OMM_Block_1_Practical
Landmark: Articular Pillars (Lateral Masses) of C2-7
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Landmark: Body of Sternum Pt supine; Dr standing on dominant eye side of Pt
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Landmark: Inferior Costal Margins Pt supine; Dr standing on dominant eye side of Pt
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Landmark: Mandible, Angle & Ascending Ramus
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Landmark: Manubrium of Sternum Pt supine; Dr standing on dominant eye side of Pt
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Landmark: Tibial Tuberosities Pt supine; Dr standing on dominant eye side of Pt
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Landmark: Xiphoid Process of Sternum Pt supine; Dr standing on dominant eye side of Pt
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Soft Tissue. Lateral Recumbant: Shoulder Stretch
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Soft Tissue. Supine: Pectoral Traction Muscle Stretch
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Soft Tissue. Cervical: Supine: Cervical Kneading & Stretching (Cervical Push-Pull)
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Soft Tissue. Cervical: Supine: Cervical Unilateral Stretch
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Soft Tissue. Thoracic: Prone: Thoracic & Lumbar Para-Spinal Inhibition
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Soft Tissue. Thoracic: Prone: Thoracolumbar Long Axis Stretch (Bi-directional & Unidirectional)
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Soft Tissue. Thoracic: Seated: Thoracolumbar Stretch
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Soft Tissue. Thoracic: Lateral Recumbent: Lower Thoracic & Lumbar Kneading & Stretching
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Identify issues beyond the actual techniques to keep in mind.
1. Demonstrate proper use of dominant eye while evaluating asymmetry of landmarks 2. Utilize proper posture/ergonomics while examining Pt 3. Avoid common palpation errors such as: --lack of concentration --excessive pressure --excessive movement 4. Demonstrate professionalism while examining Pt
Describe the process involved with using Active Flexion in differentiating C7 & T1
1. Palpate lower C-Spine SP's, most prominent one is ~ C7 2. Put finger from other hand on inferior SP (or finger from same hand) 3. Have Pt slowly flex neck, finger on C7 should move supreriorly, while finger on T1 stays stationary 4. Repeat motion testing on vertebral level on segment above, and one segment below. This confirms motion test
Landmark: Sternal Notch Pt supine; Dr standing on dominant eye side of Pt
AKA, jugular notch Superior part, in the midline of the Manubrium of the Sternum
Landmark: T12 SP Pt prone; Dr standing on dominant eye side of Pt
Be able to ID T12 in 3 different ways 1. Trace supero-medially along Rib12 2. Counting inferiorly from T7 3. Counting superiorly from L4
Landmark: SP of C7, T1, T3, T7, T12, L1-5 Pt seated; Dr. standing behind Pt
C7 - T1 SP: Use active cervical flexion to differentiate T3 SP: usually level w/ Scapular Spine T7: Typically level w/ Inferior Angle of Scapular Spine T12 SP: Fine Rib 12, follow it medially -- know that rib articulates superiorly to the SP of corresponding Vertebra L4 SP: Body of L4 lines up w/ Iliac Crests.
Landmark: Clavicle & Acromioclavicular Joint Pt seated; Dr. standing behind Pt
Clavicles: find medial border & trace laterally to AC joint AC Joint: are they level? Continue laterally from AC Joint to Acromion
Landmark: Greater Trochanters Pt supine; Dr standing on dominant eye side of Pt
Find using broad contact -- place palms/ finger pads at same level of a front pocket. If difficult to ID, have Pt internally/externally rotate leg to better palpate. Place index fingers on superior aspect of trochanters to see if they are level.
Landmark: Acromion Process Pt seated; Dr. standing behind Pt
From AC Joint, continue laterally to Acromion Process.
Landmark: Scapular Spine Pt seated; Dr. standing behind Pt
From posterior aspect of Acromion, continue medially as it becomes Scapular Spines
Dynamic Evaluation: Hip Flexion w Knee Flexed
Have Pt in supine position. Perform a hip lift & straighten the Pt's legs symmetrically. Ask Pt to flex their left knee by placing the left foot on the table just in front of the their left thigh. Palpate the Pt's left ASIS, grasp the proximal end of the tibia, just below the knee & flex the Pt's left hip until you identify motion in the left ASIS. Note the quantity & quality of hip flexion w/ the knee bent. Return leg to straight out on table & repeat process w/ other leg. Compare the R & L leg.
