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BR-OMM
5/21/06
| Question | Answer |
|---|---|
| TART | tissue texture changes, asymmetry, restriction, tenderness |
| Physiologic barrier | a point where a pt can actively move any given joint |
| Anatomic barrier | a ptoint where a dr can passively move any given joint; any movement beyond this point will cause ligament, tendon or skeletal injury |
| Restrictive barrier | the pathologic barrier that lies before the physiologic barrier and prevents full range of motion of that joint |
| Acute somatic dysfunction | edema, red, bogy, moist, hypertonic mm, asymmetry, painful restricted motion, severe or sharp tenderness |
| Chronic somatic dysfunction | dec or no edema, no redness, cool dry skin w/slight tension, dec muscle tone, flaccid, ropy, fibrotic; asymmetry d/t compensation in other areas of body; restriction w/o pain; dull, achy or burning tenderness |
| Freyette's principle - type I | Neutral; SB and R are opposite |
| Freyette's principle - type II | w/ F or E, SB and R are to same side |
| Orientation of superior vertebral facets | Cervical - BUM, Thoracic - BUL, Lumbar - BM; (backward, upward, medial); (backward, upward, lateral); (backward, medial) |
| Direct treatments (towards barrier) | myofascial, muscle energy, HVLA, cranial, lymphatics, chapman's |
| Indirect treatments (away from barrier) | myofascial, counterstrain, facilitated positional release, cranial |
| Active treatments (patient assists) | myofascial, muscle energy |
| Passive treatments (pt relaxes) | myofascial, counterstrain, facilitated positional release, HVLA, cranial, lymphatics, chapmans |
| Motion of vertebral segments along the sagittal plane and transverse axis is | flexion and extension |
| Motion of vertebral segments around a vertical axis and transverse plane is | rotation |
| Isometric contration | results in increased muscle tension w/o approximation of origin and insertion |
| Isotonic contraction | results in the approximation of the muscle's origin and insertion w/o change in its tension |
| Isolytic contraction | muscle contraction against resistance while forcing the muscle to lengthen |
| Concentric contraction | muscle contraction that results in the approximation of the muscle's origin and insertion |
| Eccentric contraction | lengthening of muscle during contraction d/t an external force |
| Motion of vertebral segments around a A-P axis and coronal plane is | sidebending |
| OA main motion | Flexion and extension (with SB and R to opposite sides) |
| AA main motion | Rotation (with SB to opposite side) |
| C2-C4 main motion | rotation (with SB to opposite side) |
| C5-C7 main motion | SB (with R to opposite side) |
| Nerve roots in the cervical region | exit above their corresponding vertebrae |
| Which muscle elevates 2nd rib with forced inhalation | posterior scalene |
| Which muscles elevate the 1st rib ith forced inhalation | anterior and middle scalene |
| Stenosis of IV foramen btw C3 and C4 will affect which nerve root? | C4 |
| Articular pillars | used to evaluate cervical motion, they are located btw superior and inferior facets, and also referred to as lateral masses |
| the main motion of upper/middle thoracic spine | rotation (versus F/E in lower) |
| Atypical ribs | 1, 2, 11, 12 (sometimes 10) |
| True ribs | 1-7; attach to sternum via costal cartilages |
| False ribs | 8-12; do not attach directly to sternum |
| Floating ribs | 11-12; lack anterior attachments |
| Pump handle, bucket handle, caliper motion | 1-5; 6-10; 1-12, respectivley |
| Pump handle Inhalation dysfunction | rib elevated anteriorly (restricted in caudad direction); superior edge of posterior rib angle is prominant; tenderness at costochondral/sternal jxn and at posterior rib angle; narrow above rib |
| Bucket handle Inhalation dysfunction | elevated laterally (restricted in caudad direction); lower edge of shaft is prominent; tender along mid-axillary line and posterior rib angle; narrow above rib |
| Pump handle Exhalation dysfunction | depressed anteriorly (restricted in cephalad direction); narrowing of intercostal space below rib; inferior edge of rib angle prominent |
| Bucket handle Exhalation dysfunction | depressed laterally (restricted in cephalad direction); narrow below rib |
| The key rib in inhalation dysfunction | is the lowest of the group |
| Key rib in exhalation dysfunction | is the highest of the group |
