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143 Cards in this Set
- Front
- Back
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Person who Defined the dysfunctional motions of the bones and joints of the skull
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William Garner Sutherland, D.O.
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Juncture of Coronal & Sagital Sutures
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Bregma
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Juncture @ the posterior end of the sagital suture
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Lambda
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Shape and motion of Serrate suture
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sawtooth - rocking
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Shape and motion of Squamous suture
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scale-like - Gliding motion
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Shape and motion of Harmonic suture
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edge to edge motion - allowing shearing motion
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Shape and motion of Squamoserrate suture
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Combination
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____ junction is the reference point around which diagnostic motion patterns are described
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Sphenobasilar
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A model describing the interdependent functions among five body components
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PRIMARY RESPIRATORY MECHANISM (PRM)
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If oligodendroglia do not contract, the brain and spinal cord (CNS) would have to ___ to accommodate the changes in shape of the cranium during the cranial rhythmic impulse
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change shape
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Wavelike motion of fluid felt by palpation
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2. Fluctuation of the CSF and the Potency of the Tide
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The motility of the CNS combined with fluctuation of CSF manifests itself as a_____
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hydrodynamic activity
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Pressure gradients produced by production and release of CSF into the cranial cavity by the ___ in the ventricles, and drainage of CSF into the venous system
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choroid plexus
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CSF produced in the ____ of the lateral, 3rd, and 4th ventricles
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choroid plexuses
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CSF flows from the lateral and 3rd ventricles into the 4th ventricle via ____
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aqueduct of Sylvius
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CSF exits 4th ventrical through 3 openings: midline via the foramen of ___ and two lateral foramina of ___
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Magendie, Luschka
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CSF enters the ____, which lies behind the medulla and beneath the cerebellum
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cisterna magna
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CSF ultimately flows into ______, which project into the large sagittal venous sinus and other venous sinuses
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arachnoidal villi (forms arachnoidal granulations)
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The spinal and cranial dura respond to motion of the CNS & fluctuation of CSF and influence the bones of the cranium and the sacrum
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3. Mobility of the Intracranial and Intraspinal Membranes
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“three sickle shaped agencies”
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falx cerebri, falx cerebelli, tentorium cerebelli
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common origin of dural membrane
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straight sinus - “Sutherland fulcrum”
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Sacrum rocks on a transverse axis through the articular pillar of the ___ segment
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second sacral
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Sacrum rocking motion occurs in conjunction with the rocking of the ___ due to the connection of the dura
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basiocciput
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respiratory sacral motion caused by___ and contraction of the ___ (voluntary sacral motion)
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spinal motion, pelvic diaphragm
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A palpable rhythmic fluctuation believed to be synchronous with the PRM
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CRANIAL RHYTHMIC IMPULSE
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SBS rises, sphenoid tips forward (flexion) occiput moves backwards (extension)
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Flexion phase
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SBS drops, sphenoid tips backwards (extend) occiput moves forward (flexion)
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Extension phase
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What is the normal CRI rate?
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8 to 12 cycles per minute
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What can cause a increase CRI rate?
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Fast Metabolism, Acute Infection
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What can cause a high CRI amplitude?
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Increased intracranial pressure
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Amplitude of the 2 phases should be ___
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equal
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Midline bones follow ___
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flexion/extension
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Paired bones follow ____
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internal/external rotation
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Sacrum follows the ___
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occiput
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Temporals follow the ____
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occiput
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Facial bones follow the ___
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sphenoid
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CN I-VIII all run through ____
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Sphenoid
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What runs through Foramen Rotundum?
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V2
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What runs through Foramen Ovale?
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V3
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What runs through Internal Acoustic Meatus?
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CN VII, VIII
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What runs through Cribifrom plate?
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CN1
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Clinical Implications of Dural Strains
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Vascular Compromise, Cranial N. Entrapment, Pituitary dysfunction
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Innervation of the Dura: Supratentorial portion + tent
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Trigeminal nerve (V1,V2, V3)
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Innervation of the Dura: Spinal Dura
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Recurrent meningeal nerve of Luschka (sinuvertebral n.)
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Contents of anterior fossa
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Cribriform, Ant. Ethmoid, post Ethmoid,
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Contents of middle fossa
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Optic, Sup. Orbital fissure, Rotundum, Ovale, Spinosum, Hiatus of facial canal
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Contents of posterior fossa
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Magnum, Jugular, Hypoglossal, Int aud. Meatus
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Which Cranial nerve impingement: Anosmia
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CN I
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Which Cranial nerve impingement: Visual disturbances, amblyopia
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CN II, III, IV, VI
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Which Cranial nerve impingement: Strabismus
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CN VI (petrosphenoidal lig
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Which Cranial nerve impingement: Trigeminal neuralgia, trismus, headache
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CN V
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Which Cranial nerve impingement: Bell’s palsy, taste disorder (ant.), hearing disorder (tensor tympani m.)
