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Ford Tech V exam I

NYCC Tech V Dr. Ford FA10 exam 1

an adjustment has a specific ________ (exception: indirect method) contact
an adjustment has dynamic thrust of controlled _______ and ________ depth and speed
A thrust is delivered within the boundaries of a joint's anatomic ___________ integrity
an adjustment is usually associated with an audible click and improved joint ________ mobility
2 adjustment categories: specific and general adjustments
category of adjustment that focuses on the adjustive force to one articulation or joint complex specific
category of adjustment that uses short lever contacts specific
category of adjustment which has the intent of regional distraction of a group of articulations general
category of adjustment that uses long levers or multiple contacts general
Chiropractic's traditional emphasis has been on (category?, lever?) adjustments? specific, short-lever
specific, short-lever adjustments are more _______ to a desired level and safer for adjacent articulations. exact
When would a specific, short-lever adjustment be pertinent? circumstances with adjacent joint instability
How do long-lever adjustments become more specific and therefore challenge the traditional chiropractic thinking? by applying principles of joint localization, thereby making long-levers more precise or SPECIFIC
Short lever adjustments are always more specific than long lever adjustments. (T/F) False - by applying principles of joint localization, long lever adjustments become more specific and challenge traditional emphasis on short-levers for specificity
a specific form of articular manipulation using either long- or short-leverage techniques with specific contacts. It is characterized by a dynamic thrust of controlled velocity, amplitude and direction. definition of ADJUSTMENT
A chiropractic adjustment is characterized by a dynamic thrust of controlled __________, _________ & _____________. velocity, amplitude, direction (VAD)
VAD Velocity, Amplitude, Direction
3 types of lever systems direct (short), semi-direct, Indirect (long)
3 types of approaches in a bar: direct (short), semi-direct, indirect (long)
2 localization characteristics of an adjustment (categories) specific and general
lever system type of specific joint contact, high-velocity, low amplitude thrust Direct (short) lever
name an adjustment you know that uses a Direct/short lever system C-T/ thumb on spinous process
Semidirect is a combination of specific joint contact and long-lever contact - name an indirect adj spinous push
Indirect, long lever adjustment block pull
a motion segment in which alignment, movement integrity physiological function are altered although a contact between joint surfaces REMAINS INTACT. subluxation
a theoretical model of motion segment dysfunction (subluxation) that incorporates the complex interaction of PATHOLOGICAL CHANGES in the nerve, muscle, ligamentous, vascular and connective tissue. subluxation complex
an AGGREGATE of signs and symptoms that relates to pathophysiology, dysfunction of spinal and pelvic motion segments, or to peripheral joints subluxation syndrome
Is there a correlation bw joint rotation and ROM? no.
efficient adjustment with a minimum of waste, expense, or unnecessary effort economy
biggest problem in ajdust tech getting center of gravity as close to contact pts as possible
primo ext non nocere First, do no harm
through what osseous structure does the spinal cord travel? neural canal
the natural power of organ sys, organs, tissues and cells to remain free from harm or loss as a result of disturbances, perturbations or loading interference capacity
If Interference capacity is exceeded by disturbances WITHOUT DESTRUCTION TAKING PLACE, what occurs? Reversible functional impairment
when the body heals itself, the functional impairment is said to be reversible
2/3 of our body mass is 2/3 of our body height
3 components of normal spine stabilization function spinal posture, dynamic loading, static loading
passive, active and control components are all part of Panjabi's control system towards the ________ goal. stability
an immediate response from other subsystems to successfully compensate NORMAL function
a long-term adaptation response of one or more subsystems normal function with ALTERED (control)system
an injury to one or more components of any subsystem Overall (control) system dysfunction producing PAIN syndromes
enjoying a weekend of gardening is an example of normal function (successful compensation)
soreness in low back after weekend in yardwork leads to prolonged increased stiffness and change in forces across the joints is an example of Normal function with ALTERED stabilization system (long-term adaptation response of one or more subsystems)
long term, sudden or overwhelming transmission of unusual forces across joint leading to tissue damage and pain Overall System Dysfunction Producing Pain syndromes (an injury to one or more subsys components)
Goal of chiropractic examination determination of reversible functional impairments
What is the reason to take a history? rule out more complicated problems!