| Rule of three's for SP/TP relationships in throacic vertebrae | T1-3 (SP at level of TP); T4-6 (SP is one half segment below the TP); T7-9 (SP is at level of TP of vertebra below); T10 (upper); T11 (middle); T12 (lower) |
| Spine of scapula | corresponds with T3 |
| Inferior angle of scapula | corresponds with T7 |
| Sternal notch | T2 |
| Sternal angle | 2nd rib attaches at level of T4 |
| Nipple | T4 dermatome |
| Umbilicus | T10 dermatome |
| Secondary muscles of respiration | scalenes, pectoralis minor, serratus ant/post; quadratus lumborum, latissimus dorsi |
| Primary muscles of respiration | diaphragm; intercostals (external, internal, innermost, subcostal) |
| Typical ribs (3-10) have the following landmarks | tubercle, head, neck, angle, shaft |
| muscle energy on rib 6 which is stuck down engages | serratus anterior muscle |
| Ribs 6 thru 9 attach to | T5-T9 |
| Lumbar Erector spinae muscle group (SILO) | spinalis, iliocostalis, longissimus |
| Iliopsoas | origin: T12-L5; inserstion: lesser trochanter of femur; primary flexor of hip; common site of somatic dysfunction |
| Spina bifida occulta | no herniation defect; a patch of hair may be only sign |
| Spina bifida meningocele | herniation of meninges thru a defect in lamina |
| Spina bifida meningomyelocele | heniation of meninges and the nerve roots thru a defect in vertebral lamina; a/w neurological defects |
| Main motion of lumbar spine | flexion and extension |
| Flexion contracture of iliopsoas is a/w | nonneutral dysfunction of L1 or L2 |
| Spondylolisthesis | ANTERIOR displacement of one vertebra in relation to the one below; usu L4 or L5 and d/t fatigue fx of pars interarticularis |
| Spondylolysis | defect in pars interarticularis WITHOUT anterior displacement of vertebral body; "collar" on neck of scotty dog on xray |
| Spondylosis | radiographical term for degenerative changes in IV disc and ankylosing of adjacent vertebral bodies |
| Diagnosis of spondylolisthesis versus spondylosis | lateral xray versus oblique xrays |
| Which nerve root exits btw L4 and L5 | L4 |
| A posteriolateral disc herniation of the IV disc of L4/L5 will most likely compress | L5 nerve root |
| Right sided psoas syndrome | Positive Thomas test, tenderpoint medial to ASIS, somatic dysfunction of upper lumbars, +L pelvic shift; sacral dysfxn on oblique axis; contralateral piriformis spasm |
| Thomas test | flex both knees to pts chest to eliminate lumbar lordosis; hold one knee in place and lower the other leg toward table; dysfunction is noted in ability to straighten lowered leg |
| Cauda equina syndrome | can be d/t large central herniation of cauda equina; may cause weakness in both legs; surgical emergency; may progress to paralysis rapidly especially of bladder/rectum; dec sensation to medial thigh/groin is called "saddle" anesthesia |
| Organic causes of psoas syndrome | ureter dysfxn or stone, salpingitis, sigmoid colon dysfxn, appendicitis, prostate metastasis |
| Specifics about spondylolisthesis | HVLA of lumbars is contraindicated; 30% vertrbral displacement = Grade II (grade IV >75%); pt is relieved in flexion; usu has normal sensation in both extremities |
| Dextroscoliosis | the apex points to the right; sidebent left |
| Levoscoliosis | the apex points to the left; sidbent right |
| Respiratory compromise from scoliotic curve occurs at | thoracic curvature >50* |
| Cardiovascular function is compromised by scoliotic curve greater than | 75* |
| Most common cause of scoliosis is | idiopathic |
| Surgery for scoliosis has favorable results for | patients with a curve that has progressed despite bracing and is causing respiratory compromise |
| Patients with short leg syndrome display | anterior innominate rotation on side of short leg; an increase in lumbosacral angle of 2-3*; a sacral base that is lower on the side of the short leg |
| Most common cause of anatomic leg length discrepency is | total hip replacement |
| Pt with leg length discrepency of 1.5cm; Right femoral head is 13mm cephalad compared to left; what is course of action | use 1.5mm heel lift and increase it 1.5mm every other week until a final height of 6-9mm is reached (b/c the final height should be 1/2 to 3/4 of the discrepency) |
| Sacrospinous ligament | divides the greater and lesser sciatic foramen; originates at sacrum attaches at ischial spines |
| Sacrotuberous ligament | for ILA to ischial tuberosity; can diagnose dysfxn of innominate or sacrum |
| Iliolumbar ligament | from TP of L4/L5 to medial side of iliac crest; usu the 1st ligament to have pain w/lumbosacral decompensation |
