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157 Cards in this Set
- Front
- Back
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Accessory movements
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movements used to potentiate, accentuate, or compensate for an impairment in a physiological motion
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Accommodation
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self reversing and nonpersistent adaptation
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Lumbolumbar lordotic angle
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an objective quantification of lumbar loridosis typically determined by measuring the angle between the superior surface of the second lumbar vertebrae and the inferior surface of the fifth lumbar vertbrae
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Lumbosacral angle
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represents the angle of the lumbosacral junction as measured by the inclination of the superior surface of the first sacral vertebrae to the horizontal
aslo known as Ferguson's angle |
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Lumbosacral lordotic angle
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an objective quantification of lumbar lordosis typically determined by measuring the angle between the superior surface of the second lumbar vertebra and the superior surface of the first sacral segment
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Caliper rib motion
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rib motion of ribs 11 and 12 characterized by single joint being held in a position of inhalation such that motion towards inhalation is more free and motion towards exhalation is restricted
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Facet asymmetry
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configuration in which the structure, position and/or motion of the facets are not equal bilaterally
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Gravitational line
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viewing the patient from the imaginary line in a coronal plane which is the theoretical ideal posture, starts slightly anterior to the lateral malleolus, passes across the lateral condyle of the knee, the greater trochanter, through the lateral head of the humerus at the tip of the shoulder to the external auditory meatus; if this were a plane through the body, it would intersect the middle of the third lumbar vertebra and the anterior one third of the sacrum
It is used to evaluate the A-P curves of the spine |
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LInkage
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dysfunctional segment behavior where a single vertebra and an adjacent rib responds to the same regional motion tests with identical asymmetric behaviors.
This suggest a visceral reflex input |
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Lovett Law
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states that there is an association between the superior and inferior vertebra, which are paired two by two.
The cervical and superior thoracic biomechanics act in a synchronous manner with the lumber and inferior thoracic biomechanics. For example if C1 is right posterior positional lesion, L5 also moves into the right posterior position L5 is the Lovett partner of C1 The treatment of L5 helps stabilize C1 and the skull by changing the line of gravity |
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Mid-heel line
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a vertical line used as a reference in standing AP x-rays and postural evaluations passing equidistant between the heels
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Mid-malleolar line
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a vertical line passing through the lateral malleolus used as a point of reference in standing lateral x-rays and postural evaluations
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Osteopathic postural examination
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the part of the osteopathic exam that focuses on the static and dynamic responses of the body to gravity while in the erect position
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Patient cooperation
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voluntary movement by the patient to assist in the palpatory diagnosis and treatment process
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Pelvic declination
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pelvic unleveling
pelvic rotation about an A-P axis |
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Pelvic index
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represents a ratio of the measurements determined from postural radiograph:
One beginning from a vertical line originating at the sacral promontory to the intersection with the horizontal line from the anterior-superior position of the pubic bone The second measurement is along the same horizontal line Normal values are age related and increase in subjects with sagittal plane postural decompensation |
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Postural balance
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a condition of optimal distribution of body mass in relation to gravity
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Postural decompensation
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distribution of body mass away from ideal when postural homeostatic mechanisms are overwhelmed
It occurs in all cardinal planes but is classified by the major plane affected |
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Postural imbalance
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a condition in which ideal body mass distribution is not achieved
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Posture
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position of the body
the distribution of body mass in relation to gravity |
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Prime mover
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a muscle primarily responsible for causing a specific joint action
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anterior pubic shear
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a somatic dysfunction in which one pubic bone is displaced anteriorly with relation to its normal mate
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Inferior pubic shear
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a somatic dysfunction in which one pubic bone is displaced inferiorly with relation to its normal mate
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Posterior pubic shear
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a somatic dysfunction in which one pubic bone is displaced posteriorly with relation to its normal mate
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pubic abduction
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gapping
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pubic adduction
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compression
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pubic compression
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a somatic dysfunction in which the pubic bone are forced toward each other at the pubic symphysis
This dysfunction is characterized by TTP over the pubic symphysis, lack of apparent asymmetry, but associated with restricted motion of the pelvic ring |
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pubic gapping
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a somatic dysfunction in which the pubic bones are pulled away from each other at the pubic symphysis. This dysfunction is frequently seen in women following childbirth
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superior pubic shear
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a somatic dysfunction in which one pubic bone is displaced superiorly with relation to its normal mate
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regional extension
