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379 Cards in this Set
- Front
- Back
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In general, what type of movement should be included in treatment for anterior tender points with counterstrain?
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Flexion
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What is the position of the patients shoulder when using counterstrain to treat the supraspinatus tender point?
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Arm flexed to 45 degrees, abducted, and externally rotated.
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Explain the difference between isotonic, isometric, and isolytic contractions.
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Isotonic – muscle length shortens
Isometric – muscle length remains the same Isolytic – muscle length increases |
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What primarily determines the level of aggressiveness of the OMM technique which should be used?
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Patient tolerance
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Explain the difference between a functional scoliotic curve and a structural scoliotic curve.
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A functional curve CAN be reduced with side bending, rotation, or flexion.
A structural curve CANNOT be reduced by movement. |
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Give the degree ranges for mild, moderate, and severe scoliotic curves. At what degree ranges do cardiac and pulmonary compromise occur?
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Mild: 5-15 degrees
Moderate: 20-45 degrees Severe: 50 degrees or more Pulmonary compromise: > 50 Cariac compromise: > 75 |
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When performing counterstrain, more lateral tender points will typically require more of what motion?
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Sidebending
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Name the main muscles creating shoulder abduction in the following degree ranges: 0-90, 90-150, 150-180
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0-90: Supraspinatus and deltoid
90-150: Trapezius and serratus anterior 150-180: Contralateral erector spinae |
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What spinal segments provide sympathetic innervation to the upper limb?
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T2 through T8
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Name the reflexes that can be used to test C5, C6, and C7
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C5 – Biceps reflex
C6 – Brachioradialis reflex C7 – Triceps reflex |
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Which type of Fryette’s mechanics dysfunction typically has a traumatic origin?
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Type II
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Would coolness, pallor, and atrophic tissue indicate acute or chronic somatic dysfunction?
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Chronic
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Explain how to complete the Neer test and what results indicate.
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Stabilize patients shoulder and then passively fully forward flex shoulder (forearm pronated) above the shoulder.
Provoking pain in this movement is a positive test and indicates rotator cuff impingement (and possibly subacromial bursa irritation). |
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Explain how to complete the Hawkin’s test and what results indicate.
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With arm flexed to 90 degrees and elbow flexed to 90 degrees, hold the elbow with one hand and uses the other to passively internally rotate the humerus.
Provoking pain in this movement is a positive test and indicates rotator cuff impingement. |
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Explain how to perform Spurling’s test, what a positive result is, and what it indicates.
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Extend the patients neck. Rotate and side bend to one side while applying a downward force on the top of the head.
A positive sign is pain elicited down the ipsilateral arm (note: not just the neck). This indicates cervical disc issues and/or nerve root irritation. |
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Explain how to perform Adson’s test, what a positive result is, and what it indicates.
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The patient turns the neck to one side and extends while the physician palpates the radial pulse.
A diminished pulse (positive test) indicates thoracic outlet system. |
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Explain how to perform the cross arm test, what a positive result is, and what it indicates.
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Physician passively adducts arm across the chest to opposite shoulder.
A positive test is pain in the acromioclavicular joint at the end range, indicating pathology of the joint. |
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Explain how to perform Speed’s test, what a positive result is, and what it indicates.
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A supinated arm with elbow extended is elevated against resistance.
A positive test is pain in the bicipital grove, usually indicating biceps tendinitis. |
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Explain how to follow up the apprehension test with the relocation test. What is a positive test and what does it indicate?
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Re-perform the apprehension test while pressing downward on the humeral head. A positive test is indicated by improvement of apprehension symptoms. This confirms glenohumeral instability.
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Name the three common entrapment sites of thoracic outlet syndrome.
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Between anterior and middle scalene muscles
Between clavicle and first rib Between pectoralis minor and ribs |
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Explain how to perform Wright’s test, what a positive result is, and what it indicates.
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Patient hyperabducts arm while physician palpates radial pulse.
A positive sign is a diminishing pulse. This indicates compression of neurovasculature between pectoralis minor and rib cage (thoracic outlet/hyperabduction syndrome) |
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Explain how to perform the Halstead (aka military) test, what a positive result is, and what it indicates.
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Patient’s arm is laterally rotated and extended. Physician applies traction while palpating radial pulse.
A positive sign is diminished pulse, indicating neurovascular compression between clavicle and first rib (thoracic outlet/costoclavicular syndrome) |
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Where is the center of gravity in an ideal posture located?
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5 cm anterior to the S2 vertebra.
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A scoliosis Cobb angle over what amount is likely to require surgery?
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Over 50 degrees
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What is the most common variety of scoliosis?
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Thoraco-lumbar double
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What scoliometer angle equates to a 20 or greater Cobb angle (and subsequently requiring referral to a scoliosis specialist)?
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7 degrees or greater
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What is the proper guideline for adjusting the length of crutches?
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The crutches should be 5 cm below the axilla.
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Name some gait changes that might be seen with L5 radiculopathy or peroneal neuropathy.
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Circumduction and hip hiking of swing leg
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In general, posterior tender points require more __________ when seeking a counterstrain position.
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Extension
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Describe how to treat a Chapman’s reflex point.
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Firmly rub the point in a circular direction for 30 seconds
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Alternate name for Parkinsonian gait
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Festinating gait
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What Chapman’s reflex points are found in the 5th intercostal spaces?
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Liver on right, stomach acid on left
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What Chapman’s reflex points are found in the 6th intercostal spaces?
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On the right is the liver or gallbladder
On the left is stomach peristalsis |
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What Chapman’s reflex points are found in the 7th intercostal spaces?
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Pancreas on right, spleen on left
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Name the location of the following anterior Chapman’s reflex points:
Stomach Acid Gall Bladder Spleen Pancreas Stomach Peristalsis |
Stomach Acid - 5th ICS on left
Gall Bladder - 6th ICS on right Spleen - 7th ICS on left Pancreas - 7th ICS on right Stomach Peristalsis - 6th ICS on left |
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Where is the anterior Chapman’s reflex point for the Pylorus?
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Directly over the sternum
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What abdominal viscera has two anterior Chapman’s reflex points? Where are those points?
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The liver. One is on the right side of the 5th intercostal space and one is on the right side of the 6th intercostal space.
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Where are the anterior/posterior Chapman’s reflex points for the bronchi?
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Anterior – 2nd intercostal space close to the sternum
Posterior – Midway between spinous process and tips of transverse processes of T2 |
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Where are the anterior/posterior Chapman’s reflex points for the upper lung?
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Anterior – 3rd intercostal space close to the sternum
Posterior – Midway between spinous process and tips of transverse processes of T3 and T4 |
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Where are the anterior/posterior Chapman’s reflex points for the lower lung?
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Anterior – 4th intercostal space close to the sternum
Posterior – Midway between spinous process and tips of transverse processes of T4 and T5 |
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For Chapman points, which have anterior and posterior sides, which sides are diagnostic and which are used for treatment?
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Anterior are diagnostic, posterior are treatment
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Where are the anterior and posterior Chapman points for the adrenal glands?
