Omm 11-29-07 Gynecologic Disorders

Front 1

Pubic symphysis dysfunction
Can cause distortion of the ____ especially in women post-partum

Back 1

urethra

Front 2

urethra distortion produces symptoms of urinary frequency, urgency and burning, mimicking infectious _____.

Back 2

cystitis

Front 3

urethra distortion: Urinalysis will reveal ____

Back 3

normal uninfected urine

Front 4

In children, Pubic symphysis dysfunction is one cause of _____

Back 4

enuresis

(The uncontrolled or involuntary discharge of urine.)

Front 5

Labia Majora
sensation nerve roots

Back 5

L1,L2

genital br of genitofemoral nerve: L1, L2
ilioinguinal nerve: L1

Front 6

Nerve roots for:
Perineum
Vulva
Lower Vagina

Back 6

S2,S3,S4

Front 7

In general the effect of somatic dysfunction is to cause a ____-sensitivity of the sensory fibers,

Back 7

hyper

thus the sensation of pain when painful stimuli are not present

Front 8

The Genitofemoral nerve (L1, L2) traverses the belly of the psoas major muscle to supply sensation to the ____

Back 8

labia majora

Front 9

____ Spasm can directly irritate the nerve with resultant changes in labial sensation. These sensory changes may be either decreased sensation or an irritating hyperesthesia

Back 9

Psoas

Front 10

This can be one of the causes of _______

a) dyspareunia
b) enuresis

Back 10

Dyspareunia

Front 11

Sympathetics to

Ovaries
Distal 2/3 of the Fallopian Tubes

Back 11

T9,T10

Front 12

Sympathetics to

Uterine Fundus
Proximal 1/3 of Fallopian Tubes
Broad Ligament

Back 12

T11,T12,L1

Front 13

Sympathetics Principally have their effect through vasomotor changes influencing ___ supply to the pelvic viscera.

Back 13

blood

Front 14

It has been shown that normal hormonal function occurs despite total sympathetic & parasympathetic ______ of the female pelvic organs

Back 14

denervation

Front 15

_____-sympathecotonia can result in organ ischemia and dysfunction.

Back 15

Hyper

Front 16

Parasympathetics nerve roots

Upper Vagina
Cervix
Lower Uterine Segment
Uterosacral Ligaments
Cardinal Ligaments (Transverse Cervical)

Back 16

S2,S3,S4

Front 17

P or S?

Arousal
Engorgement
Lubrication
Erection

Back 17

Parasympathetics

Front 18

P or S?

Orgasm
Ejaculation

Back 18

Sympathetics

Front 19

These same trigger points have been implicated as a cause of Dysmenorrhea. Where are they?

Back 19

about a couple inches below the umbilicus, a couple inches apart

Front 20

Multiple trigger point sites throughout the body have been documented to have been maintained by _____ infection

Back 20

urinary tract

Front 21

_____ Trigger Points (Pelvic Floor Tension Myalgia)
Pain in Urinary Bladder
Urinary Sphincter Spasm

Back 21

Intrapelvic

Front 22

Note: Colonic Chapman’s Points are located on the ITB or anterior to it, ______ Points are located more Posteriorly

Back 22

Uterine

Front 23

Areas associated with pelvic visceral dysfunction are located where?

Back 23

just above the pubic bone and inguinal ligament.

Front 24

Chronic Pelvic Pain lasts for how long before dx?

Back 24

Pain present for 6 months or more

Front 25

Use what osteopathic techniques to assist in identifying possible hidden organic causes of Chronic Pelvic Pain?

Back 25

Chapman’s Reflexes and Viscero-Somatic Reflexes

Front 26

Chronic Pelvic Pain

"the list" of etiologies

GGUMP

Back 26

Gynecologic
Urologic
Gastrointestinal
Musculoskeletal
Psychogenic

Front 27

Gynecologic causes of Chronic Pelvic Pain

Back 27

Endometriosis
Abdominopelvic Adhesions
Severe Pelvic Relaxation
Uterine Myomata
Pelvic Engorgement Syndrome
Benign Ovarian Neoplasms
(Solid or Cystic

Front 28

Urologic causes of Chronic Pelvic Pain

Back 28

Interstitial Cystitis

Front 29

Gastrointestinal causes of Chronic Pelvic Pain

Back 29

Irritable Bowel Syndrome
Crohn Disease
Diverticulitis
Constipation
Chronic Constipation is a cause of not only pelvic pain and back pain, but also for headaches!

Front 30

Musculoskeletal causes of Chronic Pelvic Pain

Back 30

Somatic Dysfunction
Pelvic Floor Trigger Points
Hernias
Degenerative Disc Disease
Fibromyalgia Syndrome
Chronic Fatigue Syndrome / Myalgic Encephalopathy
Bone Tumors

Front 31

Psychogenic causes of Chronic Pelvic Pain

Back 31

Psychosexual Trauma
Psychosexual Abuse
Depression
Somatization
Body Dysmorphic Disorder

Front 32

Dysmenorrhea
Incidence
50% of all menstruating women
10% require bed rest
Peak at age _____

Back 32

20-24

Front 33

Dysmenorrhea
What is the underlined Osteopathic Manipulative Treatment?

Back 33

Sacral Rocking (underlined)

Chapman’s Points along the Iliotibial Band

Front 34

Somatic Dysfunctions treated to ease dysmenorrhea?