| Muscles of pelvic diaphragm (primary) | levator ani and cocygeus muscles |
| Secondary pelvic muscles (partial attachment to true pelvis) | iliopsoas, obturator internus, piriformis |
| Piriformis significance | 11% of population has the entire or peroneal portion of the sciatic nerve running thru the belly of this muscle; hypertonicity causes buttock pain that radiates down the thigh, but not below the knee |
| Physiologic axes of sacrum and innominates (DRIP) | dynamic, respiratory, inherent/innominate, postural |
| Respiratory and craniosacral motions of sacrum | occur at superior transverse axis |
| Postural motion of sacrum | occurs at middle transverse axis |
| Dynamic motion of sacrum | occurs at L or R oblique axis |
| Innominate rotation | occurs along inferior transverse axis |
| Sacral torsion rules; when L5 is SB | a sacral oblique axis is on same side |
| Sacral torsion rules: when L5 is rotated | the sacrum rotates the opposite way on an oblique axis |
| Sacral torsion rules: the seated flexion test | will be positive on the opposite side of the oblique axis |
| Sacral torsion rules: if L5 is FRrSr | positive seated flexion on L; sacrum is rotated to L on R oblique axis (L on R) |
| Sacral torsion rules: if L5 is N SB left, R right | positive seated flexion on R; sacrum rotated to L on oblique axis (L on L) |
| Common dysfunction post-partum | bilateral sacral flexion |
| During swing phase of R lower extremity, the sacrum | moves about a L oblique axis |
| What causes sacral base to move anterior? | cranial extension |
| Sacral counternutation | occurs during craniosacral flexion as sacral base moves posterior |
| Positive seated flexion on R; L5 rotated R; Post/Infer ILA on R; Sup sulcus deep on R | L sacral rotation on L oblique axis |
| What L5 dysfxn corresponds with a R sacral rotation on a L oblique axis? | L5 F R and SB left |
| The following can cause a positive seated flexion test on the right | Unilateral sacral extension OR flexion on R; Left sacral rotation on L axis; Sacral margin is posterior on R |
| The following will cause a deep sacral sulcus on the R | unilateral sacral flexion on the right |
| Left innominate anterior rotation | PSIS superior on L |
| Rotator Cuff Muscles: SITS | Supraspinatus (abduction), Infraspinatus (ER), Teres minor (ER), Subscarpularis (IR) |
| Brachial Plexus: Really Thirsty, Drink Cold Beer! | Roots, Trunks, Divisions, Cords, Branches |
| Most common brachial plexus injury | Erb-Duchenne's palsy during childbirth; injury to C5/C6 roots |
| Erb-Duchenne's palsy causes paralysis in these muscles | deltoid, external rotators (infraspinatus/teres minor), biceps, brachioradioalis, supinator mm; C5-C6 |
| Klumpke's palsy | d/t C8-T1 injury; paralysis of intrinsic mm of hand |
| Carpal Bones: Some Lovers Try Positions That They Can't Handle | scaphoid, lunate, triquetral, pisiform, traqezium, trapezoid, capate, hamate |
| Deep finger flexors | flexor digitorum profundus; attach to the DIPs |
| Increased carrying angle | ulna is abducted and wrist is adducted |
| Swan-neck deformity | flexion contracture of MCP and DIP; extension of PIP; a/w rheumatoid arthritis and contracture of intrinsic muscles of hand |
| Boutonniere deformity | extension contracture of MCP and DIP; flexion of PIP; d/t rupture of hood of extensor tendon at PIP; a/w rheumatoid arthritis |
| Claw hand | extension of MCP and flexion of PIP and DIP; d/t median and ulnar nerve injury (loss of intrinsic mm control and overactivity of extensor mm) |
| Ape hand | d/t median nerve damage; wasting of thenar eminance, extension of MCP and flexion of PIP and DIP |
| Bishops deformity | contracture of last 2 digits w/atrophy of hypothenar eminence d/t ulnar nerve damage |
| Dupuytren's contracture | flexion contracture of MCP and PIP usu seen w/contracture of last 2 digits; d/t a contracture in palmar fascia |
| Drop-wrist deformity | radial nerve damage results in paralysis of extensor muscles |
| Radial artery | forms most of the deep palmar arch of the hand |
| Dorsal scapular nerve | only contains fibers from C5 nerve root |
| Which reflex will be decreased in C5/C6 injury | biceps and triceps |
| Thoracic outlet syndrome | dull ache in neck that radiates to arm; no sensory or strength deficits and normal DTR; right anterior scalene tenderpoint and positive Adson's test |
| Throacic outlet syndrome is d/t compression of | neurovascular bundle (subclavian artery, vein and brachial plexus); it can occur btw ant & mid scalene, btw pec minor & upper ribs, or btw clavicle & 1st rib |