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Anterior – Lateral rectus abdominis at the inferior side of the costal margin OR 2 cm above and 1 cm lateral to the umbilicus
Posterior – Space between T11 and T12 midway between spinous and transverse processes |
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Where are the anterior and posterior Chapman points for the myocardium?
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Anterior – 2nd intercostal space near sternal border
Posterior – Space between T2 and T3 midway between spinous and transverse processes |
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Counterstrain normalizes muscle hypertonicity by reducing __________ _________.
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Gamma gain
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When performing facilitated positional release, what should be done prior to adding an activating force?
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The body part should be placed into a neutral position.
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Golfer’s elbow is an alternate term for what condition?
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Medial epicondylitis
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What types of falls typically create anterior and posterior radial head dysfunctions?
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Anterior radial head – From a fall backwards on outstretched arm
Posterior radial head – from a fall forward on outstretched arms |
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What test assesses the stability of the long head of the biceps tendon in the bicipital groove?
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Yergason’s test
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Explain anterior scalene syndrome.
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The compression of brachial plexus and subclavian artery between the anterior and middle scalene muscles.
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What tests for anterior scalene syndrome?
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Adson’s test
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What is hyperabduction syndrome? What tests for it?
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Compression of a neurovascular bundle between pectoralis minor muscle and thoracic cage. Wright’s test can assess for it.
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What is costoclavicular syndrome? What tests for it?
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Compression of neurovascular bundle between the clavicle and the first rib. The Halstead (aka military) test assesses for it.
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What is the “clunk sign” test and what does it indicate?
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With patient supine the arm is rotated against a force from extension through forward flexion. A clunk sound or clicking indicates a labral tear.
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With lateral epicondylitis, what types of movements will reproduce pain? Why?
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Grasping and lifting movements that involve wrist extension. This occurs because these movements use wrist extensors (which attach to the lateral epicondyle).
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What types of movements reproduce pain in medial epicondylitis?
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Wrest flexion against resistance.
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Out of lateral and medial epicondylitis, which involves extensors and which involves flexors?
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Flexors – medial epicondylitis, Extensors – lateral epicondylitis
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What way does the radial head move with supination and pronation?
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Supination – moves anteriorly, Pronation – moves posteriorly
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What test for carpal tunnel syndrome is performed by compressing and holding the transverse carpal ligament?
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The provocation test
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Define military neck. What is a common type of trauma which causes it?
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Military neck is a straightening of the cervical lordosis. It is often caused by whiplash (car accidents).
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What direction do the superior articular facets of the cervical spine face?
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Backwards, upward, and medial (BUM)
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Are discs more likely to herniate anteriorly or posteriorly? Why?
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Posteriorly. Anterior herniation is prevented by the thick anterior longitudinal ligament
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What types of positions would a patient prefer/not prefer in the event of a cervical disk herniation? Why?
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They would prefer to back bend and slightly sidebend toward to herniation. This keeps the nucleus pulposus away from neural structures.
They would not like to forward bend and sidebend away from the herniation. This does the opposite. |
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Which cervical spinal segment does the vagus nerve receive branches from as it travels down through the neck?
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C2
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Which node (SA or AV) do the right and left vagus nerves travel to?
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Right vagus nerve = SA node, Left vagus nerve = AV node
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How long should one hold the neck in position when doing the Underberg test? What is a positive result?
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For 30 seconds. Nausea, lightheadedness, or dizziness would indicate a positive test.
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Where are the two different posterior C1 tender points? What position should be used to treat each by counterstrain?
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At the inion (external occipital protuberance). Flex only for counterstrain.
Low on the occiput 2 cm lateral to the muscle mass at the back of the neck. Extend, sidebend away, and rotate away for counterstrain. |
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What position can be used for counterstrain of almost all posterior tender points for C2-C7? What is the exception?
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Extend, sidebend away, and rotate away. (remember SARA). The exception is C3, for which you flex, sidebend toward, and rotate away. (remember STRAw)
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Where are the anterior tenderpoints for C1, C7, and C8?
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C1 – Posterior edge of ascending mandible
C7 – Lateral attachment of sternocleidomastoid to clavicle C8 – Medial tip of clavicle |
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What position can be used to perform counterstrain for nearly all anterior cervical tenderpoints? Name the three exceptions.
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Flex, Sidebend away, Rotate away (Flex Sara)
C1 – Just rotate away C4 – Sometimes you need to extend instead of flex C7 – Flex, sidebend toward, rotate away. |
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Give the rule of threes for finding the location of all 12 thoracic spinous/transverse processes
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T1-T3: Spinous process on the same plane as transverse process
T4-T6: Tip of SP is halfway between its transverse processes and the ones below it. T7-T9: SP in like with TP from the next vertebra down T10 like 7-9, T11 like 4-6, T12 like 1-3 |
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According to the rule of three’s, give the location for the following structures:
T5 spinous process T7 spinous process T11 transverse process |
T5 spinous process – Between transverse process of the T5 and T6
T7 spinous process – At level of T8 spinous process T11 transverse process – Between transverse process of T11 and T12 |
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What is the most common somatic dysfunction following a coronary artery bypass graft (CABG)?
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Inhaled (elevated) ribs on the left.
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What are the most common intrinsic back muscles to cause type II dysfunction?
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Rotatores
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Pick from stretching or strengthening:
Tonic muscles favor __________ treatments. Phasic muscles favor ____________ treatments. |
Tonic muscles favor stretching treatments.
Phasic muscles favor strengthening treatments. |
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Are the rhomboids tonic or phasic muscles?
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Phasic
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Name the three major sympathetic abdominal ganglia and the spinal segments which contribute to them.
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Celiac – T5 to T9
Superior mesenteric – T10 and T11 Inferior mesenteric – T12 to L2 |
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Name the spinal segments which provide sympathetic innervation to the following areas:
Head and neck Stomach, duodenum, liver, gall bladder, pancreas, spleen Small intestine, kidney, ureters, gonads, right colon Left colon and pelvic organs |
Head and neck – T1 to T4
Stomach, duodenum, liver, gall bladder, pancreas, spleen – T5 to T9 Small intestine, kidney, ureters, gonads, right colon – T10 and T11 Left colon and pelvic organs – T12 to L2 |
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Name the GI/urinary viscera receiving sympathetic innervation from the following spinal segments: T5-T9, T10-T11, T12-L2
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T5-T9 – Stomach, duodenum, liver, gall bladder, pancreas, spleen
T10 and T11 – Remainder of small intestines, kidney, upper half of ureters, gonads, right colon T12-L2 – Left colon, lower half of ureters and other pelvic organs |
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What vertebral level is marked by the umbilicus?
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L3-L4
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For both the scalene triangle and costoclavicular space, give the major neurovascular structures which pass through them.
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Scalene triangle: brachial plexus, subclavian artery.
Costoclavicular space: brachial plexus, subclavian artery, subclavian vein. |
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Explain how to perform the EAST (aka Roo’s) test, what a positive result is, and what results indicate.
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Patient abducts shoulders to 90 degrees, flexes elbow to 90 degrees, and faces palms forward. The patient then opens and closes palms for three minutes.