Back 34

T10 to L2 (Sympathetics)
Innominate & Sacrum (S2-4 Parasympathetics)

Front 35

Where are the Chapman's points to treat dysmenorrhea

Back 35

Chapman’s Points along the Iliotibial Band

Front 36

Lymphatic Approach
to treating dysmenorrhea

Back 36

Treat Thoracic Inlet Dysfunction
Abdominal Diaphragm
Pelvic Floor
Pumps
Thoracic Pump
Abdominal Pump
Dalrymple Pedal Pump
Marion Clarke Drainage

Front 37

What were Chadwick & Morgan's Findings of Somatic Dysfunction in Dysmenorrhea?

Back 37

T10, T11, T12 - 62.5%

L5 - 75%

Sacral Torsion - 100%

Front 38

Chadwick & Morgan treated the pts for how long?

Back 38

four consecutive menstrual cycles

Front 39

Treatment ideally should be carried out when?

Back 39

a minimum of 24 hours before menstruation begins

Once pain is already established, it is less effective.

Front 40

If pain is present for >___hours, manipulative treatment was largely ineffective.

Back 40

12

Front 41

In another study David Boesler, DO, et.al. measured skin electrode EMG response to treatment
It has been reported that dysmenorrhea causes EMG changes where?

Back 41

in the lumbar paravertebral musculature consistent with that seen in an acute lumbar injury

Front 42

OMT Treatment Protocol Used
by Boesler

( sorry)

Back 42

Muscle Energy to long muscle restrictions of the hip girdle muscles
Muscle Energy to any innominate or pubic symphysis dysfunctions
Ischial tuberosity spread
Lumbosacral & Thoracolumbar lateral recumbent HVLA
Thoracic Crossed Arm HVLA
Cervical Segmental HVLA

Front 43

OMT reduced the EMG activity in all subjects and abolished spontaneous EMG activity in ____ subjects experiencing menstrual cramping at the time of the study.

Back 43

all

Front 44

The subjective response among the subjects (treated by Boesler was as follows:

Back 44

More Relaxed Feeling
Ability to move with less resistance
Reduced or complete absence of low back pain.
Alleviation or significant reduction in dysmenorrhea

Front 45

In 1926 Louisa Burns, DO induced somatic dysfunction at the level of L2 & L3 in animals. Subsequent necropsy revealed congestion, hemorrhage and edema of the ____.

Back 45

ovaries

Front 46

The L2 & L3 dysfunctions produced edema, inflammatory hyperplasia of the endometrium, weakness and atony of the ____.

Back 46

uterine walls

Front 47

Use _________ to help identify the source of ovarian pain

Back 47

Chapman’s Reflexes

Front 48

Leg length discrepancy has been reported to be associated with ovarian cyst formation on the side of the ______ leg

Back 48

longer

Front 49

Long standing ____ somatic dysfunction has also been associated with ovarian cyst formation.

Back 49

lumbar

Front 50

Did the lumbar dysfunction predispose to ovarian cyst formation or did the ovarian cyst cause the lumbar dysfunctions.

Back 50

No one knows

Front 51

Chronic Ovarian Dysfunction and inflammation can cause ____ spasm by direct irritation of the pelvic portion of the muscle

Back 51

psoas

Front 52

______ of the uterus may be associated with dyspareunia on deep penetration.

Back 52

Retroversion

Front 53

If uterus is fixed in retroversion, there is stretching of the ______ ligaments and inflammation of the pelvic nerves

Back 53

uterosacral

Front 54

If the uterus is fixed in retroversion it should arouse suspicion of adhesions due to what?

Back 54

pelvic inflammatory disease or endometriosis

Front 55

Uterine Pain May respond to manipulation of ____ dysfunction, or bimanual manipulation of the uterus itself

Back 55

sacral

Front 56

Pelvic Congestion Syndrome
An etiology of low back pain or pelvic pain
Varicosities of the uterine veins
Common in multiparous women
Can also be caused by uterine ____
There may be associated menorrhagia and urinary frequency.

Back 56

retroversion

Front 57

Leiomyomas (Fibroids)
Present in 20% of women by age 40
If large enough, may sit on the iliacus muscle and psoas tendon and provoke recurrent _____ hypertonicity and spasm.

Back 57

psoas

Front 58

For PID,
Application of thoracic pump or ______ stimulation techniques to enhance the immune response to the infection.

Back 58

splenic

Front 59

For Interstitial Cystitis, Thoracic and Pelvic ______ Motion is Critical

Back 59

Diaphragmatic

Front 60

The bladder sits on the pelvic floor. Loss of normal motion here causes _____ venous and lymphatic drainage and chronic engorgement of the organ

Back 60

decreased

Front 61

Interstitial Cystitis is a common accompaniment of ______ Syndrome and Chronic Fatigue Syndrome / Myalgic Encephalopathy.

Back 61

Fibromyalgia

Front 62

Pelvic Floor Syndrome: where's the pain?

Back 62

Pain in the pelvis, coccyx, vagina, buttock or anus.

Front 63

In pelvic floor syndrome, Trigger Points have been identified in the following muscles:

Back 63

Coccygeus
Levator Ani
Obturator Internus
Adductor Magnus
Piriformis
Abdominal Obliques

Front 64

These pelvic muscle somatic dysfunctions may be treated with ____

Back 64

bimanual soft tissue and myofascial release techniques

Front 65

The _____- palpating digits may apply inhibitory pressure, or use the principles of counterstrain or indirect myofascial release

Back 65

intravaginal