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133 Cards in this Set
- Front
- Back
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Describe the significance of the superior saggital sinus |
The diameter increases as it passes posteriorly and receives blood from the superior cerebral veins which enter at an anterior direction. Strain patterns can affect drainage from the cerebral veins into the superior sagittal sinus due to venous flow entering the sinus in a counter-current direction.
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What percentage of the venous drainage from the brain passes from the sigmoid sinous to the intern jugular?
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94%
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How does an SBS compression present?
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May have possible peripheral suture compression which presents as a hard, rigid head.
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What are contraindications for venous sinous technique?
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1. Recent trauma with suspected significant or serious injury to brain, blood vessels with bleeding, cranium, or other structures.
2. Infection (meningitis, encephalitis, etc.) 3. Elevated intracranial pressure. 4. Cerebral edema. 5. Recent shunt surgery or neurosurgery. 6. Recent stroke 7. Tumor 8. Congenital malformations 9. Any abnormal finding not thought to be somatic dysfunction. |
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What is the Axis of Motion for the Occiuput?
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Transvers axis: above foramen magnum at level of confluence of sinuses
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What is the Axis of Motion for the sphenoic?
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Transverse axis: center of its body
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What is the Axis of Motion for the sacrum related to the PRM?
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Transverse axis at s2
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What is the moment of the sacruim in flexion?
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2. Flexioncounternutation due to dural tension
a) Base moves superiorly and posteriorly b) Coccyx moves anteriorly |
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What is the moment of the sacruim in extension?
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3. Extensionnutation due to dural relaxation
a) Base moves inferiorly and anteriorly b) Coccyx moves posteriorly |
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Describe hand placement of vault hold
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1. Thumbs: frontal bones
2. Index fingers: greater wings of sphenoid 3. Middle fingers: squamous portion of temporal 4. Ring fingers: mastoid process 5. Little fingers: occipital squama |
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What does this palpitory experience describe: hands move cephalad (toward physician)
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Extension
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What does this palpitory experience describe: hands move caudad (toward patient)
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Flexion
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What is the axis for a torsion? What is the mechanics?
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1. Axis: A-P from nasion to opsithion
2. Mechanics: sphenoid and occiput rotate in OPPOSITE directions |
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How is a torsion named and what would cause it?
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Named for superior greater wing of sphenoid
caused by blow that affects one side of sphenoid or occiput |
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What is the axis for Sidebending?
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AKA Sidebending Rotation
a) Vertical through sphenoid b) Vertical through foramen magnum of occipit c) A-P axis from nasion to opsithion |
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What is the mechanics of a sidebending-Rotation strain
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2. Mechanics: sphenoid and occiput move in opposite directions around vertical axes and in same direction around A-P axis
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How is a sidbending rotation named?
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For the side of the convexity. The sphenoid and occiput will move in opposite cw/cww rotations to acheive this
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What is the axis for a vertical strain?
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: 2 transverse axes (one at sphenoid and one at occiput)
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what is the mechanics of a vertical strain
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rotation of occiput and sphenoid in same direction on transverse
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Describe a Superior vertical strain:
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(1) Sphenoid in relative flexion and occiput in relative extension
(2) Base of sphenoid elevated; base of occiput depressed (3) Greater wings of sphenoid rotated anteriorly and inferiorly |
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What are the axis for lateral strains?
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2 vertical axes (one through sphenoid and one through foramen magnum of occiput)
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What are the mechanics of a lateral strain?
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2. Mechanics: sphenoid and occiput rotate in same direction around their vertical axisbase of sphenoid to left/right relative to base of occiput
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How do you name a lateral strain?
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Based on the base of the sphenoid
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What is the axis for a SBS compression?
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AP
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What is the mechanics for a SBS compression?
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Flexion and extenaion are inhibited. head feels like a bowling ball
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Describe the 5 components of the Primary Respiratory mechanism
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1. Inherent motility of brain and spinal cord
2. CSF fluctuations 3. Mobility of intracranial and intraspinal membanes-RTM (reciprocal tension membranes) 4. Articular mobility of cranial bones 5. Articular mobility of sacrum on ilia |
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Describe the CV4 Technique
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a) Place hands under cranium with thenar eminences on lateral angles of occiput (must be MEDIAL to occipito-mastoid suture and NOT on suture)
b) Encourage extension, discourage flexion c) Amplitude increases until a still point is reached d) Softening follows with palpable warmth and gentle CRI |
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Describe B. Balanced membranous tension treatment
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1. Use dural membrane (RTM) mobility and resilience to treat cranium, face, and sacrum
2. To find BMT-find point between normal motion and dysfunctional strainpoint of neutrality |
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Describe V Spread Treatment
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1. Identify restricted suture: index finger on one side and middle finger on opposite side of suture
2. Palm of other hand on cranium at longest diameter from restricted suture (opposite side of head) 3. Palpate for pulse and gently propel it towards the restricted suture 4. A gentle wave may be felt between 2 points: as the wave causes release at the restricted suture, the impulse will soften and balance will be achieved 5. DO NOT leave patient with a persistent impulse or wave—must achieve balance |
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What happens in Craniosacral flexion?