A positive response is pain or easy fatigue. It indicates thoracic outlet syndrome. |
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Explain the two major difference in performing thoracic HVLA on an extension dysfunction as opposed to flexion or neutral.
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For extension dysfunctions, thenar eminence is placed one transverse process below the dysfunction segment instead of directly on it.
Force is applied 45 degrees cephalad instead of straight down. |
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At what vertebral level do the inferior vena cava, aorta, and esophagus pass through the diaphragm?
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IVC at T8, Esophagus at T10, Aorta at T12
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What spinal segments contribute sympathetic innervation to the esophagus?
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T2-T8
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If both a thoracic and rib dysfunction are present, which should be treated first? Why?
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The thoracic dysfunction. Often fixing the thoracics fixes the rib dysfunction.
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For treating exhalation dysfunction with muscle energy, the patient first places the arm on the side of the dysfunction on the forehead palm up. They then complete a specific movement while holding breath in inhalation. List these movements for each of the 12 ribs.
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Rib 1: Raise head toward ceiling
Rib 2: Turn head 30 degrees away from dysfunction and lift head toward ceiling Ribs 3-5: Elbow of affected side toward opposite ASIS Ribs 6-9: Push arm anteriorly Ribs 10-12: Abduct arm |
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With exhalation and inhalation dysfunction, what should be treated first: the highest rib in a group or the lowest rib in a group?
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Exhalation dysfunction – highest rib in the group
Inhalation dysfunction – lowest rib in the group |
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Explain how to perform muscle energy techniques for inhalation dysfunctions.
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1) Flex patient for pump handle dysfunctions or sidebend patient for bucket handle dysfunctions until tension is taken off dysfunctional rib.
2) Patient inhales and physician resists motion of target rib (lowest if there is a group) 3) Upon expiration, physician follows rib down with force 4) Patient holds breath in expiration, during which physician moves to new barrier. |
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State the muscles used when correcting exhalation dysfunctions for all 12 ribs
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Rib 1: Anterior and middle scalene
Rib 2: Posterior scalene Ribs 3-5: Pectoralis minor Ribs 6-9: Serratus anterior Ribs 10-11: Latissimus dorsi Rib 12: Quadratus lumborum |
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Describe the position of the patient when performing exhalation dysfunction muscle energy.
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Patient is supine. Arm on dysfunction side is on forehead with palm up.
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To what angle should the leg be elevated in the straight leg test?
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70-90 degrees
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1) What is a positive result for the straight leg test?
2) What test should be performed following a positive result? Explain how to perform it. 3) What is the relevance of this additional test? |
1) Lower back pain on the involved side which shoots down the leg.
2) Braggard’s test. Lower the leg just until the pain goes away and dorsiflex the foot. 3) If the pain is reproduced (positive test), this confirms a lower back problem. If negative, the pain is due to tight hamstrings. |
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Explain how to perform the Thomas test, what a positive test is, and what results indicate.
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The physician pushes the thigh (knee flexed) towards the patient’s chest while monitoring the contralateral popliteal fossa.
A positive test is the contralateral thigh and knee raising often the table. This indicates a shortened psoas muscle. |
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A posterior sacral ILA is also?
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Inferior
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An anterior sacral ILA is also?
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Superior
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In short leg syndrome, does the lumbar spine side bend toward the long or short leg?
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The long leg
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State what occurs at each of the three transverse axes of the sacrum.
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Superior – Motion from respiration
Middle – Forward and backward bending of the sacrum Inferior - Rotation of the innominates |
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Give the rules for determining how L5 will sidebend and rotate relative to oblique sacral dysfunctions.
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L5 will always rotate opposite of the sacrum's rotation. L5 will side bend toward the side of the oblique axis
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A neutral oblique sacral dysfunction is called __________ sacral torsion.
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Forward
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A non-neutral oblique sacral dysfunction is called ____________ sacral torsion.
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Backward
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Explain the nomenclature behind oblique sacral dysfunction (for example, what is meant by right on left)?
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The first term is the rotation direction; the second is the side of the axis. So, “right on left” means a right rotation on a left oblique axis.
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Which sacral oblique axis gets engaged during walking: the weight bearing or non-weight bearing side?
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The weight bearing side
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What pubic symphysis dysfunction is common with pregnancy and childbirth?
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Abduction
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What is the only difference between performing muscle energy for a posterior innominate versus a superior pubic shear?
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When doing it for a superior pubic shear, you stand between the patients legs so you can abduct the knee thereby gapping the pubic symphysis.
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At what vertebral level are the iliac crests found?
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L4
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For a superior innominate shear, list what the following physical findings would be: iliac crest, ASIS, PSIS, pubic ramus, medial malleolus
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All findings would be more superior on dysfunctional side.
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Give two alternate names for an abducted and adducted innominate.
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Abducted – Lateral or out-flare
Adducted – Medial or in-flare |
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Give an alternate name for an up-slipped and down-slipped innominate.
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Up-slipped: Superior shear
Down-slipped: Inferior shear |
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What is the most common innominate dysfunction?
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Anterior rotation
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What type of trauma typically leads to superior innominate shear?
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Fall on an ischial tuberosity
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For a inferior innominate shear, list what the following physical findings would be: iliac crest, ASIS, PSIS, pubic ramus, medial malleolus
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All findings would be more inferior on dysfunctional side.
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With a posterior innominate, which side would have a shorter leg?
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The side of the dysfunction
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Explain the difference in skin temperature and moisture found in acute versus chronic dysfunctions.
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Acute – Skin will be moist and have an elevated temperature
Chronic – Skin will be dry and have a closer to neutral temperature (might be slightly elevated or depressed) |
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Will edema and tenderness be found in an acute or chronic somatic dysfunction?
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Tenderness would be found in both
Edema would only be found in an acute dysfunction. |
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Explain how the erythema test can help segregate between acute and chronic somatic dysfunctions.
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If acute, the redness will last.
If chronic, the redness will fade quickly or blanching will occur. |
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Explain how skin texture can help segregate between acute and chronic somatic dysfunction.
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Acute: Skin will rough and boggy
Chronic – Skin will be thin/ropy/stringy |
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On what axis does a sagittal plane rotate?
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A transverse (horizontal) axis
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On what axis does a transverse plane rotate?
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A longitudinal axis
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On what axis does a coronal plane rotate?
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An anteroposterior axis
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Briefly explain type III mechanics.
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Type III mechanics states that motion in one plane will affect and modify motion in other planes.
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Describe the orientation of the superior facets in the cervical, thoracic, and lumbar spines. What acronyms can help you remember?
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Cervical: BUM – Backward, upward, medial
Thoracic: BUL – Backward, upward, lateral Lumbar: BM – Backward, medial |
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What locations are typically weak points in the vertebral column?
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Transition areas between one section and another
(Occipito-atlantal, C7-T1, T12-L1, L5-S1) |
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Pain in what spinal segment is associated with asthma?
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T2
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What type of dysfunction is characterized by returning within 24 hours after correction?
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Chronic viscerosomatic dysfunctions
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For a patient crutches, what should they lead with going up and down stairs?
