Opp 2 Test Cards

Front 1

A 35 yo female with chronic back pain has tenderness at the superior aspect of both posterior superior iliac spines that reproduces her pain. Which chronic back pain syndrome does she most likely have?

Back 1

iliolumbar ligament syndrome

**bilateral UPL5 tender points**

Front 2

A 28 year old male with chronic back pain has reproduction of his pain with the ASIS compression test. What does he most likely have?

Back 2

Sacroiliitis


**ASIS compression worsens, diffuse SI tenderness**

Front 3

A 42 yo female with chronic back pain has tendrness medial to both ASIS's that reproduce her back pain. Hip extension is NOT restricted. Which chronic back pain syndrome does she most likely have?

Back 3

Pelvic Pain

**anterior pelvic tender points**

Front 4

A 16 year old male patient exhibits sacrococcygeal tenderness. A structural exam reveals coccyx flexion. What low back pain syndrome does this patient have?

Back 4

Coccydynia

**sacrococcygeal tenderness, coccyx flexion**

Front 5

Head and Neck

Sympathetic:

Parasympathetic:

Back 5

Sympathetic: T1-4

Parasympathetic: Vagus

Front 6

Cardiovascular

Sympathetic:

Parasympathetic:

Back 6

Sympathetic: T1-5

Parasympathetic: Vagus

Front 7

Respiratory

Sympathetic:

Parasympathetic:

Back 7

Sympathetic: T2-7

Parasympathetic: Vagus

Front 8

Stomach, liver, gallbladder

Sympathetic:

Parasympathetic:

Back 8

Sympathetic: T5-9

Parasympathetic: Vagus

Front 9

Small Intestine

Sympathetic:

Parasympathetic:

Back 9

Sympathetic: T9-11

Parasympathetic: Vagus

Front 10

Ovary, Testicle

Sympathetic:

Parasympathetic:

Back 10

Sympathetic: T9-T10

Parasympathetic: S2-4

Front 11

Kidney, Ureter, Bladder

Sympathetic:

Parasympathetic:

Back 11

Sympathetic: T10-L1

Parasympathetic: S2-4

Front 12

Large Intestine

Sympathetic:

Parasympathetic:

Back 12

Sympathetic: T8-L2

Parasympathetic: Vagus & S2-4

Front 13

Uterus

Sympathetic:

Parasympathetic:

Back 13

Sympathetic: T10-L1

Parasympathetic: S2-4

Front 14

Prostate

Sympathetic:

Parasympathetic:

Back 14

Sympathetic: L1-2

Parasympathetic: S2-4

Front 15

Patient presents with pelvic pain. R ASIS is inferior. R PSIS is superior

Back 15

R Anterior Innominate

Front 16

Patient presents with pelvic pain. L ASIS is superior. L PSIS is inferior

Back 16

L Posterior Innominate

Front 17

Patient presents with pelvic pain. R ASIS is superior. R PSIS is superior

Back 17

R Superior Innominate Shear

Front 18

Patient presents with pelvic pain. L ASIS is inferior. L PSIS is inferior

Back 18

L Inferior Innominate Shear

Front 19

Patient presents with pelvic pain. R ASIS is medial. R PSIS is lateral

Back 19

R Innominate Inflare

Front 20

Patient presents with pelvic pain. L ASIS is lateral. L PSIS is medial

Back 20

Innominate Outflare

Front 21

Patient has a left short leg, what
direction is the pelvic side shift?

Lumbar concavity is likely toward
what direction?

Back 21

Pelvic side-shift and rotation
toward side of long leg. (Right Leg)

In the lumbar spine the
convexity points towards the
short leg and the concavity
towards the long leg. (Concavity toward R leg)

Front 22

In Short Leg syndrome:

What side does the pelvis shift to?

Back 22

Pelvic side-shift and rotation
toward side of long leg.

Front 23

In Short Leg syndrome:

Concavity of L-spine = ?

Convexity of L-spine = ?

Back 23

convexity points towards the short leg

the concavity towards the long leg.

Front 24

What ligament is often first to react to Short Leg?

Back 24

Iliolumbar lig. on side of
convexity (short leg) is often the 1st to react

• Referred pain:
– Ipsilateral groin and hip

Front 25

Sciatic nerve may pierce through this muscle and cause sciatica type symptoms

Back 25

Piriformis m.

(Externally rotates femur)

Front 26

Posititve Standing flexion test and ASIS compression test both indicate what?

Back 26

Side of Restriction

Front 27

Associated Clinical Findings:

-Ipsilateral tight hamstrings, tight
iliolumbar ligament. May be
accompanied by symptoms of
sciatica (piriformis dysfunction)

Back 27

Associated with Anterior Innominate

Front 28

Clinical Associations:

Usually Caused by trauma. Pt may
complain of pelvic pain.

Back 28

Superior Iliac Shear

Front 29

Clinical Associations:

Can be caused by tripping (imagine beingtackled by foot).

