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176 Cards in this Set

  • Front
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what are the models of osteopathic care?
1. psychobehavioral
2. respiratory-circulatory
3. postural-structural
4. neurological
5. bioenergetic
Name this model of osteopathic care and provide examples:

patient is approached from a biomechaimical orientation toward the musculoskeletal system
Postural-structural model

postural exam
structural exam
s/d diagnosis
omt
exercise prescription
Name this model of osteopathic care and provide examples:

the patient is approached by diagnosis or treatment of the autominic nervous system and associated reflexes
Neurological model

referred pain
viscerosomatic reflexes
Chapmans points
Name this model of osteopathic care and provide examples:

the patient is approached from the perspective of improving blood and lymph flow
Respiratory-circulatory model

-palpation for edema
-evaluation and treatment of fascial diaphragms
-OMT to improve drainage
Name this model of osteopathic care and provide examples:

the patient is approached from the perspective of enhancing the capacity to relate and both internal and external environments
Psychobehavioral model

stress/anxiety
chronic pain
insomnia
mood disorders
Name this model of osteopathic care

examples include:
chronic myofascial pain
trauma rehabilitation
resistant s/d
complementary and alternative medicine
Bioenergetic model
what osteopathic model would you use?

musculoskeletal problems
postural treatment
sports medicine
rehab.
postural-structural
what osteopathic model would you use?

somatization
behavior modification
chronic pain
depression
psychobehavioral
what osteopathic model would you use?

referred pain
visceral diagnosis
visceral treatment
neurologic
what osteopathic model would you use?

systemic problems
edema
infectious disease
immune function
respiratory-circulatory
Name this treatment

1. find tender point
2. name 10/10
3. position to 2/10
4. fine tune to 0/10
5. hold 90 sec.
6. SLOW passive return
7. retest
Counterstrain
Name this treatment

1. diagnosis restricted motion
2. slowly move into position of laxity
3. follow release until completed (indirect)---or---slowly move inot restriction and stretch until tissue give is completed (direct)
4. retest
myofacial release
what are 3 types of manipulation in the cranial field?
1. balanced membranous tension

2. ligamentous articular strain

3. sutural disengagement
Name this treatment:

1. diagnose restriction
2. move into restrictive barrier
3. isometric contraction 3-5 seconds
4. stretch until give stops
5. repeat 3-5 times
6. retest motion
muscle energy technique
Name this treatment

1. diagnosis restriction
2. move into restrictive barrier for all planes
3. short, quick movement through the barrier
4. retest motion
thrust technique
name the treatment:

1. diagnosis restricted joint motion
2. slow movement of joint to its position of laxity for all planes
3. slow movement of joint into its restriction for all planes
4. 3-5 repetitions as one smooth movement
5. retest
articulatory technique
What techniques are utilized in autonomic normalization?
sympathetic techniques

parasympathetic techniques
What techniques are utilized in lymphatic treatments?
diaphragm release
lymphatic release
effleurage/petrissage
what techniques are utilized in visceral treatments?
ventral techniques
visceral manipulation
When are indirect techniques subjectively better?
1. rapid onset
2. acute duration (<2 weeks)
3. elderly
4. trauma
5. neurological symptoms
6. systemic/visceral symptoms
when are indirect treatments objectively better?
1. abnormal vital signs
2. traumatic signs (bruising/swelling)
3. antalgic posture
4. severe tenderness
5. guarding with movement
6. visceral abnormalities
A patient comes to you with an acute severe problem...what is your

method?
dose?
frequency?
duration?
ACUTE/SEVERE

indirect method
fewer regions/lower dose
1-2 tx. per week
2-4 treatments in duration
A patient comes to you with a chronic problem...what is your

method?
dose?
frequency?
duration?
any technique method
more regions/higher dose
every 2-6 weeks
can continue as long as helpful
Describe the movement of rib 1
elevation and depression
Describe the movment of ribs 2-10
*pump handle inhalation and exhalation

*bucket handle inhalation and exhalation
Describe the movement of ribs 11-12
caliper type inhalation and exhalation
Which ribs move primarily in pump handle motion moving anterior and superior with inhalation?
ribs 2-5
Which ribs move primarily in lateral and superior motion with inhalation?
ribs 6-10
How do you evaluate ribs 2-5?
karate chop
How do you evaluate ribs 6-10?
palpate at the lateral chest
How do you evaluate ribs 11 &12?
patient is prone
how do you name sternum somatic dysfunctions?
sternum in flexion or extension
What are the s/d that can be occuring in ribs 2-10?
1. inhalation or exhalation
2. anterior or posterior subluxation
How do you treat anterior rib tender point?
1. lean opposite shoulder on your knee
2. turn their head toward the rib
3. lean them away from rib tender point
How do you treat a posterior rib tender point?
1. put the same side arm on your knee
2. lean them toward side of affected rib
what rib do you treat for exhaled rib s/d?
treat top rib
what is the proper sequence for treating ribs?
1. treat thoracic first (type II and then type I)