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Up stairs – Lead with the good leg
Down stairs – Lead with crutches |
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For a posterior rotated innominate, list what the following physical findings on the dysfunctional side would be: ASIS, PSIS, medial malleolus, sacral sulcus
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ASIS - Superior
PSIS - Inferior Medial malleolus - Superior Sacral sulcus - Deeper |
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For a anterior rotated innominate, list what the following physical findings on the dysfunctional side would be: ASIS, PSIS, medial malleolus, sacral sulcus
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ASIS - Inferior
PSIS - Superior Medial malleolus - Inferior Sacral sulcus - Shallower |
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How can one diagnose an innominate in-flare or out-flare?
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Compare the distance of each ASIS to the umbilicus. If they are asymmetrical one can use standing flexion to see on which side the dysfunction is on.
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For an innominate out-flare, would sacral sulcus be deeper or more narrow?
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More narrow
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An inferior pubic shear can mimic a ____________ innominate rotation.
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Anterior
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An superior pubic shear can mimic a ____________ innominate rotation.
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Posterior
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Name something that can create a false positive in the standing flexion test.
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Tight hamstrings contralateral to the “positive” side.
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The lumbosacral spring test will only be positive under what circumstance?
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If part of the sacral base has moved posteriorly. (sacral extension, non-neutral oblique dysfunction)
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Assume that a patient has an oblique axis dysfunction of the sacrum. What can the lumbosacral spring test tell you? How?
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If the dysfunction is neutral or non-neutral. A positive spring test means there is a non-neutral dysfunction. A negative test means there is a neutral dysfunction.
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There is only one case in which the spring and sphinx test can have different results. What is it and what are the results?
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A bilateral sacral extension. In this case the spring test will be positive and the sphinx test will be negative.
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Give an alternate name for the sphinx test.
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The backward bending test.
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In the case of bilateral sacral flexion, what would the results of the sphinx and spring tests be?
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Both would be negative.
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For bilateral sacral extension, will the sacrotuberous ligaments be tight or loose?
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Loose bilaterally
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During gait, the side of the oblique axis of the sacrum will always match the side of what?
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The weight bearing leg
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With a left on left sacral dysfunction, how would L5 be oriented?
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Sidebend left, rotated right
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Would part of the sacral base be posterior, giving a positive spring/sphinx test, with a neutral or non-neutral torsion?
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Non-neutral
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Give four differentials for a positive seated flexion test on the left.
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Right on right
Left on right Left unilateral sacral flexion Left unilateral sacral extension |
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List the following physical findings for a left on left sacral dysfunction (list relative to left side): Sacral sulcus, sacral base, ILA, sacrotuberous ligament, spring test, sphinx test
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Sacral sulcus – Shallow on left
Sacral base – Posterior on left ILA – Posterior and inferior on left Sacrotuberous ligament – Tight on left Spring test - Negative Sphinx test - Negative |
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List the following physical findings for a right on right sacral dysfunction (list relative to right side): Sacral sulcus, sacral base, ILA, sacrotuberous ligament, spring test, sphinx test
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Sacral sulcus – Shallow on right
Sacral base – Posterior on right ILA – Posterior and inferior on right Sacrotuberous ligament – Tight on right Spring test - Negative Sphinx test - Negative |
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List the following physical findings for a right on left sacral dysfunction (list relative to left side): Sacral sulcus, sacral base, ILA, sacrotuberous ligament, spring test, sphinx test
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Sacral sulcus – Deep on left
Sacral base – Anterior on left ILA – Anterior and superior on left Sacrotuberous ligament – Loose on left Spring test - Positive Sphinx test - Positive |
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List the following physical findings for a left on right sacral dysfunction (list relative to right side): Sacral sulcus, sacral base, ILA, sacrotuberous ligament, spring test, sphinx test
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Sacral sulcus – Deep on right
Sacral base – Anterior on right ILA – Anterior and superior on right Sacrotuberous ligament – Loose on right Spring test - Positive Sphinx test - Positive |
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List the following physical findings for a right unilateral sacral flexion:
Right sacral sulcus Right sacral base Right ILA Sphinx test Spring test |
Right sacral sulcus - Deeper
Right sacral base - Anterior Right ILA – Posterior/Inferior Sphinx test - Negative Spring test - Negative |
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List the following physical findings for a right unilateral sacral extension:
Right sacral sulcus Right sacral base Right ILA Sphinx test Spring test |
Right sacral sulcus - Shallower
Right sacral base - Posterior Right ILA – Anterior/Superior Sphinx test – Positive Spring test - Positive |
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Give four differentials for a positive lumbosacral spring test.
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Left on right
Right on left Unilateral sacral extension Bilateral sacral extension |
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Assuming the patient has a sacral dysfunction, give four differentials for a negative lumbosacral spring test.
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Left on left
Right on right Unilateral sacral flexion Bilateral sacral flexion |
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Give four differentials for a positive seated flexion test on the right.
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Left on Left
Right of Left Right unilateral sacral flexion Right unilateral sacral extension |
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If the base and ILA on one side of the sacrum are either both anterior or both posterior, what type of dysfunction must have occurred?
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An oblique dysfunction
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When performing muscle energy of an neutral oblique sacral dysfunction, what side should the patient have upward prior to hugging the table?
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The side opposite of the oblique axis. (Axis side down)
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What does the term “sacral shear” refer to?
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Unilateral sacral flexion or extension
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What spinal segments provide sympathetic innervation to the lower limbs?
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T11 through L2
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Explain how to perform Ober’s test. What is a positive result and what does it indicate?
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Patient lies lateral recumbent with testing side up. Stabilize the hip and knee and extend hip slightly. Then adduct the hip toward the table.
Being unable to adduct past midline is a positive result. It indicates contracture of the iliotibial band or tensor fascia latae. |
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Explain how to perform the Trendelenburg test. What is a positive test and what does it indicate?
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Have the patient stand on one foot while flexing the opposite knee.
The pelvis should stay level. If not, this is a positive sign indicating weakness the gluteus medius (superior gluteal nerve) on the weight-bearing side. |
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Terrible triad usually occurs due to _________ force to the knee
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Valgus
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What is chondromalacia patellae? What typically causes it?
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Wearing/roughening of the posterior articular surface of the patellofemoral joint. It is typically caused by overuse.
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What is patellofemoral syndrome? Name three possible causes.
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Improper tracking of the patella. Possible causes include increased Q-angle, weakness of the vastus medialis, or overuse.
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Explain the relationship between anterior/posterior motions of the fibular head versus the distal fibula.
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The motions are reciprocal (posterior fibular head = anterior distal fibula and vice versa)
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Explain the relationship between distal fibula motion and foot inversion/eversion.
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Foot inversion = anterior distal fibula
Foot eversion = posterior distal fibula |
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When the fibular head is posterior, it also has a minor _________ glide.
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Medial
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When the fibular head is anterior, it also has a minor _________ glide.
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Lateral
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What fibular head motions will be created by a posterolateral and anteromedial tibia?
