cranial
founding chair of NMM/OMM dept at COMP - attempted to explore uninhibited cranial bone motion - traced on polygraph machine and and showed motion separate from cardiac or respirations
describe the mechanism for radial head subluxation (Nursemaid's elbow)
from a sudden pull on extended arm
AA diagnosis
function- rotation Either rotated R or L
motion, packaging, protection, pathway
functions of fascia
what OMM can you do for otitis media? - pretty much the same for sinusitis too
galbreath, target areas for lymphatics (cervicals, thoracic inlet, rib raising) chapman's points sinusitis do sinus effleurage
what are chapman points
gangliform contractions that block lymphatic drainage and cause SNS dysfunction *neurolymphatic* viscerosomatic reflexes
decompress sutures to improve movement, exaggerates membrane strain to improve RTM
goal of balanced membranous tension technique (BMT)
improve ROM, restore CSF circulation
goals of CV4 technique
what is eudynia
good pain
no LOC, sx last <15 minutes
grade 1 concussion
no LOC, sx last >15 minutes
grade 2 concussion
LOC
grade 3 concussion
stretched, slightly torn
grade I ligament sprain
partially torn
grade II ligament sprain
completely torn
grade III ligament sprain
what are the three nerves most commonly associated with causing a cervicogenic headache?
greater occipital nerve, lesser occipital nerve, area innervated by C3
Osteokinematics
gross movement of bones at joints flexion/extension
what is a gram negative pleomorphic rod?
h. flu HIB
what can cause a false negative in an anterior/posterior drawer test
hamstring guarding
Inferior Vertical Strain - Hand model
hand coming back toward you from vault hold#$https://o.quizlet.com/6PlJBGMxXe.EdK2J9w9ksQ_m.png
what kind of suture has a shearing force to it?
harmonic --> lacrimal, ethmoid suture
HOw to test if scoliosis is functional or structural?
have them bend forward - if it staightens out = functional, if not = stxrl
describe the viscerosomatics of T1-5
head neck thyroid heart
what are some physical signs of a concussion?
headache, N/V, balance problems, dizzy, visual problems, light sensitivity, fatigue, sensitivity to light or noise
what are two other scenarios in which OMT can help?
headaches from dental work or orthodontics, bells palsy, trigeminal neuralgia
describe the compensatory patterns for healthy vs unhealthy people
healthy: alternating pattern unhealthy: not alternating
repetitive lifting, prolonged sitting, twisting/rotation, chronic cough, prior spinal injury, tobacco
herniated disc risk factors
what is a syndesmotic sprain
high ankle sprain due to dorsiflexion and/or eversion of the ankle
pavlik harness
hip dysplasia treatment
recommendation 1 of the clinical guidelines from the ACP and APS
history and physical to place pt into three categories of lbp
what were the primary measured outcomes for the MOPSE study
hospital length of stay time to clinical stability symptomatic and functional recovery score
superior greater wing of sphenoid
how are craniosacral torsions named?
position of base of sphenoid relative to base of occiput
how are lateral strain named?
position of base of sphenoid relative to base of occiput
how are vertical strains named?
stretch/lengthen hypertonic antagonist
how can inhibition or weaker muscles in the arm be reduced? (Dr. Greenman)
side of convexity
how is SBS sidebending rotation named?
push down on head
how is the axial compression test performed?