Static Findings. Standing: Lateral View
ID AP curve asymmetry (using gravitational line) compared to the fixed reference of the LM w/ Pt in Natural Stance & Uniform Base compared to: -EAM -AC -GT
Static Findings. Standing: Anterior View
ID asymmetry (relative to transverse plane) of landmarks w/ Pt in Natural Stance & Uniform Base of EAM, AC, GT. Uniform Base Eval of the following: -Head & Neck (S & R, Left & Right) -AC Joints (Low Side) -Iliac Crests (Low Side) -GTs (Low side) -Tibial Tuberosities (L & R) -Foot Position/Rotated (L & R) -Arch Height (L & R)
Static Findings. Supine
ID asymmetry relative to the transverse plane, R & L, of: -Foot Position (relative to vertical) L & R -Pelvic Symmetry of landmarks after Hip Lift & Legs straightened about midsagittal plane, ID'ing low side if asymmetrical
Landmark: Scapula Pt seated; Dr. standing behind Pt
In anatomy, the scapula is the bone that connects the humerus with the clavicle.
Landmark: Patellae Pt supine; Dr standing on dominant eye side of Pt
Knee cap.
Landmark: L1-L5 SP
Note change in shape of SP's from T to L-Spine 1. Move inferiorly from T12, or use Iliac Crest, which lines up w/ body of L4 2. Find SP of L4 & count inferiorly to find L5 3. Move superiorly from there back to L1
Dynamic Evaluation: Hip Drop Test
Perform Hip Drop Test by asking Pt to let R knee relax into flexion & observe L lumbar sidebending. Return Pt to uniform base & repeat w/ opposite side. Compare lumbar sidebending for symmetry magnitude of the curve. Also note range & quality of lumbar sidebending motion.
Landmark: SP of C2
SP of C2 is the 1st Palpalble SP inferior to the skull. The axis does not form a neural foramen for spinal roots. Its transverse processes are the only ones in the cervical spine that are not grooved to allow exit of a nerve root. The spinous process of the axis (C2) is larger, palpable, and prominent on x-ray.
Landmark: Pubic Tubercles Pt supine; Dr standing on dominant eye side of Pt
The pubic tubercle is a prominent forward-projecting tubercle on the upper border of the medial portion of the superior ramus of the pubis. The inguinal ligament attaches to it. To Palpate: Gently press heel of hand into lower abdomen, slowly move down, 1 - 2 '' at a time, until superior aspect of pubic bones are reached. Use fingers/thumb to deliniate the superior & inferior pubic margins by rolling fingers inferiorly & superiorly about .25 - .5''. Now move medially until the most anterior portion is reached, which is the tubercles.
Landmark: 2nd Rib: Anterior Aspect Only
The second rib is much longer than the first, but has a very similar curvature. Anterior Aspect: Move inferiorly from Rib 1 or, follow laterally from Sternal Angle.
Landmark: Inion
The inion is the most prominent projection of the occipital bone at the posterioinferior (lower rear) part of the skull. The ligamentum nuchae and trapezius muscle attach to it. The term external occipital protuberance (protuberantia occipitalis externa) is sometimes used as a synonym, but more precisely the term "inion" refers to the highest point of the external occipital protuberance.
Landmark: Mastoid Process
The mastoid process is a conical prominence projecting from the undersurface of the mastoid portion of the temporal bone. It is located just behind the external acoustic meatus, and lateral to the styloid process. Its size and form vary somewhat; it is larger in the male than in the female.
