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169 Cards in this Set
- Front
- Back
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How do migranines usually present?
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Episodic
unilateral, pulsating, with moderate to severe intensity - associated neruo symptoms, or an aura |
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What criteria gives you a migraine diagnosis?
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least two attacks with these characteristics.
- fully reversible aura symptoms - least 1 aura developing over 4 min, or 2 in succession - no single aura lasts more than 60 min -headache follows aura |
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what is an aura?
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-visual disturbance
-unilateral numbness, weakness, or tingling -aphasia |
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what age does primary cephalgia/migraine begin?
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childhood/early adolescence
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what is the character of the pain in migraines?
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persistent unilateral throbbing
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what is the character of the pain in cluster headaches?
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this is a deep boring pain- like the pain of studying OMM
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is there pain between migraine attacks?
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no there is not
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when do migraines usually occur?
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weekends, vacations, specific days of week, menstruation, stress, conflict
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How do you react to other people when you get a migraine?
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withdrawn, prefer dark
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how do you react to other people when you have a cluster headache
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hyperactive, cannot stop moving
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how do you react to other people when you have a tension headache?
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you are willing to get a massage, or feel better
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who gets cluster headaches?
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men mostly
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what are cluster headaches?
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this is a vascular episodic attacks of periorbital pain. unilateral
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how do cluster head aches come on?
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no pain warning, a crescendo in about 5 min. excruciating deep non fluctuating and explosive pain
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what does an acute onset thunderclap headache indicate?
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subarachnoid bleed
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what does headache with vomiting but NO nausea indicate?
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posterior fossa tumors
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how does a patent foramen ovale related to headaches?
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having a PFO increases your likely hood of having migraines two fold
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what are the contraindications to OMT for neck pain?
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cervical fracture
history of trauma bone disease they say no muscle/joint disease vertebral carotid artery dissection |
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what nerve roots make up the cervical plexus
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C1-C4
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what nerve roots make up the brachial plexus
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C5-T1
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what nerve roots provide SNS to head/neck
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T1- T4
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where does subocciptial nerve radiate pain to?
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vertex or retroorbital
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what is the character of cervicogenic cephalgia?
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usually bialteral, tight vice like. may have photophobia/nausea
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what is cervicogenic headache?
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this is pain referred to the head, usually unilateral from musculoskeltal dysfunction
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who usually gets cervicogenic headaches?
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women, of about 42.9 (fakers!)
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What is the mydural bridge?
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this is formed by the suboccipital muscles, and their tendons+ sheaths.
this forms the posterior atlantooccpital membrane |
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is the C spine dura innervated? what can it cause?
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yes it is- this can cause pain in the posterior occipital area with strain or prolonged contraction
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where can nociception from cervical region project pain to?
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this can project to head pain anywhere CN V goes
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How does the vagus cause myofascial tissue tensions? where?
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the vagus can get an nociceptive response from larynx, pharynx, and some more viscera.
projects up, and can cause vagus discharge of spinal motor nerves- causing tension |
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How low does the trigmeinal nucleus caudalis descend?
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to C4, located in the grey matter of the dorsal horn
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Where do lower C's (C5-C7) refer pain to?
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these can send pain to the head and neck, via the trigeminal nucleus caudalis
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What do C1-C3 form? Where do they innervate?
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this form the greater and lesser occipital nerves, which innervate the posterior scalp
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what does C1-C3 entrapment lead to?
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this leads to occipital neuralgia
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What does C1 innervate? where does it refer pain to?
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this innvervates OA joint- can send pain to occipital region
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what does C2 innervate? where does it send pain to?
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this innervates AA, and C2/C3 joints.
this sends deep dull pain for occiput to - parietal, temporal, frontal, and periorbital regions |
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what does C3 innervate? where does it send pain to?
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this innervates C2 and C3 joints.
WHIPLASH injury sends pain to frontal, temporal, and periorbital regions |
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What inflammatory markers are higher in a person with CHA?
