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147 Cards in this Set

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What is the indication for HVLA treatment?
Somatic dysfunction with articular restriction
Articular restriction is often accompanied by:
A reflex muscle guarding response
Articular Restriction may be generated by:
Acute Trauma; Sustained Muscle Hypertonicity; Repetitive Microtrauma; Fascial/Ligamentous Contracture; Poor Posture
What maintains Articular restriction?
1. Thin layer adherence
2. Muscle guarding
3. Fascial contracture
4. Desiccation of the facet joint
A process where 2 congruent surfaces are "glued" together by a typically lubricating substance when said substance is spread thinly enough.
Thin Layer Adherence
All joint surfaces are in complete contact with each other in anatomic position.
Congruent surfaces
SYNOVIAL FLUID + CONGRUENT FACETS + COMPRESSIVE FORCES = ?
Articular Dysfunction
Where does the synovial fluid go in an acute injury?
It is squeezed out into the joint capsule with subsequent capsular distention and pain
Where does the synovial fluid go in a chronic injury?
It is absorbed into the surface of the cartilage and removed from the surrounding tissues via the lymphatics
A sound similar to a loud thud.
Articular Clunk
Artciular clunk is a noise that is normally present from the ____ joint and may emanate from any _________ joint
Sacroiliac;
Osteoarthritic
Popping noise expressed as a single modal curve on a sound frequency scale
Articular Pop
A "breaking" noise; may exhibit on sound wave analysis as a bimodal or multimodal peak
Articular Crack
Sound that is emitted most frequently when the wrist is placed in lateral extension.
Crepitus
A crackling sound akin to rubbing hair between fingers
Crepitus
Sound that results from a tense ligament or fascial structure rolling over a bone or solid prominence.
Ligamentous Strums
Example of a ligamentous strum
a snapping ankle
A high-pitched, non-repeatable "tearing" sound; similar to peeling Velcro apart
Torn Adhesion Sound
Example of a torn adhesion sound
Frozen Shoulder
A sound similar to 2 hard surfaces being rubbed together
Tendinous Click
With articular release, there is a ___%-___% gain in joint range of motion
5-10%
Articular release occurs with about ____kg of tension.
8 kg
Sudden separation that doesn't return to baseline
Articular release
What are 3 theories of articular popping?
1. Bone being put back into place
2. Snapping of adhesions
3. Breaking of joint seal or thin layer adherence.
(Fill in the blank with "more" or "less")

The larger the joint, the _____ likely it will "pop."
LESS
What are some results of too frequent articular mobilization?
Hypermobility;
Ligamentous & capsular hypertrophy
Most effective way to mobilize a small joint
Combination of:
Gapping force &
Gliding force
What is the refractory period for which a joint must be left unattended before an articular pop can again be obtained?
20 minutes (range 17-22 minutes)

Although spinal articulation seem to range from one to several hours
When external barometric pressure is _____, it makes joints easier to crack.
LOW
When external barometric pressure is ___, it makes joints more difficult to crack.
HIGH
Refers to number of new cases
Incidence
Refers to the number of cases currently existing
Prevalence
10 years after onset of neck pain, 79% of patients had ______ neck pain.

(FIll in the blank: NO, DECREASED, SEVERE)
DECREASED
10 years after the onset of neck pain, 43% of patients had _____ neck pain.

(FIll in the blank: NO, DECREASED, SEVERE)
NO
10 years after the onset of neck pain, 32% of patients had ______ or ______ neck pain
MODERATE OR SEVERE
What are some red flags for possible infection for the cause of neck pain?
Under 20 and over 50;
Fever or Chills;
Pain worse supine;
Recent UTI;
IV Drug Abuse;
Immune Suppression (HIV, diabetes, organ transplant, stress)
At what level is spinous process percussive pain indicative of a possible infection as a cause for neck pain?
C7 & T1
What are some possible causes for neck pain?
Trauma; Infection; Tumor; Vertebrobasilar Artery Compromise;
Injury caused by sudden, forceful hyperextension of the neck with flexion recoil
Whiplash injury
Other terms describing whiplash injury
Cervical strain/sprain;
Neck sprain;
Acceleration-deceleration injuries
Whiplash "high risk groups"
Women;
Elderly;
Significant underlying degenerative disc disease
In whiplash, body parts INITIALLY move _____ the point of impact and then recoil.