Why should you ask the patient if they have any paresthesia of the arms and legs or numbness of arms and legs when examining the thoracic spine? Because the cord ends at L1/L2 and also innervates both arms and legs
Why should you observe pelvic posture when examining the thoracic spine? it is the base of the thorax
what are you looking for skeletally when patient sits then stands during thoracic exam? trauma, anomaly, joint pathology
what are you looking for muscularly when patient sits then stands in a thoracic exam? tightness and lengthening
The scapula should rest between thoracic vertebrae? T2-T7
how many inches mid-height between normal scapular medial borders? 4"
how should the scap sit against the thoracic cage? flat
scapular positions anterior tilt, depression (opposite elevation), adduction, abduction, downward/medial rotation, upward/lateral rotation
does scap winging cause abduction or adduction abduction
why does the scap wing/ supraspinatus weakness, hypertonicity of internal shoulder rotators, serratus anterior (duh), lower and middle traps, rhomboids weak with tight pecs
what sleeping posture exacerbates winged scap? sidelying with forward drawn shoulder as a continuous stretch
why would shoulder flexion be limited by winged scap? anterior tilt of scaps
how to test winged scaps? disturbed movement pattern: push-up test and shoulder ab-duction
Posture is not merely about statics; it is about _________ and how they impact tissues. It is about _________! forces, function
should slight deviations be considered pathological posture? no
the purpose of examining posture glean info about the state of function, for example, given that there is not significant damage to the bones and disks, if the patient cannot establish normal spinal curve and maintain, then one can assume proper muscle fcn is impaired
What complex relationship does posture allow us to examine? the impact of ADL's as they affect the function of muscle and joint
to damage or make worse by or as if by diminishing in some material respect Impairment
material means having real _________ or great __________. importance, consequences
abnormal states with accompanying functional changes that have a particular syndrome or disease pathophys
when testing motion function, watch for (4) limitation, smoothness, asymmetrical movement, uncoordinated movement
What do we use to test painless, full range of motion? Passive Overpressure at End of Active ROM (after patient takes to active end range, add pressure in vector)
What should we examine above the thoracic spine for motion? neck and upper limb
example of how the arm movement affects the thoracic spine? elevation of arm extends thoracics
There is not much __________ in the thoracics extension
Where is the lateral flexion in thoracics? lower
thoracic spine ROM procedures slump-flexion, lateral rotation, lateral flexion, extension
When examining thoracics, what should you NOT do? allow the movement to progress down to lumbar spine
Supine thoracic examination flexion screen test - passive (assisted) neck flexion, then straight leg raise, then active neck flexion (unassisted) with each straight leg raise
why is neck flexion and straight leg raise part of thoracic exam? pulls on both ends of thoracic spine
why test SI joint when thoracic examination? it is the base for the thorax - where load is translated from thoracic
how many parts of a neural arch should you palpate to make a diagnosis? 3
Assess the thoracic spine to (4) Determine mechanism of injury/dysfunction, Develop a diagnosis, Develop a treatment plan w/ rehab, Patient education
The most immediate aspect of Assessment of the thoracic spine exam is where to place the first emphasis on treatment (1st action step)
How do you isolate motion segment dysfunction? P.A.R.T.S. - an efficient method of scanning the spine and locomotor sys for possible sites of disease or dysfunction
P in PARTS Pain/Tenderness (location, quality, intensity)
A in PARTS Asymmetry (sectional as regional alignment and segmental as local alignment)
R in PARTS Range of motion (active, passive, accessory)
T in PARTS Tone/Texture/Temperature
S in PARTS Special tests or procedures (A.K., SOT, CBP)
During palpation, find the abnormality then decide whether it's significant
how to palpate for abnormalities general, segmental, moving the joint
sweep a flat hand paravertebrally for skin texture and moisture
thumbs across erector spinae for tone changes
fingers longitudinally in paraspinal gully for undue prominence in spinal line
flat-handed vertical pressure for resilience
ways to move the joint in palpation thumb tip or preferably flat handed pisiform, heel of hand, hypothenar eminence pressure against vertebral prominences, increase movement progressively
3 ways to elicit differing responses in palpation P-A CENTRAL pressure, P-A UNILATERAL pressure, TRANSVERSE pressure
abnormalities in palpation include spasm (irritability), pain or paraesthesia provoked local or distal, diminished or increased accessory movement
normal MOTION palpation END FEEL qualities soft, firm, hard
Abnormal MOTION palpation END FEEL specifics less elastic, Springing block, Empty, Premature/early, Extended
the sensation or tissue sense felt at the point at which passive movement STOPs end feel
soft tissue approximation as in flexion of the elbow joint soft end feel
ligament or capsular stretching as in knee joint rotation firm end feel
bone-to-bone stop, as in the olecranon impacting the trochlea of the humerus hard end feel
scar tissue or connecting tissue contracture less-elastic end feel(abnormal)
increased muscle tone or shortened muscles more-elastic end feel (abnormal) because it pull back from you
internal dysfunction or deterioration such as meniscal tear. A REBOUND is often felt and can be seen Springing block end feel (abnormal)
no reason for the stop of motion other than patient PAIN and immediate spontaneous rx Empty end feel (abnormal) PAIN!!!
