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118 Cards in this Set
- Front
- Back
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What do anterior scalene muscles do
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Attach cervical vertebrae to 1st rib
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Brachial plexus emerges between
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anterior and middle scalenes
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Posterior scalene attaches to
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2nd rib
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1st rib is also attached to the clavicle by
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costoclavicular ligament and its sternoclavicular joint
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Describe chest movements on inhalation
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Manubrium swings forward lifting body and mediastinum creating negative pressure
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Respiratory axis of manubrium
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3d costal cartilage
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Which diameter enlarged during inspiration
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AP diameter
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Which ribs primarily have pump handle action
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Ribs 2-5
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In pump handle motion axis of rotation is closer to
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transverse plane
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What do ribs do in pump handle motion
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Rise up and go down with sternum
Lifted by pectoralis minor (ribs 3-4-5)pectoralis major rib2 - posterior scalenes |
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Pump handle motion enlarges chest...
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anteriorly
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Bucket handle motion is primary action of ribs
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7-10
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In bucket handle motion axis of rotation is closer to
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saggital plane
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What do ribs do in bucket handle motion
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Rise and fall laterally
Lifted by serratus anterior |
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Bucket handle motion enlarges chest..
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laterally
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Which ribs have primarily caliper motion
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Ribs 11-12
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In caliper motion axis of rotation close to
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Transverse plane
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What do ribs do in caliper motion
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Rise and fall posteriorly
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Caliper motion enlarges chest...
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posteriorly
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What is the motion of rib 12 in quiet breathing
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Rib 12 is anchored by quadratus lumborum and has no movement in quiet breathing
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Which rib has 1/2 bucket and 1/2 pump motion
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Rib 1, lifted by anterior and middle scalenes, practically no motion in quiet breathing
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What causes most respiratory restrictions of ribs
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Thoracic vertebral segmental dysfunctions
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How do you know which rib is restricted
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Restricted rib will stop moving first and start moving after its partner
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Exhalation dysfunction
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Restricted inhalation
Rib is "down" |
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Inhalation dysfunction
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Restricted exhalation
Rib is "up" |
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To treat an inhalation dysfunction treat...
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lowest rib in group
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To treat exhalation dysfunction treat
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highest rib in group
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Key rib for exhalation restriction is
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bottom rib of the group
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Key rib for inhalation restriction is
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top rib of group
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What is the relationship between rib and vertebra
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Rib has two demifacets so two vertebrae influence motion of one rib
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Which ribs have only one connection with body of vertebra
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1, 11, 12
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What can compress stellate ganglion
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1st rib elevation
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What kind of motion does T1 have
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Type II, side bend rotate in same direction
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What type of motion does C1-C7 have
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type II mechanics
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If elevation of the rib is on the right , what would be side bending and rotation of T1
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to the left
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Which lymphatic structure can be damaged in thoracic inlet
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Thoracic duct
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How can 1st rib affect upper extremity
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On top of 1st rib is anterior trunk of brachial plexus - C8-T1, can get parasthesias and pain along ulnar nerve distribution of upper extremity
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Which muscles responsible for principle rib elevation
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External and internal intercostals
diaphragm for lower ribs |
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What are accessory muscles of rib elevation
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Sternum
Anterior and posterior scalene Diaphragm Serratus posterior superior Levatores costarum |
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Which muscle elevates ribs during forced inspiration
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Pectoralis minor
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What is used for rib depression in quiet breathing
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Passive recoil from lungs
Diaphragm relaxation |
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What is used for rib depression in active breathing
