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406 Cards in this Set

  • Front
  • Back
what does TART stand for?
Tissue texture changes
Assymetry
Restriction
Tenderness
the furthest point to which the patient can move a given joint
physiologic barrier
the furthest point at which the physician can move any given joint
anatomic barrier
somatic dysfunction occurs when what barrier is present?
restrictive barrier
Acute or chronic TTA:
edematous, erythematous, boggy with increased moisture, hypertonic muscles
acute
Acute or chronic TTA:
asymmetry without compensation
acute
Acute or chronic TTA:
restriction present and pain with movement
acute
Acute or chronic TTA:
severe, sharp tenderness
acute
Acute or chronic TTA:
decreased or no edema, no erythema, cool dry skin, slight tension, decreased tone, flaccid, ropy, fibrotic
chronic
Acute or chronic TTA:
asymmetry present with compensation in other parts of body
chronic
Acute or chronic TTA:
restriction present, decreased or no pain
chronic
Acute or chronic TTA:
tenderness that is dull, achy, burning
chronic
what is Fryettes first law?
if the spine is in the neutral position (no flexion/extension), and if sidebending is introduced, rotation would occur to the opposite side
what is Fryettes second law?
when the spine is non-neutral (flexed/extended) and rotation is introduced, sidebending will occur to the same side
which parts of the spine does Fryette's laws I and II apply to?
thoracic and lumbar
what is the orientation of the superior facets in the cervical spine?
BUM (backward, upward, medial)
what is the orientation of the superior facets in the thoracic spine?
BUL (backward, upward, lateral)
what is the orientation of the superior facets in the lumbar spine?
BM (backward, medial)
name this contraction:
muscle contraction that results in the approximation of the muscle's origin and insertion without a change in tension; operators force is less than patients force
isotonic contraction
name this contraction:
muscle contraction that results in the increase of tension without an approximation of origin and insertion; operators force is equal to patients force
isometric contraction
name this contraction:
muscle contraction against resistance while forcing the muscle to lengthen; operators force is greater than patients force
isolytic contraction
name this contraction:
muscle contraction that results in approximation of origin and insertion
concentric contraction
name this contraction:
lengthening of the muscle during contraction due to an external force
eccentric contraction
what is the difference between direct and indirect treatments?
direct moves into the barrier, indirect moves away from the barrier
what type of treatment(s) are indicated for elderly and hospitalized patients?
indirect or gentle direct/articulatory techniques
which treatment is contraindicated in patients with osteoporosis or metastatic cancer?
HVLA
what treatment works best for acute neck strain/sprain?
indirect
what do you need to treat prior to treating psoas syndrome?
lumbar spine, thoraco-lumbar spine
what do you need to treat before the cervical spine?
the ribs and upper thoracic spine
what do you need to treat before treating rib dysfunctions?
the thoracic spine
what do you need to treat before treating the extremities?
spine/sacrum/ribs (axial skeleton)
which cervical vertebrae are atypical?
C1 and C2
which scalenes elevate the first rib during forced inhalation?
anterior and middle scalenes
which scalene elevates the second rib during forced inhalation?
posterior scalene
which muscle divides the neck into anterior and posterior triangles?
the SCM
shortening or restrictions of which neck muscle results in torticollis?
the SCM
which ligament of the neck is weakened with RA and Down's resulting in increased risk of atlanto-axial subluxation?
transverse ligament
what is the most common cause of cervical nerve root pressure?
degeneration of the Joints of Luschka plus hypertrophic arthritis of the intervertebral synovial (facet) joints
what is the primary motion of the OA? how does sidebending occur with this joint?
primarily flexion/extension; sidebending and rotation occur opposite when flexed/extended
what type of motion occurs at the atlanto-axial joint?
rotation only
what type of sidebending/rotation relationship is there in C2 to C7?
sidebending and rotation occur to the same side (coupled)
which treatments are indicated for an acute injury to the cervical spine?
indirect fascial techniques or counterstrain
symptoms of opoid withdrawal
N/V, abdominal pain, diarrhea, restlessness, arthralgias, myalgias
symptoms of beta-blocker overdose
AV block, bradycardia, hypotension, wheezing, cardiogenic shock
treatment for beta-blockers
first treat with atropine and fluids, then glucagon to reverse beta-blockers
ethylene glycol has what effect on calcium and kidneys?
associated with hypocalcemia and calcium oxalate deposits in the kidneys
treatment for ethylene glycol poisoning
fomepizole or ethanol
first line treatment for anaphylaxis with intact airway
subcutaneous epinephrine
what should you do with positive fingerstick test for lead?
repeat serum lead level since the fingerstick test has a high rate of false positive
acute iron intoxication stages are...?
1. GI upset/disturbance
2. shock, metabolic acidosis
3. hepatic failure
4. bowel obstruction from GI scarring
what features are seen with opoid overdose that you don't see with a benzo overdose?
opoid overdoses have respiratory depression and pupillary constriction that benzos don't have
treatment for Torsades
discontinue the offending agent and give MgSO4
when should you check the acetominophen levels in case of overdose?
4 hours after consumption
when do you need to being N-acetylcysteine with an acetominophen overdose?
within 8 hours of consumption
what is lye?
sodium hydroxide cleaning solution
