Surface Anatomy, Landmarks, and Static Symmetry Lecture

Sagittal Plane Symmetry (plum line)

- Coronal suture - External auditory meatus - Acromion - Greater tuberosity of the humerus - Greater trochanter of the femur - Patella - Lateral malleolus

Causes of deviations

- Osseous-Muscular Factors - Structural-Mechanical Factors

What is the incidence or diagnosis

1/20 by teenage years and diagnosed during time of rapid growth

Example of how curves provide spinal flexibility and strength.

A straight spine would transmit force directly through vertebrae resulting in fractures.

Lower Cross syndrome

AKA Janda - Weak gluteus maximus and tight hip flexors, - weak abdominal and tight erector spinae. - Weak glut medius and minimus. Tight TFL?/QL?. - an anterior pelvic tilt which increases lumbar lordosis. This causes hypermobility of the lower T/L spine

Coronal plane rotates on what axis?

Anteroposterior (AP)

bearing posture (created by drilling in "chest out, stomach in" position) Head tilted slightly posterior, cervical curve and thoracic curve normal, chest elevated, creating anterior cervical posterior thoracic deviation from plumb line, increased lumbar lordosis, anterior pelvic tilt, knees extended, ankles plantar flexed.

Military back

•consists of shortening & tightening of muscle groups, weakness of other muscle groups, and loss of control of integrated muscle function.

Muscle imbalance

Naming of lateral recumbent position

Named for the side that is down

Structural Exam

Observation Palpation Active ROM Passive ROM Special Tests

Know the difference between pectus carinatum and pectus excavatum?

Pectus carinatum- "pigeon chest" pectus excavatum

Cobb angle measurements used for?

Severity of scoliosis

What are the positions?

Standing Seated Supine, Lateral Recumbent Prone

Head forward, C-spine lordotic, thoracic spine kyphotic, decreased lordosis of lumbar spine, posterior tilt of pelvis, hip and knee joints hyperextended.

Sway Back

Level of suprasternal notch

T2

level of spine of scapula

T3

Level of angle of louis

T4

level of root of scapula

T4

Level of inferior angle of scapula

T7

level of Xiphoid process

T9

Severity can be measured as either mild, moderate or severe in which may result in respiratory and cardiovasular compromise What Osteopathic principle is this?

The 2nd princple how structure can affect function.

Vertebrae are designed to absorb stress of convexity changing, if curve changes at different levels can cause pain and dysfunction.

Transitional Points

Sagittal plane rotates on what axis?

Transverse (horizontal)

other name for anterior

anterior

Entire body leans forward; supports weight in metatarsals

anterior posture

extension of the sacrum leads to?

decreased lumbar lordosis

is continually adapting the body's posture to gravity, however faulty posture results in alteration of the center of gravity, which initiates mechanical responses requiring muscle adaptation. Over time, these postural changes lead to a change in NM memory from a normal to an abnormal adaptation pattern, resulting in

muscle imbalance

muscle imbalance

muscle imbalance

other name for dorsal

posterior

Entire body leans backward, balance maintained by anterior thrust of pelvis and hips, marked lordosis from mid-thoracic down.

posterior posture

Body rotated to right or left

rotary posture

•"An appreciable deviation of a group of vertebrae from the normal straight vertical line of the spine, as viewed in the posterior plane."

scoliosis

most common scoliosis

thoracolumbar (double major)

Osseous-Muscular Factors

•Bone deformities: congenital deformities of vertebrae, trauma with dislocation and/or fracture, and diseases (tumor, infection, osteoporosis, etc.) •Muscle tone (ventral or dorsal): Atrophy (disuse, neurologic disease), obesity/pregnancy, and contracture.

What are the 4 physiologic curves?

•Cervical Lordosis (convex forward) C1-7 •Thoracic Kyphosis (concave forward) T1-12 •Lumbar Lordosis (convex forward) L1-5 •Sacrum (concave forward) fused S1-5

•Structural-Mechanical Factors:

•Change of location of sagittal curve transitions: congenital vertebrae formation, sacral base imbalance, scoliosis, kyphoscoliosis, high heels, habit/occupation. •Endomorphic characteristics. •Hereditary characteristics. •Foot defects (pronation or calcaneal valgus). •Genu valgus or varus. •Hip joint changes (femoral ante/retroversion or varus/valgus). •Localized somatic dysfunction.

