5/21/06

Help!

Question

Answer

TART

tissue texture changes, asymmetry, restriction, tenderness

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Physiologic barrier

a point where a pt can actively move any given joint

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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

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Restrictive barrier

the pathologic barrier that lies before the physiologic barrier and prevents full range of motion of that joint

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Acute somatic dysfunction

edema, red, bogy, moist, hypertonic mm, asymmetry, painful restricted motion, severe or sharp tenderness

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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

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Freyette's principle - type I

Neutral; SB and R are opposite

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Freyette's principle - type II

w/ F or E, SB and R are to same side

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Orientation of superior vertebral facets

Cervical - BUM, Thoracic - BUL, Lumbar - BM; (backward, upward, medial); (backward, upward, lateral); (backward, medial)

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Direct treatments (towards barrier)

myofascial, muscle energy, HVLA, cranial, lymphatics, chapman's

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Indirect treatments (away from barrier)

myofascial, counterstrain, facilitated positional release, cranial

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Active treatments (patient assists)

myofascial, muscle energy

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Passive treatments (pt relaxes)

myofascial, counterstrain, facilitated positional release, HVLA, cranial, lymphatics, chapmans

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Motion of vertebral segments along the sagittal plane and transverse axis is

flexion and extension

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Motion of vertebral segments around a vertical axis and transverse plane is

rotation

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Isometric contration

results in increased muscle tension w/o approximation of origin and insertion

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Isotonic contraction

results in the approximation of the muscle's origin and insertion w/o change in its tension

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Isolytic contraction

muscle contraction against resistance while forcing the muscle to lengthen

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Concentric contraction

muscle contraction that results in the approximation of the muscle's origin and insertion

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Eccentric contraction

lengthening of muscle during contraction d/t an external force

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Motion of vertebral segments around a A-P axis and coronal plane is

sidebending

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OA main motion

Flexion and extension (with SB and R to opposite sides)

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AA main motion

Rotation (with SB to opposite side)

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C2-C4 main motion

rotation (with SB to opposite side)

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C5-C7 main motion

SB (with R to opposite side)

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Nerve roots in the cervical region

exit above their corresponding vertebrae

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Which muscle elevates 2nd rib with forced inhalation

posterior scalene

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Which muscles elevate the 1st rib ith forced inhalation

anterior and middle scalene

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Stenosis of IV foramen btw C3 and C4 will affect which nerve root?

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Articular pillars

used to evaluate cervical motion, they are located btw superior and inferior facets, and also referred to as lateral masses

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the main motion of upper/middle thoracic spine

rotation (versus F/E in lower)

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Atypical ribs

1, 2, 11, 12 (sometimes 10)

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True ribs

1-7; attach to sternum via costal cartilages

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False ribs

8-12; do not attach directly to sternum

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Floating ribs

11-12; lack anterior attachments

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Pump handle, bucket handle, caliper motion

1-5; 6-10; 1-12, respectivley

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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

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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

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Pump handle Exhalation dysfunction

depressed anteriorly (restricted in cephalad direction); narrowing of intercostal space below rib; inferior edge of rib angle prominent

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Bucket handle Exhalation dysfunction

depressed laterally (restricted in cephalad direction); narrow below rib

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The key rib in inhalation dysfunction

is the lowest of the group

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Key rib in exhalation dysfunction

is the highest of the group

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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)

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Spine of scapula

corresponds with T3

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Inferior angle of scapula

corresponds with T7

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Sternal notch

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Sternal angle

2nd rib attaches at level of T4

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Nipple

T4 dermatome

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Umbilicus

T10 dermatome

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Secondary muscles of respiration

scalenes, pectoralis minor, serratus ant/post; quadratus lumborum, latissimus dorsi

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Primary muscles of respiration

diaphragm; intercostals (external, internal, innermost, subcostal)

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Typical ribs (3-10) have the following landmarks

tubercle, head, neck, angle, shaft

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muscle energy on rib 6 which is stuck down engages

serratus anterior muscle

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Ribs 6 thru 9 attach to

T5-T9

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Lumbar Erector spinae muscle group (SILO)

spinalis, iliocostalis, longissimus

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Iliopsoas

origin: T12-L5; inserstion: lesser trochanter of femur; primary flexor of hip; common site of somatic dysfunction