where do the intrinsic mm of the shoulder attach and what is the fxn of the intrinsic shoulder mm
humerus to scapula stabilize GH joint
define circulation of the CSF
hydrostatic forces at the choroid plexuses and the arachnoid granulation
CV4
identify the technique
SBS decompression
identify the technique
V spread
identify the technique
anterior clavicular head ME
identify the technique
anterior innominate rotation ME
identify the technique
backward sacral torsion ME
identify the technique
bilateral sacral extension articulatory technique
identify the technique
bilateral sacral flexion articulatory technique
identify the technique
exhaled 1st rib ME
identify the technique
exhaled 2nd rib ME
identify the technique
forward sacral torsion ME
identify the technique
frontal lift
identify the technique
fronto-occipital hold
identify the technique
inferior innominate shear ME
identify the technique
innominate inflare ME
identify the technique
innominate outflare ME
identify the technique
lower pole 5th lumbar CS
identify the technique
parietal lift
identify the technique
posterior 1st sacral CS
identify the technique
posterior 5th sacral CS
identify the technique
posterior innominate rotation ME
identify the technique
pronator/medial epicondyle counterstrain
identify the technique
radial head/lateral epicondyle counterstrain
identify the technique
spheno-occipital hold
identify the technique
superior innominate shear ME
identify the technique
temporal bone release
identify the technique
temporal hold
identify the technique
unilateral sacral extension articulatory technique
identify the technique
unilateral sacral flexion articulatory technique
identify the technique
upper pole 5th lumbar CS
identify the technique
lower pole 5th lumbar
identify the tenderpoint
posterior 1st sacral
identify the tenderpoint
posterior 5th sacral
identify the tenderpoint
upper pole 5th lumbar
identify the tenderpoint
90/90 test
identify the test
Apley's compression test
identify the test
Apley's distraction test
identify the test
Jobe's sign
identify the test
McMurray's test
identify the test
Ober's test
identify the test
Thomas test
identify the test
anterior ankle drawer test
identify the test
apprehension test
identify the test
crossover test
identify the test
drawer test
identify the test
hip compression test
identify the test
hip drop test
identify the test
hip scour test
identify the test
lachman test
identify the test
patella apprehension test
identify the test
patella grind test
identify the test
patrick's test
identify the test
speed's sign
identify the test
squeeze test
identify the test
sulcus test
identify the test
trendelenburg test
identify the test
compression
identify the type of craniosacral strain
left lateral strain
identify the type of craniosacral strain
left sidebending rotation
identify the type of craniosacral strain
left torsion
identify the type of craniosacral strain
superior vertical strain
identify the type of craniosacral strain
difference between complex regional pain syndrom type 1 and 2
if nerves are involved it is type 2
when should you order imaging for lbp
if they have severe/progressive neuro deficits or serious uderlying conditions are suspected based on hx and PE *if they have persistant LBP or sxs of radiculopathy or spinal stenosis ONLY IF THEY ARE A CANDIDATE FOR SURGERY
what did the study by Hermen et al show in regards to GI
ileus rate was 0.3 in OMT group and 7.6 in non OMT group - shorter length of hospital stay
What is the strongest ligament in the hip joint?
iliofemoral (prevents the trunk from falling backwards)
preseason computer exam to get baseline neuro exam
imPACT test (concussions)
what is cervicogenic vertigo?
improper input to proprioceptive neck muscles
describe the effects of OMT on chronic prostatitis
improved lower UT sx reduced chronic pelvic pain improved quality of life
Secondary Afferents
in brainstem or medulla
3rd order
in the thalmus
where is CSF found?
in the ventricles, subarachnoid space and central canal of the cord
what is somatic dysfunction initiated/maintained by
increase in the gamma motor neuron activity in mm
Is a pacifier usage good or bad for OM risk?
increased risk
flexion does what to the Transverse diameter of the cranium?
increases the transverse diameter
allow frontal bone to perform normal motion
indication for this technique
articulation brought toward direction of ease
indirect/exaggeration membranous tension technique (BMT) procedure
what is the most common MOI of a lateral ankle sprain
inersion of a *plantar-flexed food* -> lateral lig damage (ATFL, CFL, posterior talofibular lig)
Where is the Chapman's point for pharynx?
inferior aspect of the clavicle
what is the expansive phase?
inhalation
How to treat post op ileus with omt?
inhibition to the lower T and L paraspinal muscles = --SANS
describe the study that supported the presence of a somato somatic reflex
injected hypertonic saline into interspinour ligaments -> deep dense pain down the arm (NOT actual injection site) novocain injected in painful site was not helpful because the pain was referring from the injury but when injected into the interspinous ligaments - relieved pain
describe the results of the Wesselman study
injected rat with Evans Blue dye and subjected to noxious uterine stimulation observed extravasation of die in dermatomal pattern nociception in Uterus -> spinal cord -> outflow through cutaenous nerves -> peptide release -> vasodilation "Wessel = vessel" (the dye weaseled its way into the dermatome)
what did the study by Dr. Sato show
injected saline into knee joint of cat to cause inflammation nociceptive somatic stimuli -> elevation of HR and BP severing the spinal afferent nerve eliminates the autonomic response to pain therefore the dorsal ganglion viscerosomatic reflex exists "Sato = Sodium filled soy sauce = HTN"
what is prolotherapy?
injecting a substance to irritate area and cause fibroblasts to proliferate
what is a sclerotome
innervation of hard tissues
which layer of the dura mater surrounds the brain and comes together to form the fall cerebri, tentorium cerebelli, falx cerebelli
internal or meningeal layer of the dura mater
what also keeps the baby's head from collapsing during delivery?
internal support from dura
what is the motion of the paired cranial bones
internal/external rotation
what is the most common ankle injury due to
inversion of a plantar-flexed foot ATFL damaged. fib head posterior
Cranial Rhythmic Impulse definition? Rate?
is the palpable, rhythmic fluctuations brought about by the PRM. Term developed by Dr.s' John and Rachel Woods. CRI's inherent rate is between 6-12/min. Depends on who you read; 6-10, 8-12, 10-14.