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Posterolateral tibia – Posteromedial and inferior fibular head
Anteromedial tibia – Anterolateral and superior fibular head |
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State how to perform the McMurray test, what a positive result is and what results indicate.
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With patient supine, flex both hip and knee to 90 degrees. Place one hand on the knee and the other at the heel.
To test medial meniscus, extend and externally rotate with distal hand and apply valgus stress with proximal hand. To test lateral lemniscus, extend and internally rotate with distal hand and apply varus stress with proximal hand. A click accompanied by pain indicates a tear. |
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Which is more sensitive for ACL instability: the anterior drawer or Lachman’s test?
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Lachman’s test is more sensitive.
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Name the components of pes planus and pes cavus
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Pes planus – longitudinal and transverse arches fall, talocalcaneal axis more horizontal, tarsal somatic dysfunction, navicular prominence on medial side of foot
Pes cavus – longitudinal and transverse arches rise, talocalcaneal axis more vertical, navicular less prominent |
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State how the following ipsilateral structures would be affected by an inversion ankle sprain:
Calcaneus Talus Fibular head Tibia Femur |
Calcaneus - Eversion
Talus – Posterolateral glide Fibular head - Posterior Tibia – External rotation with anteromedial glide Femur – Internal rotation |
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State how the following structures would be affected by an inversion ankle sprain:
Ipsilateral innominate Sacrum Lumbar vertebrae |
Ipsilateral innominate – Posterior rotation
Sacrum – Neutral ipsilateral oblique axis dysfunction Lumbar vertebrae – Neutral dysfunction with ipsilateral sidebend and contralateral rotation |
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Explain how to perform the “bounce home test,” what a positive result is, and what it indicates.
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With patient supine, hold the ankle. Flex the knee then allow it to go into full extension.
Incomplete extension or a slight bounce is a positive result, which indicates effusion or a torn meniscus. |
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Explain how to perform the patellar grinding (aka apprehension) test, what a positive result is, and what it indicates.
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With the patient supine, push the patella distally while the patient tightens their quadriceps.
Patellar movement should be gliding and smooth. Roughness, crepitation, or pain/discomfort is a positive result. It indicates problems with the patellar articulating surfaces and/or the trochlear groove of the femur. |
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With an anterior fibular head, how might the following structures be affected:
Lateral malleolus Talus |
Lateral malleolus – May be held posterior and restricted in anterior glide
Talus – May be held in dorsiflexion and eversion |
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With a posterior fibular head, how might the following structures be affected:
Lateral malleolus Talus |
Lateral malleolus – may be held anterior and restricted in posterior glide
Talus – May be held in plantar flexion and inversion |
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Explain the acronyms DEA and PIP as they apply to the fibular head.
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DEA – Dorsiflexion and eversion move the fibular head anterior.
PIP – Plantar flexion and inversion move the fibular head posterior. |
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What suture forms the jugular foramen? What two bones make it up?
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The occipitomastoid suture, which is made from the occipital and temporal bones.
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What spinal levels contribute sympathetic innervation to the following structures:
Respiratory system Appendix Adrenal medulla Lower extremities |
Respiratory system – T2 through T8
Appendix – T12 Adrenal medulla – T10 Lower extremities – T11 through L2 |
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What gives parasympathetic innervation to the left and right colon?
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Right colon – Right vagus nerve
Left colon – Pelvic splanchnic nerves |
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Where are the anterior adrenal and kidney Chapman’s points relative to the umbilicus?
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Adrenal – 2 inches superior and 1 inch lateral to the umbilicus
Kidney – 1 inch superior and 1 inch lateral to the umbilicus |
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Where are the posterior Chapman’s reflex points for the following viscera:
Appendix Adrenal glands Kidney’s |
Appendix – At the T11 transverse process
Adrenal glands – Between spinous and transverse process of T11 and T12 Kidney’s – Between spinous and transverse process of T12 and L1 |
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Name the ten principles (dysfunctions) of the common compensatory pattern.
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Innominate – Anterior rotation on right
Sacrum – Left on left torsion Lumbosacral junction (L5) - SLRR Thoracolumbar junction – SLRL Tenth Rib – Posterior on Left Fifth Rib – Elevated on left T3 - SRRR First rib – Elevated on Left T1 - SRRR Upper Cervical Complex (OA) – SRRL |
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Where is the anterior Chapman reflex point for the bladder?
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In the periumbilical region
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Which nerve roots can be involved in sciatica? 95% of cases involve which two?
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Anything from L4 to S3; L5 or S1
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Describe how to locate the piriformis tender point.
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First, locate the point halfway between the PSIS and ipsilateral ILA of the sacrum.
Then, find the point halfway between that point and the greater trochanter of the femur. |
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Describe the patient position for piriformis counterstrain
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With patient prone, flex hip to 135 degrees, abduct, and externally rotate. Flex the knee.
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Describe the typical pain pattern of piriformis syndrome.
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Hip and buttock pain which radiates down the posterior thigh, but not past the knee.
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Name four other somatic dysfunctions which may occur along with psoas syndrome.
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Non-neutral L1 and/or L2 dysfunction – usually flexed and to same side as syndrome
Oblique sacral dysfunction on same side as syndrome Pelvis shift to opposite side Piriformis spasm and resulting sciatic irritation on opposite side |
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What two viscera contact the psoas fascia?
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Sigmoid colon and ureters
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Why can psoas syndrome be caused by a viscerosomatic reflex?
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Because the psoas fascia touches the sigmoid colon and ureters.
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Sphenobasilar synchondrosis (SBS) is an articulation between which bones?
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Sphenoid + occiput
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Normal rate of CRI?
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8-12 or 10-14 cycles per minute (depending on text)
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Three causes of increased CRI rate?
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Fast metabolism, acute infection, vigorous exercise
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Three causes of decreased CRI rate?
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Slow metabolism, chronic infection, fatigue
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Three causes of low CRI amplitude?
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Aging, dural tension, sphenobasilar compression
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Cause of high CRI amplitude?
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Increased intracranial pressure
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Relationship between the anatomically motion of sphenoid versus occiput during normal cranial motion?
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Always opposite (one flexes while other extends)
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Relationship between motion of the occiput versus the sacrum?
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The same (both flexing or extending)
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List the five rules of cranial motion:
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Midline bones follow flexion/extension
paired bones follow internal/external rotation sacrum follows occiput temporals follow occiput facial bones follow the sphenoid |
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Frontal and mandible are ___________ bones
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PAIRED
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Is the sacrum considered a midline or paired cranial bone?
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Midline
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Name three paired cranial bones
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Frontal, parietal, temporal
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Name four midline cranial bones
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Sphenoid, occiput, ethmoid, sacrum
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Name a midline facial bone
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Vomer
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Bones making up the pterion? (four)
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Frontal, parietal, sphenoid, temporal
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Bones making up the asterion?
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Parietal, temporal, occiput
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Bones making up the lambda?
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Parietals x 2, Occiput
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Lambdoid suture is between which bones?
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Occiput + parietal
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Coronal suture is between which bones?
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Frontal + parietal
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Sagittal suture is between which bones?