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Spina bifida occulta

no herniation defect; a patch of hair may be only sign

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Spina bifida meningocele

herniation of meninges thru a defect in lamina

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Spina bifida meningomyelocele

heniation of meninges and the nerve roots thru a defect in vertebral lamina; a/w neurological defects

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Main motion of lumbar spine

flexion and extension

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Flexion contracture of iliopsoas is a/w

nonneutral dysfunction of L1 or L2

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Spondylolisthesis

ANTERIOR displacement of one vertebra in relation to the one below; usu L4 or L5 and d/t fatigue fx of pars interarticularis

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Spondylolysis

defect in pars interarticularis WITHOUT anterior displacement of vertebral body; "collar" on neck of scotty dog on xray

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Spondylosis

radiographical term for degenerative changes in IV disc and ankylosing of adjacent vertebral bodies

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Diagnosis of spondylolisthesis versus spondylosis

lateral xray versus oblique xrays

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Which nerve root exits btw L4 and L5

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A posteriolateral disc herniation of the IV disc of L4/L5 will most likely compress

L5 nerve root

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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

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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

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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

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Organic causes of psoas syndrome

ureter dysfxn or stone, salpingitis, sigmoid colon dysfxn, appendicitis, prostate metastasis

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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

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Dextroscoliosis

the apex points to the right; sidebent left

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Levoscoliosis

the apex points to the left; sidbent right

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Respiratory compromise from scoliotic curve occurs at

thoracic curvature >50*

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Cardiovascular function is compromised by scoliotic curve greater than

75*

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Most common cause of scoliosis is

idiopathic

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Surgery for scoliosis has favorable results for

patients with a curve that has progressed despite bracing and is causing respiratory compromise

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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

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Most common cause of anatomic leg length discrepency is

total hip replacement

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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)

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Sacrospinous ligament

divides the greater and lesser sciatic foramen; originates at sacrum attaches at ischial spines

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Sacrotuberous ligament

for ILA to ischial tuberosity; can diagnose dysfxn of innominate or sacrum

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Iliolumbar ligament

from TP of L4/L5 to medial side of iliac crest; usu the 1st ligament to have pain w/lumbosacral decompensation

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Muscles of pelvic diaphragm (primary)

levator ani and cocygeus muscles

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Secondary pelvic muscles (partial attachment to true pelvis)

iliopsoas, obturator internus, piriformis

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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

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Physiologic axes of sacrum and innominates (DRIP)

dynamic, respiratory, inherent/innominate, postural

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Respiratory and craniosacral motions of sacrum

occur at superior transverse axis

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Postural motion of sacrum

occurs at middle transverse axis

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Dynamic motion of sacrum

occurs at L or R oblique axis

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Innominate rotation

occurs along inferior transverse axis

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Sacral torsion rules; when L5 is SB

a sacral oblique axis is on same side

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Sacral torsion rules: when L5 is rotated

the sacrum rotates the opposite way on an oblique axis

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Sacral torsion rules: the seated flexion test

will be positive on the opposite side of the oblique axis

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Sacral torsion rules: if L5 is FRrSr

positive seated flexion on L; sacrum is rotated to L on R oblique axis (L on R)

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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)

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Common dysfunction post-partum

bilateral sacral flexion

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During swing phase of R lower extremity, the sacrum

moves about a L oblique axis

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What causes sacral base to move anterior?

cranial extension

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Sacral counternutation

occurs during craniosacral flexion as sacral base moves posterior

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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

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What L5 dysfxn corresponds with a R sacral rotation on a L oblique axis?

L5 F R and SB left

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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

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The following will cause a deep sacral sulcus on the R

unilateral sacral flexion on the right

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Left innominate anterior rotation

PSIS superior on L

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Rotator Cuff Muscles: SITS

Supraspinatus (abduction), Infraspinatus (ER), Teres minor (ER), Subscarpularis (IR)

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Brachial Plexus: Really Thirsty, Drink Cold Beer!

