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OPP Test 1
Lectures 7-8
| Question | Answer |
|---|---|
| Functionally and structurally, where does the LE extend up to? | Functionally extends up to the iliosacral joint and anatomically to the hip |
| what are minor motions of a joint? | joint glides that are often not able to be produced voluntarily and are typically assessed by end-feel palpation; these motions are typically responsible for somatic dysfunction |
| what is end feel? | the sensation imparted to the examiner's hands at the end point of the available ROM- it varies, felt during passive ROM |
| ortopedic end feel problem | absent end feel (ligament injury) |
| rheumatologic end feel problem | restriction in all or most planes of motion- also called capsular pattern (joint destruction) |
| biomechanical end feel problem | increase in the fascial tension (somatic dysfunction) |
| what are the major motions? | the ones that the patient can voluntarily create |
| what are the major hip counterstrain tender points? | lateral trochanter, piriformis, iliopsoas |
| what are the major motions of the knee? | flexion and extension |
| what are the minor motions of the knee? | anterior and posterior glide; medial and lateral glide; internal and external rotation; flexion results in an anterior glide of the tibial plateau and extension results in posterior glide of the tibial plateau |
| anterior tibia somatic dysfunction | restricted posterior glide; this can cause restriction in knee extension, and pain at the end of knee extension |
| posterior tibia somatic dysfunction | restricted anterior glide; this can cause a restriction in knee flexion and pain at the end of knee flexion |
| how is tibia external/internal rotation checked? | by placing the tip of your index finger on the tibial tuberosity and seeing if it bisects the patella evenly |
| how is fibular head dysfunction checked? | gliding the fibular head anterolateral and posteriomedial |
| what is the reciprical motion of the fibular head when it is moved anteriorly? | the distal fibula (lateral maleolus) glides posteriorly |
| what is the reciprical motion of the fibular head when it is moved posteriorly? | the distal fibula glides anteriorly |
| what is the reciprocal motion of the fibular head when it is moved externally? | carries the distal fibula posteriorly and glides the fibular head anteriorly |
| what is the reciprocal motion of the fibular head when it is moved internally? | carries the distal fibula anteriorly and glides the fibular head posteriorly |
| what is the motion of the fibula during eversion of the ankle? | glides the distal fibula posteriorly and the fibula head anteriorly |
| what is the motion of the fibula during inversion of the ankle? | glides the distal fibula anteriorly and the fibula head posteriorly |
| what happens with ankle sprains? | bc of the reciprocal motion of the fibular head when the distal fibula moves,fibular head dysfunction often occurs with ankle sprains so failure to treat the fibula head can cause continued pain in the lower leg that persists after the sprain has healed |
| fibular neuritis | caused by posterior fibular head somatic dysfunctions; entrapment neuropathy; common fibular nerve L4- S2; causes weak plantar flexion and eversion of the foot, dysthesias of lat leg and foot |
| what are the counterstrain tenderpoints of the knee? | patella tendon, medial meniscus, lateral meniscus, anterior cruciate, and posterior cruciate |
| Ankle joints | upper joint= tibiotalar (talocrural); lower joint= subtalar(talocalcaneal); the upper joint involves the talus moving in the ankle mortise |
| what are the major motions of the tibiotalar joint? | dorsiflexion and plantar flexion |
| what are the ankle (talotibial) mechanics | talus glides anteriorly with plantar flexion and posteriorly with dorsiflexion |
| ankle swing test | tests for talus anterior glide somatic dysfunction- posterior talus glide and ankle dorsiflexion restriction |
| what does a positive ankle swing test tell you? | restricted posterior talus glide= anterior talus= plantar flexed ankle= restricted ankle dorsiflexion |
| what are the ankle counterstrain tenderpoints? | extension ankle, lateral ankle, medial ankle |
| what is the proximal transverse arch? | the cross-sectional arch of the foot located just behind the metatarsal heads |
| what is the common somatic dysfunctions in the foot? | inversion somatic dysfunctions of the navicular and cuboid bones |
| Pes Planus (flat foot) | talus anteromedial glide, navicular inversion, cuboid inversion, flattening of medial longitudinal (inside) arch, eversion of forefoot and ankle, valgus pattern of achilles tendon |
| Muscle energy technique (first proposed by Fred Mitchell) | form of OMT in which the patient's muscle are actively used on request, from a precisely controlled position, in a specific direction, and against a distinctly executed counterforce; it is a direct technique- the restrictive barrier is engaged |
| when can muscle energy not be used? | if the patient is in a coma, uncooperative, too young to cooperate, unresponsive, unable to understand the physician due to a language barrier or hearing loss |
| concentric contraction | contraction of the muscle resulting in approximation of its attachments (counterforce is less than patient force; isokenetic= against resistance in which the angular change of joint motion is at the same rate; isotonic: a constant force is applied |
| eccentric contraction | lengthening of muscle during contraction due to an external force (counterforce is greater than the patient force); isolytic= designed to break adhesions using an operator induced force to lengthen the muscle |
| isometric contraction | change in the tension of the muscle without approximation of its attachments(counterforce is equal to patient force)- most commonly used in muscle energy |
| what are other muscle energy techniques? | respiratory assistance: exaggerated respiratory motion; Oculocephalogyric reflex: automatic movement of the head that leads or accompanies movement of the eyes= AKA oculogyric reflex |
| what are the 4 major factors that ensure you get good results with the muscle energy technique? | 1. begin with an accurate diagnosis 2. make sure appropriate levels of force are used (both you and the patient) 3. allow the patient to relax between contractions- sense the tissue relaxation with your own propropceptors 4. localize your treatment |
| Can Muscle energy techniques be used with any other techniques? | yes,it can be useful in creating the soft tissue relaxation necessary to accomplish HVLA thrust or it can be used to lengthen muscle shortened by hypertonicity & contracture-once the hypertonicity has been eliminated,direct myofascial release can be used |
| what are the proposed physiologic mechanisms of muscle energy? | tissue creep, conditioning, post-isometric relaxation, reciprocal inhibition |
| tissue creep | constant load causes tissue give |
| conditioning | less tissue resistance with repeated stretch |
| post-isometric relaxation | reduction in tone of the agonist muscle after isometric contraction; thought to occur due to activation of golgi tendon reflex- strong pull triggers muscle relaxation to prevent tearing |
| reciprocal inhibition | inhibition of the antagonist muscle when isometric contraction occurs in the agonist |
| what are some common complications of MET? | the self-limiting muscle or joint soreness that usually lasts 24-48 hours; use of inappropriate excessive force has been reported to result in the complication of tendon avulsion from bone and rib fracture |
| what are the absolute contraindications of direct methods? | absence of somatic dysfunction patient refusal |
| what are the relative contraindications of direct methods in which the area can not be treated? | acute sprain or facture, cancer, infection |
| what are the relative contraindications of direct methods in which the are can be treated with caution? | joint inflammation, hypermobility, osteoporosis, elderly, worse symptoms at direct barrier, patient apprehension/ guarding |
| what is hypermobility? | greater than normal ROM in a joint; any motion occuring in a joint in response to the reactive force of gravity at a time when that joint should be stable under such a load- may be a contraindication |
| how do you diagnose hypermobility? | Index finger extension > 90; thumb flexion to forearm; elbow extension >or = -10, knee extension >or= -10 |
| what is the hypermobility screening interpretation? | 0-3/5= generalized hypermobility unlikely, caution for hypermobile joints only; 4-5/5= generalized hypermobility likely ; caution for all direct treatments |
Created by:
sptakowski