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Abdominal muscles
Internal and innermost intercostals |
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Accessory muscles for rib depression
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Serratus posterior inferior
External internal obliques, transversus abdominis Transversus thoracis |
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Describe inhalation somatic dysfunction
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Inhalation is good, cant exhale --> ribs do not go down
Key rib --> lower |
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Describe exhalation somatic dysfunction
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Ribs go down with ease, but wont go up
Key rib --> upper |
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Preganglionic sympathetic fibers have cell bodies in
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IML T1-L2
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Post ganglionic sympathetic fibers are in
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Sympathetic chain ganglia (paravertebral and prevertebral)
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Preganglionic parasympathetic fibers
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Brainstem nuclei of CN 3, 7, 9, 10
S2-S4 lateral cord |
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Postganglionic parasympathetic fibers come from
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Parasympathetic ganglia - head, effector organs
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Pre vs post ganglionic fibers length in sympathetic
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SHort pre
Long post |
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Pre vs post ganglionic fibers length in parasympathetic
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Long pre
Short post |
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Describe viscerosomatic reflex
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Organ is dysfunctional, affects segmental part of musculoskeletal system
ex. Heart attack --> pain in jaw, shoulder GERD - middle back pain From autonomic to somatic nerves |
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Describe somatovisceral reflex
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Dysfunction in neuromusculoskeletal system results in disease of the organ
ex - something wrong with ribs, presses on sympathetic nerves, increases heart rate - you get palpitations, tachycardia |
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Define facilitation
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Area of impairment or restriction develops lower threshold for irritation or dysfunction when other areas are stimulated
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Describe facilitated segments
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Chronically hyperirritable, hyperresponsive
Muscles hypertonic, tender |
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Define Chapman reflexes
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Anterior and posterior tender points that may result from viscerosomatic reflexes
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Chapman point for stomach is located
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rib 5, 6 on the left
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Chapman point for liver, GB is located
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Between ribs 5 and 6 on the right
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Palpatory characteristics of facilitated segment when its acute
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Congestion, warm, moist, tender, muscle contraction, sidebending rotation on the side of problem
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Palpatory characteristics of chronic facilitated segment
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Ropey, stringy, cool, dry, color changes (white), decreased range of motion due to contracture, fibrotic
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Functions of CT/fascia
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Structural support
Compartmentalization Nutrition Immunity/lymphatics Repair Sensorimotor Communication |
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Superficial fascia is also called
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Subcutaneous
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Deep fascia is also called
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investing
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Subserous fascia is located in ...
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pleura
pericardium peritoneum |
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Submucosal fascia is located in
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lamina propria - intestinal mucosa, bronchial mucosa
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Fascia can be considered to consist of
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Horizontal diaphragms and longitudinal cables
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Describe horizontal diaphragms
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Fibrous or myofascial partitions acting as tension/counterstrain sheets
Connected to fascial cables Anchored to skeletal structures |
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Give examples of horizontal diaphragms
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Tentorium cerebelli
Thoracic inlet/outlet Respiratory diaphragm Pelvic diaphragm Plantar fascia/arches of feet |
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Give examples of longitudinal cables
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-Dural sleeve to S2
-Longitudinal ligaments occiput -S2 -Psoas major to lower extremity -Pre vertebral, alar , bucopharyngeal fascia -Rectus abdominis, quadratus lumborum, internal obliques -trachea, esophagus, pericardium on central tendon of diaphragm |
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What is included in somatic dysfunction
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-Skeletal
-Arthrodial -myofascial -vascular -lymphatic -nerural elements |
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Name fascial OMT techniques
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Soft tissue
Myofascial release Indirect balancing Balanced ligamentous tension |
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What are indication for fascial OMT technique
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acute painful conditions
chronic pain metastatic patients RA Fibromyalgia Myofascial pain Visceral disorders |
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Relationship of asymmetry to looseness and tightness
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Tightness creates
Looseness permits |
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Describe direct action
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Gentle forces are applied with the hand TOWARD THE BARRIER or direction of least ease
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Describe indirect action
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Gentle forces are applied with hand AWAY FROM barrier - direction of most ease
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Describe recoil technique
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Gentle forces are applied with the hand AWAY from the barrier (indirect technique) while patient breathes in and out. The force is suddenly released on in breath during 3d repitition
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Describe unwinding technique