TTP over ischial tuberosity, relieved with standing
ischiogluteal bursitis clinical presentation
what does a backward sacral torsion mean for L5?
it means it participates in a type 2 sd
what does a forward sacral torsion mean for L5?
it means it's a type 1 sd
when is the slump test used
its more sensitive might be used in herniations in which the SLR is negative
which osteopathic research was known for differentiating viscero-somatic dysfunction using motion tests
johnston
high
joint capsules relative concentration of nociceptors
when babies move down the birthing cancel they are usually sliding on their occiput causing dysfunction and compression where?
jugular foramen
85% of venous drainage from the head is through the? TX? First sign of congestion?
jugular foramen. V-spread. fullness in the supraclavicular tissues.Address by inlet and trapezius pinch.
what are the contents of the jugular foramen?
jugular vein, cranial nerves 9,10,11
treatment of key lesion will resolve others, other lesions are compensatory
key lesion model
navicular
keystone of medial longitudinal arch of the food
which chapman point is located 1 cm lateral and 1 cm superior to umbilicus
kidney
describe the viscerosomatics of T10-L1
kidneys, cervix
which osteopathic research was known for demonstrating the trophic function of nerves
korr *trophic changes are important to the "korr"*
which chapman point is located on the infra-medial part of the clavicle
larynx
AL3 tenderpoint location
lateral aspect of ASIS
Prostate or broad ligament
lateral aspect of IT band
tennis elbow
lateral epicondylitis alternate name
rest, heat/ice, NSAIDs, local steroids, home exercises, surgery
lateral epicondylitis treatment (non-osteopathic approach)
joint play, HVLA, ME, MFR, CS, lymphatic
lateral epicondylitis treatment (osteopathic approach)
Which nerve is associated with meralgia paresthetica?
lateral femoral cutaneous nerve (purely sensory nerve)
tentorium cerebelli attachment to petrous ridge of temporal bone, transverse ridge of occiput
lateral poles
increasing resistance
leads to increasing tone
walking/biking for 15 minutes
level 1 test for returning to play
sports specific activities
level 2 test for returning to play
non-contact with pads
level 3 test for returning to play
contact with pads
level 4 test for returning to play
return
level 5 test for returning to play
high
ligaments relative concentration of nociceptors
Hair root plexus
light touch
Contraindications for Soft tissue
localized infection/inflammation, risk of bleeding, acute injury to soft tissue or bone, lack of tissue/joint stability, disease of soft tissue, excessive pain, pt. refusal,
posterosuperolateral surface of greater trochanter
locatino of posterolateral trochanter tenderpoint
cribriform plate
location of exit from skull of CN I
optic canal
location of exit from skull of CN II
superior orbital fissure
location of exit from skull of CN III
superior orbital fissure
location of exit from skull of CN IV
jugular foramen
location of exit from skull of CN IX
superior orbital fissure
location of exit from skull of CN V1
foramen rotundum
location of exit from skull of CN V2
foramen ovale
location of exit from skull of CN V3
superior orbital fissure
location of exit from skull of CN VI
stylomastoid foramen
location of exit from skull of CN VII
internal acoustic meatus
location of exit from skull of CN VIII
jugular foramen
location of exit from skull of CN X
jugular foramen
location of exit from skull of CN XI
hypoglossal canal
location of exit from skull of CN XII
inferolateral to lateral malleolus
location of lateral ankle (fibularis brevis/longus) tenderpoint
transverse through jugular notch
location of occipital bone axis motion
perimeter of patella
location of patella tenderpoint
belly of piriformis
location of piriformis tenderpoint
transverse through body of sphenoid
location of sphenoid axis of motion
oblique along petrous portion
location of temporal bone axis of motion
anywhere within muscle
location of temporalis tenderpoint
medial to occipitomastoid suture
location of thenar eminence placement in CV4 technique
if the rib is locked up what is the dysfunction, inhalation or exhalation?
locked up = exhalation restriction = inhalation somatic dysfunction (ease of motion is during inhalation)
age >50, hx of cancer, unexplained fevers, nightsweats, weight loss, >1 month duration, not improved with therapy
low back pain alarm sx
What information would be most predictvie in ruling out a lower extremity DVT?
low probability Wells score and negative D-dimer
is the bladder upper, middle, or lower GI?
lower - T11-L2
which neck joint/s is/are type 2 like
lower cervicals. from c2-c7
which chapman point is located on the fourth intercostal space on the sternum
lower lung
What attaches the sacrum to L5?