| Humeral dislocation occurs in what direction | anterior and inferior |
| Supraspinatus tendonitis | pitcher w/shoulder pain that has worsened over a month; tenderness at tip of acromion, full range of motion, but pain w/abduction; positive drop test |
| Winging of scapula | long thoracic nerve damage |
| Carpal bone located most medially | hamate |
| Pronators of arm are innervated primarily by | median nerve |
| Inc carrying angle on left; tenderpoints at elbow and wrist; wrist restriction in abduction; diagnosis is: | Abduction of ulna |
| What movement will cause radial head to glide anteriorly? | Supination of forearm |
| Tennis elbow has tenderness at: | lateral epicondyle |
| Wrist drop | radial nerve damage |
| Origin of brachial artery is located at: | inferior border of teres minor |
| The following are a/w abduction of ulna somatic dysfunction | cubitis valgus, inc carrying angle, adduction of wrist |
| Primary extensor and flexor of Hip | Gluteus maximus and Iliopsoas |
| Primary extensor and flexors of Knee | Quadriceps (rectus femoris, vastus lateralis, medialis, intermedius) and Semimebrainous, Semitendinosus (hamstrings) |
| External Rotation Somatic dysfunction of hip | Hip restricted in internal rotation; Piriformis or iliopsoas spasm |
| Internal Rotation Somatic Dysfunction of Hip | hip restricted in external rotation; d/t spasm of internal rotators (gluteus minimus, semimembranosus/tendinosus, TFL, adductor magnus/longus) |
| Pronation of ankle | dorsiflexion, eversion, abduction |
| Supination of ankle | plantarflexion, inversion, adduction |
| Common peroneal nerve | lies directly posterior to proximal fibular head and can be damaged w/fibular head fx |
| O'Donahue's "Terrible" Triad | knee injury of ACL, MCL, medial meniscus |
| Greatest ankle stability is in what position | dorsiflexion |
| The most commonly injured ligament in the food is: | Anterior TaloFibular (ATF = always tears first) |
| Primary flexor of hip | iliopsoas |
| What prevents hyperextension of knee? | anterior cruciate ligament |
| Posterior fibular head dysfxn | occurs following supination ankle sprain; talus is internally rotated, distal fibular head is anterior, dorsiflexion of ankle is restricted |
| Coxa vara | a decreased angle btw the neck and shaft of the femur |
| Decreased Q angle is a/w | a bow-legged appearance |
| Lateral femoral patella tracking | a/w accelerated wear of posterior surface of patella; usu in women; deep knee pain w/stair climbing |
| Treatment for lateral femoral patella tracking is focused on strengthening | the vastus medialis |
| Compartment syndrome of leg usu affects | anterior compartment |
| Lateral stabilizers of the ankle | anterior talofibular, calcaneofibular, posterior talofibular ligaments |
| The ligament most often injured in ankle supination injuries | anterior talofibular ligament |
| Type II supination ankle sprain refers to | damage to anterior talofibular and calcaneofibular ligaments |
| Components of lateral longitudinal arch of foot | cuboid, 4th and 5th metatarsal, calcaneous |
| Who established the Cranial Field? | William Garner Sutherland |
| What is involved in the PRM (primary respiratory motion)? | CNS, CSF, Dural membranes, cranial bones, sacrum |
| What decreases the cranial rhythmic impulse? | stress, depression, chronic fatigue, chronic infections |
| What factors increase the cranial rhythmic impulse? | vigorous physical exercise, systemic fever, following OMT to the craniosacral mechanism |
| Where are the dural attachments? | Foramen magnum, C2, C3 and S2 |
| Describe craniosacral flexion | flexion of midline bones (sphenoid, occiput), counternutation of sacrum (posterior), dec AP diameter of cranium, ER of paired bones |
| Describe craniosacral extension | extension of midline bones, nutation of sacral base (anterior), inc AP diameter of cranium, IR of paired bones |
| What will head trauma do to the cranial rhythmic impulse? | it will compress the SBS and decrease the CRI; esp if trauma is at back of head |
| Vagal somatic dysfunction can be due to dysfunction at what cervical levels? | OA, AA, and/or C2 |
| Dysfunction of what cranial nerve causes tinnitus, vertigo or hearing loss? | CN VIII |
| Poor suckling in a newborn may be d/t occipital condylar compression of which CN? what about at jugular foramen? | CN XII; CN IX, X |