what needs to be done in of ingestion of a strong alkalinic solution and why?
must get upper GI imaging and endoscopy since it leads to almost instantaneous damage due to liquefactive necrosis of the esophagus leading to perforation
treatment for diphenhydramine overdose and why?
treat with physostigmine to counteract the anti-cholinergic effects
treatment for organophosphate intoxication
remove clothes, wash the skin to prevent further absorption, give atropine to reverse effects
T1-T3 spinous processes are located where in reference to the transverse process?
at the level of corresponding transverse process
T4-T6 spinous processes are located where in reference to the transverse process?
located one-half segment below corresponding transverse process
T7-T9 spinous processes are located where in reference to the transverse process?
located at the level of the transverse process of the vertebrae below
spine of scapula corresponds to which spinous process
T3
inferior angle of the scapula corresponds with which spinous process?
T7
sternal notch is at the level of which vertebrae?
T2
nipple is located at which dermatome
T4
umbilicus is located at which dermatome
T10
what is the main motion of the thorax?
rotation
the intercostal muscles do what to the ribs during inspiration?
elevated the ribs
the upper ribs (ribs 1-5) have which type of motion?
pump-handle motion
the middle ribs (ribs 6-10) have which type of motion?
bucket-handle motion
the lower ribs (ribs 11 and 12) have which type of motion
caliper motion
the pump-handle ribs will be displaced which direction with inhalation/exhalation dysfunctions
anteriorly
the bucket-handle ribs will be displaced which direction with inhalation/exhalation dysfunctions
laterally
with inhalation dysfunctions which rib is the "key rib"
the lowest rib in the dysfunction
with exhalation dysfunctions which rib is the "key rib"
the uppermost rib of the dysfunction
where does the posterior longitudinal ligament begin to narrow?
starts narrowing at L1
narrowing of which ligament makes the lumbar discs more susceptible to herniation
posterior longitudinal ligament
iliac crest is at what vertebral disc level
L4-L5
what is spina bifida occulta
no herniation through defect, often only physical sign is hairy patch and is rarely associated with neurological deficit
spina bifida meningocele
herniation of the meninges through the defect
spina bifida meningomyelocele
herniation of meninges and the nerve roots through the defect with associated neurological deficits
90% of herniations occur with which disc
L4-L5 disc
a lumbar herniation will affect the nerve root for the vertebrae above or below?
below; i.e. L3/L4 herniation will affect L4 nerve root
what is the gold standard test for a herniated nucleus pulposus
MRI
is HVLA contraindicatd with a herniated nucleus pulposus?
it is a relative contraindication
a flexion contracture of the iliopsoas is often associated with what vertebral dysfunction?
a non-neutral dysfunction of L1 or L2
is HVLA indicated with spondylolisthesis?
it is contraindicated
what is spondylolisthesis?
anterior displacement of one vertebrae in relation to the one below
name the grading for a spondylolisthesis?
grade I = 0-25%
grade II = 25-50%
grade III = 50-75%
grade IV = >75%
positive vertebral step-off sign = ??
likely spondylolisthesis
what image is used to diagnose a spondylolisthesis?
lateral x-ray
what image is used to diagnose a spondylolysis?
oblique x-ray
what curve of the thoracic spine will compromise respiratory function?
>50%
what curve of the thoracic spine will compromise cardiovascular function?
>75%
most common cause of anatomical leg length discrepency
hip replacement
what is the innominate composed of?
three fused bones: the ilium, the ischium, the pubis bone
what are the true pelvic ligaments? (sacroiliac ligaments)
anteior, posterior and interosseus sacroiliac ligaments
which ligament divides the greater and lesser sciatic foramen?
sacrospinous ligament
which muscles make up the pelvic diaphragm?
levator ani
coccygeus muscles
which way does the sacral base move during inhalation and exhalation?
during inhalation the sacral base moves posterior; during exhalation it moves anterior
which way does the sacral base move during craniosacral flexion/extension?
during craniosacral flexion the sacral base moves posteriorly (counternutation); with extension the sacral base moves anterior (nutation)
respiratory motion moves the sacral base about which axis?
superior transverse axis
craniosacral motion moves the sacral base about which axis?
superior transverse axis
postural motion moves the sacral base about which axis?
middle transverse axis
when a person bends forward the sacral base moves which direction?
it moves anteriorly at first, then at terminal flexion it moves posteriorly
when a person steps forward with the right leg which sacral axis will be engaged? and stepping forward with the left foot?
when stepping forward with the right leg the left sacral axis is engaged; when stepping forward with the left foot the right sacral base is engaged
dynamic motion occurs about which axis on the sacrum?
the right or left oblique axis
innominate motion occurs about which sacral axis?
inferior transverse axis
a positive standing flexion test with an innominate rotation points to the problem being on the ipsilateral or contralateral side?
ipsilateral side
when L5 is sidebent, the sacral oblique axis is engaged on the same side of opposite side?
same side
when L5 is rotated, the sacrum rotates the same/opposite way on an oblique axis?
rotates opposite
the seated flexion test is positive on the same/opposite side as the oblique axis?
opposite side the oblique axis
sacral springing motion is present when the sacrum has moved anterior/posterior?
present when the sacrum moves anterior
sacral springing motion is restricted when the sacrum has moved anterior/posterior?
