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Philosophy III

Philosophy III, Midterm Notes

orthopedic subluxation partial or incomplete dislocation
chiropractic subluxation motion segment which alignment, movement integrity, or physiologic function is altered, although the contact between the joint surfaces remains intact
subluxation syndrome aggregate of signs & symptoms
subluxation complex theoretic model of motion segment dysfunction
joint dysfunction joint mechanics showing area disturbances of function w/o structural change
joint hypomobility decreased angular or linear joint movement
joint hypermobility increased angular or linear joint movemnt; aberrent joint movements are typically not present
clinical joint instability increased linear and aberrant joint movement; instaneous axes of rotation & patterns of movement are disturbed
what you adjust joint hypomobility
chiropractor's oath professional conduct
chiropractor's oath keep an open mind
chiropractor's oath serve my patients
chiropractor's oath violating neither his confidences nor his dignity
chiropractor's oath not violate that which is moral and right
chiropractor's oath improve my knowledge & skill
chiropractors' oath responsibility
record keeping & reporting provide quality clinic care
record keeping & reporting assist dr. in reporting or testifying
record keeping & reporting protect from malpractice claims
record keeping & reporting inter- & intra- office communication
record keeping & reporting education & research
active rom motion produced by muscular action
passive rom motion produced by traction or springing the joint-joint play, up to the elastic barrier of resistance
paraphysiologic rom motion beyond the elastic barrier of resistance up to the limit of anatomic integrity
pathologic movements motion beyond the limit of normal anatomic integrity
which can hurt the patient? pathologic movements
strain/sprain pathologic movements
strain injury to muscle
sprain injury to ligament
manipulation manual procedure that involves a directed thrust to move a joint past the physiologic range of motion w/o exceeding the anatomic limit
mobilization movement applied singluarly or repetively within or at the physiologic range of joint motion, w/o imparting a thrust of impulse, with the goal of restoring joint mobility
manipulation elastic barrier into paraphysiologic joint space
mobilization continued to physiologic joint space
adjustment any chiropractic therapeutic procedure that uses controlled force, leverage, direction, amplitude & velocity directec at specific joints or anatomic regions
nonmanipulable subluxation vertebral motion segment or motion segment w/radiological or clincal features indicating that an adjustive force or osseous manipulation to this motion segment would be harmfusl or dangerous & is therefore contraindicated
manual therapy contraindicated when procedure may ... produce injury, worsen associated disorder, delay appropriate curative or life-saving treatment
clincial reasons to take x-rays establish clinical (pathologic) diagnosis
clincial reasons to take x-rays evaulate biomechanics & posture
clincial reasons to take x-rays identify anomalies
clincial reasons to take x-rays screen for contraindications
clincial reasons to take x-rays monitor degenerative processes
clinical indications to take x-rays (patient selection) pateint 50+ years
clinical indications to take x-rays (patient selection) trauma
clinical indications to take x-rays (patient selection) neuromotor deficits
clinical indications to take x-rays (patient selection) unexplained weight loss
clinical indications to take x-rays (patient selection) history of cancer
clinical indications to take x-rays (patient selection) recent visit for same problem, but not improved
functional radiographs persistant s/s or unsatifactory response
functional radiographs persistant segmental dysfunction, suggested by segmental instability
functional radiographs imaging studies inconclusive in the establishing of joint dsyfunction
full spine vs. sectional studies clinical necessity
full spine vs. sectional studies severe postural distortion
full spine vs. sectional studies scoliosis evaluation after clinical assessment
full spine vs. sectional studies mechanical problem - one area adversely affects another
full spine vs. sectional studies specifically evaluate biomechanical or postural disorders (weight bearing conditions)
complication unexpected aggravation of an existing disorder on the onset of an unexpected new disorder as a result of treatment
contraindication problem identified b/f procedure is applied taht would make application of treatment inadvisable b/c of potential cause to harm/delay appropriate treatments
absolute contraindication circumstance which renders a form of treatment or clinicla intervation inappropriate because it places the patient at undue risk
relative contraindication circumstance which may place patient at undue risk unless treatment approach is modified. Decision to TX is dependent on the individual circumstances of the presenting case
hypermobility mobility of a given motion unit which is excessive, but not so extreme as to be life threatening or require surgery
hypermobility typically maintain their stability & function normally under physiologic loads
instability more severe, does threaten the neural elements
instability requires surgical intervention; supporting structures are damaaged therefore danger of neurological complications
instability damage to structures leads to abnormal patterns of translational movements & mutliple planes of aberrant joint movement