Roots, Trunks, Divisions, Cords, Branches

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Most common brachial plexus injury

Erb-Duchenne's palsy during childbirth; injury to C5/C6 roots

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Erb-Duchenne's palsy causes paralysis in these muscles

deltoid, external rotators (infraspinatus/teres minor), biceps, brachioradioalis, supinator mm; C5-C6

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Klumpke's palsy

d/t C8-T1 injury; paralysis of intrinsic mm of hand

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Carpal Bones: Some Lovers Try Positions That They Can't Handle

scaphoid, lunate, triquetral, pisiform, traqezium, trapezoid, capate, hamate

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Deep finger flexors

flexor digitorum profundus; attach to the DIPs

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Increased carrying angle

ulna is abducted and wrist is adducted

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Swan-neck deformity

flexion contracture of MCP and DIP; extension of PIP; a/w rheumatoid arthritis and contracture of intrinsic muscles of hand

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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

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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)

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Ape hand

d/t median nerve damage; wasting of thenar eminance, extension of MCP and flexion of PIP and DIP

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Bishops deformity

contracture of last 2 digits w/atrophy of hypothenar eminence d/t ulnar nerve damage

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Dupuytren's contracture

flexion contracture of MCP and PIP usu seen w/contracture of last 2 digits; d/t a contracture in palmar fascia

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Drop-wrist deformity

radial nerve damage results in paralysis of extensor muscles

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Radial artery

forms most of the deep palmar arch of the hand

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Dorsal scapular nerve

only contains fibers from C5 nerve root

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Which reflex will be decreased in C5/C6 injury

biceps and triceps

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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

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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

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Humeral dislocation occurs in what direction

anterior and inferior

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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

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Winging of scapula

long thoracic nerve damage

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Carpal bone located most medially

hamate

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Pronators of arm are innervated primarily by

median nerve

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Inc carrying angle on left; tenderpoints at elbow and wrist; wrist restriction in abduction; diagnosis is:

Abduction of ulna

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What movement will cause radial head to glide anteriorly?

Supination of forearm

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Tennis elbow has tenderness at:

lateral epicondyle

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Wrist drop

radial nerve damage

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Origin of brachial artery is located at:

inferior border of teres minor

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The following are a/w abduction of ulna somatic dysfunction

cubitis valgus, inc carrying angle, adduction of wrist

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Primary extensor and flexor of Hip

Gluteus maximus and Iliopsoas

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Primary extensor and flexors of Knee

Quadriceps (rectus femoris, vastus lateralis, medialis, intermedius) and Semimebrainous, Semitendinosus (hamstrings)

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External Rotation Somatic dysfunction of hip

Hip restricted in internal rotation; Piriformis or iliopsoas spasm

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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)

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Pronation of ankle

dorsiflexion, eversion, abduction

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Supination of ankle

plantarflexion, inversion, adduction

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Common peroneal nerve

lies directly posterior to proximal fibular head and can be damaged w/fibular head fx

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O'Donahue's "Terrible" Triad

knee injury of ACL, MCL, medial meniscus

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Greatest ankle stability is in what position

dorsiflexion

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The most commonly injured ligament in the food is:

Anterior TaloFibular (ATF = always tears first)

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Primary flexor of hip

iliopsoas

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What prevents hyperextension of knee?

anterior cruciate ligament

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Posterior fibular head dysfxn

occurs following supination ankle sprain; talus is internally rotated, distal fibular head is anterior, dorsiflexion of ankle is restricted

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Coxa vara

a decreased angle btw the neck and shaft of the femur

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Decreased Q angle is a/w

a bow-legged appearance

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Lateral femoral patella tracking

a/w accelerated wear of posterior surface of patella; usu in women; deep knee pain w/stair climbing

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Treatment for lateral femoral patella tracking is focused on strengthening

the vastus medialis

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Compartment syndrome of leg usu affects

anterior compartment

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Lateral stabilizers of the ankle

anterior talofibular, calcaneofibular, posterior talofibular ligaments

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The ligament most often injured in ankle supination injuries

anterior talofibular ligament

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Type II supination ankle sprain refers to

damage to anterior talofibular and calcaneofibular ligaments

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Components of lateral longitudinal arch of foot

cuboid, 4th and 5th metatarsal, calcaneous

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Who established the Cranial Field?

