Omm Exam Iii -

Front 1

OA has mostly _ with almost no _

Back 1

FLEXION/EXTENSION

SIDE BENDING

Front 2

When you diagnose OA which side is posterior

Back 2

The sulcus that is deeper - NOT the one that is tender

Front 3

Translational and side bending components of OA are same or opposite side?

Back 3

OPPOSITE

Front 4

Although OA doesnt follow Fryettes principles it follows _ like mechanics

Back 4

TYPE I - rotation and side bending to opposite sides

Front 5

Describe HVLA for OA

Back 5

1.patient supine, doc standing at patient’s head with his/her hands on both sides of the patient’s neck
2.place metacarpophalangeal (MCP) joint on the posterior occiput (remember…tender DOES NOT equal posterior)
3.side-bend patient’s head towards the direction of rotation until you feel motion at the rotated segment (do not over bend), will be a very slight amount
4.rotate the patient’s head away from the side of rotation until you feel the selected segment “lock out” (be careful not to lose the side-bending you already induced), will be a very slight amount
5.once patient is locked out, thrust towards the patient’s opposite eye with slight rotational component (some traction of the OA will also have been induced by the rotational component)
6.RECHECK

Front 6

In diagnosis of OA there is only _ component

Back 6

ROTATIONAL

Front 7

How do you termine which way is AA rotated

Back 7

You flex head and turn it each way using nose as a pointer. AA is rotated TOWARDS freedom of motion

Front 8

Describe HVLA for AA

Back 8

1.patient supine, doc standing at patient’s head with his/her hands on both sides of the patient’s neck
2.place metacarpophalangeal (MCP) joint on the posterior transverse process (yes, C1 has a transverse process, not articular pillars) of C1 (side vertebrae is rotated towards), make sure you don’t have your thumb on the patient’s carotid or jugular
3.side-bend patient’s head towards the direction of rotation, slightly, until you feel motion at the rotated segment (remember, C1 does not actually have side bending capability, side bending should be very minimal)
4.rotate the patient’s head away from the side of rotation until you feel C1 “lock out” (be careful not to lose the side-bending you already induced)
5.once patient is locked out, thrust in the same direction as you have induced rotation towards (rotate his/her head slightly farther than the restriction)
-you should not be thrusting so the patient’s nose ends up pointing directly to the side, but instead it should be pointing slightly more cephalad
-be sure patient’s neck muscles are relaxed before you thrust (often having him/her inhale and thrusting on the exhale helps)
6. RECHECK

Front 9

Describe cervical C3-C7 HVLA

Back 9

1.patient supine, doc standing at patient’s head with his/her hands on both sides of the patient’s neck
2.place metacarpophalangeal (MCP) joint on the posterior articular pillar (where the facets come together) of the rotated vertebrae (side vertebrae is rotated towards), make sure you don’t have your thumb on the patient’s carotid or jugular
3.translate the patient’s head in direction opposite from the way they are rotated, until you feel motion at the selected segment
4.side-bend patient’s head towards the direction of rotation until you feel motion at the rotated segment (do not over bend)
5.rotate the patient’s head away from the side of rotation until you feel the selected segment “lock out” (be careful not to lose the side-bending you already induced)
6.once patient is locked out, thrust in the same direction as you have induced rotation or towards the restriction, using either a rotational or side bending thrust
-be sure patient’s neck muscles are relaxed before you thrust (often having him/her inhale and thrusting on the exhale helps)
7.RECHECK

Front 10

Is HVLA direct or indirect technique

Back 10

DIRECT - move into and through the barrier

Front 11

Quadratus Lumborum is attached to _

Back 11

12th rib
Iliac crest
Vertebral column

Front 12

Quadratus Lumborum functions with _

Back 12

RESPIRATION

Front 13

Quadratus Lumborum stabilizes _

Back 13

Origin of the diaphragm

Front 14

Innervation of the Quadratus Lumborum

Back 14

T12-L3

Front 15

Bilateral contraction of the Quadratus Lumborum causes _

Back 15

EXTENSION

Front 16

Unilateral contraction of the Quadratus Lumborum causes _

Back 16

Extension and ipsilateral side bending

Front 17

Quadratus Lumborum spasm causes _

Back 17

- Low back pain
- Referred pain to hip and groin
- Exhalation 12th rib dysfunction
- Diaphragm restriction

Front 18

Psoas syndrome presents how?