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proinflamatory cytokines, and NO
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what gene product is higher in pts with migraines?
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calcitonin
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What are the four big differentials of CHA?
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occipital neuralgia
Migraine Tension type HA or this long list of cervical pathologies |
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What are the long list of possible cervical pathologies that are differentials for CHA?
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AV malformation
OA spondylosis Herniated disk RA Trauma Tumor Vasculitis Vertebral artery dissection |
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what kind of headache can be triggered by the valsalva maneuver?
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a cervicogenic headache (CHA)
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how do you confirm your diagnosis of CHA's?
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once the somatic dysfunction has resolved, the pain is gone
or you inject anesethesia into the facet/ nerve you suspect. |
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What are the pearl indications of Craniosacral Tx?
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after birth of kid
trauma to the PRM after dentistry |
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what is the classic triad of TMJ dysfunction?
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pain
altered function bruxism |
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with regards to TMJ, what does the occiput drive?
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this drives the posterior cranium, temporals/parietals
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what does the sphenoid drive?
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the face, especially the maxilla
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what do the temporals drive?
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these drive the mandible, External rotation and internal rotation
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What does the glenoid fossa do during flexion?
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this (apparently) is above the axis of rotation for the temporal bone. So when making a stewie head- the glenoid fossa will externally rotate posterior, inferior, and lateral
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what does the glenoid fossa do during extension?
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this is above the axis of rotation of the temporal bone.
SO during extension (brian head)- it internally rotates, anterior, superior, medial |
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What does the mandible/jaw do during flexion?
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this follows the glenoid fossa- so in flexion it moves posterior, retruding the jaw
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what does the mandible/jaw do during extenion?
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this follows the glenoid fossa- so in extension it moves anterior, and the jaw protrudes
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What cranial motion does an overbite relate to?
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this relates to flexion, with a retruded jaw due to posterior rotation of the glenoid fossa
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what cranial motion does an underbite relate to?
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this relates to extension, with a protruded jaw due to anterior rotation of the glenoid fossa
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What is the articular disk of the TMJ made of?
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fibrocartiladge
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what muscle attaches to the articular tubercle of the mandible?
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the lateral pterygoid
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what type of joint is the TMJ?
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this is a synovial joint
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What is the origin an insertion of the temporalis?
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O: temporal fossa
I: medial aspect of ramus/coronoid process of mandible |
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What is the origin an insertion of the masseter?
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O: zygomatic arch/maxilla
I: posterior lateral aspect of angle of mandible |
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What is the origin an insertion of the lateral pterygoid superior head?
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O: inferior lateral greater wing of sphenoid
I: investing fascia of Disc and Joint capsule |
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What is the origin an insertion of the lateral pterygoid inferior head
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O: lateral aspect of the pterygoid plate of sphenoid
I: anterior lateral condylar process of mandible |
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What is the origin an insertion of the medial pterygoid?
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O: medial aspect of lateral pterygoid plate of sphenoid
I: medial aspect of angle of mandible |
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in dental terms, what is the mouth closed?
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dental extension
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in dental terms, what is the mouth fully open?
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dental flexion
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what shape does the articular disk in the TMJ take when the jaw is fully open?
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this forms a bowtie shape
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What is O' Donahues terrible triad in the TMJ?
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LCL
MCL and articular disk (no cruciate ligaments...duh) |
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When the TMJ fails, what ligament fails first?
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the LCL
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How does the cartilage disk move in O Donahues terrible triad?
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this moves anterior, due to the motion of the condyle...NOT due to muscles pulling on it
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On full opening, where should the disk be seated?
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this should be seated mid-condyle giving the classic bowtie appearance
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To produce an early opening click, what direction is the joint disk displaced?
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this disk must be displaced anterior.
the click sound is found on pg 201 of the book |
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in acute closed lock TMJ, what motion do you retain, and what motion is lost?