lumbosacral disc, 2 lumbosacral synovial joints, ligaments
describe the viscerosomatics of T2-4
lungs
eversion sprain/fracture
maisonneuve fracture pathogenesis
psoas, piriformis, QL, erector spinae, gluteals, abdominals, hamstrings
major muscles associated with low back pain
describe Class 3 Ney York Heart Association Functional Classification for CHF
marked limitation of activity comfortable only at rest
sacral spring test shows good spring.. so what?
means it is a negative spring test = forward torsion, or flexion
which meniscus is more commonly injured
medial 3x more than lateral
golfer's elbow
medial epicondylitis alternate name
Ascending Colon (R) and Descending Colon (L)
medial thigh
where is the L1 ant. TP?
medial to the ASIS
describe the shape of the medial meniscus? lateral?
medial: C shaped lateral: O shaped
recommendation 6 of the clinical guidelines from the ACP and APS
meds with proven benefits in conjunction with back care info and self care assess severity of baseline pain and functional deficits potential benefits risks relative lack of long term efficacy and safety data before initiating therapy
lateral femoral cutaneous nerve entrapment
meralgia paresthetic
painful metatarsal heads
metatarsalgia
name the vertical suture in the frontal bone
metopic suture
describe the viscerosomatics of T10-11
mid GI through prox 2/3 of transverse colon gonads *lesser splanchnic*
which chapman point is located on the top of mid clavicle
middle ear
Tonsils
midle lateral edge of manubrium (btw ribs 1-2)
headache lasting 4-72 hours
migraine diagnostic criteria B
2+ of: unilteral, pulsating, moderate-severe, aggrivated by movement
migraine diagnostic criteria C
1+ associated: N/V, photophobia, phonophobia
migraine diagnostic criteria D
no evidence of organic disease
migraine diagnostic criteria E
F>M
migraine gender distribution
10-45
migraine typical age of onset
Pt. with history of asthma, been using inhaler 4-5 days per week and waking up once a week in the middle of the night. what is her asthma severity?
mild persistent
describe the Cobb angle and their associated degree of scoliosis
mild: 5-20 degrees moderate: 20-45 severe: 50+
Motion of ribs 5-7
mixed (pump/bucket)
what are the mm of the eustachian tube and what are their innervations
mm: tensor veli palatini - V3 levator veli palatini - X salpingopharyngeus - X tensor tympany - V3
what are the mobility components of the primary respiratory mechanism?
mobility of the intracranial, intraspinal membranes (RTM), articular mobility of the cranial bones, involuntary mobility of the sacrum
what is the goal of treatment for chapman points
mobilize lymph and improves function of affected organs/decreases sns
describe the bladder study by Sato
monitor pelvic nerve and bladder pressure demonstrated that a prolonged stimulus could render a full bladder unable to increased vesicular pressure despite being full (can't contract)
interdigital nerve entrapment
morton's neuroma
mechanical, muscle imbalance
most common cause of low back pain
organic cause
most common cause of migraine in someone >50 years
posterolateral
most common direction of disc herniations
L4-L5, L5-S1
most common vertebral disc levels that herniate
what is the zinc diagnosis technique testing
motion testing at 4 diaphragms and the transition zone regions OA, AA C7, T1 T12, L1 L5, sacrum
provides peripheral neuroreflexive alterations in muscle tone, neural facilitation via mechanoreceptor influence
myofascial release MOA
fx, open wounds, infection, DVT, anticoagulation, neoplasm, post-operative, AAA
myofascial release relative contraindications
what is responsible for fascial contractions
myofibroblasts
which chapman point is located on the inferior portion of rib 1
nasal sinus
what are some red flags that need further eval when assessing for concussion?
neck pain, increasing confusion or irritability, repeated vomiting, seizure or confusion, weakness or tingling in arms or legs, deteriorating conscious state, severe or increasing headache, double vision, unusual behavior
L4
nerve roots tested with ankle dorsiflexion
L4-S3
nerve roots tested with ankle eversion
S1
nerve roots tested with ankle plantar flexion
C7
nerve roots tested with elbow extension
C5
nerve roots tested with elbow flexion
T1
nerve roots tested with finger abduction/adduction
L5
nerve roots tested with great toe dorsiflexion
C8
nerve roots tested with hand grip strength
L5
nerve roots tested with hip abduction
L2
nerve roots tested with hip adduction
L5-S1
nerve roots tested with hip extension
L1
nerve roots tested with hip flexion
L3
nerve roots tested with knee extension
L5-S1
nerve roots tested with knee flexion
C5
nerve roots tested with shoulder abduction
C5-T1
nerve roots tested with shoulder adduction
C6
nerve roots tested with wrist extension
C8
nerve roots tested with wrist flexion
weakness, numbness, paresthesia
neurologic symptoms that indicate Thoracic outlet syndrome
radiating/specific, burning, prickling, tingling, electric
neuropathic pain characteristics
increased
neurotransmitter levels after a concussion
What abx can be used to treat UTI in pregnancy?