2. treat subluxation

3. treat respiratory ribs
what are some reasons for Rib OMT?
rib pain
chest wall pain
mechanical back pain
tension headache
thoracic outlet syndrome
pneumonia
asthma
postural problems (scoliosis)
congenital deformities (pectus excavatum or pectus carinatum)
List the absolute contraindications for direct rib treatment.
multiple myeloma
rib metastasis
rib fracture
costochondral separation
List the relative contraindications for direct rib treatment
osteoporosis
costochondritis
arrhythmia
osteoarthritis
when is rib raising used?
Rib raising is used for rib restriction or related organ autonomic dysfunction
what are the major motions of the hips?
1. flexion/extesion
2. adbuction/adduction
3. internal rotation/external rotation
what are the minor motions of the hips?
1. anterior glide (hip external rotation)

2. posterior glide (hip internal rotation)
When you turn the knee medial and the ankle lateral---what motion are you testing in the hip?
internal rotation
What would you check if the hip was in external rotation?

(restricted in internal rotation?)
piriformis or gluteus
What would you check if the hip was in internal rotation?
hip adductors
hip internal rotators
What would you check if the hip was in flexion (restricted in extension)
quadriceps or iliopsoas
What would you check if the hip was in extension (restricted in flexion)
hamstrings
gluteus
What would you check if the hip was in abduction (restricted in adduction)
gluteus
greater trochanter or iliotibial band
What would you check if the hip was in adduction (restricted in abduction)
hip adductors
if you have a hip s/d what else should be evaluated?
SI joint
sacrum
pelvis
lumbar
short leg

**lower extremity s/d!!
What are some indications for Hip treatment?
Hip pain
-trochanteric bursitis
-iliotibial band syndrome
-psoas syndrome
-piriformis syndrom
-hamstring strain

Any s/d a joint above or a joint below--low back, pelvic, sacral, knee pain ***
List contraindications to hip treatment.
1. hip fracture/dislocation
2. infection, inflammation, cancer
3. DVT
4. femoral head avascular necrosis
5. severe hip or knee arthritis
What are the knee s/d?
patella: restricted in patellofemoral glide

tibia:
Flexion/extension
internal/external rotation

tibiofibular joint:
anterior fibular head, posterior fibular head
When the anterior tibial tuberosity is lateral to the midline of the patella, what is the s/d?
tibia in external rotation
List some indications for treating the knee:
knee pain
-strain
-chondromalacia patellae
-patella tendonitis
-osgood Schlatter syndrome
-osteoarthritis

shin splints
hip or ankle sprain
plantar fasciitis
what is this a treatment for:

1. locate the tender point at the medial knee joint line; labeling it 10/10

2. hold ankle, flex knee by dropping it off the table and retest for tenderness

3. fine tune with slight tibia internal rotation and adduction until tenderness is 2/10

4. hold 90 sec.

5. slowly and passively return leg to neutral
medial meniscus counterstrain
Name this treatment

1. place pillow under the foot and locate the tender point in the patella tendon

2. push the distal femur posterior to extend the knee and retest for tenderness

3. fine tune with slight tibia internal or external rotation

4. 90 seconds

5. slowly, return
patella tendon counterstrain
what s/d can occur at the occipitoatlantal joint?
flexion/extension** primary
sidebending and rotation to the opposite sides
What s/d can occur at the atlanto axial joint?
rotation only
what s/d can occur at C2-C7?
flexion-extension
sidebending and rotation to the same sides
in relation to movement in the neck--what is the 50% rule?
50% of cervical flexion and extension occurs at the OA joint

50% of the cervical rotation occurs at the AA joint
how many turns does the vertebral artery make around the foramen magnum?
3 turns therefore increasing the risk of arterial compromise with s/d and OMT
what screening tests should be performed before treatment of cervical s/d?

(5 things)
1. vertebral artery challenge test (DeKlejn's)

2. cervical compression test (Spurlings maneuver)

3. hypermobility screen (Beighton's score)

4. DTRs

5. upper extremity strength testing
what nerve is responsible?

DTR= biceps
strength= biceps
C5
what nerve is responsible?