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CN VII
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Which Cranial nerve impingement: Vertigo, tinnitus, nystagmus, hearing disorders
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CN VIII
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Which Cranial nerve impingement: Dysphagia, loss of gag reflex, taste disorder (post.), BP, cardiac arrhythmia
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CN IX
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Which Cranial nerve impingement: GI, respiratory, cardiac arrhythmia, colic, nausea/vomiting
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CN X
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Which Cranial nerve impingement: Dysphagia, dysphonia
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CN IX, X I.e. SVE innervating larynx, pharynx.
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Which Cranial nerve impingement: Torticollis (SCM), upper trapezius spasm or weakness
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CN XI
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Which Cranial nerve impingement: Sucking/swallowing problems in infant
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CN IX, X, XI,XII
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Failure to Suckle Etiology: Compression of _________
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CN IX, X, XI,XII
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Treatment for Failure to Suckle
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Condylar decompression and release petrosquamous
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Facial muscle paralysis CN VII, chroda tympani loss taste anterior 2/3 of tongue, hyperacusis paralyzed of stapedius
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Bell’s Palsy
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Treatment of Bell’s Palsy
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temporal, sphenoid, occipital bones and stylomastoid foramen somatic dysfunctions
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28 year old male complaining of ringing in his ear and neck pain
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Compression CN VIII
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Treatment of Tinnitus
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Temporal, Sphenoid, and Occipital bones and Sternocleidomastoid muscle
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Child w/ poor suck reflex is due to ____ compression associated w/____compression
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CN XII,XI,X; condylar
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Pt c/o of dizziness/tinnitus/vertigo associated w/ ________
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Temporal bone dysfunction CNVIII
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SBS compression no ___
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CRI
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In Cranial Flexion: ___ in transverse diameter
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Increase
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In Cranial Flexion: ___ in the anteroposterior diameter
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Decrease
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In Cranial Flexion: Brain and spinal cord___ slightly
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change shape
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In Cranial Flexion: ___ rotation of the sphenoid
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Anterior
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In Cranial Flexion: Basiocciput moves ___
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anterosuperiorly
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In Cranial Flexion: Foramen magnum moves ___
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superiorly
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In Cranial Flexion: Sacral base drawn ___ - opposite of anatomical flexion
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posteriorly
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In Cranial Flexion: the midline structures ___
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Flex
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In Cranial Flexion: the paired structures ___
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externally rotate
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In Cranial Extension: Cranial transverse diameter
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Decreases
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In Cranial Extension: Cranial A/P diameter
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Increases
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In Cranial Extension: Basi-occiput
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Posteriorly/Inferiorly
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In Cranial Extension: Paired Bones motion?
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Internally Rotate
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In Cranial Extension: Midline Bones motion?
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Extend (Extension!!!)
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In Cranial Extension: Sacral Base
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Anteriorly
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In Cranial Extension: Sphenoid
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Rotates posteriorly
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In Cranial Extension: Foramen magnum
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Moves inferiorly
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SPECIFIC BONE MOTIONS: PARIETALS
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Wing-like motion
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PARIETALS Axis
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Connects anterior and posterior bevel points
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SPECIFIC BONE MOTIONS: Frontals?
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Wing-like motion
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FRONTALS AXIS
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From the frontal eminence to the center of the orbital plate
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SPECIFIC BONE MOTIONS: TEMPORALS
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Flare in & out
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TEMPORALS AXIS
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Diagonal along petrous ridge
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SPHENOID Axis
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Transverse through center of the body
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What is the axis for normal torsions?
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AP
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In normal torsions, Sphenoid & Occiput rotate ___ directions about this A/P axis
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opposite
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How are normal cranial torsions named?
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Side of the High great wing of the sphenoid
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Axis for cranial sidebending
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Two parallel vertical & one A/P axis
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In cranial sidebending: Sphenoid & occiput rotate ____ directions about the vertical axes
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opposite
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In cranial sidebending: Sphenoid & occiput rotate the ___ direction about the side of the A/P axis
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same
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How is cranial sidebending named?
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Side of the convexity
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LEFT SIDEBENDING ROTATION:Left hand feels ___
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fuller
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In Cranial LATERAL STRAINS Sphenoid & occiput rotate in the ___ direction
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same
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How are Cranial lateral strains named?
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According to location of the base of the sphenoid
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LEFT LATERAL STRAIN: Seems your index fingers are pointing ___
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right
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VERTICAL STRAINS/SHEARS AXIS
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Two parallel transverse axes
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VERTICAL STRAINS/SHEARS Rotation: Sphenoid & occiput move in ___ direction
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same
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How are Cranial VERTICAL STRAINS/SHEARS named?