the motion stops before it should as in RA, OA or ligamentous capsular contraction Premature or Early end feel (abnormal)
as in constitutional hypermobility of joints. The SULCUS SIGN of the shoulder is a multidirectional instability and good example of this kind of abnormal end feel. Extended end feel (abnormal) SULCUS SIGN
how should flexion/extension feel in C6-T3 area? freer than in lower regions BUT are not great
physiological movement coupling is the same as typical cervical region for C6-T3, meaning? lateral flexion is accompanied by rotation to SAME SIDE (named side)
Active use of the arms, pulling, pressing, influences the _____ directly. ribs
activities like ironing or cleaning windows can aggrabate ___________ joints of ribs costospinal
breathing should start lower and go upwards yes, this is true
which ribs elevate the sternum 2-6
In T3-T10, you can feel ________ easier, even though there are more degrees of flexion. extension
Flexion or extension has more degrees of movement in thoracic 3-10? flexion
What are the degrees of sagittal movement in T3-10? 2-6 degrees sagittal
percentage of extension in T3-10 30-40%
percentage of flexion in T3-10 60-70%
T5-6 has only ____ degree of movement 2
breathing should start lower and go upwards yes, this is true
which ribs elevate the sternum 2-6
In T3-T10, you can feel ________ easier, even though there are more degrees of flexion. extension
Flexion or extension has more degrees of movement in thoracic 3-10? flexion
What are the degrees of sagittal movement in T3-10? 2-6 degrees sagittal
percentage of extension in T3-10 30-40%
percentage of flexion in T3-10 60-70%
T5-6 has only ____ degree of movement 2
T9-10 has only ______ degrees of movement 1-2
which thoracic segment has the least degree of movement T9-10
Degrees of lateral flexion and rotation are _____ than flexion or extension of thoracics smaller
T3-10 instantaneous axis of rotation EXTENSION above the disc of segment
T3-10 instantaneous axis FLEXION below the disc
T3-10 instantaneous axis LATERAL FLEXION at or near the disc and slightly to the convex side
T3-10 instantaneous axis AXIAL ROTATION varied along a line from anterior to middle point of the vertebral body to the spinal canal
Primary curve of the vertebral column Kyphotic Kurve of thoracics
primary curve of vertebral column thoracic kyphosis
with a concomitant axial load tending to increase the curve, where does the line of gravity pass through the thoracic kyphosis? ventral to vertebral bodies
bending forces are resisted by Passive and Contractile
Passive resistant forces to the thoracic kyphosis are the posterior ligaments
Contractile forces to the kyphotic curve are the deep one joint muscles, thoracic components of the erector spinae
Passive muscle length and trunk muscle strength have no influence on the __________ standing thoracic curve. relaxed
do passive muscle length or trunk muscle strength have any influence on the relaxed standing curve? no!