restricted when sacrum has moved posterior
lumbosacral spring test is positive if the sacral base has moved anterior/posterior?
posterior
with a forward sacral torsion the rotation is the same/opposite side of the axis?
rotation is the same as the side of the axis
with a backward sacral torsion the rotation is the same/opposite side of the axis?
rotation is opposite the side of the axis
the seated flexion test is same/opposite the axis of rotation?
the seated flexion test is opposite the side of the axis of rotation
due to birth mechanics, which dysfunction is common in the post-partum patient?
bilateral sacral flexion
springing at both sulci/bases are restricted + springing at both ILA/apex are present = ??
bilateral sacral flexion
the standing flexion test is used for which dysfunction?
innominate dysfunction
the seated flexion test is used for which dysfunction?
sacral torsions
how is the Cobb score for scoliolosis measured?
it is measured at the intersection of perpendicular lines drawn from the most superior and inferior vertebrae affected
best initial imaging for scoliosis
PA/lateral x-ray
mild scoliosis is best treated how?
with Konstancin exercises and OMM
scoliosis with respiratory compromise is an indication for what?
surgical repair
which rib should you target with inhalation dysfunctions?
target the lowest rib
what is Nursemaids elbow?
radial head subluxation
how does a patient with a radial head subluxation typically present?
with the elbow in slight flexion and pressed up against their body to reduce strain
treatment for radial head subluxation
treat by flexing elbow to 180 degrees with supination at the same time
where are somatic dysfunctions associated with the heart located posteriorly?
at T1-T5
the medial mallelous is sensory innervated by which nerve root?
L4
the lateral mallelous is sensory innervated by which nerve root?
S1
the dorsum of the foot and great toe are sensory innervated by which nerve root?
L5
the gastrocnemius muscle is innervated by which nerve root?
S1
the tibalis anterior is innervated by which nerve root? and loss of innervation to this muscle will result in what?
L4; foot drop
the Thomas sign is useful for diagnosing what?
psoas syndrome
which condition unique to females must be ruled out prior to diagnosing psoas syndrome?
salpingitis
what does a fibular head that is stuck posteriorly and resists anterior springing indicate?
posterior fibular head dysfunction
common foot position associated with a posterior fibular head dysfunction and how do you treat it?
tends to invert and plantarflex; treat it by putting the patient in the prone position, everting and dorsiflexing
what nerve is at risk for injury with a posterior fibular head dysfunction?
common peroneal nerve
test to assess medial meniscus injury
McMurray test
what is the only bone connecting the upper extremity to the axial spine?
clavicle
name the muscles of the rotator cuff and their actions
SITS
Supraspinatus - abduction
Infraspinatu - external rotation
Teres minor - external rotation
Subscapularis - internal rotation
the subclavian artery passes where in relation to the scalenes?
between the anterior and middle scalene; therefore contraction may compromise blood flow
where does the subclavian vein pass in relation to the scalenes?
anterior to the anterior scalene; therefore contraction of the scalenes does not compromise blood flow
where does the subclavian artery become the axillary artery?
at the lateral border of the first rib
where does the axillary artery become the brachial artery?
inferior border of teres minor
the radial artery supplies which palmar arch?
the deep palmar arch
the ulnar artery supplies which palmar arch?
the superficial palmar arch
the right upper extremity lymph drains where?
into the right/minor duct
the left upper extremity lymph drains where?
into the left/main duct
what is the most common somatic dysfunction of the shoulder?
internal/external rotation restriction
a positive arm drop test indicates what?
supraspinatus tear
prolonged shoulder immobilization can lead to what problem? and which OMM treatment should you use to treat this?
adhesive capsulitis/frozen shoulder syndrome; treat with Spencer techniques
humeral dislocations commonly occur in which direction
anterior and inferior
what causes winging of the scapula?
weakness of the anterior serratus muscle due to long thoracic nerve injury
what is the most common brachial plexus injury? damage to which nerve roots causes this?
Erb-Duchenne's palsy; C5/C6 nerve roots
which nerve is the most common nerve injured in the upper extremity?
radial nerve
which nerve is damaged with crutch palsy?
radial nerve
wrist drop is caused by injury to which nerve
radial nerve
primary flexors of the wrist and hand originate where and are innervated by which nerve?
originate at the medial epicondyle and are innervated by the median nerve
primary extensors of the wrist and hand originate where and are innervated by which nerve?
originate at the lateral epicondyle and are innervated by the radial nerve
the primary supinators of the forearm are which muscles innervated by which nerves?
biceps (musculocutaneous nerve) and the supinator (radial nerve)
which muscles pronate the forearm and are innervated by which nerve?
primary pronators are the pronator teres and pronator quadratus, innervated by the median nerve
muscles of the thenar eminence are innervated by which nerve?
median nerve
the hypothenar eminence and interossi muscles are innervated by which nerve?
ulnar nerve
what is the normal carrying angle for men? women?
men 5 degrees
women 10-12 degrees
a carrying angle of >15 degrees is called what?
abduction of the ulna
a carrying angle of <3 degrees is called what?
adduction of the ulna
what is the radial head motion with supination/pronation?
when pronated, radial head moves posteriorly