nitrofurantoin
are cluster or trigeminal HA common?
no
if someone is suspected of a concussion should they return to play the same day?
no
is there any treatment for concussion?
no FDA approved treatment - rest is key
did back specific functioning, general health, work disability specific to LBP, safety outcomes, and treatment adherance differ between pts receiving OMT and sham OMT
no but pts in the OMT group were more liely to be very satisfied with their back care throughout the study
describe Class 1 Ney York Heart Association Functional Classification for CHF
no limitation of activity no symptoms from ordinary activity
what were the main findings of the Giles and Hansel article about suboccipital decompression
no significant differences between sham and time control
characteristics of tension headaches?
nonpulsatile, band like tension, mild to moderate intensity, bilateral, no aggravation by physical activity, no N/V
will you see a concussion on imaging?
nope - reflects a functional disturbance not a structural injury
14, 17
normal Q angle in men/women (respectively)
Physiologic ROM
normal active ROM
compare OMM vs sham treatment for 3rd trimaester lbp
not very different OMT slows or halts the deterioration of back specific functioning during the third trimester
when the cranium extends what happens to the sacrum?
nutation (flexes - anterior sacral base)
tachycardia, hypertension, mydriasis, increased muscle tension
objective signs of acute pain
what is empirical knowledge?
observation, develop a theory based on said observation and refine theory with observation and experience
where does the falx cerebri attach?
occiput, parietals, frontals and ethmoid
what is second impact syndrome
occurs when symptoms of concussion still persist after initial injury then the patient returns to play and sustains a second hea dinjury
QL3 tenderpoint location
on the superior aspect of the crest of the ilium, where the quadratus attaches
is OMM helpful compared to physical therapy
one study concluded that manipulation was more helpful than traditional physical therapy modalities
what are the key times to treat children?
onset of crawling or walking, recurrent otitis media or congestion, frequent headaches or abdominal pain, growth spurt, early scoliosis, short leg, onset and end of sports activities
ATF>CF>PTF
order of likelihood of ankle ligaments with an inversion sprain
confluence of sinus, occipital sinus, condylar decompression, transverse sinus, straight sinus, sagittal sinus, metopic suture
order of treatment for venous sinus drainage technique
describe the origin and insertion of pec major
origin: clavicle, sternum, costal cartilages 1-7 insertion: intertubercular sulcus of humerus
describe the origin and insertion of pc minor
origin: ribs 3-5 insertion: coracoid process
describe the location and function of intrinsic mm of the wrist and hand
originate in hand and act on digits
obesity, trauma, chronic somatic dysfunction
other than sex, what factors can increase the carrying angle?
worse with sitting, flexion
pain description of compression fractures (low back pain)
pain in back, facet region, no radiation below knee, worse in morning, hyperextension, decreased with activity
pain description of facet joint syndrome (low back pain)
back pain with radicular sx in nerve root distribution
pain description of foraminal stenosis (low back pain)
worse with rest, improved with warmth
pain description of myofascial pain (low back pain)
worse with any LE exertion, better with rest
pain description of peripheral vascular disease (claudication) (low back pain)
radiates to buttocks, thighs, legs, worse in extension, better in flexion
pain description of spinal stenosis
worse with extension, compressive loads
pain description of spondylolysis
when is foot xray indicated
pain in midfoot zone AND - 5th metatarsal base or navicular - can't bear weight immediately after injury or for 4 steps at evaluation
how is a cervicogenic headache described?
pain starting in neck and spreading to oculo-fronto-temporal areas
Spinothalmic pathway
pain, itch, temp, crude touch
what did the study of Dr. Dick and Dr. Rodgers show
palatory findins in T4 and T5 in pts that had coronary artery occlusions found by non DOs The MD dick broke your heart and then Dr. Rodgers gave you a massage to make you feel better"
Bind
palpable restriction for motion
rock hard cranium, very little movement
palpatory findings of SBS compression
what is occipital neuralgia?