William Garner Sutherland

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What is involved in the PRM (primary respiratory motion)?

CNS, CSF, Dural membranes, cranial bones, sacrum

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What decreases the cranial rhythmic impulse?

stress, depression, chronic fatigue, chronic infections

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What factors increase the cranial rhythmic impulse?

vigorous physical exercise, systemic fever, following OMT to the craniosacral mechanism

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Where are the dural attachments?

Foramen magnum, C2, C3 and S2

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Describe craniosacral flexion

flexion of midline bones (sphenoid, occiput), counternutation of sacrum (posterior), dec AP diameter of cranium, ER of paired bones

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Describe craniosacral extension

extension of midline bones, nutation of sacral base (anterior), inc AP diameter of cranium, IR of paired bones

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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

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Vagal somatic dysfunction can be due to dysfunction at what cervical levels?

OA, AA, and/or C2

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Dysfunction of what cranial nerve causes tinnitus, vertigo or hearing loss?

CN VIII

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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

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The CV4 technique will do what do the CRI?

it will increase the amplitude; helps with homeostasis and UTERINE contractions in post-gravid woman

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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

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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

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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

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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)

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Cranial Vertical Strains

Superior if sphenoid deviates cephalad; Inferior if sphenoid moves caudad; 2 transverse axes

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Cranial Lateral Strains

Sphenoid deviates laterally in relation to the occiput; parallelogram

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Which strains can be superimposed on others?

vertical and lateral

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What are considered midline bones?

sphenoid, occiput, vomer, ethmoid

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Deviation of the SBS caudad is an

inferior vertical strain

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Normal craniosacral flexion exhibits:

couternutation, sacral extension about a superior axis, inc width of cranium, ER of temporal bones

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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

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Which strain pattern can be considered physiologic if it doesn't interfere with the flexion/extension components of the mechanism?

torsions

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Which somatic dysfxns may cause diplopia?

sphenoid, temporal, CN III, CN VI, CN IV

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Dysfunction of which CN causes symptoms similar to Tic Douloureux (trigeminal neuralgia)

CN V2

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Which CN exits from the foramen rotundum

CN V2

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CN V3 passes through with foramina?

foramen ovale

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Which CN exit the jugular foramen?

CN IX, X, XI

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Venous sinus techniques enhance what?

blood flow thru the venous sinuses (spread sutures over occipital, transverse and sagittal sinuses)

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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

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Vault hold allows you to..

diagnose the SBS

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Temporal rocking can help...

TMJ dysfunction

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what does the V spread do?

separates any restricted or impacted sutures

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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

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Output of a spinal segment can go to...

lower motor neurons (dorsal/ventral rami) to muscle or to viscera via autonomics

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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)

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A facilitated segment can lead to:

TART (tissue texture change, asymmetry, restriction, tenderness)...somatic dysfunction

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CN III (midbrain) parasympathetics

ciliary ganglion; constricts pupil

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CN VII (pons) parasympathetics (2)

Sphenopalatine gangion = inc lacrimal/nasal secretions; Submandibular ganglion = inc submandibular/sublingual secretions

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CN IX (medulla) parasympathetics

Otic ganglion = inc paratid gland secretions

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CN X (medulla) parasympathetics (5)

Heart, Bronchial tree, GI system, Reproductive System, Urinary System

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Which visceral systems have innervation from cranial and sacral parasympathetics?

Urinary system, Reproductive system, GI system

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T1-T4 Sympathetics

head/neck

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T1-T5 Sympathetics

heart

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T2-T8 Sympathetics

esophagus

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T5-T9 Sympathetics; Greater Splanchnic Nerve, Celiac Ganglion

Upper GI: Gallbladder, stomach, liver, spleen, part of pancreas and duodenum

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T10-T11 Sympathetics: Lesser Splanchnic Nerve, Superior Mesenteric Ganglion

Middle GI = Part of pancreas, duodenum, jejunum, ileum, ascending colon/proximal transverse (right)