Hieronymus 1746, 1st author discussing subluxation in terms of loss of joint motion
Hieronymus criteria decreased motion in joints, pain, change in joint alignment
palpation gentle application of hand or fingers to surface of body for purpose of determining condition of surface & adjacent parts of a certain locality or organ of the body
static palpation soft tisse, bony
soft tissue tenderness, edema, temp
soft tissue moisture, m.tone, motility
soft tissue hyperemia response, trophic change
bony tenderness, malposition, anomolies
motion palpation active/passive segmental rom, accessory motions
active/passive segemental rom tenderness, quanity, quality
accessory motions joint play, end play (feel), joint challenge/tenderness
joint play accessory motion, necessary for normal arom & prom, represents amount of capsular laxity within a joint
joint play reduced arom restricted or abnormal & may be painful
end play (feel) assessment of resistance supplied by elastic barrier, assesed at end of prom & tests integrity of capsular & ligamentous fibers
end play (feel) is assesed at end of prom & tests integrity of capsular & ligamentous fibers
radiographic classification of subluxation static intersegmental misalignments, kinetic intersegemental dysfucntions, sectional subluxations, paravertebral subluxations
statis intersegmental misalignments flex, ext, lat flex, rotational malpositions; antereo-, spondylo-, retro-, latero- listhesis; dec. interosseous spacing, formainal encroachments
kinetic intersegmental dysfunctions hypo-, hyper-mobility, aberrant motion
sectional subluxations scoliosis secondary to m. imbalance & structural asymmetry, decompensation of adaptational curavatures, abnormalities of global motion
paravertebral subluxations costovertebral, costotransverse, sacroiliac
radicular pain pain arising from dorsal root or drg usually causes pain to be referred along portion of course of n. or nn. formed from affected dorsal root; a dermatomal pattern
somatic referred pain dull ache, difficult to localize, rather constant in nature
PARTS mnemonic for identifying characteristics of joint dysfunctions
P pain/tendersness
A asymmetry/alignment
R range of motion abnormality
T tone/texture/temp. of soft tissue
S special tests
Sandoz chart 4 stages of range of movement in diarthrodial joints
goals of manual therapy mechanical, soft tissue, neurologic, psychologic effects
mechanical effects - mechanical effects produce changes in ... joint alignments, dysfunction of motion
mechanical effects - mechanical effects produce changes in ... spinal curvature dynamics, entrapment or extrapment of synovial fold
soft tissue effects changes in tone & strength of supporting musculature
soft tissue effects influences dynamics of supportive capsuloligamentous CT
neurologic effects pain reduction
neurologic effects altering motor & sensory function
neurologic effects influencing autonomic nervous system regulation
psychologic effects laying on of hangs
psychologic effects placebo effect, patient satisfaction
radiography not to be used as a general screening procedure w/o clinical indications
non-clinical reasons for taking x-rays financial gain
non-clinical reasons for taking x-rays force of habit
non-clinical reasons for taking x-rays mediolegal advantage
non-clinical reasons for taking x-rays patient education
spinography analyzing spine radiographs for postural & structural abnormalities
1910, B.J. Palmer introduced spinography
1918-1936 full spine radiographic techniques
radiography structural study static
radiography functional study movement
functional films cerival, lumbar
functional films used to establish presence of local segmental or global hypermobility or fixation and post surgical anthrodesis
functional films (instability) 3-5 mm translation on f/e may be indicative of ligamentous laxity (instability)
instability ligamentous laxity - do not adjust
Myerding's methods used to measure slippage in spondylolithesis; sacrum/inferior vertebrae is divided into 4 seg.; location that back of slipping vert. indicates the grade of spondylolisthesis
George's line drawn to detect evidence of anterolithesis or retrolithesis; continuous vertical line drawn along posterior margins of vertebral bodies; used for lumbars & cervicals
Lumbosacral base angle line drawn across top of sacrum base
lumbar gravitational line draw X through L3 body and draw line straight down; should fall in front of sacrum. If posterior - post. weight bearing & vice versa
cervical spine center of gravity superior pt. of odontoid, draw line down, should intersect C7 body
cervical f/e overlay trace nuetral bodies onto f/e film to check for excessive/abnormal motion
disc angles lines drawn at sup. & inf. IVD
D.D. Palmer father of chiropractic
D.D. Palmer used manipulation to improve nervous system
Andrew Still father of osteopathy
Andrew Still used manipulation to improve blood & lymph
hypermobility increase in joint motion reversible
tropism mostly at L5-S1
tropism anomalous condition which articular facings are asymmetric (1 side facing saggital; 1 side facing coronal)
tropism facets guid motion
tropism asymmetrical facects disrupt normal biomechanics
tropism-clincial context: complicationg factor; modification of adjustment to accomodate joint planes
down's syndrome integrity of transverse ligament
down's syndrome up to 20% born w/o transverse ligament
down's syndrome flexion radiography used for validation of condition
down's syndrome-normal atlantodental interspace 1-3mm - adults; 1-5mm children
Created by: JYarger
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