paroxysmal jabbing pain in the distribution of the greater or lesser occipital nerves
L4
patellar tendon reflex nerve root
describe Class 4 Ney York Heart Association Functional Classification for CHF
patients should be at complete rest - confined to bed or chair any physical activity brings on discomfort and sxs occur at rest
prevents extension, limits adduction, allows flexion, abduction
pavlik harness physiologic effects (hip dysplasia)
3-4 cm inferior to coracoid process
pectoralis minor location of tenderpoint
shoulder hyperextension, muscle overuse/fatigue, exhaled rib, abnormal coracoid process position
pectoralis minor mechanisms of dysfunction that can cause Thoracic outlet syndrome
what are the diaphragm associated with: L5, sacrum
pelvic diaphragm
recommendation 3 of the clinical guidelines from the ACP and APS
perform diagnostic for pt with low back pain when severe or neurologic deficits are severe or when serious underlying conditions are suspected based on H&P
high
periosteum relative concentration of nociceptors
Primary afferents
periphery sensory receptor, transmits info to brain
bladder
periumbilical region/umbilicus
what important structure runs posterior to the head of the fibula
peroneal nerve
How would you treat mild persistent asthma in a patient already on albuterol inhaler?
perscribe a low dose inhaled corticosteroid
abnormally high foot arch
pes cavus
flat feet
pes planus
what two pediatric things usually present together?
plagiocephaly and torticollis
sleeve/fold of synovial tissue
plica bands (Patellofemoral pain syndrome (PFPS))
what can lead to cervicogenic headaches?
positioning of body/neck, nerve entrapment by muscles and fasicle tension, chronic muscle spasm
what did Upledger contribute to cranial
researcher cranial approach, coined "cranio sacral therapy" term "plunge your hand up into their sacrum"
Thoracic spine movement
rotation
what is the motion of the AA joints?
rotation (no joint) - test in complete flexion
what makes up the glenohumeral joint
rotator cuff mm glenolabrum glenohumeral lig
Which of the following is the most common bacterial cause of acute OM?
s. pneumoniae
posterior
sacral base movement in counter-nutation
anterior
sacral base movement in nutation
how to treat PMS?
sacral inhibition
second head injury while still recovering from concussion
second impact syndrome
increased ICP
second impact syndrome typical cause of death
where do you monitor and describe the motion for a still technique on the anterior rotated innominate
sense at lower pole move leg in and down into aDduction
where do you monitor and describe the motion for a still technique on the posterior rotated innominate
sense at upper pole move leg out and down into aBduction (start in & finish out)
Golgi Tendon Organs
sensitive to minute changes in muscle tension, have an inhibitory force
what kind of suture is the sagittal suture?
serrated
characteristics of trigeminal/cluster HAs
severe unilateral orbital or supraorbital pain, ipsilateral: conjunctival injection, lacrimation, nasal congestion, miosis, ptosis, eye edema, sweating
what is the duration of time for a concussion?
short-lived impairment of neuro function that resolves spontaneously
Nociceptors
signal that the body is being damaged mechanical (strong pressure from sharp objects), thermal, chemically sensitive, polymodal
sx progressively resolve without complications
simple concussions
which chapman point is located on the top of rib 2
sinus
what are the effect of smoking on the disc of the spine and the mechanism
smoke condensate *independent of nicotine* causes disc inflammation and reduced matrix synthesis
localized, stabbing, sharp
somatic pain characteristics
what is the mneumonic for the carpal bones
some lovers try positions that they can't handle
what keeps the baby's head from collapsing during delivery?
spaces between neonates cranial bones allows for motion
CCP, or fascial patterns
specific finding of *alternating* fascial motion preference at *transitional* regions of the body
L5
spinal roots tested by extensor hallucis longus contraction
S1
spinal roots tested by gastrocnemius contraction
L1-L2
spinal roots tested by psoas contraction
L3
spinal roots tested by quadriceps contraction
L4
spinal roots tested by tibialis anterior contraction
0-25% displacement
spondylolisthesis grade I definition
monitor
spondylolisthesis grade I treatment
25-50% displacement
spondylolisthesis grade II definition
monitor
spondylolisthesis grade II treatment
50-75% displacement
spondylolisthesis grade III definition
surgery
spondylolisthesis grade III treatment
70-100% displacement
spondylolisthesis grade IV definition
surgery
spondylolisthesis grade IV treatment
pars interarticularis fracture
spondylolysis
degeneration of spinal column leading to fusion/immobilization of vertebral bodies
spondylosis (definition)
What ligament stabilizes the arch of the foot?
spring ligament
what kind of suture is the temporal/parietal suture?
squamous
what is the path f the eustacian tube and the important landmarks
squamous, petrous and tympanic ring three parts joined by caritilage eustachian tube travels from middle ear through petrous portion of temporal bone, across articulation between the sphenoid and petrous tip,
what are the special tests performed for syndesmotic injury
squeeze test external rotation stress test anterior drawer test talar tilt test
Where is the only point in the body where the upper extremity articulates with the axial skeleton?