| The CV4 technique will do what do the CRI? | it will increase the amplitude; helps with homeostasis and UTERINE contractions in post-gravid woman |
| Describe the Vault Hold | index on greater wing of sphenoid, middle on temporal bone in front of ear, ring on mastoid of temporal, little on squamous of occiput |
| Cranial Torsions | occurs when SBS is twisted; it is named for the superior greater wing of the shenoid; along an AP axis (shenoid and occiput sidebend in different directions |
| Cranial Sidebending/Rotations | the sphenoid and occiput rotate in the same direction along an AP axis; name it for the deviation of the SBS; 2 vertical axes and a single AP axis |
| Cranial Flexion/Extension | extension lesion occurs when SBS deviates caudad (decreasing the amt of flexion); a flexion lesion causes the SBS to deviate cephalad (dec the amt of extension of SBS) |
| Cranial Vertical Strains | Superior if sphenoid deviates cephalad; Inferior if sphenoid moves caudad; 2 transverse axes |
| Cranial Lateral Strains | Sphenoid deviates laterally in relation to the occiput; parallelogram |
| Which strains can be superimposed on others? | vertical and lateral |
| What are considered midline bones? | sphenoid, occiput, vomer, ethmoid |
| Deviation of the SBS caudad is an | inferior vertical strain |
| Normal craniosacral flexion exhibits: | couternutation, sacral extension about a superior axis, inc width of cranium, ER of temporal bones |
| The greater wing of the sphenoid is more superior than the left and the occiput is rotated in the opposite direction, what is the strain pattern? | Right Torsion |
| Which strain pattern can be considered physiologic if it doesn't interfere with the flexion/extension components of the mechanism? | torsions |
| Which somatic dysfxns may cause diplopia? | sphenoid, temporal, CN III, CN VI, CN IV |
| Dysfunction of which CN causes symptoms similar to Tic Douloureux (trigeminal neuralgia) | CN V2 |
| Which CN exits from the foramen rotundum | CN V2 |
| CN V3 passes through with foramina? | foramen ovale |
| Which CN exit the jugular foramen? | CN IX, X, XI |
| Venous sinus techniques enhance what? | blood flow thru the venous sinuses (spread sutures over occipital, transverse and sagittal sinuses) |
| How do you do the CV4 technique? | resist flexion phase and encourage extension until a "still point" is reached; then allow normal F/E to be restored |
| Vault hold allows you to.. | diagnose the SBS |
| Temporal rocking can help... | TMJ dysfunction |
| what does the V spread do? | separates any restricted or impacted sutures |
| Simplification of a spinal reflex: | sensory input is transmitted by an afferent limb, processed by the central limb (interneurons in spinal cord), then a motor response is transmitted by efferent limb |
| Output of a spinal segment can go to... | lower motor neurons (dorsal/ventral rami) to muscle or to viscera via autonomics |
| How does a spinal segment become (and stay) facilitated? | an abnormal sensory stimulus from an overstretched muscle spindle sensitizes 2 interneruons; this causes inc output to the initiating site (inc muscle tension) as well as brain (awareness of pain) and local cutaneous tissue (tissue texture changes) |
| A facilitated segment can lead to: | TART (tissue texture change, asymmetry, restriction, tenderness)...somatic dysfunction |
| CN III (midbrain) parasympathetics | ciliary ganglion; constricts pupil |
| CN VII (pons) parasympathetics (2) | Sphenopalatine gangion = inc lacrimal/nasal secretions; Submandibular ganglion = inc submandibular/sublingual secretions |
| CN IX (medulla) parasympathetics | Otic ganglion = inc paratid gland secretions |
| CN X (medulla) parasympathetics (5) | Heart, Bronchial tree, GI system, Reproductive System, Urinary System |
| Which visceral systems have innervation from cranial and sacral parasympathetics? | Urinary system, Reproductive system, GI system |
| T1-T4 Sympathetics | head/neck |
| T1-T5 Sympathetics | heart |
| T2-T8 Sympathetics | esophagus |
| T5-T9 Sympathetics; Greater Splanchnic Nerve, Celiac Ganglion | Upper GI: Gallbladder, stomach, liver, spleen, part of pancreas and duodenum |
| T10-T11 Sympathetics: Lesser Splanchnic Nerve, Superior Mesenteric Ganglion | Middle GI = Part of pancreas, duodenum, jejunum, ileum, ascending colon/proximal transverse (right) |
| T12-L2 Sympathetics: Least Splanchnic Nerve, Inferior Mesenteric Ganglion | Lower GI: distal 1/3 of transverse colon, descending/sigmoid colon; rectum |
| T12 Sympathetics | appendix |