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Parietal + parietal
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Two cranial nerve foramen which can be affected by sternocleidomastoid dysfunction? Why?
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Jugular or stylomastoid. Mastoid process attaches to temporal bone
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Bones making up the jugular foramen?
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Temporal and occiput
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Superior orbital fissure, optic canal, foramen rotundum, and foramen ovale are all found in what bone?
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Sphenoid
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What bone is the internal acoustic meatus in?
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Temporal
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Innervation of the tentorium and supratentorial dura
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Trigeminal
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OMM tx for infant with failure to suckle?
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Condylar decompression and petrosquamous release
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Cranial OMM cause of dizziness, tinnitus, or vertigo
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Temporal bone dysfunction
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Characterize the anatomical movements of the sphenoid, occiput, and sacrum during cranial flexion
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Sphenoid flexes; occiput and sacrum extend
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Characterize the anatomical movements of the sphenoid, occiput, and sacrum during cranial extension
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Sphenoid extends; occiput and sacrum flex
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Alternate name and location of craniosacral axis
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Also called superior transverse axis of the sacrum. Transverse through S2
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Change in transverse and A/P cranial diameters with cranial flexion?
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Transverse increased, A/P decreased
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Change in transverse and A/P cranial diameters with cranial extension?
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Transverse decreased, A/P increased
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Movement in paired and midline bones during cranial flexion?
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Paired bones externally rotate, midline bones flex
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Axis direction in torsional strain?
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Anteroposterior
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Relationship between movement of sphenoid/occiput in torsional strain?
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Opposite rotations (around A/P axis)
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How are torsional strains named (left vs right)?
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For which greater wing of the sphenoid is higher
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In a right torsion, the left greater wing of the sphenoid would be?
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Lower
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In cranial sidebending/rotation, which side "drops"
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The convex side (the side the dysfunction is named for)
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How many axes in cranial sidebending/rotation? What direction?
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Three. Two vertical and one A/P
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In sidebending/rotation, the occiput and sphenoid move opposite around the ________ axis, but the same around the ______ axis
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Opposite around vertical axes, together around A/P axis
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How is cranial sidebending/rotation named?
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By the side of the convexity (the side the "opens up")
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In sidebending/rotation, which hand feels "fuller?"
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The hand on the side of the dysfunction (convex side)
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Location and direction of the axes in lateral strains?
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2 vertical; one through sphenoid, one through foramen magnum
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In lateral strain, sphenoid and occiput rotate in the _________ direction
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Same
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How are lateral strains named?
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According to the location of the base of the sphenoid
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Number and direction of axes in vertical strains?
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Two parallel transverse axes
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In vertical strain, sphenoid and occiput rotate in the _________ direction
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Same (both anatomically flex or extend)
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How are vertical strains named?
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For the direction the sphenoid moves relative to the occiput
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Usual cause of SBS compression
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Trauma (particularly to back of head)
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Position of index, middle, ring, and pinky fingers during vault hold?
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Index - greater wings of sphenoid, Middle - zygomatic processes of temporal bone, Ring - Mastoid processes of temporal bones, Pinky - squamous portion of occiput
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Define nutration and counternutration
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Nutation - sacral base moves anterior, counternutation - moves posterior
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During cranial flexion, extremities ___________ rotate.
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Externally
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Cranial OMM technique that can induce labor
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CV-4
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CV-4 is used to treat the?
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Medulla (in the fourth ventricle)
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Autonomic affects of CV-4
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Decreases overall sympathetic tone
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For a right torsion, list the position (superior/inferior) for each side of the sphenoid and occiput
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Right sphenoid: superior, left sphenoid: inferior, right occiput: inferior, left occiput: superior
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For a left torsion, list the position (superior/inferior) for each side of the sphenoid and occiput
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Right sphenoid: inferior, left sphenoid: superior, right occiput: superior, left occiput: inferior
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For a torsion, give the following ipsilateral findings: orbit, eye, frontal bone, ear, mastoid tip
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Orbit - wide, Eye - protruded, Frontal - full, Ear - away from head, Mastoid tip - posteromedial
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For a torsion, give the following contralateral findings: orbit, eye, ear
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Orbit - narrow, Eye - retruded, Ear - closer to head
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Around what axis does cranial "sidebending" occur?
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Vertical
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Around what axis does cranial "rotation" occur?
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Anteroposterior
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Vault hold findings for sidebending rotation?
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Finger spread, inferior movement, and fuller feeling on side of dysfunction. Opposite on contralateral side
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Vault hold findings for torsion?
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Hand on side of dysfunction rotates towards the operator, other one away
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For sidebending rotation, give the following ipsilateral findings: Orbit, Eye, Frontal bone, Ear, Mastoid tip
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Orbit - narrow, Eye - retracted, Frontal - flat, Ear - away from head, Mastoid tip - posteromedial
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For a left sidebending/rotation, list the position (A/P and superior/inferior) for each side of the sphenoid and occiput
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Right sphenoid: posterosuperior, Left sphenoid: anteroinferior, Right occiput: anterosuperior, Left occiput: Posteroinferior
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For a right sidebending/rotation, list the position (A/P and superior/inferior) for each side of the sphenoid and occiput
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Right sphenoid: anteroinferior, Left sphenoid: posterosuperior, Right occiput: Posteroinferior, Left occiput: anterosuperior
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In superior vertical strain, list the position of the sphenoid, occiput, or temporals (cranial position, not anatomical)
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Sphenoid in flexion, occiput in extension, temporals externally rotated
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In inferior vertical strain, list the position of the sphenoid, occiput, or temporals (cranial position, not anatomical)
|
Sphenoid in extension, occiput in flexion, temporals externally rotated
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List the vault hold findings for superior vertical strain
|
Forefingers move inferiorly, while little fingers move superiorly, both hands move inferiorly
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List the vault hold findings for inferior vertical strain
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Forefingers move superiorly, little fingers move inferiorly, both hands move superiorly
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Blow on top head of head posterior to SBS will cause?
|
Superior vertical strain
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Blow on top head of head anterior to SBS will cause?
|
Inferior vertical strain
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Blow from below the head posterior to SBS will cause?
|
Inferior vertical strain
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Blow from below the head anterior to SBS will cause?
|
Superior vertical strain
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For a superior vertical strain, list the position (superior/inferior) for each side of the sphenoid and occiput
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Sphenoid (both sides) inferior, Occiput (both sides) superior
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For an inferior vertical strain, list the position (superior/inferior) for each side of the sphenoid and occiput
|
Sphenoid (both sides) superior, Occiput (both sides) inferior
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In a left lateral strain, which way will the bases of the sphenoid and occiput move?
|
Sphenoid left, occiput right
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In a right lateral strain, which way will the bases of the sphenoid and occiput move?
|
Sphenoid right, occiput left
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Vault hold finding for lateral strain?