(FILL IN THE BLANK WITH "TOWARD" or "AWAY FROM")
TOWARD
Facet joints are innervated by:
Posterior primary ramus of nerve root of both that segment, the segment above and the segment below
Recurrent meningeal nerve innervates:
the posterior longitudinal ligament and outer 1/3 of the annulus fibrosus posteriorly
Visceral afferents from the sympathetic nervous system make up the sensory supply for the:
anterior longitudinal ligmanet and the outer 1/3 of the annulus fibrosis anterolaterally
Spinal facet joints are also called the_____________ joints
Zygapophyseal joints
The spinal facet joints, the sacroiliac joints and the Joints of Lushka in the C-spine are all what types of joints?
Synovial joints
What is the sequence of events of osteoarthritis of a synovial joint?
1.Articular Dysfunction; 2.Facet Synovitis;
3.Cartilage Degenerates; 4.Capsular Laxity;
5.Subluxation;
6.Osteophyte Formation; 7.Facet and Laminar Enlargement
What is a major contributor to cartilage nutrition?
synovial fluid
The compression and adherence of the joint surfaces results in what?
It impairs the flow of synovial fluid across the joint
Simple joint immobility leads to:
Thinning of the hyaline cartilage of a joint.
Joint immobility leading to thinning of hyaline cartilage of joint is believed to be due to:
Reduced trophic support from decreased blood flow, both arterial and venous
What is considered to be a non-inflammatory arthropathy?
Osteoarthritis
In this arthropathy, there is a small amount of joint inflammation that occurs and can be more painful than very advanced arthritic changes in the cartilage proper
Facet Synovitis (of osteoarthritis)
When cartilage break off into the joint and "sand away" at the joint surface and invokes a more intense inflammatory response.
Cartilage Degeneration
A result of this results in the inability to maintain normal apposition of the joint surfaces leading to hypermobility.
Capsular Laxity
What is the term for partial dislocation of a facet joint?
Facet Subluxation
Commonly referred to as bone spurs
Osteophyte Formation
Nature's way of attempting to restabilize a joint
Osteophyte formation (bone spurs)
Site where the joint capsule and ligament attach into bone is referred to as the ______.
Enthesis
Diseases and disorders at the site of a bone where the joint capsule and ligament attach
Enthesopathies
What is Wolff's Law?
Bone will remodel in accordance with the stresses placed upon it.
Likely due to traction on the periosteum where the joint capsule and ligaments attach into the bone.
Bone spurs
Pain which follows a nerve root distribution
Radiculitis
This "event" of osteoarthritis, though not painful in and of itself, may encroach on neighboring pain sensitive structures.
Facet and Laminar Enlargement (bone getting bigger)
Circumferential (annular) micro tears in the annulus fibrosus leads to:
Disc degeneration
If a radial tear involves the _____ 1/3 of the annulus fibrosus or the annular ligament, it can produce pain.

(Fill in the blank: INNER or OUTER)
OUTER
The nucleus itself and the _____ 2/3 of the annulus fibrosus contain no free nerve endings.