when supinated, radial head moves anteriorly
gold standard test for carpal tunnel syndrome
EMG
tennis elbow occurs on which epicondyle?
lateral
golfers elbow occurs on which epicondyle?
medial
what is this deformity called?
swan neck deformity
what is this deformity called?
boutonniere deformity
what disease are swan-neck and boutonniere deformities associated with?
RA
claw hand results from damage to which nerves?
median and ulnar injury resulting in loss of intrinsic hand muscles
contraction of the palmar fascia results in what?
Dupuytrens contracture
contracture of the last two hand digits with atrophy of the hypothenar eminence is called what and due to damage to which nerve?
Bishops deformity; due to ulnar nerve damage
wrist-drop occurs due to damage to which nerve?
radial nerve
which scalene attaches to the 2nd rib?
posterior scalene
which scalene attaches to the 1st rib?
anterior and middle scalenes
DeQuervains tenosynovitis is diagnosed with what test?
Finkelsteins test
DeQuervains tenosynovitis involves tendonitis to which muscle tendons?
abductor pollicis longus
extensor pollicis brevis
the head of the femur glides which direction with external rotation of the hip?
glides anteriorly
the head of the femur glides which direction with internal rotation of the hip?
glides posteriorly
spasms of which two muscles cause an external rotation somatic dysfunction?
piriformis or iliopsoas
which direction will the fibular head glide with foot pronation?
glides anteriorly
which direction will the fibular head glide with foot supination?
glides posteriorly
dorsiflexion + eversion + abduction of the ankle = ?
pronation
plantarflexion + inversion + adduction of the ankle = ??
supination
the femoral nerve innervates which muscles?
quadriceps, iliacus, sartorius, pectineus
the femoral nerve does sensory to what part of the LE?
anterior thigh and medial leg
the tibial nerve provides motor output to which muscles?
hamstrings except biceps femoris, most plantar flexors
the tibial nerve gets sensory input from where?
lower leg and plantar aspect of foot
the peroneal nerve gives motor output to which muscles?
short head of biceps, dorsiflexors of the foot, toe extensors
the peroneal nerve recieves sensory input from where?
lower leg and dorsum of foot
the normal angle of the head of the femur is what?
120-135 degrees
if the angle of the head of the femur is >135 the condition is called?
coxa valga
if the angle of the head of the femur is <120 the condition is called?
coxa vara
name the grades for a sprain
first degree - no tear resulting in good tensile strength and no laxity