|
Little fingers shift toward dysfunction side, forefingers shift away (form a parallelogram)
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For a left lateral strain, list the position (A/P and medial/lateral) for each side of the sphenoid and occiput
|
Right sphenoid: Posterolateral, Left sphenoid: Anteromedial, Right occiput: Posteromedial, Left occiput: anterolateral
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For a right lateral strain, list the position (A/P and medial/lateral) for each side of the sphenoid and occiput
|
Right sphenoid: Anteromedial, Left sphenoid: Posterolateral, Right occiput: Anterolateral, Left occiput: Posteromedial
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Describe SBS compression
|
Sphenoid and occiput compress together on an anteroposterior axis
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Vault hold findings for SBS compression
|
Fingers of both hands approximate, distance between sphenoid and occipital angles reduced, motion is reduced
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Effects of early and late of pregnancy on innominate
|
Early - posterior rotation. Late - anterior rotation, pressure on pubis
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Levels for sympathetic innervation of fallopian tubes and vagina
|
T11-12
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Levels for sympathetic innervation of uterus and cervix
|
T10-L2
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Treat to decreased uterine pain threshold: sympathetic or parasympathetic
|
Sympathetic (you want to decrease sympathetic tone)
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Treat to decreased cervix pain threshold: sympathetic or parasympathetic
|
Parasympathetic (you want to decrease parasympathetic tone)
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Treat to cause uterine relaxation: sympathetic or parasympathetic
|
Parasympathetic (you want to decrease parasympathetic tone)
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|
Chapman points for uterus (anterior and posterior)
|
IT band, anterior pubic bone, transverse process of L5
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Chapman points for ovaries (anterior and posterior)
|
Ramus of pubic bone and transverse process of T10
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|
Chapman point for fallopian tubes
|
PSIS
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Chapman points for vagina
|
Sacral base, medial posterior thigh
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Chapman points for broad ligament
|
IT band, sacral base
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Technique which pumps eustachian tube
|
Galbreath
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|
Maneuver to fix nursemaid's elbow
|
Simultaneous supination /extension or forearm, followed by flexion (still supinated)
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In what muscle can a trigger point have a roll in initiating or perpetuating supraventricular tachyarrhythmia?
|
The right pectoralis major
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What spinal segments contribute sympathetic innervation to the heart? Does the right or left side provide more dominance?
|
T1-T6. The left side is more dominant.
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True or false: Increased sympathetic tone adversely affects degree of recovery post-MI.
|
TRUE
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Explain the relationship between autonomic tone and development of collateral circulation.
|
Increased sympathetic tone inhibits development of collateral circulation.
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Deep pressure over which skull suture is likely to reflexively slow the heart?
|
The occipitomastoid suture
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What is the main goal of manipulation in post-MI or HTN patients?
|
To lower sympathetic tone.
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For what period of time post-MI should you limit yourself to indirect and soft tissues techniques?
|
At least 72 hours
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|
Describe the effect on the heart of hypertonicity of the right versus left vagal nerves.
|
Right – Could lead to bradyarrhythmia
Left – Could cause AV block |
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|
Where is the right pectoralis major trigger point found?
|
Fifth intercostal space
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|
List the segments of somatic dysfunction typically associated within anterior versus inferior wall MI.
|
Anterior Wall – T2-T3 on the left
Inferior wall – T3-T5 on the left, C2 |
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|
In what three spinal segments has a significant correlation between hypertension and somatic dysfunction been found?
|
C6, T2, T6
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Dose sympathetic stimulation increase or decrease goblet cell production and the number of ciliated cells?
|
Goblet cell production is increased.
Number of ciliated cells is decreased. |
|
|
Does vagal stimulation have a net effect of thinner or thicker mucous? Explain why.
|
Thinner. Secretion by goblet cells decreases and number of ciliated cells increases.
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List the posterior Chapman’s points for the bronchi, upper lung, and lower lung.
|
Bronchi – Midway between spinous and transverse processes of T2
Upper Lung - Midway between spinous and transverse processes of T3 and T4 Lower Lung - Midway between spinous and transverse processes of T4 and T5 |
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|
When treating a patient with bronchospasm, should sympathetics or parasympathetics be treated first? Why?
|
Parasympathetics. It is important to first eliminate any neurally mediated bronchoconstriction. If sympathetics are treated first, the patient may go into acute refractory bronchospasm.
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|
Will coughing create a tendency for inhalation or exhalation rib dysfunctions? What muscle will pain felt in?
|
Exhalation dysfunctions. Pain will be felt in the serratus anterior.
|
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|
In order to prevent post-op pneumonia, what areas should be treated before and after the operation?
|
Before: C3-C5
After: C3-C5 and rib raising |
|
|
Give the anterior counterstrain points for the first six ribs.
|
First rib – At articulation with the manubrium
Second rib – On the rib in the midclavicular line Ribs 3-6 – On the rib in the anterior axillary line |
|
|
Give the posterior counterstrain points for the first six ribs.
|
First rib – At the cervicothoracic junction, anterior to the trapezius
Ribs 2-6 – Superior surface of rib angles |
|
|
Out of anterior and posterior rib counterstrain points, which generally corresponds to an elevated rib and which to a depressed rib?
|
Anterior – Usually a depressed rib
Posterior – usually an elevated rib |
|
|
In what spinal segments would somatic dysfunction from diverticulitis be expected?
|
T12-L2 (remember, diverticulitis typically affects the sigmoid colon)
|
|
|
From which spinal segments to the least and lumbar splanchnic nerves carry sympathetic innervation?
|
Least: T12
Lumbar: L1-L2 |
|
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What effect will sympathetic stimulation have on lower esophageal sphincter tone?
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Decreases it
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What effect will sympathetic stimulation have on mucosal defense against digestive acids and enzymes?
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Decreases it
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At what point along the GI tract does sympathetic innervation transition from the lesser to least splanchnic nerves?
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2/3 of the way along the transverse colon
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At what point in the GI tract does parasympathetic innervation transition from the vagus to pelvic splanchnic nerves?
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Halfway through the colon.
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List the group of somatic dysfunctions collectively referred to as the upper GI reflex.
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C2 left
T3 right T5 left T7 right |
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Where is the posterior chapman point for the pancreas?
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Between the transverse processes of T7-T8 on the right
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Would sympathetic tone cause constriction or relaxation of the gall bladder and bile ducts?
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Relaxation (causing them NOT to secrete)
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Give the viscera represented by iliotibial band Chapman points for both left and right side. List from proximal to distal.
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Right – Ileocecal, Ascending colon, Hepatic flexure, Right 2/5 of transverse colon
Left – Sigmoid, Descending colon, Splenic flexure, Left 3/5 of transverse colon |
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List chapman’s points (be specific) for the following viscera:
Ileocecal Descending colon Sigmoid colon Ascending colon |
Ileocecal – Right proximal IT band
Descending colon – Left middle IT band Sigmoid colon – Left proximal IT band Ascending colon - Right middle IT band |
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List chapman’s points (be specific) for the following viscera:
Hepatic flexure Right 2/5 of transverse colon Left 3/5 of transverse colon Splenic flexure |
Hepatic flexure – Right middle IT band
Right 2/5 of transverse colon – Right distal IT band Left 3/5 of transverse colon – Left distal IT band Splenic flexure – Left middle IT band |
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List the anterior Chapman points (in reference to the umbilicus) for:
Adrenals Kidneys Bladder |
Adrenals – One inch lateral and two inches superior to the umbilicus
Kidneys – One inch lateral and one inch superior Bladder - Periumbilical |
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At what spinal segments are the posterior chapman points for:
Adrenals Kidneys Bladder |
Adrenals – T11 and T12
Kidneys – T12 and L1 Bladder – L1 and L2 |
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Where is the anterior Chapman point for the urethra?