| T10-T11 Sympathetics | kidneys, upper ureters, gonads; superior mesenteric ganglion |
| T10 Sympathetics | adrenal medulla |
| T12-L1 Sympathetics | lower ureters, inferior mesenteric ganglion |
| T11-L2 Sympathetics | bladder, penile/clitoral erectile tissue |
| T10-L2 Sympathetics | uterus/cervix |
| T12-L2 Sympathetics | prostate |
| T2-T8 Sympathetics | Arms |
| T11-L2 Sympathetics | Legs |
| Sympathetics to entire GI | T5-L2 |
| Ligament of Treitz | divides the duodenum and jejunum |
| Splenic flexure of large intestine | divides transverse and descending colon |
| Anything before ligament of treitz | T5-T9 |
| Anything between Ligament of Treitz and Splenic Flexure | T10-T11 |
| Anything after Splenic Flexure | T12-L2 |
| L3-L5 | NOTHING |
| What is the significance of rib raising? | Normalize (dec) sympathetic activity (ex: thin mucus secretions); Improve lymphatic return; Encourage maximal inhalation/more effective negative intrathoracic pressure |
| Indications for rib raising | visceral dysfxn, dec rib excersion, lymphatic congestion, fever, paraspinal muscle spasm; NOT rib/spinal fx or recent spinal surgery |
| Purpose of Treatment of Chapman's reflexes | decrease sympathetic tone to associated visceral tissues |
| How do you treat the parasympathetics? | Cranial (CN III, VII, IX, X); Sphenopalatine ganglion, Condylar decompression, Vagus nerve at OA, AA, C2, Sacrum |
| Stimulating the sympathetic chain at T3 will cause: | dilation of pupil, inc in HR, bronchodilation |
| These vertebral segments will have an effect on cardiac function: | T3, T4, OA, AA |
| Vagus nerve stimulation will cause: | dec in contractility of heart, pupillary constriction, increased gastric motility, urinary release |
| Facilitated segments: | Have low threshold for excitation; Usu caused by inc in afferent input; Have inc efferent output; Once established are sustained by normal CNS activity; Require less afferent stimulation to trigger efferent neuron discharge |
| Acute asthmatic exacerbations have viscero-somatic changes a/w what spinal level? | T2-T6 |
| The pelvic splanchnic parasympathetics control: | lower ureter/bladder, uterus, prostate, genitalia, descending/sigmoid colon and rectum |
| Treatment of the occiput and atlas may affect the following viseral structures: | kidney, ureter, transverse colon, ovaries NOT prostate |
| What will result from hypersympathetonia? | inc respiratory and heart rate; NOT inc gastric motility, glycogen synthesis, lacrimation or miosis |
| RUQ pain, radiates to tip of R scapula, positive Murphy's sign; suspecting acute cholecystitis, where would you find somatic changes? | T6-T9 |
| Obstruction of ureter from Ca-oxalate stone resulting in hydronehrosis and acute pyelonephritis will have an effect on: | Vagus, Pelvic Splanchnic, Sympathetic ganglia of T10-L1 |
| Viscero-somatic reflex from right/ascending colon cancer would be a/w somatic changes at what spinal segment? | T11 |
| Stimulation of sympathetic chain ganglion may cause: | ejaculation, vasodilation of vessels supplying skeletal muscle, diaphoresis, inc HR |
| What spinal segment may alter parasympathetic innervation to the appendix? Sympathetic | AA; T12 |
| Sympathetic innervation to the liver courses through which ganglia? | Celiac |
| Which segment has sympathetic influence to the prostate? | L1 (T12-L2) |
| Restriction of occipitomastoid suture at jugular foramen may cause visceral dysfunction that manifests as: | gastritis, diarrhea, bradycardia, irritable bowel syndrome; NOT stress incontinence |
| An increase in sympathetic tone to the abdominal cavity will cause: | inc in GNG, dec gastric motility, dec pancreatic secretions, dec GI absorption, HTN |
| Which supplies the parasympathetics to the ovaries? | vagus nerve |
| Pt with dysmenorrhea has visero-somatic changes at what level? | T12 (T10-L2) |
| Paraxysmal HTN 2* to adrenal pheochromocytoma may have somatic changes at what spinal level? | T10 |
| Parasympathetic stimulation may cause: | lacrimation, bradycardia, miosis, thinning of bronchial secretions |
| Sympathetic stimulation of secments T10-L2 may cause what kind of reaction? | ejaculation |
| What are Chapman's reflexes? | points that represent somatic manifestation of a visceral dysfunction; gentle pressure at the point will elicit sharp, nonradiating, distressing pain |
| Anterior chapman's point | smooth, firm palpable nodules deep in fascia or periosteum of bone |