sternoclavicular joint
what are the three subjoints of the shoulder girdle
sternoclavivular acromioclavicular GH joint
what is the primary test to diagnose lumbar disc herniations
straight leg raise *high correlation with findings on operation due to high sensitivity in herniations -> to root compression*
where does the tentorium cerebelli originate?
straight sinus
What structures are compressed in thoracic outlet syndrome?
subclavian artery + sympathetic n plexus
high
subcutaneous tissue relative concentration of nociceptors
describe pain reduction in the high baseline pain severity group
substantial (>50%) pain reduction, clinicaley significant improvement in back specific functioning and satisfaction with care
what is the inherent motility of the CNS?
subtle, slow, pulse-wavelike movement
what are some headache red flags?
sudden onset of first severe headache, worst HA of life, late onset of new HA, HA with fever, rash, stiff neck, progressively worsening headache, HA with neuro signs other than aura or with mental status changes
what is the allostatic load
summation of all stressors on a patient
Where is the Chapman's point for sinuses?
superior aspect of the 2nd rib, mid clavicular line
What are six non-axis dysfunctions?
superior innominate shear, inferior innominate shear, inflare, outflare, pubic symphysis compression, and pubic symphysis gapping
What does the empty can test test for?
supraspinatous impingement
where do the extrinsic mm of the shoulder attach and what is their function
suspend scapula from trunk and work to stabilize or move it
Ruffini's Endings
sustained pressure, skin stretch
what allows for slow progressive angulation to take place between the bones as the skull alters its shape during growth
sutures
what is a form of articulation characterized by the presence of a thin layer of fibrous tissue uniting the margins of the contiguous bones, found only in the skull?
sutures
what kind of a sprain is more likely to result in recurrent ankle sprain and formation of heterotropic ossification
syndesmotic sprain
hyperthyroid, DM, pregnancy, leukemia, paraproteinemia, gout, autoimmunity
systemic causes of carpal tunnel syndrome
if there is a rib dsfxn and a t spine dsfxn, what should we treat first?
t spine
how can oMT help bells palsy or trigeminal neuralgia?
take myofascial tension off the nerve
why are you more at risk for a sprain in plantar flexion
talus glides anteriorly during plantar flexion, putting the narrow less stable part of the talar facet in the ankle mortise
plantar foot N/T, burning pain
tarsal tunnel syndrome clinical presentation
what is the myodural bridge?
tendinous matrix inserting into rectus captious posterior major and posterior cervical dura mater - essentially a direct connection between cervical muscles and dura
what is the function of the tensor veli palatini
tenses soft palate assists levator veli palatini in elevating palate to occlude and prevent entry of food into nasopharynx
what are the diaphragm associated with: Oa, C1, C2
tentorium cerebelli
obers test
test for tight TFL
unable to stand on toes
test that indicates posterior tibialis tendinopathy
cranial is an internally consistent model what does this mean?
that the terms we use to describe is reflecting what actually happens -- okay?
which neck joint/s is/are type 1 like?
the OA (occipital/C1) is - side bending left, rotated right in flexion or extension
if a baby is having trouble latching what are some targets for treatment?
the OA, condyles, and submandibular muscles
what is the q angle?
the angle at the femur and the tibia 0 = straight, 10 degrees = outward pointing tibia
what is called the CORE LINK?
the dura's involuntary connection with the cranial portion of the dura - dysfunction of the sacrum can be transmitted upward - this doesn't make sense to me so sorry its a shitty card
Where is the bregma?
the junction of the coronal and sagittal sutures along the midline
what drives the physiologic motion of the PRM
the motion of the SBS
what is usually the problem in TMJ?
the muscular and fascial tension - neck dysfunction could worsen TMJ
what does the falx cerebelli attach to?
the occiput and the foramen magnum
what does the tentorium cerebelli attach to?
the occiput, temporals, and sphenoid bone
Anatomic ROM
the passive play in the joint, if gone past this point will cause damage
what also causes the CSF to fluctuate?
the primary respiratory mechanism
when treating cranial what should you always remember to assess as well?
the sacrum
which test looks for asymmetry of the sacral base?
the seated flexion test
where does the falx cerebri arise from?
the straight sinus
what part of the skull contributes to the stability during labor?
the structure of the OA
what is the respiratory axis of the sacrum?