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Gentle forces applied in various vectors until tissue unwinds and returns to state of balance
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Sequence of events in myofascial release
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1. Apply forces gently either in direct or indirect relation
2. Wait for tissue to melt, soften 3. Retest motion for symmetry |
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5 components of myofascial health
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1.Eliminate postural stresses
2.Exercise 3.Nutritional - vitamins, minerals 4. Reduce psychological stress 5. OMT, massage, shiatsu, accupuncture |
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Describe American diet
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High - in total calories, fat, protein, salt, phosphates, simple sugars
Low - fiber, calcium, potassium, trace minerals, vitamins |
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How do you calculate ideal body weight for men
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for 5 "" height, ideal body weight is 106 lb, add 6 lb for every additional inch + 10 % for frame
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Ideal body weight for females
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5 feet - 100 lb, add 5 lb for each additional inch + 10 % for frame
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Percent ideal body weight
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Current weight /ideal weight * 100 %
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Normal procent ideal body weight
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90-109 %
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What is other name for superior transverse axis
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Respiration
Craniosacral motion axis |
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Where is superior transverse axis located
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at S2 segment
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Where is middle transverse axis located
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at S2 body
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Where is inferior transverse axis located
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inferior part of SI joint
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What happens to sacrum/lumbar when you inhale
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Sacrum flexes, lumbar extends
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What happens to sacrum/lumbar when you exhale
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Sacrum extends, lumbar flexes
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Left on left
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Deep sulcus on R
ILA on L Spring neg. Seated flexion on R |
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Which torsion is most common
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Left on left
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Which torsions are flexed
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L on L
R on R |
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Right on right
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Deep sulcus on L
Post ILA on R Spring neg. Seated flexion on L |
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Left on right
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deep sulcus on R
Post ILA on left Spring pos. Seated flexion on left |
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Right on left
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Deep sulcus on left
Posterior ILA on right Spring Pos Seated flexion on right |
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Anterior inominant
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ASIS lower
PSIS higher Hamstring + sciatica TTC @ ILA + iliolumbar ligament |
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Posterior inominant
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ASIS higher
PSIS lower inguinal + knee pain TTC @sacral sulcus |
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Superior shear
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Inominate elevated
Iliac crest elevated ASIS + PSIS elevated Pelvic pain TCC @ SI joint + pubis |
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Inferior shear
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Inominant depressed
Iliac crest, ASIS, PSIS depressed Pelvic pain TTC @ SI joint RARE |
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Inominate flare
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ASIS is medial or lateral to normal
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Lumbarization
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S1 becomes additional lumbar vertebra articulating with S2
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Sacralization
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L5 takes characteristics of sacral vertebra
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Fergusons angle
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Lumbosacral angle, inclination of S1 to horizontal
Normal - 25-35 degrees |
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SI joint
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L shaped , converges posteriorly
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Are there direct muscular attachments from sacrum to ilium
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No
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Name 3 true ligaments
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Anterior sacroiliac
Interosseous Posterior sacroiliac |
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Name 3 accessory ligaments
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Sacrotuberous - ischial tuberosity to sacrum
Iliolumbar - TP L5 to iliac crest Sacrospinous - ischial spine to sacrum |
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What do true ligaments restrict
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Rotation
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What do accessory ligaments restrict
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Anterior movement, rotation, give vertical stablity
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Sacral plexus give what kind of fibers
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Motor + sensory
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What is another name for middle transverse axis
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Sacroiliac
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Which axis provides inominate rotation
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Inferior transverse
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Name motions of pubis
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Caliper
Torsional Superior inferior translatory |
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Name motions of ilium
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AP
Ilial translatory - superoinferior + AP |
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Flexion and extension of sacrum occurs around which axis
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Middle transverse
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Rotation occurs around which axis
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Vertical
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Sidebending occurs around which axis
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AP
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