What does influence the magnitude of the curve if passive muscle length and trunk muscle strength do not? AGE, Position of LINE OF GRAVITY, MORPHOLOGY of vertebral body and disc
What is affected by accentuated thoracic curve? Pattern of LOAD Bearing & Spinal MOVEMENT (ie, a harsh thoracic curve will make loads harder to carry and screw up motion due to compensation in the neck and shoulders)
Are changes in thoracic posture likely to be painful? yes
There are different classifications of thoracic pain - which one begins with "O"? Organ! - can be musculoskeletal, Neurogenic, Referred, or psychogenic
The thoracic pain classification that begins with "N" Nociceptive Source and Radiation pattern (primary and secondary nociceptive/pain sources)
From where does PRIMARY THORACIC Nociceptive pain originate? structures of the spine (home base!) such as joints, bones, ligaments, vessels, muscles or meninges
How is Primary thoracic nociceptive pain different from Secondary nociceptive pain? Primary is spinal in origin, while Secondary is referred/projected pain to the skin, supplied by a nerve which is affected by a degenerative or compressive process.
Secondary thoracic nociceptive pain referred pain to the skin from the nerve being affected by compression or degeneration process
Thoracic pain categories include Organ, Nociceptive & referred, _____________, and Stolker, et. al. Anatomical
Thoracic pain class beginning with "A" Anatomical reasons due to contents and behavior of ventral and dorsal thoracic compartments
Contents of ventral thoracic compartment IVD . Ventral body . ALL . PLL . Ventral part of Dura . Prevertebral musculature
Where is the dividing line for ventral vs. dorsal anatomical compartments? right after the PLL, along the PEDICLES
What is in the Dorsal compartment of spinal column? since division made at pedicle, dorsal has ZYGAPOPHYSEAL joints, Intrinsic BACK MUSCLES, dorsal DURA, dorsal LIGAMENTS
anatomical thoracic pain can originate from? any of the ventral or dorsal compartment structures
last thoracic pain classification, named after Mr."S" Stolker, et.al: Answer the question, "What is generating the pain?"
Mr. Stolker liked to ask, "?" What is generating the pain -1.signs, 2.Pain pattern, 3.Symptoms, 4.Data from radiographs and electro diagnosis, 5.Test blocks
MOST COMMON clinical PAIN syndromes: Dorsal compartment syndrome/FACET SYNDROME, MYOgenic pain, SEGMENTAL pain
3 most common types of clinical pain syndromes: Facet (dorsal compartment) syndrome, Myogenic pain, Segmental pain
Face My Mental pain 3 most common forms of clinical pain syndromes: Facet (FACE) Myogenic (MY) SegMental (MENTAL) pain
Instability, Annular tear, Herniated disc, Epidural Adhesions, Spinal STenosis are all common clinical pain syndromes, but the most common is Face My Mental pain (FACET MYOGENIC SegMENTAL)
Sharp, well localized pain of anatomical origin QUALITY Ligament (sharp and local)
Dull, aching pain usually associated with trauma is pain of ___________ anatomical origin QUALITY muscular/tendon (dull and achy)
Deep, boring (as in dentist drilling pain) pain that may be associated with a tumor or osteoporosis QUALITY bone (deep, boring, tumor)
Sudden!!!!! and sharp pain QUALITY Fracture! (sudden!)