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you retain the hinge (20mm motion)
but lose the glide (to full opening) |
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What are the 3 main "related interrelated" disorders of the TMJ?
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internal derangment of the join
myofascial pain degenerative joint disease |
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for concussions, if you suspect a concussion has occurred, but their symptoms clear up- do you send them back to play?
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No you do not! if you suspect concussion, sit them out
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what pattern of dysfunction is often associated with migraine headaches?
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trosion strain patterns
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What is the 6 step system of sequencing for headache dysfunctions? ALWAYS TESTED!
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Free thoracic outlet
Thoracics before cervicals Treat superior vertebra in relation to inferior one Start proximal and move distal |
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What things should make you want to do a neruo exam?
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Hx numb/weak
Hx of loss of bowel or bladder Severe pain - intuition |
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Now, what are the 12 steps of osteopathic sequencing for headaches, giving specific regions and reasons:
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1) t1-t4 (sns transition)
2) Rib 1-2 (throacic outlet) 3) SC joint 4) T 11-T12 (functional midpoint of body) 5) L5-L4 (helps body adapt around upper body problem) 6) Cervical 7) Crainal 8) Rib cage 9) UE 10) key muscles noted from tender points 11) sacrum, pelvis, and LE 12) give them home exercises |
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What is the classic triad of TMJ history presentation?
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pain
altered joint function bruxism (grinding) |
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With a C shaped deviation, which way does the jaw deviate to?
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this deviates to the dysfunctional side- the dysfunctional joint stops moving first, causing deviation
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With an S shaped deviation, which way does the jaw deviate to?
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this has the jaw deviating to both sides, one first, than the other. indicates damage in both condyles
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how many PIP knuckles should you be able to put in your mouth?
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3 of the non dominant hand
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What is the great american bite?
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this is an over bite- with the big ass buck teeth hanging out in front
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What does the palate do in crainal flexion?
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the palate is broad and shallow
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what does the palate do in cranial extension?
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the palate is narrow and high
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what is the torus palantinus?
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this is a bony prominence in the mid palate- mistaken for tumor or something by fools
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When does ME for headaches, you make a Dx, then move to the Dx...where do you make the patient look? and why?
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you have the pt look away from the barrier....you do this as the activating force of the C spine- via the oculo-cephalic reflex
(even though this a feed forward only mechanism used to stabilize the eyes relative to the movements of the head...) |
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After shoving your fingers in someones ear to diagnose TMJ dysfunction....you wanna do ME/reciprocal inhibition. What side of the jaw do you open first? the good, or bad?
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you open the good side first
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When treating TMJ with ME/ reciprocal inhibition....you sag the PTs jaw, what side of the jaw do you push on, (which they then counter with ME)
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you push from the good side- and they use the bad side to counter you
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When treating TMJ with ME/ reciprocal inhibition....you have finished pushing from the good side at various levels of sagging jaw..now what?
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now you switch, and push from the bad side @ various levels of jaw sag using ME
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When doing Still technique for the jaw, what is important to remember?
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take it to point of easy (whatever way the jaw shifts easier), then add pressure...and take it into the barrier
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For strain counter strain of the Temporalis and the Massater- what is the basic concept behind these motions?
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Grab the head and squish it around the tender point, to shorten the muscles however ya can.
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Where do you find the tender point for the temporalis? what direction do you poke it?
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anterior temporalis muscle is about 2 cm poster/lateral to orbit of eye, and superior to zygomatic arch.
apply MEDIAL pressure |
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where do you find the massater tender point? what direction do you poke it?
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this is location on the anterior border of the masseter.
you apply posterior pressure to test point |
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where is the medial pterygoid tenderpoint? which way do you press on it?
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on the posterior surface of the ascending ramus of the mandible, about 1/2 above the angle of the jaw.
push anterior |
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how do you Tx medial pterygoid via CSC?
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hold frontal bone steady
sag jaw a little bit and then push away from tp (the jaw will move medially...or towards the opposite side of the head) |
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where is the tenderpoint for the lateral pterygoid? how do you press?
