Final review set 1
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| definition of osteopathic medicine | complete system of medical care wityh a philosophy that combines th eneeds of the patient with the current practice of medicine, surgery, and obstetrics, that emphasizes the interrelationship between st,funct, body ability to heal itself
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| principles of osteopathic medicine? | body is a unit, body is capable of self regulation, healing, and health maintenance, structure and function are interrelated, treatment is based upon understaqnding of the basic principles of body, unity, self regulation, and interrelationship of st, func
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| the impaired or altered funciton of related components of the somatic (body framework) system | somatic dysfunction
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| the maintenance of a pool of neurons in a state of partial or sub threshold excitation; in this state, less afferent stimulation is required to trigger the discharge of impulses | spinal facilitation
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| in spinal facilitation, which neurons can be affeted? | premotor neurons, motor neurons, or pregangl smp neurons in one or more segments
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| once established, how is spinal facilitation maintained? | normal CNS activity
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| the therapeutic application of manually guided forces by an osteopathic physician to improve physiologic function and/or support homeostasis that has been altered by somatic dysfunction | osteopathic manipulative treatment
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| localized visceral stimuli producing patterns of reflex response in segmentally related somatic structures | viscerosomatic reflex
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| localized somatic stimulation producing patterns of reflex response in segmentally related visceral structures | somatovisceral reflex
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| what does TART stand for? | tissue texture abnormalities, asymmetry, restriction of motion, tenderness
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| what are some characteristic of acute tisue texture abnormalities? | warm/hot, erythematous/prolonged red reflex, vasodilation, boggy/edematous, moist/increased tissue drag
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| what are some characteristics of chronic tissue texutre abnormalities? | cold/cool, pale/prolonged blanching, vasoconstriction, fibrotic/roy, dry/scaly
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| this is the limit of motion imposed by anatomic structure; the limit of passive motion. | anatomic barrier
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| this is the limit of active motion | physiologic barrier
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| a funcitonal limit that abnormally diminishes the normal physiologic range | direct (aka restrictive) barrier
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| this type of motion takes a patient from one antomic barrier to another | passive motion
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| this type of motion brings a patient from one physiologic barrier to another physiologic barier | active motion
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| these type of OMT techniques are ones in which the restricte dtissue is initially taken in the direction of motion restriction. | direct techniques
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| this type of OMT technique is one that initially takes the position away from a barrier toward relative ease or freedom of motion. | indirect technique.
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| are there techniques which are a combination of both direct and indirect? | yes
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| HVLA engages which barrier? | direct (restrictive) barrier (always)
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| describe Fryette's first law | when the spine is in neutral (easy normal), SB and rotation are in opposite directions
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| are the facets engaged in neutral spine? | no
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| Fryette's mechanics applies to what? | thoracic and lumbar spine
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| type I mechanics forms what type of curves? | long curves, multiple segments. they are compensatory
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| describe Fryette's type II law | when the spine is flexed or extended (non-neutral), SB and rotation are inthe same direction (type II mechanics). the facets are engaged
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| is there type II like motion in the typical cervical spine? | yes
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| where are type II curves found? | apices and crossover and/or sites of viscerosomatic reflexes. it is a primary somatic dysfunction, and can cause a type I. due to a strain or viscerosomatic reflex.
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| describe Fryette's third law | when motion is introduced in one plane it modifies (reduces) motion in other two planes. when a segment is brought to a restrictive motion barrier it will move in the position of greatest ease in the other two planes.
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| in type I somatic dysfunction, posterior transverse process and paravertebral fullness are visible when spine is in what position? | neutral. asymemetry not latered by flexion or extension. SB and rotation are in opposite directions.
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| in type I S/D, is asymetry significantly altered by flexion/extension? | no
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| in type II S/D, are the facets engaged? | yes
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| during flexion, what happens to the facets? | they are open
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| during extension, what happens to the facets? | they are closed
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| if motion is normal during flexion and extension, is there a somatic dysfunction/ | no
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| if the right facet is locked closed, is there a somatic dysfunciton in extension? | no
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| if the right facet is locked closed, what is the most comfortable position of ease for the patient? | extension
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| if the right facet is locked closed, does flexion or extension make the spine more asymmetrical? | flexion
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| if the right facet is locked closed, what happens in flexion? | left facet can open freely, but right facet cannot, so it pivots around the facet joint. there is apparent rotation and sidebending to the right, causing exaggeration of asymmetry.
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| if the right facet is locked closed, what is the restriciton/ | flexed, rotated, SB left
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| if the right facet is locked closed, what is the somatic dysfunciton/ | extend, rotated right, SB right
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| if the right facet is locked open, is there asymmetry in flexion? | no because both facets can open easily. no apparent rotation or Sb asymmetry. This is the most comfortable position for the patient.
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| if the right facet is locked open, what happens in extension? | left facet closes normally, right facet is locked open, and cannot close freely. SB and rotation are to the left.
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| if the right facet is locked open, what is the motion restriction? | extended, rotated SB right
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| if the right facet is locked open, what is the somatic dysfunction? | FRS left
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| during a posterior static postural exam, the vertical line should normally pass through which structures? | halfway between the knees, along the gluteal fold, through all spinous processes, along the midline of the head.