second degree - partial tear resulting in decreased tensile strength and mild laxity

third degree - complete tear resulting in no tensile strength and severe laxity
which compartment of the leg is most commonly affected by compartment syndrome?
anterior
what is O'Donahue's terrible triad?
injury to the ACL, MCL, MM
the ankle is more stable in dorsi/plantar flexion?
dorsiflexion
which foot arch is most prone to somatic dysfunction and which bones make up that arch? who is it commonly seen in?
most commonly the transverse arch; consists of the navicular, cuboid, cuneiforms; seen in long distance runners
what are the three main lateral stabilizing ligaments of the ankle?
anterior talofibular ligament
calcaneofibular ligament
posterior talofibular ligament
which ankle ligament is most commonly injured?
anterior talofibular ligament
what are the three types of lateral ankle ligament injuries?
type I - anterior talofibular ligament

type II - anterior talofibular + calcaneofibular ligament

type III - anterior talofibular + calcaneofibular ligament + posterior talofibular ligament
which ligament stabilizes the medial ankle?
deltoid ligament
what is the plantar aponeurosis?
a strong, dense, connective tissue that originates at the calcaneous and attaches to the phalanges
which levels provide sympathetic input to the lower extremities?
T11-L2
entrapment of which nerve and where result in hypothenar atrophy?
ulnar nerve entrapment at the wrist (Guyon's canal)
which landmarks do you use to assess leg length discrepancy?
ASIS and medial mallelous
what size heel lift should you start with when correcting a short leg in an elderly patient post-total hip replacement?
start with a 1.5mm heel lift then increase if necessary
where is the anterior chapman's point for the kidney?
1" superior and 1" lateral to the umbilicus
where is the anterior chapmans point for the adrenals?
2" superior and 1" lateral to the umbilicus
when doing lymphatic drainage treatment, where do you start first?
treat the thoracic inlet/outlet first; unless you unblock this everything peripheral to it will be blocked
what is the J-sign used to diagnose?
patellofemoral syndrome
what is patellofemoral syndrome? how does it present?
typically presents with anterior knee pain that worsens with prolonged sitting or ambulation up/down stairs; look for J-sign; aka chondromalacia patellae
what treatment can you use for thoracic lymphatic return when the thoracic pump/inlet release are contraindicated?
pectoral traction
which lymphatic treatments are contraindicated with rib fractures?
thoracic pump, thoracic inlet release
where is the anterior Chapman's point for the prostate?
anterior along the superior margin of the IT band
sidebending at L5 engages the oblique axis on the same/opposite side?
same side
what levels provide autonomic innervation for the uterus/cervix?
T10-L2
ureteral stones can cause which viserosomatic syndrome?
psoas syndrome
preferred treatment for acute cervical strain
indirect techniques
how do you do a Spurlings test?
extend the next, sidebend towards the side being tested and add compression
treatment for plantar fasciitis
ice, strengthening, stretching exercises, orthotics if persistent
what anatomic/physiological elements is the primary respiratory mechanism composed of?
1. inherent motility of the brain/spinal cord
2. flucutation of the CSF
3. movement of the intracranial and intraspinal membranes
4. articular mobility of the cranial bones
5. involuntary mobility of the sacrum between the ilia
what is the cranial rhythmic impulse rate?
10-14 cycles per minute
what are the four factors that decrease the rate and quality of the CRI?
1. stress
2. depression
3. chronic fatigue
4. chronic infections
what are the four factors that increase the rate and quality of the CRI?
1. vigorous physical exercise
2. systemic fever
3. OMT to the craniosacral mechanism
name the four dural attachments
foramen magnum, C2, C3, S2
the involuntary mobility of the sacrum occurs on which axis between the ilia?
occurs about a transverse axis that runs through the superior transverse axis of the sacrum
which articulation of the cranium is the keystone of all cranial movement?
sphenobasilar synchondrosis (SBS)
when the midline bones of the cranium go into flexion what happens to the paired bones?
flexion of the midline bones corresponds to external rotation of the paired bones
name the midline bones of the cranium
sphenoid, occiput, ethmoid, vomer
flexion at the SBS will cause which movement of the sacrum?
counternutation
name the four movements that occur with craniosacral flexion
1. flexion of the midline bones
2. sacral base posterior (counternutation)
3. decreased AP diameter of the cranium
4. external rotation of the paired bones
extension of the SBS will cause which movement of the sacrum?
extension at the SBS --> nutation of sacrum (sacral flexion)
name the four movements that occur with craniosacral extension
1. extension of the midline bones
2. sacral base anterior (nutation)
3. increased AP diameter of the cranium
4. internal rotation of the paired bones
how does a compression strain of the SBS affect the CRI and what causes this?
often caused by trauma to the back of the head; severely decreases the CRI
what injury can cause poor suckling in the newborn?
occipital/condylar compression along with dysfunctions of CN IX and X at the jugular foramen
vagal somatic dysfunction can be caused by which cranial dysfunctions?
OA, AA, C2 dysfunction
dysfunction of which cranial nerve can cause tinnitus, vertigo, hearing loss?
CN VIII
what is the goal of craniosacral treatment?
to reduce venous congestion, mobilize articular restrictions, balance the SBS and enhance the rate/amplitude of the CRI
what is the goal of the venous sinus technique?
to increase blood flow through the venous sinuses so that blood may exit the skull through the jugular foramen
what is the purpose of CV4/bulb decompression?
to enhance the amplitude of the CRI
what is the purpose of the V spread?
to separate restricted or impacted sutures
what is the purpose of the vault hold?
to address SBS strains
what is the purpose of the lift technique?
frontal and parietal lifts are commonly used to aid in the balance of membranous tension
what are two absolute contraindications to craniosacral treatment?
acute intracranial bleed or increased ICP
what are two relative contraindications to craniosacral treatment?
known history of seizures, traumatic brain injury
treatment position for anterior cervical tenderpoint
treat by placing head in flexion with rotation and sidebending away from lesion
which nerve root is the biceps DTR testing?
C5
which DTR tests C6?
brachioradialis
C5 provides motor output to which muscles?
biceps, deltoid
respiratory disease would show viserosomatic changes at which levels?
T2-T7
pancreatic disease would show viserosomatic changes at which levels?
T5-T9
where is the supraspinatous ligament located?
it is the strong, fibrous superficial band running from C7 to the sacrum along the spinous processes
name the contraindications to using the pedal pump
DVT, lower extremity fractures, recent abdominal surgery
where would the viserosomatic changes for ulcerative colitis be and why?
T12-L2 because UC affects the distal colon
name visceral spinal cord level for: head and neck
T1-T4
name visceral spinal cord level for: heart
T1-T5
name visceral spinal cord level for: respiratory system
T2-T7
name visceral spinal cord level for: upper GI tract
T5-T9
name visceral spinal cord level for: middle GI tract
T10-T11
name visceral spinal cord level for: lower GI tract
T12-L2
name visceral spinal cord level for: appendix
T12
name visceral spinal cord level for: kidneys
T10-T11
name visceral spinal cord level for: bladder
T11-L2
name visceral spinal cord level for: penis
T11-L2
name visceral spinal cord level for: arms
T2-T8
name visceral spinal cord level for: legs
T11-L2
name the corresponding nerve and ganglion: upper GI tract
greater splanchnic nerve
celiac ganglion
name the corresponding nerve and ganglion: middle GI tract
lesser splanchnic nerve
superior mesenteric ganglion
name the corresponding nerve and ganglion: lower GI tract
least splanchnic nerve
inferior mesenteric ganglion
parasympathetic innervation to all viscera above the diaphragm = which nerve?
vagus nerve
parasympathetic innervation to the distal GI system = which nerve?
pelvic splanchnic nerves
which ligament divides the duodenum from the jejunum?
ligament of Treitz
which landmark divides the transverse colon from the descending colon?
splenic flexure of the large intestine
what provides sympathetic input to the GI tract before the ligament of Treitz?
T5-T9
what provides sympathetic input to the GI tract between the ligament of Treitz and splenic flexure?
T10-T11
what provides sympathetic input to the GI tract after the splenic flexure?
T12-L2
what does L3-L5 provide sympathetic input for?
nothing
in disease states there is too much sympathetic/parasympathetic input? how do you treat this?
sympathetic; treat with rib raising/paraspinal inhibition
what are the contraindications for rib raising/paraspinal inhibition?
spinal/rib fracture
recent spinal surgery
what are the indications and contraindications for mesenteric inhibition?
indications = GI dysfunction, pelvic dysfunction