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2 inches anterior to the mandbular condyle, inferior to the zygomatic arch.
you push posterior medial into their face |
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how do you Tx lateral pterygoid?
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hold frontal bone
sag jaw a little bit push away from tp AND protrude the jaw |
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Where is the anterior 1st cervical AC1 tender point? PROBABLE TEST Q as it has a tricky relation
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this on the posterior surface of the ramus of the mandible. about 1 inch superior to mandible angle.
push anterior to piss it off. (SO it is slightly superior/lateral to the medial pterygoid point- probably gonna try and trick you on the test) |
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What is the Tx for AC1? (using SCS)
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rotation away from TP
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Where is the AC2 tender point?
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on the anterior surface of the transverse process of C2.
press posterior medially to piss it off |
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What is the Tx for AC2 tender point ? (using SCS)
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Flex, Rotate away
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What muscle is being treated with a PC1 tenderpoint?
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superior oblique
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where is the PC1 tender point?
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this is on the occipital bone, lateral to the main muscle mass (about 1.5 inches from midline)
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What is the Tx for PC1 tender point?
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1st flex, then extend (so you get better extension)
Side bend, rotate away from TP |
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What muscle is being treated for PC2 tender point?
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Rectus major
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where is the PC2 tender point?
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superior to spinous process of C2
(and on the lateral border of the main muscle mass of the neck...below occiput, lateral to midline?) |
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what is the Tx for PC2?
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exactly the same as C1
Flex then hyperextend and SB and Rotate away |
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What muscle is being treated with PC1 Inion?
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Rectus captius minor
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where is the PC1 (inoin) tenderpoint?
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@ midline of the base of occiput, slightly lateral to inion
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what is the Tx for PC1(inion)?
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this is Flexion, followed by serious extension
SB/ Rotate away |
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Where is the occipital mastoid tender point?
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posterior, medial, superior to the mastoid process
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whats the Tx for occipital mastoid suture?
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vault hold.
test CW and CCW rotation across the transverse axis Take into direction of ease and hold for 90 seconds |
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What are Descartes 3 stages of pain?
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onset of tissue damage
movement of pain signal up transmission line experience of pain, and behavior response |
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What are some of the signs/symptoms of chronic pain?
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poor sleep
appetite changes decreased libido irritability depression decreased energy |
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What are Waddell signs used for?
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these test to find malinging pts who fake their disorders.
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where are the places with the highest level of nociception?
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Subcute tissue
Periosteum Fasica Ligaments Joint Capsules corena of the eye |
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Where are places of low nocicieptor concentration?
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bone
skeletal muscle cartilage |
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What are the chemical mediators released during injury that activate nociceptors?
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serotonin, substance P, bradykinin, and histamine
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What is the fastest nerve fiber?
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type A
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what is the slowest nerve fiber?
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type C
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what does the A-delta subtype of nerve fibers do?
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this responds to strong stimuli that is rapid and localized, like a finger stick
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what are the 3 main features of type C nerve fibers?
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slow transmission
unmyelinated responsible for dull and prolonged pain |
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where does pain enter the spine?
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dorsal root ganglion
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What part of the brain can inhibit ascending pain transmission?
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the substantia gelatinosa
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what kind of diagnosis is fibromyalgia?
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this is a diagnosis of exclusion
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who usually have fibromyalgia?
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women between 20-60 years old
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how does fbromyalgia affect peoples sleeping brain waves?
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70% have alpha wave intrusion into non-REM delta wave sleep
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when you have fibromyalgia pts exercise, how should they go about it?
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they should do gradual exercise, and stop at the point that they know is safe
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what kind of OMT techniques do you used for fibromyalgia?
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indirect techniques only
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What are the 3 guide lines for chronic pain management
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1) reduce or eliminate pain and suffering
2) improve range of motion and activities of daily living 3) improve overall quality of life |
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What is type 1 CRPS?