Landmark: Posterior Superior Iliac Spines Pt prone; Dr standing on dominant eye side of Pt
The posterior border of the ala, shorter than the anterior, also presents two projections separated by a notch, the posterior superior iliac spine and the posterior inferior iliac spine. The posterior superior iliac spine serves for the attachment of the oblique portion of the posterior sacroiliac ligaments and the Multifidus. When palpating, place thumbs on inferior aspect. Place hands on Iliac Crests, drop thumbs down at 45 deg. angle. Roll thumbs in circular motion to ID bony protruberance.
Dynamic Evaluation: Internal/External Rotation of Hip, w/ Straight Leg
Have Pt in supine position. Perform a hip lift & straighten the Pt's legs symmetrically. Be at end of table & grasp Pt's calcaneous of both feet & lift feet off of table ~4' & hold feet ~12' apart. Start with the Pt's left foot, slowly rotate the foot medially, to the end point of hip motion, noting the quantity & quality of the motion. Return foot to starting position & repeat for other leg. Next, laterally rotate the Pt's left, & then right leg noting the same aspects as prior. Compare internal & external rotation of each leg & also the same motion between the 2 legs.
Dynamic Evaluation: Internal/External Rotation of Hip w/ Knee/Hip at 90 degrees.
Have Pt in supine position. Perform a hip lift & straighten the Pt's legs symmetrically. Be at side of the Pt & flex both the hip & knee to 90 degrees, w/ contact on the calcaneous & knee to maintain the upper leg at 90 degrees and parallel to the table. Move the Pt's foot toward midline, to the end of motion, noting quantity & quality. Move the Pt's leg to the neutral starting position & move the foot laterally, to the end of motion, noting quantity & quality. Return the Pt's leg to the table & repeat w/ other leg. Compare internal & external rotation of each leg & also the same motion between the 2 legs.
Dynamic Evaluation: Thomas Test
Have Pt in supine position. Perform a hip lift & straighten the Pt's legs symmetrically. Have Pt move so that both legs are dangling off table from the mid-thigh. Have Pt bring both knees to chest. Instruct them to hold the right knee to chest while letting the left leg completely extend to a relaxed position. Note the angle the left leg forms with the table. Have Pt return left leg to chest, & repeat process w/ right leg. The side of the least extension is the side of the tighter Psoas Muscle
Dynamic Evaluation: Foot/Ankle Dorsiflexion/Plantarflexion
Have Pt in supine position. Perform a hip lift & straighten the Pt's legs symmetrically. Have Pt move so that their feet & ankles are off the table. Grasp distal end of the left leg w/ one hand & end of the foot with the other hand. Move foot caudad (dorsiflexion) to the end of motion, and then move back to position with foot perpendicular to the floor. Move foot away from head (plantar flexion) to end of motion. Repeat with other leg & compare R vs L motions.
Dynamic Evaluation: Hip Flexion w/ Knee Straight
Have Pt in supine position. Perform a hip lift & straighten the Pt's legs symmetrically. Identify the Pt's left ASIS w/ your left hand & grasp the Pt's right calcaneous w/ your right hand. Slowly flex the right hip w/ the Pt's knee straight until motion is palpated at the left ASIS, noting the quantity & quality of motion. Move to other side of table & repeat process for other hip. Compare motion of the R & L hips.
Dynamic Evaluation: Foot/Ankle Pronation/Supination
Have Pt in supine position. Perform a hip lift & straighten the Pt's legs symmetrically. have Pt move so that their feet & ankles are off the table. Grasp distal end of the right leg w/ one hand & grasp the end of the same foot w/ the other hand. Position foot so that the sole is perpendicular to the floor. Test supination by inverting & adducting the foot to the end of motion, noting quantity & quality. Return foot to starting position & test pronation by everting & abducting the foot to end of motion. Repeat with other foot, comparing the L vs R ankle motions.
Dynamic Evaluation: ASIS Compression Test (ACT)
Have Pt in supine position. Perform a hip lift & straighten the Pts' legs symmetrically. Place both hands on both ASIS's. Initially, maintain gentle pressure w/ left hand on Pt's right ASIS & then gently press the right ASIS posterior & slightly medial toward table, noting resistance of motion. Repeat with opposite hands & ASIS. Compare the R vs L compression & if asymmetrical the side of the positive ACT is the side w/ greatest resistance.