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T12-L2 Sympathetics: Least Splanchnic Nerve, Inferior Mesenteric Ganglion

Lower GI: distal 1/3 of transverse colon, descending/sigmoid colon; rectum

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T12 Sympathetics

appendix

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T10-T11 Sympathetics

kidneys, upper ureters, gonads; superior mesenteric ganglion

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T10 Sympathetics

adrenal medulla

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T12-L1 Sympathetics

lower ureters, inferior mesenteric ganglion

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T11-L2 Sympathetics

bladder, penile/clitoral erectile tissue

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T10-L2 Sympathetics

uterus/cervix

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T12-L2 Sympathetics

prostate

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T2-T8 Sympathetics

Arms

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T11-L2 Sympathetics

Legs

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Sympathetics to entire GI

T5-L2

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Ligament of Treitz

divides the duodenum and jejunum

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Splenic flexure of large intestine

divides transverse and descending colon

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Anything before ligament of treitz

T5-T9

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Anything between Ligament of Treitz and Splenic Flexure

T10-T11

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Anything after Splenic Flexure

T12-L2

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L3-L5

NOTHING

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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

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Indications for rib raising

visceral dysfxn, dec rib excersion, lymphatic congestion, fever, paraspinal muscle spasm; NOT rib/spinal fx or recent spinal surgery

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Purpose of Treatment of Chapman's reflexes

decrease sympathetic tone to associated visceral tissues

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How do you treat the parasympathetics?

Cranial (CN III, VII, IX, X); Sphenopalatine ganglion, Condylar decompression, Vagus nerve at OA, AA, C2, Sacrum

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Stimulating the sympathetic chain at T3 will cause:

dilation of pupil, inc in HR, bronchodilation

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These vertebral segments will have an effect on cardiac function:

T3, T4, OA, AA

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Vagus nerve stimulation will cause:

dec in contractility of heart, pupillary constriction, increased gastric motility, urinary release

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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

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Acute asthmatic exacerbations have viscero-somatic changes a/w what spinal level?

T2-T6

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The pelvic splanchnic parasympathetics control:

lower ureter/bladder, uterus, prostate, genitalia, descending/sigmoid colon and rectum

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Treatment of the occiput and atlas may affect the following viseral structures:

kidney, ureter, transverse colon, ovaries NOT prostate

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What will result from hypersympathetonia?

inc respiratory and heart rate; NOT inc gastric motility, glycogen synthesis, lacrimation or miosis

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RUQ pain, radiates to tip of R scapula, positive Murphy's sign; suspecting acute cholecystitis, where would you find somatic changes?

T6-T9

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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

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Viscero-somatic reflex from right/ascending colon cancer would be a/w somatic changes at what spinal segment?

T11

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Stimulation of sympathetic chain ganglion may cause:

ejaculation, vasodilation of vessels supplying skeletal muscle, diaphoresis, inc HR

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What spinal segment may alter parasympathetic innervation to the appendix? Sympathetic

AA; T12

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Sympathetic innervation to the liver courses through which ganglia?

Celiac

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Which segment has sympathetic influence to the prostate?

L1 (T12-L2)

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Restriction of occipitomastoid suture at jugular foramen may cause visceral dysfunction that manifests as:

gastritis, diarrhea, bradycardia, irritable bowel syndrome; NOT stress incontinence

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An increase in sympathetic tone to the abdominal cavity will cause:

inc in GNG, dec gastric motility, dec pancreatic secretions, dec GI absorption, HTN

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Which supplies the parasympathetics to the ovaries?

vagus nerve

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Pt with dysmenorrhea has visero-somatic changes at what level?

T12 (T10-L2)

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Paraxysmal HTN 2* to adrenal pheochromocytoma may have somatic changes at what spinal level?