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Direction of sphenoid movement
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SUPERIOR VERTICAL STRAIN: Hands move ____
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inferiorly
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SPHENOBASILAR COMPRESSION: Palate ____ movement due to compression
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very little
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What is the goal treatment in Sphenobasilar compression?
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Remove restrictions
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REACTIONS from Sphenobasilar compression treatment?
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Headache, dizziness or nausea
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Otitis Media Occurs on ___% of infants and children b/w ages _____
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20% 6months and 6 years
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Otitis Media There is a significant decline at ___ old
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3 years, due to E.Tube change
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12-month old with left ear pulling, poor feeding, fever and vomiting and this is the third time this has occurred in 6 months
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Concept: Eustachian tube somatic dysfunction
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Otitis Media Etiology
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Eustachian tube dysfunction, allergy, passive smoke exposure
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Otitis Media Treatment
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Temporal bone, Eustachian tube and somatic dysfunction of pharynx
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Choice of permitted motion: Move bones in to pattern of lesion
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Exaggeration
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Choice of permitted motion: Retrace path of lesion toward more normal physiologic function
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Direct action
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Choice of permitted motion: Separate opposing surfaces before balancing
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Disengagement
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Choice of permitted motion: One component held toward physiologic position i.e. direct action and other one held away from it i.e. exaggeration
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Opposite physiologic motion
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Choice of permitted motion: Direct action to normalize contours of bone
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Molding
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postulated cause of inherent motion of CNS
cells contain contractile elements |
Coordinated contraction of oligodendroglia
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Cranial sutures allow for motion of the cranial bones
Sutures form to accommodate the cranial rhythmic impulse as the skull ossifies |
4. Articular mobility of the cranial bones
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What can decrease the CRI rate?
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Slow Metabolism
Chronic Infection Fatigue |
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What can cause a low CRI amplitude?
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Dural Tension
SBS Compression |
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What are the Cranial midline bones?
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Sphenoid
Occiput Ethmoid Although not a cranial bone, remember the sacrum is a midline bone Flex & Extend |
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What are the Cranial paired bones?
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Frontal
Parietal Temporal Internally & Externally rotate |
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What are the Facial midline bones?
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Vomer
Flex & Extend |
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What are the Facial paired bones?
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Maxilla
Zygoma Lacrimal Nasal Palatines Internally & Externally rotate |
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The intracranial & spinal dural membrane including the:
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falx cerebri
Falx cerebelli Tentorium Spinal dura |
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DURAL ATTACHMENTS
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Falx Cerebri
Tentorium Cerebelli Falx Cerebelli Foramen magnum C2 and C3 S2 |
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What runs through Superior Orbital Fissure?
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CN III, IV, V1,VI
Ophthalmic V |
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What runs through Jugular Foramen?
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CN IX, X, XI
Petrosal & Sigmoid sinus |
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What runs through Optic canal ?
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CN II
Ophthalmic A. Central Retinal V. |
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Innervation of the Dura: Post. Cranial fossa
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C1,2,3
Sup. Cervical ganglion Enter through f. magnum, hypoglossal canal, and jugular foramen with CN XII, X. |
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Occiput is in 4 parts at birth :
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Base
Squama Two condylar parts Begin to ossify at 3 years of age |
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Craniosacral Axis:
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Superior Transverse Axis
Transverse through S2 segment Flexion & Extension |
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Midline structures in Cranial Flexion
cranial bones - facial bones - plus? |
cranial bones - occiput, sphenoid
facial bones - ethmoid, vomer sacrum |
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Paired structures in Cranial Flexion
cranial bones - facial bones - plus? |
cranial bones - parietals, temporals, frontal*
facial bones - others innominates upper and lower extremities |
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Lateral Strain Axis
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2 parallel vertical axes
One through sphenoid One through foramen magnum |
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CONTRAINDICATIONS for cranial treatment
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Increased intracranial pressure
Intracranial hemorrhage Cranial Aneurysms Tumors Skull fractures |
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41 y/o female c/o facial pain, nasal congestion, sinusitis, allergies x 6 weeks
Sx began 2 days after slipping on icy step, fell backwards on buttocks. 2 courses of antibiotics with no relief |
Concept: Blunt trauma to sacrum
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TX somatic dysfunction of craniosacrel mechanism to restore Primary Respiratory Mechanism:
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Normalize nerve function
Eliminate circulatory stasis Normalize cerebrospinal fluid fluctuation Release Dural membranous tension Correct cranial articular lesions Modify gross structural patterns |
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Ear infections are more common in children because their eustachian tubes:
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Shorter
Narrower More horizontal |
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Choices of treatment:
Direct best for ___ Indirect best for ___ |
Direct best for children
Indirect best for adults |