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historically, the straightening in the sagittal plane of the spinal region
Fryette's regional extension |
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respiratory cooperation
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an osteopathic practitioner directed inhalation and or exhalation by the patient to assit in the manipulative treatment process
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sacral base declination
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with the patient standing or seated, any deviation of the sacral base from the horizontal in a coronal plane
Generally the rotation of the sacrum about an A-P axis |
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Sherrington Law
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1. every posterior spinal nerve root supplies a specific region of the skin, although fibers from adjacent spinal segments may invade such a region
2. When a muscle receives a nerve impulse to contract, its antagonist receives simultaneously an impulse to relax |
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Tonus
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the slight continuous contraction of muscle which in skeletal muscles, aids in the maintenance of posture and in the return of blood to the heart
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Tropism, facet
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unequal size and/or facing of hte zygapophyseal joint of the vertebra
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Viscosity
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1. a measurement of the rate of deformation of any material under a load
2. the capability possessed by a solid of yielding continually under stress |
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Enthesitis
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1. traumatic disease occurring at the insertion of muscles where recurring concentration of muscle stress provokes inflammation with a strong tendency towards fibrosis and calcification
2. inflammation of the muscular or tendinous attachment of the bone |
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Percussion vibrator technique
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1. a manipulative technique involving the specific application of mechanical vibratory force to treat somatic dysfucntion
2. An osteopathic manipulative technique developed by Robert Fulford, DO |
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Psoas syndrome
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a painful low back condition characterized by hypertonicity of psoas musculature
The syndrome consists of a constellation of typically related signs and symptoms |
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Typical posture os psoas syndrome
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flexion at the hip and sidebending of the lumbar spine to the side of the most hypertonic psoas muscle
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typical gait of psoas syndrome
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trendelenburg gait
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typical pain pattern of psoas syndrome
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low back pain frequently accompanied by pain on the lateral aspect of the lower extremity extending no lower than the knee
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typical associated somatic dysfunction of psoas syndrome
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as a long restrictor muscle psoas hypertonicity is frequently associated with:
flexed dysfunction o the upper lumbars extended dysfunction of L5 Variable sacral and innominate dysfunction Tender points typically are found on the ipsilateral iliacus and contralateral piriformis muscles |
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Sclerotherapy
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1. treatment involving injections of a proliferant solution of the osseous-ligamentous junction
2. treatment involving injection of irritating substances into weakened connective tissues areas such as fascia, varicose veins, hemorrhoids, esophageal varices, or weakened ligaments. The intended bodys response to the irritant is fibrous proliferation with shortening/strengthening of the tissues injected |
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Sclerotome
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the pattern of innervation of structures derived from embryonal mesenchyme
the area of bone innervated by a single spinal segment The group of mesenchymal cells emerging from the ventromedial part of the mesodermal somite and migrating toward the notochord Sclerotomal cells from adjacent somites become merged in intersomaticaly located masses that are the primordia of the centra of the vertebra |
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Sclerotomal pain
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deep, dull achy pain associated with tissue derived from common sclerotome
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Subluxation
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1. a partial or incomplete dislocation
2. a term describing an abnormal anatomical position of a joint which exceeds the normal physiological limit but does not exceed the joints anatomical limit |
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Transitional region
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areas of the axial skeleton where structures change significantly lead to functional change
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Elevated arm test
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elevate arms over head
clench and release fist for 3 minutes If symptoms recur, positive for TOS |
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Adson's test
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flex arm to 60 degrees and aBduct it while palpating radial pulse.
Have patient turn head ipsilaterally Decrease in pulse is positive for TOS |
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Modified Adson's test
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flex arm to 60 degrees and aBduct it while palpating radial pulse
Have patient turn head contralaterally Decrease in pulse is positive for TOS |
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What are two test that can be done to assess your patient for carpel tunnel syndrome?
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Phalens
Tinnels |
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Phalens sign
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forced flexion for 30-60 seconds (increasing pressure in CT) reproduces symptoms
- Positive for Carpel tunnel |
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Tinnel's sign
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tapping over the median nerve reproduces pain/parasthesia
+ Carpel tunnel |
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What are the structures normally involved in Thoracic Outlet Syndrome?
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Anterior scalene
Middle scalene Subclavian vessels Brachial plexus |
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Anterior scalene syndrome
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involves the brachial plexus or subclavian artery
Dx: Adson's test Risk: increased muscular hypertrophy |
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what is something that puts you at risk for developing anterior scalene syndrome?
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increased muscular hypertrophy of the neck
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Cervical rib syndrome
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Sx: subclavian artery > brachial plexus
Dx: modified Adson's Risks: attributed to cervical rib |
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what syndrome are you at risk for if you have a cervical rib?