(Fill in the blank: INNER or OUTER)
INNER
Pain in the case of a radial disc tear is presumed to be due to:
The leakage of the nucleus pulposus into the pain sensitive area of the disc (which is the outer 1/3 of the disc)
This disc "dysfunction"--which can occur if the annulus is weakened enough--is much like the bubble that can form on a weakened tire.
Focal disc bulging
Nerve root distribution pain without identifiable neurological deficits; can be caused by a disc bulge rubbing against a nerve root
Radiculitis
Nerve root distribution pain with neurological deficits
Radiculopathy
Caused by the deterioration of the disc architecture, leading to further weakening of the annulus
Circumferential disc bulging
By age 40, the nucleus pulposus is no longer gelatinous but has taken on a more _____ consistency.
FIBROUS
Volume loss is produced by desiccation and the loss of muccopolysaccharides.
Disc narrowing
The __________ enlarge with age alone, but this process is accelerated and worsened by degenerative disc disease
VERTEBRAL BODIES
What is the challenge in spinal osteoarthritis?
To identify the pain generator. It is common for a single patient to have both facet joint and disc disease together.
What are the stages of Spinal Degeneration?
I: Stage of dysfunction
II: Stage of instability
III: Stage of restabilization & stenosis
For Stage I of spinal degeneration, what are the basic principles of treatment?
OMT and Exercise
For Stage II of spinal degeneration, what are the basic principles of treatment?
OMT; Exercise; Bracing; Pain Mgmt Strategies; Rhizotomy; Fusion Surgery; Disc Replacement Surgery
For Stage III of spinal degeneration, what are the basic principles of treatment?
OMT; Exercise; Pain Mgmt Strategies; Surgical Decompression
Form of OMT in which the patient's muscles are actively used on request, from a precisely controlled position, and against a distinctly executed counterforce
Muscle Energy Technique
What are the goals of muscle energy techniques?
Decrease muscle hypertonicity; Lengthen muscle fibers; Reduce the restraint of movement; Produce joint mobilization; Improve respiratory and circulatory function; Strengthen the weaker side in the event of muscle asymmetry
Contraction in which the muscle contracts against resistance, but the distance between origin and insertion remains static
Isometric
The most common form of muscle contraction used in muscle energy technique.
Isometric
Type of contraction in which the patient contracts the muscle against resistance, however, the physician applied force overcomes the muscle force.
Isolytic contraction
This type of contraction is used to lengthen muscles shortened by contracture
Isolytic contraction
Type of contraction in which the muscle contractile force remains constant while the proximal and distal attachments of the muscle approximate.
Concentric isotonic contraction
This type of contraction is used to increase muscle strength in muscles reflexly weakened by somatic dysfunction.
Concentric isotonic contraction
Type of contraction in which the muscle contractile force remains constant while the proximal and distal attachments of the muscle are permitted to separate.
Eccentric isotonic contraction.
This type of contraction is used to strengthen weak muscle.
Eccentric isotonic
What are the physiologic principles of muscle energy technique?
Post-isometric relaxation; joint mobilization using muscular force; respiratory assistance; oculocephalogyric reflex; reciprocal inhibition; crossed extensor reflex
What is the goal of post-isometric relaxation?
To accomplish muscle relaxation
What state is the neuromuscular appparatus in immediately after a sustained muscle contraction?
A refractory state
When the neuromuscular apparatus is in a refractory state, what can be done to the muscle?
The muscle may be passively stretched without encountering reflex opposition.
After a sustained contraction, the _______________ system depletes ALL the available neurotransmitters needed to function normally.
PROPRIOCEPTIVE
When can the muscle be lengthened slightly without reactivating the proprioceptive system?
During the refractory period.
What is the goal of joint mobilization using muscle force?
To accomplish restoration of joint motion in an articular dysfunction.
The patient offers a muscle contraction against a physician counterforce which accomplishes this:______________
JOINT MOBILIZATION USING MUSCLE FORCE
What is the force used for joint mobilization?
Maximum muscle contraction that can be comfortably resisted by the physician (30-50 lbs of pressure)
What is the goal of respiratory assistance?
To improve body physiology usint the patient's forced respiratory motion.
The muscular forces produced in this technique are generated by the simple act of breathing.
Respiratory assistance
What is the goal of oculocephalogyric reflex?
To effect reflex muscle contraction using eye movement.
Functional muscle groups are contracted in response to voluntary eye motion on the part of the patient. Generally used in the neck and upper trunk
Oculocephalogyric Reflex
What is the goal of reciprocal inhibition?
To lengthen a muscle shortened by acute cramp or spasm
When a gentle contraction is initiated in an agonist muscle, there is a reflex relaxation of that muscle's antagonistic group.
Reciprocal inhibition
What is the goal of crossed extensor reflex?
To treat muscle dysfunction in the extremities where the muscle requiring treatment is in an area so severely injured that it is directly unmanipulable or inaccessible.
This form of muscle energy technique uses the learned cross pattern locomotion reflexes engrammed into the CNS. When a flexor muscle in one extremity is contracted voluntarily, the same muscle in the contralateral extremity relaxes and the extensor contracts.