DTR= brachioradials
strength= wrist extensors
C6
what nerve is responsible?

DTR = triceps
strength= wrist flexors
C7
what nerve is responsible?

DTR= none
strength= finger flexors
C8
what nerve is responsible?

DTR= none
strength= interossei
T1
List some indications for cranial manipulation
neck pain--acute or chronic

headache

TMJ dysfunction

pharyngitis, sinusitis

cranial/thoracic/rib s/d
what are the absolute contraindications for cervial OMT?
patient refusal
risk outweighs benefits
pain or intolerance during the procedure
What are the relative contraindications for cervical OMT?
vertebral arter insufficiency
sprain
joint inflammation
joint hypermobility (thrust)
rheumatoid arthritis
downs syndrome
translating the cervical spine right means sidebending in which direction?
translating right = sidebending left

sidebending and rotation are to the same side C2-C7
name the somatic dysfunction if C3 is restricted in right sidebending worse in flexion
C3 ERS left
What levels to Fryette mechanics not apply?
cervical region
Name the cervical technique:

begin at the indirect barrier and rotate through the direct barrier
articulatory
Name the cervical technique:

generally sidebend and rotate away
counterstrain
Name the cervical technique:

rotation: at direct flexion/extension and rotation barrier
rotation ME
Name the cervical technique:

sidebending: at direct flexion/extension and sidebending barrier
sidebending ME
What is Fryette's Law #1?
when the spine is in neutral sidebending and rotation are in opposite directions

-facets are not engaged
-found in thoracic and lumbar spines
-forms long curves, multiple segments
-compensatory
What is Fryette's Law #2?
when the spine is flexed or extended sidebending and rotation are in the same directions

-facets are engaged
-occurs in thoracic and lumbar spines
-usually single segements
-found at apices and crossovers and/or sites of viscerosomatic reflexes
-primary somatic dysfunction
What is Fryette's Law #3?
when motion introduced in one plane it modifies (reduces) motion in other two planes

-when a segment is brought up to a restrictive motion barrier it will move in the position of greatest ease in the other two planes

-restriction = direction it won't go

-s/d = direction it wants to be
which type of thoracic/lumbar somatic dysfunction rotates towards the concavity?
type II
name the diaphragm

L5-S1
pelvic diaphragm
name the diaphragm

T12-L1
thoracic diaphragm
name the diaphragm

T1-1st rib
thoracic inlet
name the diaphragm

OA, AA
suboccipital
which model does Zink's fascial diaphragm theory utilize?
respiratory-circulatory
what are the 4 patterns of body structure according to Zink's fascial diaphragm theory?
1. ideal
2. common compensatory
3. uncommon compensatory
4. uncompensated or disparent
when evaluating fascial diaphragms what is the treatment approach?
emphasis on crossover points of spinal curves

treat the worst first!
what is the common compensatory pattern of diaphragms?
pelvic = right
abdominal = left
thoracic inlet = right
suboccipital = left
what joints make up the shoulder complex?
scapulothoracic
acromioclavicular
sternoclavicular
costovertebral
glenohumeral
Describe the relationship between the glenohumeral joint and the scapulothoracic joint during arm abduction
for every 3 degrees of abduction--2 degrees occurs in the glenoumeral joint and 1 degree in the scapulothoracic joint
A restriction in scapular rotation leads you to believe there is what kind of problem?
shoulder girdle problem
A restriction in humeral abduction leads you to believe there is what kind of problem?
glenohumeral problem
what is the role of the clavical in abduction?
elevates from a pivot at the sternoclavicular joint as well as rotating on a long axis
what is this treatment for?

1. push or pull the medial clavical into its restrictive barrier

2. patient's flexed arm pulls posteriorly into your shoulder
anterior clavicle
what is this treatment for?

1. push or pull the medial clavical into its restrictive barrier

2. patient's internally rotated arm pushes anteriorly
superior clavicle
what is this treatment for?