Back 18

Initially as bilateral psoas spasm but later concentrates on one side

Front 19

Key somatic dysfunction in Psoas Syndrome

Back 19

Non-neutral dysfunction of L1-L2

Front 20

Origin of Psoas

Back 20

L1-L4 (L5)

Front 21

Where does psoas extend

Back 21

Over pubic ramus and under the inguinal ligament

Front 22

Psoas inserts _

Back 22

On lesser trochanter on the medial side of the femur

Front 23

Psoas is innervated by _

Back 23

L2-L3

Front 24

Function of psoas

Back 24

Flexes trunk on thigh, flexes lumbar spine and laterally flexes lumbar unilaterally

Shortens and externally rotates the leg

Front 25

When considering psoas syndrome as diagnosis you must first rule out organic causes - name them

Back 25

- Femoral bursitis and arthritis of the hip
- Iliac or femoral phlebitis
- Retroperitoneal lymphadenopathy
- Diverticulitis of the colon
- Cancer of sigmoid or descending colon
- Renal or urethral dysfunction (calculi)
- Prostatitis, salpingitis, appendicitis

Front 26

How do you usually get psoas syndrome

Explain physiologically

Back 26

Sitting in a soft chair or slumped in hard chair OR bending over at waist for a long period of time - then patient returns to neutral suddenly

When person is in flexed position, intrafusal muscle fibers of spindle tighten to better monitor relaxed fibers of the psoas muscle. Rapid return to neutral produces confusion of spindles and spinal cord - CAUSE SPASM OF PSOAS

Front 27

Describe findings in Left Psoas Spasm

Back 27

At first both are involved causing flattening of the lumbar spine (forward bending). Then one usually becomes more prominent

- L1 or L2 will rotate left and sidebend left - then the rest of the spine will side bend left

- Other vertebrae act according to type I

L1 or L2 = KEY LESION

Front 28

If spastic psoas carries through to the sacrum, left side bending induces _

Back 28

Non-neutral sacral response

Front 29

In LEFT SPASM OF PSOAS

_ oblique axis is engaged

_ rotation of sacrum

_ sulcus is shallow

_ prominent ILA

Back 29

LEFT axis

RIGHT rotation

RIGHT

RIGHT

Front 30

Where does pelvic side shift occur in psoas dysfunction

Back 30

TO OPPOSITE SIDE

Front 31

In psoas spasm you can get sciatic nerve irritation on which side

Back 31

OPPOSITE (same side of piriformis spasm)

Front 32

What is the pain location in psoas spasm

Back 32

Gluteal muscular and posterior thigh pain that doesnt go past the knee (OPPOSITE SIDE)

Front 33

Describe pain development in psoas syndrome

Back 33

First there is pain when patients sits especially straight and also vague pain in lumbar and lumbo-sacral area.Soon key lesion pain leaves and moves down and over to OPPOSITE SI JOINT. Now patient is bent forward and to the same side but there is not much pain. Same side leg is short and EXTERNALLY ROTATED
Piriformis on the opposite side is involved so pain includes gluteal area on the opposite side, then sciatic irritation occurs, pain develops down the posterior thigh

Front 34

Describe treatment for psoas syndrome

Back 34

Depends on acuteness and stage - remember to rule out and treat any organic cause - use counterstrain on iliopsoas point - patient supine with knees flexed
- Ice
- HVLA if not acute
- Must cool down acute muscle - DO NOT STRETCH

Front 35

How would weak psoas present in a patient

Back 35

Allows excessive backward bending of lumbar spine because of strong back muscles - Increased lordosis, protruding abdomen

Front 36

Define piriformis syndrome

Back 36

Peripheral neuritis of sciatic nerve caused by the abnormality of the piriformis muscle

Front 37

Origin of piriformis

Back 37

Anterolateral border of the sacrum at SI joint capsule

Anterior portion of sacrotuberous ligament

Front 38

Insertion of piriformis

Back 38

Superomedial aspect of greater trochanter of femur

Front 39

Describe path of sciatic nerve

Back 39

Passes through greater sciatic foramen, under piriformis and on posterior thigh

Front 40

Name causes of irritation of sciatic nerve

Back 40

- Piriformis muscle spasm
- Piriformis contracture
- Local trauma to buttocks
- Repeated mechanical stressors (running)
- Sacral base unleveling
- Pelvic instability
- Excessive local pressure
- Anatomic variation
- Local inflammation

Front 41

Irritation of sciatic nerve is easily confused with _

Back 41

Herniated disk or facet joint pathology