Crossed extensor reflex
What point of the barrier should be reached for muscle energy treatment?
Only the "feather edge" of the restrictive barrier should be engaged for maximal efficacy of the technique
What is a contraindication of post-isometric type techniques?
Post-isometric type techniques should NOT be applied to muscles that are acutely injured or exceptionally painful. These would be better treated with a reciprocal inhibition technique.
What is a contraindication of muscle energy techniques?
Should NOT be performed on a patient who is so debilitated that the patient's health could be further compromised by the effort. (e.g., post-op patient or patient in ICU recovering from myocardial infarction)
What are the 3 steps of the osteopathic structural exam?
1. Screen
2. Scan
3. Segmental Definition
When is it most appropriate to use INDIRECT techniques?
In an acute injury;
If there is significant inflammation or edema present
When is it most appropriate to use DIRECT techniques?
In a chronic condition;
If the cardinal signs of inflammation are ABSENT
What are the cardinal signs of inflammation?
1. Rubor
2. Calor
3. Tumor
4. Dolor
What is the goal of respiratory assistance?
To improve body physiology usint the patient's forced respiratory motion.
The muscular forces produced in this technique are generated by the simple act of breathing.
Respiratory assistance
What is the goal of oculocephalogyric reflex?
To effect reflex muscle contraction using eye movement.
Functional muscle groups are contracted in response to voluntary eye motion on the part of the patient. Generally used in the neck and upper trunk
Oculocephalogyric Reflex
What is the goal of reciprocal inhibition?
To lengthen a muscle shortened by acute cramp or spasm
When a gentle contraction is initiated in an agonist muscle, there is a reflex relaxation of that muscle's antagonistic group.
Reciprocal inhibition
What is the goal of crossed extensor reflex?
To treat muscle dysfunction in the extremities where the muscle requiring treatment is in an area so severely injured that it is directly unmanipulable or inaccessible.
This form of muscle energy technique uses the learned cross pattern locomotion reflexes engrammed into the CNS. When a flexor muscle in one extremity is contracted voluntarily, the same muscle in the contralateral extremity relaxes and the extensor contracts.
Crossed extensor reflex
What point of the barrier should be reached for muscle energy treatment?
Only the "feather edge" of the restrictive barrier should be engaged for maximal efficacy of the technique
What is a contraindication of post-isometric type techniques?
Post-isometric type techniques should NOT be applied to muscles that are acutely injured or exceptionally painful. These would be better treated with a reciprocal inhibition technique.
What is a contraindication of muscle energy techniques?
Should NOT be performed on a patient who is so debilitated that the patient's health could be further compromised by the effort. (e.g., post-op patient or patient in ICU recovering from myocardial infarction)
What are the 3 steps of the osteopathic structural exam?
1. Screen
2. Scan
3. Segmental Definition
When is it most appropriate to use INDIRECT techniques?
In an acute injury;
If there is significant inflammation or edema present
When is it most appropriate to use DIRECT techniques?
In a chronic condition;
If the cardinal signs of inflammation are ABSENT
What are the cardinal signs of inflammation?
1. Rubor (redness)
2. Calor (Heat)
3. Tumor (Swelling)
4. Dolor (Pain, NOT tenderness)
If muscle tone is most responsible for the somatic dysfunction, what techniques are appropriate?
Soft tissue;
Myofascial release;
Counterstrain;
Muscle Energy
If fascial contraction/contracture is most responsible for the somatic dysfunction, what techniques are appropriate?
Myofascialrelease;
Ligamentous Articular Strain/Balanced Ligamentous Tension
If facet joint restriction & disc disease are most responsible for the somatic dysfunction, what techniques are appropriate?
Articulatory;
HVLA Thrust;
Muscle Energy
If edema is most responsible for the somatic dysfunction, what techniques are appropriate?
Lymphatic techniques
If tenderness is most responsible for the somatic dysfunction, what techniques are appropriate?
Counterstrain;
Indirect myofascial release;
LAS/BLT
What does the Wallenberg Test test for?
Vertebrobasilar Artery Compromise
Name the test: Pt supine, flex neck and hold 10 sec, then extend neck and hold 10 sec, then rotate right, rotate left. Positive if pt complains of dizziness, visual changes, lightheadedness, or nystagmus
WALLENBERG'S TEST
What are some red flags for possible tumor?
Under 20 and over 50; Unexplained weight loss; pain worse when supine; severe nocturnal pain
Any sense of acute anxiety or panic on the part of the patient during any part of the examination or treatment can be an indicator of:________
Cerebral Ischemia
The thyroid is level with what vertebrae?
C4-C5
Whiplash avulsion most common at what 2 spinal levels?
C2 and T1
What are 2 congenital anomalies that can cause a significant loss in cervical range of motion?
Klippel-Feil Syndrome;
Block Vertebrae
1/2 of cervivcal motion occurs where?
At the atlanto-axial joints
If a distraction test decreases pain, what could be the cause?
Neuroforaminal Compromise;
Facet Joint
If a distraction test increases pain, what could be the cause?
Myoligamentous
Compression test increases pain in the presence of: _______
Disc herniation; Neuroforaminal Compromise; Facet Joint Disease
Spurling test (cervical extension and rotation) reproduces pain of: ______ and _______
Neuroforaminal compromise
and pain of facet joint origin