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this is reflex sympathetic dystrophy, with no evidence of nerve damage
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What is type 2 CRPS?
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this is causalgia, this has evidence of nerve damage
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What are the signs of stage 1 CRPS?
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severe burning at injury site. vasospam, restricted mobility, and muscle spasm
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what are the signs of stage 2 CRPS
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more intense burning and pain, spread of swelling, osteopenia
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what are the signs of stage 3 CRPS?
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irreversible changes in skin, bone, and soft tissue, marked atrophy, flexor tendon contractions
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when doing OMT for CRPS, where do you tend to focus?
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you focus on upper thoracics, and upper cervical, to affect the SNS/PNS
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Whats the most common type of scoliosis?
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adolescent idiopathic scoliosis
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what gender is more likely to have scoliosis progression, and problems from it?
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girls are 3-5 times more likely to progress and have problems
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when do scolisosis curves tend to get worse?
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ages 8-15
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Define Scolisosis
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this is a rotary deformation of the spinal vertebrae, that results in a sideways curve
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With a structural scolisosis, is it moveable? what happens to the muscles and ligaments?
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no, this is a fixed formation
the muscles on the concave side shorten |
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with a functional scolisosis, is it moveable?
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this is moveable, but it can progress to structural
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Where does type II mechanics show up in a type 1 curve of scolisosis?
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top and bottom of curve
apex crossover points in the middle of an S curve |
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How is a scoliosis curve named?
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this is named for which side the convexity lies on- this is the way the vertebra are rotated
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which side of the scoliosis curve is the sidebending?
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this is on the concavity
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What is Adams test?
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this is the forward bend test for scoliosis
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Which side of the scoliotic curve is the short leg usually found on?
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this is usually on the convexity side
For S curves, used the convexity that actually interacts with the pelvis |
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in typical scoliosis findings, which way does the thoracic spine go in an S shaped curve?
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it usually bends Right
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what degree of COBB angle causes respiratory compromise?
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above 50 degrees
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what degree of COBB angle cause cardiovascular compromise?
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above 75 degrees
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what degree of COBB angle will likely lead to long term problems?
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above 50 degrees
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with wide spread screening for scoliosis, is there a better outcome from this?
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no not really
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how do you Tx mild scoliosis of less than 20 degrees?
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omt, pt, home exercises to strengthen truck, and improve flexibility
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how do you Tx moderate scoliosis of 20-45 degrees?
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you brace them, in addition to OMT, PT, and core training
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how do you Tx severe scoliosis above 50 degrees?
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you chop it up with surgery
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what is the treatment of choice of scoliosis in OMT?
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muscle energy is king....you treat the hidden segments that lock down the curve
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what causes short leg syndrome?
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un leveling of the sacral base
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What is the most common short leg?
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the left leg is usually short
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with short leg syndrome, how does the fergusons angle change?
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this increases by 2-3 degrees
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what does the innominates do on the short leg side?
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they rotate anterior
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how does the sacrum move relative to the short leg side?
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this sidebends towards the short leg side
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What is the initial lift in elderly people?
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1/16th of an inch
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what is the initial lift in more flexible people?
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1/8th of an inch
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what is the maximum lift inside of a shoe?
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1/4 inch
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if you wanna lift the shoe above 1/4 inch, where do you put it?
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you put it outside the shoe
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if you need to lift a shoe above 1/2 inch, what do you do?
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you lift the entire heel and sole on the outside of the shoe
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How large should the final lift be?
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this should be 1/2 to 3/4 of the total measured leg discrepancy
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What measure is the best observation of diagnosis of short leg syndrome?
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greater trochanter heights
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whats the treatment for Upper Pole L5?
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extend hip, adduct leg, internal or external rotation for fine tuning
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what is the treatment for lower pole L5?
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prone pt.
drop affected leg off table. flex hip to 90 degrees Adduct leg internal rotation |