contraindications = aortic aneurysm, open surgical wound
what is the purpose of treating Chapman's reflexes?
to decrease sympathetic tone to associated visceral tissues
condylar compression may cause what dysfunction in newborns?
suckling difficulties
name the anterior and posterior location of Chapmans point: appendix
anterior - tip of 12th rib on right

posterior - transverse process of T11
name the anterior and posterior location of Chapmans point: adrenals
anteriorly - 2" superior, 1" lateral to umbilicus

posterior - between spinous process and transverse process of T11 and T12
name the anterior and posterior location of Chapmans point: kidneys
anterior - 1" superior, 1" lateral to umbilicus

posterior - between spinous process and transverse process of T12 and L1
name the location of Chapmans point: bladder
periumbilical region
name the location of Chapmans point: colon
on the lateral thigh within the IT band from the greater trochanter to just above the knee
where is the trigger point that has been associated with SVTs?
in the right pectoralis muscle between the 5th and 6th rib near the sternum
what is the difference between tenderpoints and trigger points?
trigger points may refer pain when pressed; tenderpoints do not refer pain when pressed
permanent limitations of motion secondary to disease process or injury are referred to as what type of barrier?
pathological barrier
in a (forward/backward) sacral torsion, L5 has a good spring and the lumbosacral spring test is negative?
forward torsion
in a (forward/backward) sacral torsion, L5 does not have a good spring and the lumbosacral spring test is positive?
backward torsion
when a set of ribs have restricted motion when the patient exhales, this is what type of dysfunction?
inhalation dysfunction
when a set of ribs have restricted motion when the patient inhales, this is what type of dysfunction?
exhalation dysfunction
where is the anterior Chapman's point for the myocardium?
2nd intercostal space, near the sternum
a bilateral sacral (flexion/extension) has a restriction in springing motion at both ILAs
bilateral sacral flexion
what is Phalen's test?
tests for carpal tunnel syndrome by having the patient hold their hands in complete forced flexion for one minute and noting the distribution of numbness/tingling
with indirect myofascial treatment, the operator applies what kind of force?
compression along the long-axis of the muscle
with direct myofascial treatment, the operator applies what kind of force?
traction along the long-axis of the muscle into the restriction
"fine tuning" with myofascial treatment occurs by doing what?
adding twisting or transverse forces
what enhancers are used when doing myofascial treatment?
respiration, eye movement, muscle contraction
name the steps in myofascial treatments
1. palpate restriction
2. apply compression (indirect) or traction (direct)
3. add twisting or transverse forces
4. use enhancers
5. await release in the form of "melting" or "give-away"
what is the goal of myofascial release?
improve lymphatic flow
what are the four diaphragms in the body that play a role in lymphatic return?
tentorium cerebelli
thoracic inlet
abdominal diaphragm
pelvic diaphragm
which diaphragm plays the largest role in lymphatic return?
abdominal diaphragm
what are the four compensatory curves throughout the spine as noted by Zink?
occipitoatlantal junction
cervicothoracic junction
thoracolumbar juction
lumbosacral junction
what is the Zink compensatory pattern in 80% of the population?
OA - rotated left
cervicothoracic - rotated right
thoracolumbar - rotated left
lumbosacral - rotated right
which parts drain into the right lymphatic duct?
right UE, right hemicranium, heart, lobes of lungs (except LUL)
the left lymphatic duct traverses which fascia?
Sibson's fascia
how much lymph flows per day both in percent of ECF and volume?
10-20% of ECF, or 3L
the lymph system absorbs which compounds from the intestinal tract?
long chain fats, chylomicrons, cholesterol
what is the main cell found in lymph?
lymphocytes
the SNS affects the lymph capillaries in what way?
sympathetic input contracts the lymph capillaries
the cisterna chyli of the lymph system is innervated by which spinal nerve?
T11
which lymphatic treatment is particularly good in pediatric patients?
pedal pump
which lymphatic technique is indicated for sinus congestion or otitis media?
facial sinus pressure/Galbreath's technique
unless contraindicated, which lympathic technique should be done first?
thoracic inlet
what are the four relative contraindications for lymphatic treatment?
1. osseus fractures
2. bacterial infections with fever >102
3. abscess or localized infection
4. certain stages of carcinoma
acute spasm of the SCM leads to what?
torticollis
what two things can separate an innominate inflare from and outflare?
1. positive standing flexion test on affected side
2. ipsilateral resistance to compression of ASIS
what nerve controls extension of the wrist and digits?
radial nerve
acute lumbar pain in a young, healthy patient without neurological findings is likely what?
acute lumbar strain
what part of the colon is mostly affected by Crohn's?
80% of the time it's the terminal ileum
OMT for asthma patient to reduce viscerosomatic/somatovisceral action
rib raising
how do you prevent and treat patellofemoral syndrome?
by strengthening the vastus medials
treatment to increase parasympathic action for a URI should be directed at what ganglion?
sphenopalatine
treatment to increase parasympathic action for upper GI dysfunction should be directed at what ganglion?
celiac ganglion
symptoms of complex regional pain syndrome type 1
constant pain, allodynia, joint stiffness, localized edema, increase hair growth, vasospasm, no evidence of nerve damage; aka reflex sympathetic dystrophy
symptoms of complex regional pain syndrome type 2
intense pain, widespread edema, decreased hair growth, cracked/brittle nails, increased osteoporosis, joint thickening, muscle atrophy, evidence of nerve damage; aka causalgia
which OMT technique is a passive indirect technique in which the tissue being treated is positioned at the point of balance, ease, away from the restrictive barrier
counterstrain
with counterstrain, if multiple tenderpoints exist, which one do you treat first?
treat the most tenderpoint first
what are Maverick Points?
approximately 5% of counterstrain tenderpoints do not disappear when positioned properly, these points need to be treated by moving the patient into the opposite position that one would intuitively use
success with counterstrain is marked by what level of improvement in tenderness?
>70% improvement
anterior cervical tenderpoints are treated in what position? (except C7)
sidebent and rotated away from the tenderpoint
anterior C7 tenderpoints are located where and how do you position them for treatment?
located lateral to the medial end of the clavicle where the SCM attaches; treat with flexion, sidebend towards and rotate away from tenderpoint
where are the posterior certical tenderpoints located and how do you position them for treatment?
located at the tip of the spinous process or on lateral sides of spinous processes; position with extension, slight sidebending and rotate away
where is the counterstrain inion located and how do you position it for treatment?
posterior C1 located at the occipital protuberance; position with marked flexion
where are the anterior thoracic counterstrain tenderpoints located and how do you position for treatment?
T1-T6: midline of sternum at rib attachment point