the superior transverse axis
Ease
the way soft tissue moves most easily
What did Guinn and Seffinger find
they used transcutaneous laser doppler flowmeter to capture the still point and show that during the still point SNS are decreased and PNS are increased also found that CV4 is reproducible by multiple operators
L5, SI joint, short leg, iliolumbar ligament, myofascial injury
vertebral segments/ligamentous dysfunctions associated with low back pain
generalized, aching, pressure
visceral pain characteristics
what kind of auras can you have with migraine?
visual, sensory, motor, speech changes
Chronic somatic dysfunction
weeks-years ischemia- cool, fibrous, dry
cranial, thoracic, respiratory, pelvic
what are the 4 diaphragms of the body?
flexion, extension, small/large circumduction, abduction, internal rotation, traction
what are the 7 steps of the spencer technique (shoulder)?
serotonin, substance P, bradykinin, histamine
what chemical mediators are associated with nociception?
pain down the arm
what constitutes a positive Jackson's test?
sx reproduction
what constitutes a positive Roos test?
pain down the arm
what constitutes a positive Spurling's maneuver?
pain/numbness in nerve distribution
what constitutes a positive axial compression test
meniscus tear
what does Apley's compression test indicate?
MCL/LCL tear
what does Apley's distraction test indicate?
meniscus tear
what does Childress' sign indicate?
supraspinatus tear
what does Jobe's test indicate?
meniscus tear
what does McMurray's test indicate?
adhesive capsulitis
what does Neer's test indicate?
hip/SI joint pathology
what does Patrick's test indicate?
biceps long head weakness/tendinitis
what does Speed's sign indicate
hypertonic psoas
what does Thomas test indicate?
nerve root impingement
what does a Jackson's test indicate?
thoracic outlet syndrome due to hypertonic anterior/middle scalene
what does a positive Adson's test indicate?
nerve root impingement
what does a positive Spurling's maneuver indicate?
spinal nerve impingement at level of spine
what does a positive axial compression test indicate?
thoracic outlet syndrome due to entrapment at costoclavicular region
what does a positive costoclavicular maneuver indicate?
thoracic outlet syndrome due to hypertonic pectoralis minor
what does a positive hyperabduction test indicate?
truncal ataxia
what does a positive pronator drift test indicate?
shoulder separation
what does cross over test indicate?
hip dysplasia
what does ortolani's sign indicate?
long thoracic nerve injury
what does scapular winging indicate?
adhesive capsulitis
what does test indicate?
hamstring flexibility
what does the 90/90 test indicate?
ACL tear
what does the Lachman's test indicate?
achilles tendon rupture
what does the Thompson test indicate?
gluteus medius weakness
what does the Trendelenburg test indicate?
AC joint pathology
what does the crossover test indicate
ACL/PCL tear
what does the drawer test indicate?
rotator cuff tear
what does the drop arm test indicate?
tight posterior hip capsule
what does the hip scour test indicate?
patella prone to lateral dislocation
what does the patella apprehension test indicate?
shoulder dislocation
what does the shoulder apprehension test indicate?
anterior tibiofibular ligament injury
what does the squeeze test indicate?
cervical-cranial, cervico-thoracic, thoracolumbar, lumbosarcal
what myofascial junctions should be assessed for compensatory pattern?
median
what nerve is being tested?
ulnar
what nerve is being tested?
hyperextension
what type of injury typically causes spondylolysis
what is linkage and how is it manifested as
what: distingushing feature of viscero-somaticreflex manifests: central vertebral dysfxn + paraspinal and ipsilateral intercostal ST changes
what are WDR cells, where are they and where do they send signals
what: receive information from somatic and visceral input sources send signal to brain and ventral horn located in dorsal root
Sherringtons Law of Recipocal Inhibition
when one muscle is active, the antagonist is inhibited
where is the lambda suture?
where the sagittal suture meets the lambdoidal suture
temporal bone
which bone drives the movement of the mandible?
sphenoid
which bone drives the movement of the maxilla?
occiput, temporal bone
which bones form the jugular foramen?
frontal, sphenoid, zygomatic, maxilla, lacrimal, ethmoid, palatine
which bones make up the orbit?
CN X
which cranial nerve is commonly associated with headaches?
CN IX, X, XI
which cranial nerves pass through the jugular foramen?
deltoid, external rotators, biceps, brachioradialis, supinator
which muscles/groups are paralyzed in Erb-Duchenne palsy?
with the Zinc model the diaphragms are ________ ________ of the veous and lymphatic systems and restriction _________________
with the Zinc model the diaphragms are *transverse restrictors* of the venous and lymphatic systems and restriction *impedes venous and lymphatic flow*
where do artery enter bones?
within bones in the skull
Is OMT effective for acute LBP in the military
yes