Dynamic Evaluation: Rib Springing (Costal Cage 3 Position Screening Exam)
Have Pt lay supine. 1. Place palm of each hand of over the upper 4 ribs on the midclavicular line. If Pt is female, have your hands on top of theirs. Gently spring the upper 4 ribs from anterior to posterior noting the R & then L resistance to the motion. 2. Reposition hands over the middle 4 ribs by placing them on the R & L midaxillary lines. Gently spring the middle 4 ribs from lateral to medial, noting the R & then the L resistance to motion. 3. Reposition hands over the lower 4 ribs by placing your hands posterior & lateral over the costal cage approximately 45 degrees posterior. Gently spring the lower 4 ribs from posterior-lateral to anterior-medial, noting the R, then L resistance to motion.
Dynamic Evaluation: Cervical Sidebending
Have Pt seated w/ arms draped off each side. Identify & monitor T1. Ask Pt to bring their right ear toward their shoulder, while keeping their eyes forward until you palpate motion at T1. Note quantity of sidebending in degrees & the quality of motion. Return to starting position & repeat for left sidebending.
Dynamic Evaluation: Cervical Rotation
Have Pt seated, w/ arms draped off each side. Identify & monitor T1. Then, start w/ the Pt looking straight ahead & ask Pt to turn their head maximally to the right. Have them keep their eyes level all the while you are monitoring T1. Note quantity of rotation in degrees & the quality of the motion. Return Pt to starting position & repeat w/ left rotation.
Dynamic Evaluation: Shoulder Abduction
Have Pt straddle a Still bench, arms draped off the sides w/ the palmar surface of the hands facing the midsagittal plane. Instruct Pt to slowly bring their hands over their heads (abduction), while keeping their elbows straight, until the dorsal surfaces of their hands touch. Note when each scapula begins to move & the total ROM, also observe the general range, quality & symmetry of motion.
Dynamic Evaluation: Seated Flexion Test (SFT)
Have the Pt sit. Ask that Pt place their feet ~18' apart on floor or on rung of Still bench & place their hands together in front of them. Identify the inferior aspect of the PSIS w/ your R & L hands. Ask Pt to slowly flex at the waist & move hands toward the floor. Note the motion of each PSIS. Is it symmetrical or does one side move longer & further than the other? The side that moves longer/further is the positive finding side.
Landmark: Fibular Heads Pt supine; Dr standing on dominant eye side of Pt
Lateral to Tibial Tuberosity, pinch the heads between finger & thumb.
Soft Tissue. Cervical: Supine: Cervical Long Axis Stretch
Long elliptical loops. Hold skin and make a part of your movement. Skin moves along muscles. Stretch muscles starting inferiorly all the way to occipital bone.
Soft Tissue. Cervical: Supine: Suboccipital Release
Make sure to continue technique until the allotted time during the practical is over. 1. Places the pads of your fi ngers just inferior to the superior nuchal line in the suboccipital soft tissues 2. Lifts the head so that the weight of the patient's head is entirely supported on the pads of your fi ngers. The head is held slightly above, but not resting on, your palms 3. Maintain this position until you achieve the desired relaxation of the suboccipital tissues. This may take anywhere from 30 seconds to several minutes 4. Success of the technique is determined through palpation to reassess the characteristics of the soft tissues that prompted the selection of the technique to begin with. Success may also be determined in part by reassessing the patient's symptomatology Note: This technique is similar in position to the method used by A.T. Still when he created a rope sling to relieve his own headaches.
Landmark: Medial Border & Inferior Angle of Spine Pt seated; Dr. standing behind Pt
Medial border: palpate inferiorly along medial border to inferior angle of scapula Inferior angle: Are they level? Should line up with T7
Dynamic Evaluation: Standing Flexion Test (StFT)
Monitor the inferior aspect of the R & L PSIS's & compare the motion as the Pt flexes through the pelvis, noting if one side continues to move for a longer period of time, & further distance. The side that moves further/longer is the side of the positive test.