1. push or pull the medial clavical into its restrictive barrier

2. patient's head rotated toward the restricted SC joint and pushes into rotation away from the restricted joint
inferior clavicle
List the spencer technique:
1. extension
2. flexion
3. compression
4. traction
5. abduction
6. internal rotation
7. pump
8. adduction
Name this extremity nerve compression syndrome

pain and/or parathesia in the upper extremity from brachial plexus compression

neural compression is more common than vascular compression
Thoracic outlet sydrome
Name this extremity nerve compression syndrome

median nerve compression associated with numbness, and pain in the arm and hand along the median nerve distribution

repetitive micro trauma
carpal tunnel syndrome
Name this extremity nerve compression syndrome

A type of peripheral nerve compression syndrome in which there is a 'central' compression that impacts on a nerve bundle–eg, at the thoracic or pelvic outlet, and a 2nd more peripheral compression–eg, at the carpal or tarsal tunnel;
double crush syndrome
where is the compression in thoracic outlet syndrome?

what test would be positive?
-between the clavicle and the 1st rib

-anterior and middle scalene muscles

+ Adsons maneuver (scalene compression test) = diminished pulse and/or reproduction or exacerbation of symptoms
where is the compression in carpal tunnel syndrome?

what test would be positive?
carpal tunnel (duh)

+ phalen's test...MUST HOLD IN FULL FLEXION FOR UP TO 60 SECONDS!!!

+Tinel's test--gentle tapping over the median nerve in the carpal tunnel can elicit tingling in the nerve's distribution
where is the compression in thoracic outlet syndrome?

what test would be positive?
dimulatenous appearance of carpal tunnel and thoracic outlet syndrome

*compression of a nerve at one point renders it more susceptible to damage at another site

both Adson's and Phalen's +
what is the treatment for thoracic outlet syndrome?
OMT for elevated 1st rib

PT--postural correction, e. stim, deep heat

management of chronic pain

surgical resection of 1st rib
what is the treatment for carpal tunnel syndrome?
OMT--myofascial release
*release transverse carpal ligament, opponens roll, wrist extension to pull flexor tendons
*hyperextend thumb, laterally rotate, hold for 5-10 sec.

wrist braces

NSAIDs

Vitamin B6
What direction does the ulnohumeral joint passively move with extension?
abducts

= carrying angle
with a posterior radial head somatic dysfunction--what glide will be restricted?
anterior glide is restricted

therefore supination is restricted
A person falls backwards on an extended arm--what is the most likely somatic dysfunction?
anterior radial head somatic dysfunction

-ease of motion is anterior glide
-restricted motion is posterior glide with pronation
Patient with back pain...what muscles should you immediately think of evaluating?
psoas
iliacus
quadratus lumborum
name the visceral somatic levels

head/neck
T1-T4
name the visceral somatic levels

stomach, liver, gall bladder
T5-T9
name the visceral somatic levels

kidney, ureters, bladder
T10-T11
name the visceral somatic levels

colon/rectum
T8-L2
name the visceral somatic levels

heart
T1-T5
name the visceral somatic levels

lungs
T2-T7
name the visceral somatic levels

small intestine
T9-T11
name the visceral somatic levels

uterus
T10-T11
name the visceral somatic levels

prostate
L1-L2
how do you treat an anterior innominate with HVLA?
1. patient on back
2. lift affected leg up 30 degrees
3. caudad tug down the leg
how do you treat an anterior innominate with ME?
1. patient on back
2. stand beside the involved side and craddle patients bent knee (knee toward chest)
3. pull ischial tuberosity anteriorly
4. patient resists by pushing their knee against your shoulder
how do you treat a posterior innominate with ME?
1. patient laying on the table with affected leg dangling off
2. stand on invovled side and hold the opposite ASIS
3. move into the barrier and have the patient push their thigh upward
In sacral evaluation--if the spring test is positive, what does that limit your diagnosis to?
R/L
L/R
unilateral extension
describe the pathway of facilitation
ANS nerves--->organ--->aberrant activity --->affects systemic activities
name the visceral somatic levels

eye
T1-T2

dilates pupil, relaxes for far vision
name the visceral somatic levels

esophagus
T3-T6

decreases peristalsis, contracts sphincter
name the visceral somatic levels

gall bladder
T6-T9

relaxation
name the visceral somatic levels

right colon
T8-T11

decrease peristalsis and secretion
name the visceral somatic levels

cervix
L1-L2

opens cervix
name the visceral somatic levels

uterus
T9-L2

contractions
what organs have S2-S4 for parasympathetic innervation?
distal 1/3 of transverse colon to the rectum--contract lumen, relaxe sphincter, increase secretion/motility

uterus--decreases activity
what is the parasympathetic innervation for...?

eye
CN III

constricts pupil for near vision
what is the parasympathetic innervation for...?

lacrimal/nasal glands
CN VII

stimulates for extensive secretion
what is the parasympathetic innervation for...?

parotid gland
CN IX

stimulates for extensive secretions
The following findings are suggestive of what?