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Cervical rib syndrome
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Costoclavicular syndrome
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sx: involves subclavian vessels >> brachial plexus
dx: military posture risks: narrowing between 1st rib and clavicle |
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Hyperabduction syndrome
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sx: involves neurovascular bundle + pec minor
- pec minor attaches coracoid to ribs 1-3 dx: hyperabduction of affected arm |
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Form closure
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those conditions under which a concentrically loaded and arrayed joint and with balanced support of the joint, requires NO additional force to sustain stability
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Force closure
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occurs where additional asymmetric force is necessary to counterbalance an imbalanced joint
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Stability
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= form closure + force closure
(SI joint) |
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What can cause a change from FORM to FORCE closure in a joint?
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Where posture is imbalanced a mechanical shift of weight bearing joints can change from FORM to FORCE closure
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what are the three central boundaries of posture?
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1. the feet are central to equal and opposing vectors of body weight and ground support
2. the sacral base is approximately central to the outstretched frame 3. the postural control system in the brainstem of the CNS interacts with the entirety to affect the most economic stance and activity -overall these 3 limiting structures are central to postural systematic and provide boundaries within which all other structures function |
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what is the central gravitation interaction
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the feet are central to the equal and opposing vectors of body weight and ground support
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what is the geometric center
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the sacral base is approximately central to the outstretched frame
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what do the 3 central boundaries of posture provide?
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these 3 limiting structures are CENTRAL to postural systematic and provide boundaries within which all other structures function
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what are the measurements that determine if your patient has lumbopelvic loridosis?
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Standing and the angle of the sacral base relative to horizontal, is measured, and the vertical line of sacral load by the lumbar spine is constructed from the mid-body of L3 and which ideally passes through the anterior 1/3 of the sacral base.
If the sacral angle is > 41 degrees and/or the line of sacral load passes anterior to the sacral base, this is defined as lumbopelvic lordosis |
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what is the progression of the heel lift?
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1. initial shoe
2. heel lift inside of shoe < 5/16 inch 3. lift both inside and outside heel 4. with anterior lift to decrease forward pitch of shoe |
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what should the initial heel lift for those with unlevelness < 1/8 inch be?
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1/8 inch beneath the low side of the pelvis
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how is the heel lift for those with less than 1/8 unlevelness augmented each week?
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this is augmented in thickness by 1/16 inch
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what happens if the heel lift exceeds 5/16 inch?
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if the lift indicated exceeds 5/16 inch, this lift is moved to the outside of the heel of the shoe, and remainder of lift is resumed inside
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what happens to the sole of the shoe if the heel lift indicated is > 5/16 inch?
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where the net lift > 5/16 inch, the sole of the shoe is augmented such that the difference between the heel and shoe is no greater than 5/16 inch, where practical. The sole augmentation prevents too great a contrast in pitch for the feet
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Sympathetic innervation of the uterus and cervix
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T10-L2
- constricts uterine fundus - relaxes cervix |
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sympathetic innervation of the ovaries
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T10-T11
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sympathetic innervation of the clitoris and vagina
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T11-L2
- increases vascular constriction |
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Parasympathetic innervation of the ovaries
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Vagus (mesonephric innervation)
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parasympathetic innervation of the uterus
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pelvic splanchnic (S2-S4)
- relaxes fundus - constricts cervix |
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parasympathetic innervation of clitoris and vagina
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erection of clitoris
increased glandular secretion of vagina |
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what are the muscle of the pelvic diaphragm?
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Levator ani
- Iliococcygeus - Pubococcygeus Coccygeus |
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what are the indications for OMT in pregnancy?