Observation/Palpation

•General Observation •Gross deformity, scars/bruises, etc. •AP and lateral curves •Anterior and posterior landmarks •Sagittal landmarks •Posture variations •Scoliosis (rib hump)

Observation/Palpation Posterior View

•Head •Earlobes •Neck/neck meets trapezius •Shoulders/acromion processes •Inferior angle of scapula •Spine •Rib cage/rib hump •Waist crease lines •Iliac crests •PSIS •Gluteal creases •Greater trochanter •Fingertips •Popliteal creases •Medial/lateral malleoli •Achilles tendons

upper cross syndrome

•Increased cervical lordosis, thoracic kyphosis and forward head posture. •Tight: •Dorsal: upper trapezius and levator scapula. •Ventral: pectoralis major and minor. •Weak: •Dorsal: middle and lower trapezius. •Ventral: deep cervical flexors.

Anatomic Landmarks for posterior symmetry/lateral curves

•Inion •Mastoid process •Acromion •Inferior Angle of Scapula •Waist crease •Posterior superior iliac spine •Gluteal lines •Popliteal lines •Lateral/medial malleolus

Posterior Plane Symmetry (plum line)

•Inion •Spinous Processes of C/T/L/Sacral Vertebrae •Gluteal crease •Mid heel point

Observation/Palpation Anterior View

•Landmarks (eye level): •Head •Eyes •Chin •Neck •Shoulders/acromion •Clavicle •Rib cage/nipples (males/children) •Sternum •Umbilicus •Iliac crests •ASIS •Fingertips •Patellae •Greater trochanter •Medial/lateral malleoli •Medial arches

Observation/Palpation Sagittal View

•Landmarks (eye level): •Head/coronal suture •External auditory meatus •Cervical curvature •Cervical-thoracic junction •Greater tuberosity of the humerus •Thoracic curve •Thoracolumbar junction •Lumbar curve •Lumbosacral junction •Sacral curve •Great trochanter of femur/hips •Knees •Lateral malleoli/ankles

How is scoliosis named?

•Named for the side of convexity of the curve.

Factors That Commonly Influence or Cause Scoliosis

•Structural vs. Functional •Bone deformities •Changes in muscle tone •Postural changes •Structural changes •Somatic dysfunctions •term-49Fascial patterns

severity of scoliosis

mild-5-15 degrees. moderate- 20-45 severe>50. Over 50 compromises respiratory function Over 70 compromises cardiovascular function

Head forward, c-spine lordotic, thoracic spine kyphotic, scapulae abducted, lumbar spine lordotic, anterior pelvis tilt, hip joints slightly flexed, knee joints extended, plantar flexion of ankle joints in relation to ankle of legs, anterior bulging of abdomen.

Kypholordotic

Horizontal plane rotates on what axis?

Longitudinal (vertical)

Endomorphic characteristics

Endomorphs tend to struggle with their weight, gaining weight easily and losing weight with difficulty, soft round curvatous

Head forward, C-spine slightly increased lordosis, thoracic spine slightly kyphotic in upper portion, then flattens, lumbar lordosis flattened, hips and knee extended.

Flat back

other name for inferior

caudad

Other name for superior

cephalad

Scoliosis is a curvature in what plane

cornonal. AKA rotoscoliosis. incidence 1/20 by teenage years.

Kypholordosis Chain reaction.

flexion of the sacrum leads to increased lumbar lordosis. to balance, the spine must increase the kyphosis of the thoracic region. again to balance, the lordosis of the cervical region is increased and the head protrudes forward.

Estimation of rib hump and evaluation of curve unwinding as patient turns trunk from side to side

forward bending test

Example of how spinal curves are interrelated

increase lordosis will result in increased kyphosis and vice versa.

Flexion of the sacrum leads to?

increased lumbar lordosis