Landmark: Rib Angles Pt prone; Dr standing on dominant eye side of Pt
Most posterior portion of ribs. Note change in angle of rib curve while gliding medial to lateral
Dynamic Evaluation: Forward Bending Test
Starting w/ Pt in uniform base, & observing from a posterior view, ask Pt to slowly flex from head through cervical, thoracic & lumbar spine as far as they can. Observe for sequential cephalad to caudad flexion of the spine, noting individual vertebrae, or groups of vertebra flex. Finally note the position of the Pt's hands relative to the floor. Repeat process, while observing from a lateral position and identify areas of flattening or peaks along the spine.
Landmark: Rib 11 & 12 Pt supine/prone; Dr standing on dominant eye side of Pt
The 10th-12th ribs, like the 1st rib, have only one facet on their heads and articulate with a single vertebra. The 11th and 12th ribs are short and have no neck or tubercle. Anterior approach: --follow inferior costal margins laterally to Rib 10 --trace along inferior aspect of Rib 10 w/ side of index finger --the middle finger will run into Rib 11 --repeat process or Rib 12 Posterior approach: --trace along inferior aspect of Rib 10 w/ side of index finger until hands almost reach midline of back --with paddle hands, lift anteriorly until ribs are felt --glide hands laterally to confirm ribs, roll fingers inferiorly to confirm location of Rib 12
Landmark: 1st Rib: Anterior & Posterior Aspects Pt supine; Dr seated at Pt's head
The 1st rib is the broadest (i.e., its body is widest and nearly horizontal), shortest, and most sharply curved of the seven true ribs. It has a single facet on its head for articulation with the T1 vertebra only and two transversely directed grooves crossing its superior surface for the subclavian vessels; the grooves are separated by a scalene tubercle and ridge, to which the anterior scalene muscle is attached. Anterior Aspect is just inferior to clavicle. Posterior Aspect: at base of neck, find Trapezius, retract it, slide into space between anterior Trapezius & base of neck. Anterior aspect: --just inferior to clavicle. --start laterally inferior to bend in clavicle, move medially until the "ramp" of Rib 1 is felt. Posterior aspect: --at base of neck, find trapezius, retract & hold w/ other fingers, insert fingers into small space between anterior trap & base of neck.
Landmark: Iliac Crests Pt supine; Dr standing on dominant eye side of Pt
The crest of the ilium (or iliac crest) is the superior border of the wing of ilium and the superolateral margin of the greater pelvis. Palpate w/ edge of index fingers, are they level in mid-axillary line?
Landmark: External Acoustic Meatus
The ear canal (external acoustic meatus), is a tube running from the outer ear to the middle ear. The adult human ear canal extends from the pinna to the eardrum and is about 35 mm in length and 5 to 10 mm in diameter.
Landmark: TP of C1
The transverse processes are large; they project laterally and downward from the lateral masses, and serve for the attachment of muscles which assist in rotating the head. They are long, and their anterior and posterior tubercles are fused into one mass. Palpate directly inferior to Mastoid Process.
Landmark: Sternal Angle Pt supine; Dr standing on dominant eye side of Pt
This is the site of Rib 2 articulation
Landmark: Sacral Sulci Pt prone; Dr standing on dominant eye side of Pt
To Palpate: From PSIS, roll thumbs medially & 1cm superior. Press firmly anteriorly until firmest tissue layer is felt.
Landmark: Ischial Tuberosities Pt prone; Dr standing on dominant eye side of Pt
To Palpate: Use heel of hand, press anteriorly into gluteal fold, them move cephalad. Place thumbs on them to ID asymmetry.
Landmark: Anterio Superior Iliac Spines Pt supine; Dr standing on dominant eye side of Pt
W/ fingers on Iliac Crests, allow palms to rest on ASIS to ID them. Move hands & place thumbs on inferior aspect of ASIS. Are they level?
Landmark: Medial Malleoli Pt supine; Dr standing on dominant eye side of Pt
While palpating, make sure to place thumbs on most inferior aspect to ID asymmetry.