| Posterior chapman's points | located btw spinous and transverse processes; rubbery, similar to tissue texture changes a/w classic viscero-somatic reflex |
| Chapman's point for the Appendix | Anterior = tip of 12th rib; Posterior = TP of T11 |
| Chapman's point for Adrenals | Anterior = 2" superior & 1" lateral to umbilicus; Posterior = btw spinous/TPs of T11 & T12 |
| Chapman's point for Kidneys | Anterior = 1" superior, 1" lateral to umbilicus; Posterior = btw spinous/TPs of T12-L1 |
| Chapman's point for Bladder | Anterior = Periumbilical region |
| Chapman's point for Colon | Lateral thigh w/in iliotibial band from greater trochanter to just above the knee (imagine the entire large intestine flipped over and layed on your lap; transverse colon will sit btw knees) |
| What do "Trigger Points" represent? | the somatic manifestation of a viscero-somatic, somato-visceral or somato-somatic reflex; they may REFER pain, unlike tenderpoints |
| What is a Trigger Point? | a hypersensitive focus in a taut band of skeletal muscle or in muscle fascia; upon its compression it can give characteristic referred pain, tenderness and autonomic phenomena |
| To recap Chapman's Reflex points, they... | are thought to represent viscero-somatic reflexes, they are discretely palpable 2-3mm nodules, they are more used for diagnosis than treatment in clinical practice |
| Tell me about tenderpoints: | they are hypersensitive pts in myofascial tissue, they act as treatment monitor for counterstrain, they are painful when compressed, but do not refer pain |
| What is the procedure for myofascial release? | palpate restriction, apply compression (indirect) or traction (direct), add twisting/transverse forces, use enhancers, await release |
| Goal of myofascial release? | restore fxnl balance and improve lymphatic flow |
| When performing indirect myofascial release, which barrier is engaged? | anatomic |
| What is an appropriate endpoint for myofascial release treatment? | warming in the region, restoration of symmetry, "melting" of restrictive barrier, sufficient time passed w/o release |
| This is a good indication for myofasical treatment: | peripheral edema; NOT febrile bacterial infxn, fx, advanced cancer, trauma to internal organs |
| Is the tentorium cerebelli a physiologic diaphragm? | yes |
| Common compensatory pathway described by Zink: | OA fascia = Rotated L, C-T junction = Rotated R; L-S junction = Rotated R |
| Right lymphatic duct | collects lymph from right arm, right hemicranium, the heart and lungs (except for upper L lobe) |
| These structures drain into the left major thoracic duct | lymph from L eye, R leg, L upper lobe of lung; NOT from myocardium |
| Restrictions of Sibson's fascia (domed at apex of lung) could produce edema where? | in the entire body |
| What is the autonomic innervation of the lymphatic system? | thoracic duct gets sympathetics at each level; cysterna chyli is at T12; hypersympathetic tone will initually produce an increased lymph return; the role of parasympathetics isn't well understood |
| What can improve lymhatic flow? | semilunar valves in lymph vessels, flap valves in terminal lymph capillaries, pulmonary respiration, micropinocytosis, interstitial fluid pressure <0mmHg |
| What factors raise interstitial pressure above 0mmHg, collapsing lymph vessels? | Systemic HTN (inc capillary pressure), Cirrhosis (dec plasma colloid osmotic pressure), Hypoalbuminemia a/w starvation, toxins (inc capillary permeability) |
| What can decrease lymphatic return? | HTN, severe hypoalbuminemia, rattlesnake toxin; NOT decreased plasma colloid osmotic pressure |
| What is the typical sequence for lymphatic treatments? | thoracic inlet release, rib raising, thoraco-abdominal diaphragm release, lymphatic pump |
| The following are indications for lymphatic treatment: | URTI, cirrhosis, CHF, nephrotic syndrome; NOT abscesses |
| The anterior tenderpoint for L5 is located where? | 1cm lateral to the pubic symphisis on the superior ramus |
| What percentage of tenderpoints are considered to be "maverick"? | 5%; pt will only improve if you position the patient opposite to what would be typically used |
| When fine tuning a counterstrain technique, what is the minimum acceptable reduction in pain? | 70% |
| What region is a/w the greatest number of maverick points? | cervical spine |
| When using facilitated positional release (indirect myofascial release) to a superficial muscle, which is performed first? | straightening the AP spinal curves, then add facilitating compression or torsion, then shorten the muscle to be treated, hold 3-4s, then reposition and reevaluate |