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| on the posterior postural exam, you should check horizontal levelnesss of which structures? | popliteal creases; greater trochanters; iliac crests; inferior angles of scapula, tops of shoulders, and mastoid processes. observe symmetry of foot rotation; arm length, arm distance from torso.
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| during a lateral static postural exam, the weight bearing line should normally pass through which structures/ | just anterior to lateral malleolus, middle of tibial plateau, greater trochanter, body of L3 (center of body mass), middle of humeral head, external auditory meatus
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| how do you do hip drop (lumbar sidebending screening) test | ask the standing patient to shift weight onto one leg, allowing the other knee to bend, which induces lumbar sidebending toward the weight bearing leg. observe lumbar SB and amount of hip drop which is normally greater than 25 degrees.
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| what indicates a positive sign for lumbar hip drop test? | hip drop less than twenty five degrees, it indicates a restricted lumbar sidebending toward the side of the ewight bearing leg. the test is named fro the bent leg side (positive right hip drop test indicates left lumbar sidebending)
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| scholiosis is defined as... | an abnormal lateral curvature of the psine in the coronal plane.
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| what is the most common cause of scoliosis? | idiopathic. this accounts for seventy to ninety percent of all scoliosis cases
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| idiopathic scoliosis is a diagnosis of... | exclusion
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| what must be ruled out in cases of scoliosis? | neural etiology of spinal deformity must be ruled out in every case.
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| scoliosis is characterized by... | lateral curvature and vertebral rotation, giving it a characteristic "rib hump"
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| define structural scoliosis | curve does not reduce with SB toward the rib hump
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| define funcitonal scoliosis | curve reduces with sidebending toward the rib hump
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| the female to male ratio varies with the severity of scoliosis..as the cobb angle increases what happens to the female to male ratio? | it increases as well
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| what is a common cause of functional scoliosis? | short leg syndrome.
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| in scoliosis due to short leg syndrome, the sacrum and pelvis shift in which direction? | they both rotate towards the short leg. the spine curves back in an attempt to keep the eyes level.
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| if the right leg is short, the spine compensates by SB which direction? | left
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| if the right leg is short, on which side will you have a positive hip drop test? | positive hip drop test on side of the short leg
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| what are some other known causes of funcitonal scoliosis? | muscle strain (tight uscle on one side of spine causes bowstring effect, psoas syndorme. relaxing and stretching helps). another cause is weak musculature (weak m. on one side of the spine allows opposing muscles to cause "bowstring effect")
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| scoliotic curve named according to which side? | according to the side of the convexity
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| wha tis the most common pattern of scoliosis? | double major. other types include: right thoracic, left lumbar, right thoracolumnbar
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| in evaluation of scoliosis, what msut you rule out? | neurologic cause, and short leg
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| what is adams test? | patient bends over so you can determine the side and flexibiliyt of the curve.
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| are radiographs indicated in scoliosis work up? | yes. Risser (ossification of iliac crest) identified with xray. lower value=skeletal immaturity=curve more likely to progress. can also do brain MRI
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| what are determinants of a short leg? | posterior standing postural exam, iliac crest height, medial malleoli levelness.
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| what do you measure on an Xray on a scholiosis patient? | the cobb angle.
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| postural radiographs for scoliosis are taken how? | anterior posterior (AP) erect, lateral erect, obliques taken when suspect spondylolisthesis (scottie dog deformity)
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| how do you measure the cobb angle? | draw lines from the top of hte superior vertebra an the bottom of the inferior vertebra into the concavity of the curve, drop intersecting lines perpendicular to these lines and measure the acute angle.
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| what value can you measure from a lateral xray view? | lumbosacral (fergusons) angle. normal value is 40+/- 2 degrees. you can also measure the weight bearing line
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| what does the weight bearing line go through? | bisect L3, drop a vertical line. it should fall on the anterior one third of the sacral base.
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| what is a mild scoliotic curve? what is the treatment? | 5-15 degrees. treatment is conservative, including OMT, exercise, treatment of short leg
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| what is a moderate scoliotic curve? treatment? | 20-45 degrees. treatment is previous plus bracing (most do not progress with bracing), electricla stimulation
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| severe scoliosis? treatment? | more than fifty degrees, requires surgial stabilization
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| you start seeing respiratory impairment with a scoliotic curve above what value? | fifty degrees
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| you start seeing cardiac impairment with a scoliotic curve above what value? | seventy five degrees
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| prognostic factors of scoliosis: future growth potential determined by? | age at diagnosis, risser sign (lower value indicates skeletal immaturity, curve more likely to progress), menarche in females (growth spurt is critical time for curve to increase, occurs 12-18 months before menarche), curve severity at diagnosis, patterns
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| do thoracic or lumbar curves have higher risk for progression/ | thoracic
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| which gender has more likelihood of scoliotic curve progression/ | females. the older the age at diagnosis, the less likely to progress, because of timeing of growth spurt
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| principles of OMT techniques |
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