-hot
-moist
-fullness
-edema
-tension
-increased or prolonged redness
acute findings
From the location, name this Chapman's point

-at the tip of the right 12th rib?
appendix
From the location, name this Chapman's point

-2 inches superior and 1 inch lateral to the umbilicus
-spinous process T11
adrenals
From the location, name this Chapman's point

-2nd medial intercostal space
-spinous process of T2
heart
From the location, name this Chapman's point

-at the umbilicus
kidney
From the location, name this Chapman's point

-anterior IT bands
-L2-L4 spinous process
colon
what is the CRI rate?
10-14
what is the amplitude of CRI?
distance from flexion to extension (0-5)
List the 5 components of the Sutherland primary respiratory mechanism
1. mobility of cranial bones
2. motility of CNS
3. fluctuation of CSF
4. mobility of sacrum and ilia
5. reciprocal tension of dura mater/membrane
list the unpaired bones
mandible
occiput
vomer
ethmoid
sphenoid
describe the movement of unpaired bones
flexion/extension
describe the movement of paried bones
external and internal rotation
how many bones are in the adult human skull?
29
Name this cranial movment

SBS rises as sphenoid and occiput rotate opposite directions on transverse axis
cranial flexion
Name this cranial movment

-sphenoid and occiput rotate opposite directions on AP axis

-named for superior sphenoid great wing
torsion
Name this cranial movment

-2 axes sidebend by rotating same direction on 2 parallel vertical axes rotate same way on AP axis

-named for convexity of sidebending
sidebending rotation
Name this cranial movment

-rotate same direction on 2 parallel horizontal axes

-named for direction of sphenoid base
vertical strain
Name this cranial movment

-rotation same direction about 2 parellel vertical axes

-named for direction of base of sphenoid
lateral strain
Name this cranial movment

-most often due to head trauma
-limited degree of flexion and extension
SBS compression

sphenoid/occiput are compressed together
list the pysiological SBS strains
pysiological
-flexion/extension
-torsion
-sidebending rotation
what is the common cranial nerve involvement in...

EOM dysfunction?
III
IV
VI
what is the common cranial nerve involvement in...

trigeminal neuralgia
V
what is the common cranial nerve involvement in...

bells palsy
VII
what is the common cranial nerve involvement in...

feeding disorders
IX
X
XII

*occipital decompression
what is the common cranial nerve involvement in...

torticollis
XI

*occipital decompression
what are the contraindications for Osteopathy in the cranial field?
intracranial bleed
increased CSF
CNS malignancy or infection
craniofacial fracture
what points should a static lateral line go through?
1. anterior to lateral malleolus
2. middle of tibial plateau
3. greater trochanter
4. body of L3
5. middle of humeral head
6. external auditory meatus
what points should a static posterior line go through?
1. halfway between knees
2. along gluteal fold
3. through all spinous processes
4. along the midline of the head
Name this screening test

-patient shifts weight onto one leg allowing the other knee to bend which induces a lumbar sidebending toward the weight bearing leg

normally > 25 degrees

+ is less than 25 and indicates restricted lumbar sidebending toward the side of wieght bearing leg
hip drop test

*test is named for the bent leg side (+ right hip drop test indicates restricted left lumbar sidebending)
what postural x-rays should be ordered in the evaluation of scoliosis?
postural radiographs
-anterior-posterior erect
-lateral erect
both of these center on the iliac crest

scoliotic x-ray
-erect AP that includes the occiput and the sacral base!!!
when you view a postural x-ray, what 4 things should you evaluate?
1. sacral base levelness
2. iliac crest levelness
3. femoral head levelness
4. thoracic or lumbar scoliosis (cobb angle)
what is ferguson's angle?
weight bearing line and base of sacrum

normal is 40 degrees +/- 2
the convexity of functional scoliosis is usually the same side as what?
the short leg!!!
describe the appropriate progression of heel lifts
1/8 inch lift

increase lift no faster than 1/16 per week (or 1/8 every 2 weeks for non geriatric or acute pain patients)
as described by the Adam's test---name this type of scoliosis

does not reduce with side bending toward the rib hump?
structural
what is this angle

draw lines from the top of the superior vertebra and the bottom of the inferior vertebra into the concavity of the curve

drop intersecting lines perpendicular to these lines and measure the actue angle
Cobb angle
what is the cobb angle in mild scoliosis?

tx?
5-15

tx: conservative, OMT, exercises and tx of short leg
what is the cobb angle in moderate scoliosis?

tx?
20-45

tx: bracing or e. stim
what is the cobb angle in severe scoliosis?

tx?
>50

surgical stabilization
what is the OMT goal for scoliosis?
optimize the function of the existing structure
-remove joint s/d
-improve general body ROM

introduce strengthening exercises after structural strains to increase healing