T7-T12: on rectus abdominus muscle 1" lateral to midline right or left

treatment position: FSARA
flex, side bend away, rotate away
where are the posterior thoracic counterstrain tenderpoints located and how do you position them for treatment?
located on either side of the spinous process of on the transverse process; treat with ESARA (extend, rotate away, sidebend slightly away)
with counterstrain treatment for the ribs, how long should you hold the position for?
Jones recommends 120 seconds
wheres the anterior counterstrain tenderpoint for rib 1 and how do you position it for treatment?
located just below medial end of clavicle; position with flexion, sidebend and rotate towards
wheres the anterior counterstrain tenderpoint for rib 2 and how do you position it for treatment?
located 6-8cm lateral to sternum on right 2; position with flexion, sidebend rotate towards
wheres the anterior counterstrain tenderpoint for ribs 3-6 and how do you position it for treatment?
located along mid-axillary line corresponding to rib; position with sight flexion, sidebend and rotate towards
where are the counterstrain tenderpoints for the posterior ribs and how do you position them for treatment?
located at angle of corresponding rib; position with minimal flexion, sidebend away, rotate away (FSARA)
where are the anterior lumbar counterstrain tenderpoints and how do you position them for treatment?
L1: medial to ASIS
L2-L4: on AIIS
L5: 1cm lateral to pubic symphysis on superior ramus

position with patient supine, knees and hips flexed, rotate away
where are the posterior lumbar counterstrain tenderpoints and how do you position them for treatment?
L1-L2: on either side of the spinous process or transverse process
L3-L4: iliac crest
L5: PSIS