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induction of labor "prime the uterus"
Labor pains - Uterine pain: L1-L2 - Pain from descent, fetal head: S2-S4 Dystocia Perineal stretching: reduced perineal lacerations, decreased need for episiotomy |
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innervation for uterine pain
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L1-L2
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innervation for pain from descent or the fetal head
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S2-S4
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Contraindications for OMT in pregnancy
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Chorioamnionitis
Cord prolapse PPROM Placental abruption Early pregnancy (relative) HVLA (relative ) CV4 (relative) |
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type of OMT used for induction of labor
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sacral rocking
uterine manipulation |
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type of OMT used for labor pain
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L/S decompression
LIPLSIP |
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type of OMT indicated for dystocia
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sacral rocking
pelvic diaphragm release |
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OMT for perineal stretching
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myofascial release of perineum
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OMT for autonomic dysfunction in GYN problems
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sacral dysfunction
cranial manipulation Chapman's reflexes |
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OMT for mastitis and breast feeding
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chest wall release
breast manipulation shotgun thoracics |
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OMT for LBP/RLP in GYN/PREG
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LIPLSIP
Lumbopelvic release OB roll LS decompression |
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OMT for dysuria
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shotgun pubes
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OMT for mastalgia
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chest wall release
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OMT for constipation
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sacral rocking
visceral release |
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Spurling's test
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compression test
+ sign indicates radicular pain > cervical impingement |
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treatment for adhesive capsulitis
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spencer technique
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Apley's scratch test
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+ sign shows decreased ROM indicating rotator cuff dysfunction
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Empty can test
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+ sign shows weakness/pain indicating rotator cuff tear
- supraspinatous |
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Drop arm test
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cannot maintain abduction
indicates rotator cuff tear |
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Yergason's test
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painful flexion and supination
- with elbow at 90 degrees forearm pronated, attempting to supinate and flex elbow causes pain - bicipital tendonitis |
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Speeds test
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difficult with shoulder flexion against resistance
- bicipital tendonitis |
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what are the risk factors associated with shoulder disorders?
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decreased mobility in cervico-thoracic area has 84% predictive value for shoulder disorders increased risk 3X
- jobs and activities with repetitive shoulder motion/force and vibration - rheumatologic and degenerative conditions - females are more prone than males - all ages, but peaks 40-60 years of age |
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ventral ramus (radiculopathy)
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pain radiates to buttocks and legs
positive straight leg Paresthesia lower portion of leg weakness at knee and ankle Decreased DTRs EMG/NCv changes |
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Zygapophyseal joint
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facet joint/dorsal ramus syndrome
- pain in back, buttock, leg, groin - no radiation below knee - signs of spasm/deformity - paravertebral tenderness pain in morning upon rising, LESSEN with activity - Painful motion: HYPEREXTENSION - Neurological exam NOT indicate single nerve compression |
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Somatosympathetic nerve
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innervates anterior longitudinal ligament, anterior/lateral vertebral bodies, IV disc, 1/3 into disc
- DULL, Dense, BORING, and hard to localize pain (visceral quality) - distributed across the L1-L2 segments NO MATTER damage location |
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Sinu vertebral nerve
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innervates: posterior longitudinal ligament, anterior dural surface, posterior vertebral bodies, posterior IV disc, 1/3 into disc
-CROSSES MIDLINE - localized LBP - paraspinal muscle spasm - NO sensory findings, NO denervation weakness - NO EMG/NCV changes |
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Erector spinae muscles
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Iliocastalis: lateral branch of dorsal ramus
Longissimus: intermediate branch of dorsal ramus Spinalis |
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Trasversospinalis group
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semispinalis
multifidus: meidal branch of dorsal ramus rotatories |
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who is neck and upper back pain a more common complaint in?
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females > males
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what is the mc reason for a patient to seek medical care?
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LBP
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what is the second most common reason for a patient to seek medical care?
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neck and upper back pain
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T/F
only 1/3 of patients with neck pain experience complete resolution |
True
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T/F
after a whiplash injury, neck pain persists for up to 2 years in 29-90% of patients and in 74% after 10 years |
true
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T/F
Permanent medical disability occurs in 40% of patients involved in rear end MVAs |
False
10% |
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what is most neck and back pain in the US attributed to?
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in the US 85% of neck and back pain is due to chronic stress and strains
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list the work related risk factors for neck and upper back pain.
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Hand-arm vibration
Chronic neck flexion sitting at work > 95% sustained arm postures poor ergonomics |
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what type of somatic dysfunction causes head pain?
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somatic dysfunction of the OA and AA cause head pain
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what type of somatic dysfunction causes neck pain?
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C2-C7
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describe the character of pain associated with cervical facet pain.
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dull, unilateral achiness (C2-C3)
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what can cervical muscle spasm cause?
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cervical muscle spasm and venous pressure lead to pressure and entrapment of CN's IX, X, XI as they pass through the jugular foramen
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where does the SANS supply to the head emerge from?
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the SANS supply to the head emerges from the spinal cord in the upper thoracic
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what can cause a sinus headache
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inhibited venous and lymphatic drainage from the head can cause discomfort in the head and neck
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By treating the cervical and upper thoracic spine we can ______ the irritability and ________ the stability of the SANS tone to all cranial vessels
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by treating the cervical and upper thoracic spine we can decrease the irritability and increase the stability of SANS tone to all cranial vessels
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What type of injury is Whiplash?
