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OPP test 2


Carpal Tunnel contains flexor tendons, median nerve
Carpal Tunnel syndrome compression of the median nerve - numbness, pain in arm and hand
flexor retinaculum makes the roof of the carpal tunnel (aka transverse carpal ligament)
median nerve innervates all forearm flexors, sensory forearm innervation of the hand (1st 3.5 fingers)
EMG/nerve conduction studies electromyogram - can confirm a diagnosis. Nerve conduction studies show increased nerve function after OMT
myofascial release
opponens pollicus originates from the flexor retinaculum - allows you to oppose the thumb
Phalen test hands with palms together
tinel sign tap on the flexor retinaculum - positive sign = pain
transverse carpal ligament same as flexor retinaculum
double crush syndrome carpal tunnel syndrome + thoracic outlet syndrome
radiculopathy (C5-C8) nerve root pathology - impingement in the neck. Keep as a diagnostic option
Carpal Tunnel treatment: 3 phases 1. release transverse carpal lig. 2. opponens roll. 3. wrist extension to pull flexor tendons into carpal tunnel
anterior subluxation anterior position of the rib
costochondritis aka Tietze's syndrome - inflammation of 2nd costochondral junction. Treat with steroids
counterstrain can treat rib tender points: posterior tenderpoint - elevate it (stretch it out), anterior tenderpoint -depress it (bend ribcage around it)
depressed rib exhalation dysfunction (inhalation restriction)
elevated rib inhalation dysfunction (exhalation restriction)
exhalation rib rib "stuck" in exhalation (depression)
inhalation rib rib "stuck" in inhalation (elevation)
key rib inhalation dysfunction - inferior ribexhalation dysfunction - superior rib
myofascial release
posterior subluxation "speed bump"
rib tip syndrome lancinating (sharp) pain chondral mass of ribs 8-10, clicking at painful area
scapulocostal syndrome radiating pain from shoulder
xiphoidalgia pain/in the region of the xiphoid cartilage
ulnohumeral joint true elbow joint - olecranon process of ulna + trochlea of humerus
radioulnar joint allow pivot action - supination and pronation
radiocarpal joint between radius an carpal bones. Carpal bones have anterior glide in extension, posterior glide in flexion
interosseous membrane between 2 closely associated bones - e.g. ulna and radius. Somatic dysfunction of the interosseous membrane can perpetuate elbo/wrist pain after the injury should have healed
ulnar abduction somatic dysfunction evident in flexion at end point - increased carrying angle
ulner adduction somatic dysfunction decreased carrying angle - evident in extension
anterior radial head somatic dysfunction stuck in supination, restricted in pronation, radial head will not glide posteriorly, from backward fall
posterior radial head somatic dysfunction Stuck in pronation, radial head will not glide anteriorly, result from a forward fall
lateral epicondylitis actually should be termed "lateral tendinosis of elbow" does NOT involve inflammation - tissue degeneration of tendon
viscerosomatic reflex
deQuervian tenosynovitis swelling of tendon sheath that surrounds abd. pollicis longus and extensor pollicis brevis tendons at the wrist. Inflammation thickens tendon sheath and constricts tendon as it glides in sheath - crepitus over tendon sheath as pt flexes and extends thumb
nerve compression syndromes ulnar nerve (cubital tunnel syndrome), median nerve compression at the elbow, posterior interosseous nerve compression, pronator syndrome (muscular compression of median nerve in the proximmal forearm), radial tunnel syndrome
structural scoliosis spinal curve is fixed and inflexible
functional scoliosis spinal curve is flexible - correctable condition caused by postural or biomechanical factors
adams test forward bending test - patient bends forward at the waist - identify a rib hump - pt sidebends toward the side of rib hump. Disappears - functional scoliosis, persists - structural scoliosis
rib hump when patient is bent over, ribs protrude
static postural exam look for symmetry - line passes through midline of the body. Check levelness of popliteal creases, greater trochanters, iliac crests, inferior angles of the scapula, tops of shoulders, mastoid processes
postural x-rays use after finding static postural exam abnormality, structural scoliosis determined from Adam's test, OMT not successful, suspect conjenital abnormality, or to monitor progress of postural treatment regimen
cobb angle line across top survace of superior vertebra, line across bottom of inferior vertebra, perpendicular lines off of both. Then angle of intersection = Cobb angle
lumbosacral angle (ferguson's angle) angle between sacral base and line parallel to the ground - normally 25-35°
short leg syndrome unlevel sacral base due to one leg shorter than the other leads to functional scoliosis causing the spine to compensate with a type 1 curve to keep the eyes level
asymmetry can be indicative of restriction or of structural problem (i.e. short leg syndrome)
adductor tension short leg syndrome can cause this
body of vertebra L3 center of gravity - stays still and motion rotates around it
dynamic functional assessment gait provides information on how the muscle systems interact with each other. Includes relationships of agonists and antagonists.