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midline bones flex, sacrum counternutates, AP diameter decreases, paired bones externally rotate
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What happens in Craniosacral extension?
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midline bones extend, sacrum nutates, AP diameter increases, paired bones internally rotate
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how will a SBS compression affect the CRI?
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decreases CRI or causes high frequency and low amplitude strain patterns
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What is the purpose of the CV4 treatment?
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increases CRI amplitude
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What is the purpose of the V spread treatment?
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Helps treat suture restrictions and compressions
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What pole?
Falx cerebri attaches to crista galli of the ethmoid bone and to frontal crest |
a. Anterior-superior pole
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What pole?
Tentorium attaches to the anterior and posterior clinoid process of the sella trucica |
b. Anterior-inferior pole
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What pole?
i. Tentorium attaches to petrous ridge of the temporal bone and transverse edge of occiput |
c. Lateral-pole
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What pole?
i. Internal occipital protuberance |
d. Posterior pole
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What pole?
i. Dura exits foramen magnum, attaches at C2 and then hangs and finally attaches at S2 |
e. Scaral pole
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Where are the dural attachments that affect the involuntary motion of the sactum between the ilia?
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Dural attachments at C2, C3 and S2
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What bone is the jugualr foramen assocaited with and what CN exit?
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occiput
CN IX, X, XI |
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condylar compression can have what clinical effects?
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a. CN IX: swallowing
b. CN X: swallowing, nausea, vomiting, palpitations c. CN XI: abnormal tone of SCM and Trapezius (torticollis) |
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Occipitalmastoid suture compression has what clinical effects?
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a. Migraine cephalgia
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What are the paired bones?
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a. Parietals
b. Temporals c. Palatines d. Zygoma e. Frontals |
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What are the unpaired bones
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a. Ethmoid
b. Vomer c. Occiput |
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What nerves pass through the cavernous sinous?
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a. Located on either side of sella turcica
b. CN III, IV, VI, V, V(1), V(2) |
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What nerves pass through the superior orbital fissures
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a. CN III, IV, VI, V(1) and superior ophthalmic vein
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What nerve passes through the infraorbital fisssure?
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a. CN V2 - Movements of jaw
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How do you test the middle transverse axis of the sacrum?
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a. Sacro-ilial motion
b. Seated flexion test |
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What is being tested with a standing flexion test?
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Inferior transverse axis
Ilio-sacral motion |
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What nerves are affected by temporalis?
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3-11 (but not 5)
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What is the movement of the frontal bone in SBS flexion?
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Frontals are paired so they Externally Rotate
i. Glabella flattens ii. Inferior lateral angles (ILA) move laterally, inferiorly and slightly anteriorly (broaden) |
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What is the movement of the frontal bone in SBS extension?
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a. Internal rotation
i. Glabella goes anteriorly ii. ILAs narrow |
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What is the hand position of the fronto-occipital hold?
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1. Hand across frontal bone
a. Thumb: greater wing of sphenoid b. Middle finger: opposite greater wing of sphenoid c. Palm: rest on frontal bone d. Ring and little fingers: rest on superior portion of frontal bone near coronal suture 2. Other hand a. Cup occiput with palm b. Fingertips at base of cciput |
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What is the hand position of the Temporal hold?
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i. Hand position
1. Fingers interlaced cradling the occiput 2. Thenar eminence: mastoid process |
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Why preform a frontal lift?
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1. Encourage normal internal and external rotation of frontal bone
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What is the hand and treatment placement for a frontal lift?
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iii. Hand position
1. Elbows on table 2. Hypothenar eminences: lateral angels of frontal bone 3. Fingers: interlaced – not contacting forhead iv. Treatment 1. Draw fingers of one hand from fingers of other hand while gripping the fingers from the opposite hand (lumbricals) 2. Hypothenar influences internal rotation of LA of frontal bone 3. Coordinate action with lifting towards ceiling until release is felt |
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What is the hand and treatment placement for a parietal lift?