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total body injury
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LIst HYPERextension injuries
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anterior longitudinal ligament tear
anterior disc herniation avulsion fracture: vertebral bod Nerve root impingement |
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HyperFLEXION injuries
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subluxation of facets
capsule tear posterior disc herniation posterior longitudinal ligament tear injury to nerve root |
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T/F
Prevention of subsequent problems in whiplash injury is to promote motion. |
True
- get rid of cervical collars - encourage daily stretching - promote normal daily activities (including work/school) |
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define scoliosis
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lateral curvature of the spine > 10 degrees
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lateral curvature of the spine < 10 degrees defines what?
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spinal asymmetry
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describe the 3 dimensional torsional deformity affecting all 3 planes in scoliosis
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usually thoracic or lumbar
- primarily lateral curvature in coronal plane - axial rotation in horizontal plane - decreased kyphosis and lordosis in sagittal plane |
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which type of scoliosis is reversible?
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functional scoliosis is reversible
- reduce or disappear is the key to differentiating between functional and structural types |
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T/F
scoliotic curvatures begin as functional curves and then progressive to structural |
True
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what is the MCC of scoliosis?
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Idiopathic
- 80% of scoliosis - unknown cause |
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what is the 2nd MCC of scoliosis?
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Congenital scoliosis
- 75% are progressive - very aggressive |
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what are common associations with neuromuscular scoliosis?
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neuropathy: myelomeningocele
mesenchymal: Marfan syndrome neuromuscular: leg length difference, Neurofibromatosis |
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Hueter-Volkmann Law
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compression forces inhibit growth while tensile forces stimulate growth
- increased compression on concave side decreases growth - decreased compression on convex side increases growth |
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Diagnosis of Idiopathic Scoliosis is most common in what age group?
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80% of diagnosis is in adolescents
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what is the likelyhood of a female having to receive treatment for scoliosis verses a male?
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girls are 7X more likely to require treatment
progress typically between ages of 10 to 16 |
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what does significant pain associated with scoliosis suggest?
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possible bone tumor
tethered spinal cord other abnormalities (trauma) |
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what is the most important initial task in the management of idiopathic adolescent scoliosis?
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rule out secondary causes of lateral spinal curvature
- diagnosis of exclusion |
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what is the most obvious finding in idiopathic scoliosis in an adolescent?
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visible at 10 degrees: presence of rib hump with forward bending most obvious finding
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Adam's test
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forward bending test
- most sensitive test for scoliosis |
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what are the anatomical findings in idiopathic scoliosis?
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rib hump with forward bending on convexity
ribs more widely separated on convex side vertebrae rotate toward/side bent away from convexity |
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describe the vertebrae dysfunction in the convexity of a scoliotic curve
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vertebrae rotate toward/side bent away from convexity
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how do you name the curve in scoliosis?
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direction of the curve: named for convexity of the curve
type of curve: based on the apex identified by: vertebral apex, vertebra involved |
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what are the most common curves in scoliosis?
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double major curve: usually right thoracic, left lumbar
single (usually right) thoracic single lumbar curve Junctional thoracolumbar or cervicothoracic: uncommon |
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what is used to measure the curve magnitude in coronal plane?
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Cobb angle
- angle made by line along most tilted vertebrae above and below the apex |
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Risser's sign
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amount of calcification present in the apophysis of the iliac crest
5 grades: 1: up to 25% ossification 2. 25-50% ossification 3. 50-75% ossification 4. 75-100% ossification 5. fusion of apophysis to the ilium, end of height increase |
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describe the natural history of scoliosis
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40.5 years after maturity 68% of curves progress
curves < 30 tend to not progress curves > 30 usually progress Single thoracic curves between 50-75 at maturity progress steadily at 1 degree/year significant progression: > 5 increase in curvature between initial and follow up xrays in 5 months |
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describe the osteopathic management of scoliosis
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direct optimizing mobility
- improve strength of musculature; stretch tight tissues - correct somatic dysfunction - look for type II SD's within Type I - postural lifting of short leg syndrome |
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T/F
it has been noted that scoliosis has been associated with a cranial sidebending dysfunction |
True
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T/F
HVLA is ok for functional scoliosis, not structural |
True
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T/F
the greater amount of growth after the onset of the curve, the greater the risk of progression |
true
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Prognosis of curves in scoliosis
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curve < 30-50' at maturity progress an average of 10-15' over a lifetime
curve 50-75' at maturity progress steadily at 1'/year Significant progression: > 5' increase in curvature between initial and follow up x-rays within 5 months |
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Left thoracic curves in scoliosis are uncommon. What association do they have that could be very dangerous?
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significant association with spinal cord abnormalities
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