Poorly localized, achy pain that is worse with exertion but is relieved by rest QUALITY Vascular (poorly localized and achy, like what a throbbing ache would feel like in time with your heart beat)
Sharp, stabbing, maybe burning pain QUALITY nerve nerve nerve nerve nerve nerve nerve nerve sharp nerve nerve stabbing nerve nerve nerve ow it's burning nerve nerve nerve
Ligament, Muscle/tendon, Bone, Fracture, Vascular, Nerve all have anatomical origin clues from ________ of pain QUALITY
clues from Temporal character of pain (3) Acute (Now!), Chronic (episodic), Metabolic/Visceral (constantine)
What kind of Temporal pain is episodic? Chronic
Temporal pain that is constant? metabolic/visceral
the kind of complaint that PROVOKES pain due to movement or position Musculoskeletal
The kind of pain that is PROVOKED by respiratory movements thoracic and spine problems (ie, holding your breath irritates the disc)
What kind of pain is NOT usually provoked or affected by changes in position or other movements? Viscerogenic & Neurogenic
The kind of pain that is PROVOKED by use but PALLIATED/improved by rest Ligament
The kind of pain that is PROVOKED/worse in the morning but PALLIATED/better after it's used muscular
The kind of pain that is PROVOKED in both the morning and evening, but PALLIATED/improved during the day Degenerative arthritis (morning bad, day okay, night bad again)
In order to evaluate mechanically, a chiropractor will address 3 things: ROM, Active/Passive/Resisted isometric contraction, Static & Motion Palpation
ROM- what percentage of thoracic rotation is linked to the lumbar spine and hip? 35-50% (think of it as rotation through adulthood between ages 35-50)
What percentage of 90 degree Trunk flexion is from the thoracic spine? 20-45%
percentage of thoracic extension? 25-45%, but excessive kyphosis will often not extend
percentage of thoracic lateral flexion? 20-40%
At what level should you measure chest expansion? 4th intercostal space (dif. between full inhale and exhale is 4-7.5cm)
Passive ROM should be similar or slightly INcreased compared to active, but should not be ________ in passive movement! painful (no passive pain)
there should be no pain with _______ ROM. passive
If there is PAIN during ACTIVE ROM but not passive, it is probably ___________ in origin. musculotendinous (active ROM)
If ROM is painful during BOTH passive & active, then it is usually ____________ in origin. ligamentous (both active & passive ROM)
used to assess the contractile structures and as a MOBILIZATION procedure to help increase range of motion RIC ROM: Resisted Isometric Contraction ROM
RIC ROM: Resisted Isometric Contraction ROM
the same movements are tested in passive and active RIC ROM (t/f?) true
If there is PAINFUL or WEAK during RIC range, then it's probably ____________. Why? musculotendinous, because weakness increases as the seriousness of the problem increases
If there is NO pain but there is weakness, then ? it's a complete musculotendinous tear OR neural pathology
If its painful or weak during MOTION but not RIC range, then ? ligamentous
If an area is NOT painful to the touch but is painful nonetheless, it may be an area of ___________ pain. referred (this I can vouch for!). If you locate a trigger point/TrP, investigate!
Joint play/dysfunction is within the ___________ space. paraphysiologic
sharp, localized pain that does not linger after the pressure is released Joint Play Dysfunction
Pain not relieved by pressure release inflamed joints
If there is an increased radiation of RADICULAR PAIN, then what must be ruled out of joint play dysfunction assessment? foraminal encroachment
Joint play dysfunction is ________ the paraphysiological space within!
Motion Palpation can only be performed after ruling out other sources of pain, except joint play dysfunction.
Remember - the spine is a single ___________ _______ and therefore joint dysfunction in one area may influence and lead to dysfunction in another. kinetic chain
In motion palpation, note areas of hyPOmobility
Motion palp of __________ joints may reveal a prominent rib that will have pain resolution once restored to correct position. costotransverse
characteristics of subluxation (4) hyPOmobility . Local tenderness/pain . HARD END FEEL . decreased motion upon motion palpation
what exacerbates a trigger point? stretch & palpation
trigger points have a characteristic ________ pain pattern referred pain pattern with focal muscle tenderness
Chronic dull pain, worse in morning but better then worse again by night and may or may not include radiating pain is Dcubed (degenerative disc disease)
when is radiation of pain with zygapophyseal joint or rib DJD? only if degeneration has caused FORAMINAL ENCROACHMENT
Dcubed (degenerative disc disease) is dull ache, but what is zygapophyseal/rib DJD pain like? local pain and tenderness right at the site of degeneration
Rib joint pain is worsened by breathing
both Dcubed and Zyga/Rib DJD have typical temporal pain pattern = worse, then better, then worse again by nightfall
What test may brovoke pain in lower thoracic spinal joints if a zygapop joint has been sprained? KEMP's test
Zygapophyseal joint sprain is worsed with movement, and tender/pain localized
rib joint pain is localized tenderness which radiates through the chest when you ? breath
Patients with rib joint sprain may think they are having a heart attack!
what makes muscle pain worse? contraction! stretch!
Created by: hecutler