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iii. Hand position
1. Fingertips: inferior border of each parietal bone just superior to squamous temporal 2. Thumbs: cross above but not on sagittal suture a. Press thumbs against one another iv. Treatment 1. Fingers: approximate and encourage internal rotation of inferior border of parietals 2. Lift both hands cephalad until bases move into external rotation |
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What is the hand and treatment placement for a temporal bone release?
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iii. Hand Position
1. Palms: crossed, cradling the occiput 2. Thumbs: resting on mastoid processes iv. Treatment 1. Palpate internal/external rotation 2. Asses symmetry and amplitude of motion 3. Imbalances of motion a. Encouraging medial and lateral translation of mastoid process b. Follow motion and continue until “still point” is reached (synchronous rocking of temporal bones) c. Continue until motion feels balanced |
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What is the classic triad with TMJ?
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Pain
Altered Function Bruxism |
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What bones does the occiput drive?
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Posterior (temporals and parietals)
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What bones doe the sphenoid drive?
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Facial bones
maxilla |
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What bones does the temporal drive?
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Mandible
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What is the movement of the glenoid fossa (temporal) in cranial flexion?
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the temporalis will externally rotate causing movement to be posterior, inferior and lateral
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What is the movement of the condyle of the mandible in cranial flexion?
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Rotates posterior laterally
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What is the movement of the jaw in cranial flexion?
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retrudes posterior
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What is the movement of the mastoid process in cranial flexion?
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rotates medially
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Retrusion of the jaw and exaggerated cranial flexion will be seen with what bite pattern?
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Overbite
Classic TMJ |
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Protrusion of the jaw and exaggerated cranial extension results in what bite pattern?
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Underbite
classic for migraine |
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What part of the mandible is making the articulation in TMJ?
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condylar process
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What is the normal motion of the articular disc?
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Without pathology it slides forward and looks like a "bowtie"
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What are the muscles of mastication
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Temporalis
Masseter Medial and Lateral ptergoids |
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What is the pathophys in TMJ?
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The posterior portion of the articular disc should be mid condyle. When opened it looks like a bowtie. If the medial and lateral collateeral ligaments get stretched the articular disk can slip forward. In TMJ, when the jaw opens, the disk moves too far forward and the neurovascular bundle that is just posterioer gets pulled forward and pinched.
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What is internal joint derangement?
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usually an anterior displaced disc, injury to the condyle or a dislocated jaw
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How does the TMJ joint ligaments compare to those in the knee?
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There are no cruciate ligaments in the jaw to prevent hyperextension.
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How does muscle pain differ from joint pain with TMJ?
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It is diffuse, dull andgradual after eating ant turning the head.
With joint pain it is precise in location, sharp and a deviation with jaw opening and pain upon awakening. |
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What is the gold standard for imaging TMJ? What percentage of bony structures will be normal?
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MRI
only 30% will be normal! |
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What are the indications for craniosacral treatment?
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after the birth of a child
trauma to the PRM Dentistry that can compromise PRM like TMJ!!! |
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What does a c-shaped deviation tell you
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Increased motion on good side causes deviation to dysfunctional side. C faces dysfunction
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What does an S-shaped deviation tell you?
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That the dysfunctional movement of the disc from ligamentous instability involves both left and right condyles
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Describe the O/A oculo-cephalic reflex treatment.
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Used for upper C spine
Sidebend and rotate into the barrier (opposite the naming). Have patient look into barrier 3-5 seconds then away from barrier 3-5 seconds. Take up slack between, repeat 2-5 times Recheck |
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What is the muscle energy technique for TMJ.
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Diagnose by putting fingers in ear. Bad side is restricted or clicks. Hold the "bad" side on temple and cup good side at jaw. Sag jaw and ME jaw back into place
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What is the still technique for TMJ?
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Doc has forarms on table and cups patietns jaw.
Start by restin more presure on arm/side in point of ease. Wait for softening and shift to other elbow. Slight compresion, take to barrier, return to normal as with all still techniques. |
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What chemical mediators are associated with pain
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Serotonin
Substance P bradykinin histamine |
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What are low nocioceptor areas?
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Bone
skeletal muscle cartilage |
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What are high nocioceptor areas
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sub q tissue
periostium fascia ligaments joint capsules cornea of eye |
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Which fibers are largest and most rapid conducting?
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A
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Which fibers are small and slow conducting?
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C
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What fibers are triggerd with a finger stick, for example?
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A-delta
respond to strong stimuli very rapidly and localized |
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What is the pain pathway?
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pain enters the dorsal root ganglion ascends or decends giving somatic reflexes. the fibers terminate in the dorsal chord. The substantia gelatinosa is the gate keeper and decides wether the message gets to the spinthalamic tract to the higher brain centers
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What higher center does the reticular formation control
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Sleep
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What higher center does the limbic system control?