L1-L4: position prone, extend, sidebent away, rotation either direction

L5: position prone, knee/hip flexed, leg internal rotated and adducted
where is the iliacus counterstain tenderpoint located and how do you position it for treatment?
located 7cm medial to ASIS; position supine with hip flexed and externally rotated
where is the piriformis counterstrain tenderpoint located and how do you position it for treatment?
7cm medial and slightly cephalad to greater trochanter; position prone, hip/knee flexed, thich abducted and externally rotated
how do you treat using facilitated positional release (FPR)?
region of body is placed into neutral position, diminishing tissue and joint tension in all planes with a compression/torsion force added for 3-4 seconds
cranial treatment for otitis media should be directed at which bone?
temporal bone
OMT for dysmenorrhea?
sacral inhibition
first line drug therapy for dysmenorrhea
NSAIDs
what type of treatment is post-isometric relaxation?
direct and active
where would viscerosomatic changes be for ulcerative colitis?
T12-L2
where is the Chapmans point for the pancreas?
lateral to the costal cartilage between ribs 7 and 8 on the right
which is more important with muscle energy: localization or intensity?
localization
which part of the muscle cells are you attempting to active/deactivate?
golgi tendon organs
with muscle energy how long should the contraction be held? how many times should you repeat the contration?
hold for 3-5 seconds, repeat 3-5x
which patients is muscle energy contraindicated with?
patients with low vitality; i.e. post-surgical, ICU
when treating the typical cervicals with ME, are rotation and sidebending coupled or opposite?
coupled
when using muscle energy, what muscle is used to treat dysfunctions at rib 1?
anterior/middle scalenes
when using muscle energy, what muscle is used to treat dysfunctions at rib 2?
posterior scalene
when using muscle energy, what muscle is used to treat dysfunctions at ribs 3-5?
pectoralis minor
when using muscle energy, what muscle is used to treat dysfunctions at ribs 6-9?
serratus anterior
when using muscle energy, what muscle is used to treat dysfunctions at ribs 10-11?
latissimus dorsi
when using muscle energy, what muscle is used to treat dysfunctions at rib 12?
quadratus lumborum
when treating sacral torsions with ME, how do you know which side to lay the patient on?
lay them on the side of the axis; axis side down
what are the absolute contraindications to HVLA treatment?
osteoporosis
osteomyelitis
Potts disease
fractures in the region
bone metastasis
severe RA
Downs syndrome
what are the relative contraindications to HVLA treatment?
acute whiplash
pregnancy
post-surgical conditions
herniated nucleus pulpulsus
hemophilia
anti-coagulation therapy
vertebral artery ischemia (+Wallenberg's test)
when using the Kirksville Krunch to treat a flexed lesion, where should you direct your thurst and in what direction?
aim towards the floor, thrust directly at the dysfunctional segment
when using the Kirksville Krunch to treat an extended lesion, where should you direct your thurst and in what direction?
aim 45 degrees cephalad; direct the thrust at the segment below
when using the Kirksville Krunch to treat a rib 2-10 lesion, where should you thrust?
place the thenar eminence under the posterior angle of the key rib
What does the Spurling/compression test help diagnose and how do you do the test?
tests for referred pain from cervical nerve root irritation; extend and sidebend the c-spine towards the side being tested and apply a downward force
What does the Wallenberg test help diagnose and how do you do the test?
tests for vertebral artery insufficency; hold the head in flexion for 10s, then extension for 10x, repeat by going R-->L and L-->R, a positive test occurs if the patient experiences dizziness, lightheadedness, nystagmus
What does the Adson's test help diagnose and how do you do the test?
tests for neurovascular compromise due to tight scalene muscles; ask patient to take deep breath in and turn head toward ipsilateral side, positive test if radial pulse decreased or absent
What does the Wright's test help diagnose and how do you do the test?
looks for neurovascular compromise due to petoralis minor at coracoid process; +test if radial pulse decreased/absent with arm hyperabduction and extension
What does the Costoclavicular (military posture test) test help diagnose and how do you do the test?
looks for neurovascular compromise due to clavicles and first rip; depress and extend shoulder; +test if decreased radial pulse
What does the Appley scratch test help diagnose and how do you do the test?
tests ROM of shoulder by reaching behind head to opposite shoulder and as high as possible up lower back
What does the drop arm test help diagnose and how do you do the test?
rotator cuff tears; arm cannot smoothly lower to side or drops off at 90 degrees
What does the Allens test help diagnose and how do you do the test?
tests adequacy of blood flow to hand via radial/ulnar arteries; slow flushing or no flushing at all indicates positive test
What does the Finkelstein test help diagnose?
test for tenosynovitis of the abductor pollicis longus and extensor pollicis brevis test at wrist; DeQuervains disease; positive result if pain is felt over tendons at wrist
describe the Phalen's test
used to diagnose carpal tunnel syndrome; extend wrists to 90 degrees against their two hands looking for distribution of symptoms
describe reverse Phalens test
opposite motion as Phalens, patient puts dorsum of hands together downward and tests what symptoms appear after one minute
describe Tinnels test
used to diagnose carpal tunnel syndrome; tap on nerve to see if leads to paresthesias
describe the hip-drop test
purpose is to evaluate sidebending (lateral flexion) of lumbar spine; positive test if drop of greater than 20 degrees
describe the straight leg raise test
helps evaluate sciatic nerve compression test; lift left until patient feels discomfort which should be 70-80 degrees
describe the seated flexion test
tests sacroiliac motion; somatic dysfunction is present on the side of the superior PSIS
describe the standing flexion test
tests iliosacral motion; somatic dysfunction is present on the side of the superior PSIS
describe the Trendelenberg test
tests gluteus medius muscle strength; positive test on the side of the leg that they are standing on if there is a hip drop
when will the lumbosacral spring test be positive?
in all dysfunctions in which the sacral base moves posterior
describe Obers test
detects a tight tensor fascia lata and IT band
describe Patricks test
aka FABERE test; tests for pathology of the sacroiliac and hip joints such as OA
describe the anterior/posterior drawer test
tests the ACL, PCL; positive if tibia moves excessively in one direction on a particular side
describe the Bounce test
tests for meniscal tears or joint effusions; test is positive if extension is incomplete or there isn't smooth motion through the end-point
describe the Lachmans test
similar to the drawer test, looks for stability of the ACL
describe the McMurrays test
detects tears in the posterior aspect of the menisci; look for palpable or audible click when applying a varus/valgus stress to the knee
describe the patellar grind test
tests for chondromalacia patellae or patello-femoral syndrome; test is positive if they experience pain below the patella