| how long do you hold pt in position for facilitated positional release? | 3-4 seconds |
| Where is the iliacus tenderpoint? | 7cm medial to ASIS; Tx = flex/ER hip |
| Where is piriformis tenderpoint and how do you treat it? | 7cm medial to and slightly cephalad to greater trochanter on prone pt; Tx = flex hip/knee, abduct/ER thigh "peeing dog" |
| ME for forward sacral torsion | patient lies Face down |
| ME for Backward sacral torsion | patient lies on their Back |
| What is a necessary component for any successful ME treatments? | patient assistance |
| What muscle is used to treat an exhalation dysfunction of rib 11 with a ME technique? | latissimus dorsi |
| HVLA neurophys theory #1 | the forceful stretch of a contracted muscle produces a barrage of afferent impulses form the spindles to the CNS; the CNS reflexively sends inhibitory impulses to the spindle to relax the muscle |
| HVLA neurophys theory #2 | the thrust forcefully stretches a contracted muscle, pulling on its tendons and activating the Golgi tendon receptors to reflexively relax the muscle |
| Absolute contraindications to HVLA | osteoporosis, osteomyelitis, fx in area of thrust, bone metastasis, severe RA (dens; transverse ligament rupture, possible subluxation), Downs syndrome (laxity of transverse ligament of dens, AA subluxation like RA) |
| Relative contraindications to HVLA | acute whiplash, pregnancy, post-surgical conditions, herniated nucleus propulsus, pts on anticoagulants or hemophiliacs, vertebral artery ischemia (+ Wallenberg's test) |
| What does this describe: direct, short/quick thrust at exhalation, pop/click may be heard | HVLA |
| Scoliosis and Tenosyovitis and HVLA | neither are contraindications for treatment |
| What is a good technique for viral pneumonia? | Rib raising |
| The Spencer technique... | improves motion of glenohumeral joint; useful for treating adhesive capsulitis, one step requires abduction and IR; ME techniques can be used to enhance the technique |
| Spencer Technique | pump deltoid (1st and last); flexed elbow glenohumeral extension; extended elbow glenohumeral flexion; circumduction w/compression; circumduction w/traction; adduction/ER; abduction/IR (behind back); pump deltoid |
| The purpose of the hip-drop test is to evaluate... | sidebending (lateral flexion of lumbar spine) |
| Lumbosacral spring test will be positive in all dysfunctions where the sacral base moves... | posterior (counternutation) |
| Stenosis of the intervertebral foramen, resulting in radiculopathy, radiating to upper extremity can be assessed by what test? | Spurling's compression test (use to localize nerve root) |
| What test will be positive in vertebral artery insufficiency? | Wallenberg's; supine pt w/ dr holding head in flexion/rotation/rotation + extension neck |
| What are positive Wallenberg test signs? | dizziness, visual changes, lightheadedness, eye nystagmus |
| How do you evaluate shoulder range of motion when you suspect overuse injury? | Apley's scratch test (abduction/ER, IR/adduction, IR/adduction) |
| A positive Adson's test would indicate? | thoracic outlet syndrome (monitor pulse, extend/ER, abduct arm) |
| A positive Yergason's Test will indicate? | instability of biceps tendon in bicipital groove (flex elbow to 90*; pull down on elbow and ER forearm as pt resists; positive = tendon pops out) |
| What is de Quervain's Disease? | it results from inflammation of the abductor pollicis longus and/or extensor pollicis brevis tendons |
| Positive phalen's test | carpal tunnel |
| Hip drop test is positive in what condition? | group somatic dysfunction in lumbar spine (bend knee w/o lifting heel from floor; ipsilateral iliac crest should drop 20-25* in normal person; <20* = somatic dysfxn in lumbars; sidebending should occur away) |
| The Trendelenberg test will assess which muscle groups? | hip abductors (supplied by superior gluteal nerve) |
| To evaluate hip flexors, what test could you do? | Thomas test (usu + w/ tight iliopsoas; pt supine, flex both knees and let one leg down; + if pt cannot straighten leg) |
| Positive McMurray's test, Positive Apley's compression test, what is diagnosis? | medial meniscal tear |
| Excessive anterior movement of tibia on femur indicates what type of injury? | ACL tear |
| What is true of Apley's compression test? distraction? | it will be positive in meniscal injuries; ligamentous injuries |
Created by:
bscaryp