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mood and emotion
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What is the pain relay center?
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the thalamus
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What area of the brain is responsible for moticvation and personality/
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The frontal lobe and cerebreal cortx
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What is the current pain model for pain perception
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That the dorsal horn is the gatekeeper for nerve impulses to the periphery and wetther they should go to the brain or not.
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What is true about large fibers stimulating the substantia gelatinosa?
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It inhibits ascending pain transmission
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What are some changes seen with acute pain?
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increased HR and BP
Dialated pupils increase muscle tension Glycogen to glucose conversion increase NT release Body acts like it is in sympathetic mode |
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What is the 5th vital sign?
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Pain
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What is the criteria for fibromyalgia
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AC of Rheumatology state 11/18 tenderpoints for longer than 3 months that worsese with stress, cold and too much physical activity
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What sleep disturbance do FMyalgia patients have
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greater than 70% have alpha wave intrusion into non-REM delta wave sleep
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What are the pharmalogical treatments for Fmyalgia?
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SSRIs, SNRIs, sleep aids
narcotics should be avoided |
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What OMT techniques should be avoided with Fmyalgia patients?
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direct techniques and HVLA
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What patients respond best to indirect OMT techniques?
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Elderly
hospitalized acute neck strains and sprains younger can tolerate more than older |
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What are the two types of complex regional pain syndrome
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Type I: priviousl known as RSD and no evidence of nerve damage
Type II: previouly know as causalgia: has evidence of clinical nerve damage |
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What are the stages of CRPS?
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1) Severe burning at the site of injury, vasospasm, restricted mobilitym and muscle spasm
2) more intese pain, spread of swelling ad ostopenia 3) irreversable chnges in skin, bone, and soft fissue |
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Where do you direct OMT for a CRPS patient?
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SNS and PNS, but not periphery or site of injury
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Define scoliosis
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A ROTARTY deformaiton of the spine resulting in a sideways S or C shaped curve
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Define Short Leg Syndrome
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An UNLEVELING OF THE SACRAL BASE which is often caused by a compenstion for scoliosis in the spine
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What does it mean to have a structural scoliosis/
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It is inflexible or fixed
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What does it mean to have a functional scoliosis
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it is flexible and can potentially be fixed or become structural
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What is usually the primary curve in scoliosis?
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The thoracics
the lumbar compensates later |
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Fryettes Type 1:
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Spine neutral
Sidebending and Rotation are opposite |
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Fryettes type II:
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In flexion or extension. SB/R in same direction
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The apex of a scoliosis curve points to the right. What is named? How is it rotated/sidbent?
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Dextroscoliosis
Rotated Right and sidebent left. group I fryette |
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Where is the short leg usually found in relative to the lumbar convexity in scoliosis?
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Curve points to the short leg
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What is a typical finding for S shaped curve
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Thoracis spine conves on right
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Where does pelvic side sift go easier?
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longer leg
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Cobb angle
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90* from top and bottom of curves measure crossovers
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Curves greater than what degree will have compromise?
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50- respiratoyr compromise
70 will have cardiovascular |
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What is mild scoliosis and the treatment recommended?
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<20 degrees
Conservative management PT/OMT home exercises with goals to increase flexibility, stregnth |
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What is rissers score/sign?
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Skeletal maturity classification that looks at the illiac for ossification and fusion
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What is the criteria for moderate scoliosis?
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20-45 degrees. Same tx, but add back bracing
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What is the treatment for severe scoliosis and what is the marker?
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50 degress or greater
Consider surgery to reduce compromise |
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What is a functional short leg caused by?
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somatic dysfunction - use OMTt
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waht is a structrural short leg caused by?
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anatomy- use a heel lift
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What is ferguisons angle normally? how does it change with short leg?
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usually 30-40 degrees incereases 2-3 degress with a short leg.
It is a lumbosacral angal |
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What is the treatment order for leveling the sacral base?
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OMT for 3-6 tx
X ray study Heel lift if necessary |
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how is sacral base unleveling measured
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Hight of high - low (h-g)
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What are the goals for heel lift therapy?
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level iliac crests when standing
level sacral base have a negative Standing flexion testimproved forward bending symmetrical lateral bending |
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What is the procedure for heel lift therapy?
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1/16th in elderly
1/8th in more flexible patient adjust @2 week intervals with max 1/4 inside the shoe and 1/4 outside the shoe. |
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What do you do if greater than 1/2 inch heel lift needed?
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lift the heel and sole
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How much should a final lift be?
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1/2 - 3/4 of measured leg descrepency for 50-75% of amount off usually
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Is sacral base lower or higher on side of short leg?
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Lower
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