T10

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Parasympathetic stimulation may cause:

lacrimation, bradycardia, miosis, thinning of bronchial secretions

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Sympathetic stimulation of secments T10-L2 may cause what kind of reaction?

ejaculation

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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

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Anterior chapman's point

smooth, firm palpable nodules deep in fascia or periosteum of bone

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Posterior chapman's points

located btw spinous and transverse processes; rubbery, similar to tissue texture changes a/w classic viscero-somatic reflex

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Chapman's point for the Appendix

Anterior = tip of 12th rib; Posterior = TP of T11

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Chapman's point for Adrenals

Anterior = 2" superior & 1" lateral to umbilicus; Posterior = btw spinous/TPs of T11 & T12

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Chapman's point for Kidneys

Anterior = 1" superior, 1" lateral to umbilicus; Posterior = btw spinous/TPs of T12-L1

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Chapman's point for Bladder

Anterior = Periumbilical region

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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)

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What do "Trigger Points" represent?

the somatic manifestation of a viscero-somatic, somato-visceral or somato-somatic reflex; they may REFER pain, unlike tenderpoints

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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

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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

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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

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What is the procedure for myofascial release?

palpate restriction, apply compression (indirect) or traction (direct), add twisting/transverse forces, use enhancers, await release

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Goal of myofascial release?

restore fxnl balance and improve lymphatic flow

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When performing indirect myofascial release, which barrier is engaged?

anatomic

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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

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This is a good indication for myofasical treatment:

peripheral edema; NOT febrile bacterial infxn, fx, advanced cancer, trauma to internal organs

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Is the tentorium cerebelli a physiologic diaphragm?

yes

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Common compensatory pathway described by Zink:

OA fascia = Rotated L, C-T junction = Rotated R; L-S junction = Rotated R

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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

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Restrictions of Sibson's fascia (domed at apex of lung) could produce edema where?

in the entire body

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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

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What can improve lymhatic flow?

semilunar valves in lymph vessels, flap valves in terminal lymph capillaries, pulmonary respiration, micropinocytosis, interstitial fluid pressure <0mmHg

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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

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What is the typical sequence for lymphatic treatments?

thoracic inlet release, rib raising, thoraco-abdominal diaphragm release, lymphatic pump

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The following are indications for lymphatic treatment:

URTI, cirrhosis, CHF, nephrotic syndrome; NOT abscesses

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The anterior tenderpoint for L5 is located where?

1cm lateral to the pubic symphisis on the superior ramus

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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

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When fine tuning a counterstrain technique, what is the minimum acceptable reduction in pain?

70%

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What region is a/w the greatest number of maverick points?

cervical spine

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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

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how long do you hold pt in position for facilitated positional release?

3-4 seconds

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Where is the iliacus tenderpoint?

7cm medial to ASIS; Tx = flex/ER hip

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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"

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ME for forward sacral torsion

patient lies Face down

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ME for Backward sacral torsion

patient lies on their Back

🗑

What is a necessary component for any successful ME treatments?

patient assistance

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What muscle is used to treat an exhalation dysfunction of rib 11 with a ME technique?

latissimus dorsi

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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

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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

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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)

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Relative contraindications to HVLA

acute whiplash, pregnancy, post-surgical conditions, herniated nucleus propulsus, pts on anticoagulants or hemophiliacs, vertebral artery ischemia (+ Wallenberg's test)

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What does this describe: direct, short/quick thrust at exhalation, pop/click may be heard

HVLA

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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

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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

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The purpose of the hip-drop test is to evaluate...

sidebending (lateral flexion of lumbar spine)

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Lumbosacral spring test will be positive in all dysfunctions where the sacral base moves...

posterior (counternutation)

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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

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How do you evaluate shoulder range of motion when you suspect overuse injury?

Apley's scratch test (abduction/ER, IR/adduction, IR/adduction)

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A positive Adson's test would indicate?

thoracic outlet syndrome (monitor pulse, extend/ER, abduct arm)

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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)

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What is de Quervain's Disease?

it results from inflammation of the abductor pollicis longus and/or extensor pollicis brevis tendons

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Positive phalen's test

carpal tunnel

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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)

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The Trendelenberg test will assess which muscle groups?

hip abductors (supplied by superior gluteal nerve)

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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)

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Positive McMurray's test, Positive Apley's compression test, what is diagnosis?

medial meniscal tear

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Excessive anterior movement of tibia on femur indicates what type of injury?

ACL tear

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What is true of Apley's compression test? distraction?

it will be positive in meniscal injuries; ligamentous injuries

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