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Superior margin of pubic ramus about 2 cm lateral to the pubic symphysis.
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What spinal segments supply sympathetic innervation to the ureters?
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Upper half: T10-T11
Lower half: T12-L2 |
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Do the ureters receive parasympathetic innervation from the vagus or pelvic splanchnic nerves?
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The upper half – Vagus nerve
Lower half – Pelvic splanchnics |
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State the effect of sympathetic stimulation on the following:
Trigone muscle Internal urethral sphincter Micturition reflex |
Trigone muscle - Contracted
Internal urethral sphincter - Contracted Micturition reflex - Inhibited |
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Where is the tender point for the inguinal ligament?
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On the lateral border of the pubic bone near the inguinal ligament’s attachment.
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What spinal segments contribute sympathetic innervation to cause ejaculation?
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T12-L2
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What contributes parasympathetic innervation to the prostate and genitals?
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S2-S4 (pelvic splanchnics)
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Where is the Chapman point for the prostate?
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Posterior margin of iliotibial band.
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Can laryngitis/hoarseness be secondary to increased sympathetic or parasympathetic tone?
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Sympathetic
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Which cranial nerves carry parasympathetics?
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3, 7, 9, 10
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Name the parasympathetic ganglia associated with CN’s III, VII, and IX
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III – Ciliary
VII – Pterygopalatine and Submandibular IX - Otic |
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Name the gland innervated and the CN carried for:
Submandibular Ganglion Otic Ganglion Pterygopalatine Ganglion |
Submandibular Ganglion – Salivary gland, CNVII
Otic Ganglion – Parotid gland, CN IX Pterygopalatine Ganglion – Lacrimal gland, CN VII |
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What is sphenopalatine syndrome and what are its symptoms?
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Irritation of the sphenopalatine (pterygopalatine) ganglion. Causes red, engorged mucous membranes, photophobia, tearing, and pain behind the eye, nose, neck, ear, and temple.
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What is Muncie technique used to treat?
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The sphenopalatine ganglion
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Are photophobia and tinnitus associated with sympathetic or parasympathetic overstimulation?
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Sympathetic
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Is hyperesthesia and thickened secretion in pharyngeal tissue associated with sympathetic or parasympathetic activity?
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Sympathetic
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Anterior and posterior chapman points for sinuses.
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Anterior – 7-9 cm lateral to sternum on upper edge of second rib
Posterior – C2 midway between spinous and transverse processes |
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Anterior and posterior chapman points for pharynx
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Anterior – On first ribs 3-4 cm medial to where ribs emerge from beneath the clavicles
Posterior – C2 midway between spinous and transverse processes |
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Anterior and posterior chapman points for larynx
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Anterior – On second ribs, 5-7 cm lateral to sternocostal junction
Posterior - C2 midway between spinous and transverse processes |
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Anterior and posterior chapman points for middle ear
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Anterior – Superoanterior aspect of clavicles just lateral to where they cross first ribs
Posterior – Posterior aspect of tips of C1 transverse processes |
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Anterior chapman points for tonsils
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Anterior – Between first and second ribs adjacent to sternum
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Anterior and posterior chapman points for eye
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Anterior – Anterior aspect of humerus at surgical neck
Posterior – Squamous portion of occipital bone below superior nuchal line |
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Describe the sounds created by an internally versus externally rotated temporal bone. Why does this occur?
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Internal – Creates a high pitched ringing, due to closing of eustachian tube
External – Creates low pitched roar, due to opening of eustachian tube |
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Two techniques for pterygopalatine fossa drainage
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Mandibular decongestion
Gallbreath |
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Two areas that should be treated with recurrent otitis media
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Temporal bones
Pterygopalatine fossa |
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What way does the mandibular head glide when the mouth opens and closes?
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Opens – Anteriorly
Closes - Posteriorly |
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Does the jaw deviate toward the restricted or unrestricted side?
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Restricted
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Do the articular discs of the TMJ move anteriorly or posteriorly when the jaw protrudes?
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Posteriorly
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What muscle should be stretched when treating TMJ with OMT?
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Lateral Pterygoid
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Where is the tender point for the masseter? Describe how to perform the counterstrain.
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Just inferior to the zygoma (in the belly of the muscle)
Have patient slightly open jaw, then deviate it toward the dysfunctional side |
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Where is the tender point for the medial pterygoid? Describe how to perform the counterstrain.
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Just under angle of mandible or 2 cm above it
Have patient slightly open jaw, then deviate it away from dysfunctional side |
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Signs of a horizontally flexed clavicle
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More posterior statically, remains posterior upon shoulder protraction
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Horizontally flexed clavicle is restricted in ___________ motion
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Anterior
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Back of leg pain + frequent use of large wallet = ?
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Piriformis syndrome
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Alternate name for CV4
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Bulb decompression
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How to dx abducted and adducted clavicle
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Abducted = inferior, adducted = superior. Abducted will be symmetrical with shoulder shrug, adducted will not
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Name a contraindication for ALL lymphatic techniques
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Fever over 102
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Tender point that may be treated to reduce coronary artery spasm
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Left pectoralis
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Motion of the coccyx during craniosacral motion
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Anterior during flexion, posterior during extension
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OMM contraindicated in infected skin lesions? What can be used as a substitute?
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All direct lymphatic techniques (effleurage, petrissage, etc). Just elevate instead to relieve edema
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Ferguson angle of 15 degrees (normal 25-35) indicates what? What muscle is likely involved?
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Lumbosacral strain, psoas muscle contracture
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CV4: encouraging flexion or extension
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Extension
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Chapman point for terminal ileum
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Right proximal femur
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Is scoliosis named for concave or convex side?
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Convex side
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Way you would be sidebent in levoscoliosis
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To the right (levo = left, so convex on left)
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Primary internal rotator of shoulder
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Subscapularis
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Motions of teres major
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Internal rotation, adduction, extension
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Primary action of infraspinatus
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Arm external rotation
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Rotation direction of teres minor
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External
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Chapman point for rectum
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Superior medial thigh
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Innominate compensation for short leg
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Ipsilateral anterior rotation
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The sella turcica is part of what bone?
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Sphenoid
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With abducted clavicle, the sternoclavicular head will be?
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Inferior
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Parasympathetic innervation of ovaries?
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Vagus
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Single segment sympathetic innervation of adrenal medulla
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T10
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Counterstrain point for rib 4 exhalation
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Midaxillary line on rib 4
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Innervation level for sinuses
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T2-T4
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Alternate name for adducted/abducted clavicle
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Adducted = superior, abducted = inferior
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Posterior Chapman point for appendix
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Transverse process of T11
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Cranial nerves affected in poor suckling disorder
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9, 10, 12
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