energy conservation momentum from one stride is carried into the next
initial loading "heel strike" - contact --> lower forefoot to ground
initial swing in swing phase - accelerate thigh
loading response "flat foot" - after heel strike, accept weight onto foot
midstance between loading response (flat foot) and terminal stance (heel off). Stabilize the pelvis
midswing clear the foot (between initial swing and terminal swing)
pelvic rotation part of a normal stride
restriction of motion can be observed as asymmetry in stride
preswing toe off - continue to accelerate
propulsion function of gait
sacral torsion sacrum twists around its own longitudinal axis
shock absorption function of the joints (knee and hip)
stance stance phase = foot on ground (not swing phase)
stance stability symmetry
static postural exam observation of patient's symmetry
stride 1 complete gait cycle
swing swing phase - leg is in the air
terminal stance "heel off stance" - before preswing (toe off) -begin to accelerate
terminal swing "deceleration" - last part of swing phase before heel strike, extend knee, position foot
abdominal diaphragm central tendon and muscle - along rib margin. Makes up a transverse fascial diaphragm
zink's fascial pattern transverse fascial diaphragms - fascia rotates a particular way. Each fascial diaphragm alternates. 80% "healthy" people have R rotated pelvic diaphragm, L rotated abdominal dia., R rotated cervicothor., L rotated occipitoatlanto.
collectors functional unit: lymphangion. + valves, 3 layers - intima, media, adventitia
common compensatory fascial pattern Right rotated pelvic diaphragm, Left rotated abdominal diaphragm, right rotated cervicothoracic diaphragm, left rotated occipitoatlanto diaphragm
cysterna chyle large collecting duct in the pelvis
edema increased fluid in the interstitium - SYMPTOM. Disrupts anchoring filaments, disables intrinsic pumping mechanism
extrinsic lymphatic pumps diaphragms, respiratory system, adjacent arteries, exercise, peristalsis, external coompression (OMT, compression stockings, bandages)
interstitium space between cells
intrinsic lymphatic pumps lymphangions (collectors), interstitial fluid pressure
lymph fluid clear-yellow, resp. for absorbing fats from the diets (via lacteals). Contains clotting factors, lymphocytes, bacteria and viruses before filtration through org. lymph tissues
lymph capillaries 1 layer "leaky" endothelium, discontinuous BM, no valves. Patency maintained by anchoring filaments
lymph nodes organized lymph filtering centers - expose to immune system. Purifies lymph
lymphangions functional unit of lymph collection - main transporting unit of lymphatic system
lymphodynamic edema edema in normal system - accumulation of fluid bc of increased volume
lymphostatic/lymphedema abnormal system accumulates fluid. Primary (congenital) or secondary
pre-collectors 1-3 layers of endothelium, + valves
right lymphatic duct drains the right quarter of the body's lymph. Empties into the right subclavian v.
thoracic duct drains the lower body's lymph - empties into the left subclavian v. Crosses Sibson's fascia 2x.
left lymphatic duct aka thoracic duct
thoracic inlet opening to the rib cage
cervicothoracic fascia sibson's fascia
uncompensated fascial compensatory pattern zink's fascial pattern - transverse diaphragms do NOT alternate the direction they're rotated. Assoc. w. poorer health, increased constriction.
unorganized pathways improvised flow of fluid - how interstitial fluid empties into the lymphatic capillaries
lymphatic treatment remove restrictions to flow - treat transverse diaphragms (esp. cervicothoracic)
neurological model diagnosis of viscerosomatic reflexes, , normalization of autonomic tone
respiratory-circulatory model lymphatic drainage - treat thoracic inlet
viscerosomatic reflexes and treatment visceral dysfunction (organ malfunctions) send afferent info. (GVA) --> WDR that affect both visceral effects (GVE) and somatic tissue (GSA) contraction
visceral dysfunction OMT can be used to complement routine care for tx of visceral disease
treatment of sympathetic component of visceral disease rib raise, chapman's points (dx on front, treat on back), inhibition of celiac, sup. + inf. mesenteric ganglia
treatment of parasympathetic component of visceral disease cervical soft tissue (treat vagus), sacral rocking (S2-S4)
treatment of organ dysfunction component of visceral disease mesenteric lifts, organ pumps, visceral manipulation
treatment of lymphatic component of visceral disease fascial diaphragms, lymphatic pumps (e.g. thoracic pump), organ pumps
Created by: eegitto