It is fairly rare-

Walking often reduces dysfunction

Back 29

Inferior Innominate Shear

Front 30

_______ means that the probability and magnitude of harm or discomfort anticipated in the research are not greater in and of themselves than those ordinarily encountered in daily life

Back 30

Minimal Risk

Front 31

Study designed to obtain data that will occur in the FUTURE

Back 31

Prospective Study

Front 32

- Study has a COMPARISON GROUP, which does not receive the intervention

- Control Group

Back 32

Placebo Controlled

Front 33

- Subject Group(s) assignment is determined with a random process

Back 33

• Randomized Human Clinical Trial

Front 34

subjects, drug givers & data
gatherers not aware of who is in the treatment or control group.

Back 34

Double Blind Study

Front 35

Name some conditions for which a psychosomatic etiology is common (3)

Back 35

**Chronic Pain Syndromes**
- Chronic Migraine, Fibromyalgia, Neck Pain

**ANS- Related Disorders**
- IBS, Interstitial Cystitis, Orthostatic Tachy

**Neurologic Syndromes**
- Insomnia, Tinnitus, Fatigue, Parathesia

Front 36

Develop osteopathic manipulative treatment for psychosomatically correlated conditions

Back 36

Fuck this...The only real time he mentioned anything was in a table...

- Thoracic OMT
- cranial balancing
- relaxation breathing

Front 37

Cardiac related tissue
texture changes & somatic
dysfunction typically involve:

Back 37

upper thoracic region

OA, AA

C2 and C6

Front 38

Chapman’s points for heart:

Back 38

• Medial second
intercostal spaces

• Transverse process
T2

Front 39

Restriction in thorax, spine, diaphragms has significant ramifications in patients with CHF.

Back 39

***KNOW THIS ***

Front 40

OMT Goals for pt's with cardiovascular disease?

Back 40

- ↓ cardiac load of the heart
- ↑ O2 supply to myocardium
- ↓ local myofascial tension

-Alleviate restriction in thoracic cage, thoracic inlet, abdominal and pelvic diaphragm (optimizes circulatory return to the heart)

-Minimizes any facilitated segments to normalize sympathetic tone

Front 41

Explain how respiratory muscles effect CV performance

Back 41

**Inspiration**

-Creates pressure gradient to draw blood, lymph into chest and air into lungs

Squeezes viscera and moves fluid toward the chest


**Expiration**

Rib cage recoils, diaphragm relaxes, ↓ thoracic diameter

Compresses lungs--> forces air out

Fluid is drawn from periphery (veins and lymph channels)

Front 42

• Simultaneous appearance of:
– Carpal tunnel syndrome
– Thoracic outlet syndrome

• Compression of a nerve at one point renders it more susceptible to damage at another site.

• Altered function is greater than the sum of the impairment caused by individual lesions. (1+1=3)

**EXAM**

Back 42

DOUBLE CRUSH SYNDROME

Front 43

OMT - Three Phase Treatment for Carpal Tunnel

Back 43

Phase 1 - release of transverse carpal ligament

Phase 2 - Opponens roll

Phase 3 - wrist extension to pull flexor tendons into carpal tunnel

Front 44

Classical symptoms include:

– Intermittent tingling with nocturnal arm/hand pain in thumb, index, and middle fingers

– Thenar atrophy (muscle wasting)
with loss of thumb dexterity

– Proximal arm/shoulder pain

– Frequently bilateral with greater severity in the dominant hand

Back 44

Carpal Tunnel Syndrome

Front 45

What forms the Carpal Tunnel?

Back 45

STOP + Flexor Retinaculum

Scaphoid

Trapezium

hook Of hamate

Pisiform

Front 46

Less compression on the median nerve at the carpal tunnel is required to produce symptoms when a proximal lesion is present.

Back 46

DOUBLE CRUSH SYNDROME

Front 47

Altered structure of the carpal tunnel leads to altered function of the _____ nerve.

Back 47

MEDIAN NERVE

Front 48

Describe home stretching excercises for carpal tunnel patients

Back 48

Wrist and digits are simultaneously hyperextended.

• Thumb is hyperextended, hyperabducted and laterally rotated.

Front 49

What hospital tests can confirm carpal tunnel syndrome?

Back 49

-EMG/ NCS

-US

Front 50

Carpal Tunnel causes:

MEDIAN TRAP

Back 50

M- Myxoedema
E- Edema Premenstrually
D- Diabetes
I- Idiopathic
A- Acromegaly
N- Neoplasm

T- Trauma
R- Rheumatoid Arthritis
A- Amyloidosis
P- Pregnancy

Front 51

Headache with numbness or tingling
of scalp
– Pain and paresthesias limited
to one side of the head.

• May be brief, sharp lancinating
pain in distribution of nerve,
usually lasting several seconds

• May also be continuous aching or
hyperesthesia in distribution of
relevant nerve.

• “Hurts to brush hair”

Back 51

Occipital Neuralgia

**EXAM**

Front 52

Patient says it hurts to brush hair. Tinel's Sign Worsen's headache. Problem and where do you focus tx?

Back 52

Occipital Neuralgia

Focus Tx on:
-OA
-AA
Sub-occipital triangle

Front 53

You should Avoid direct action OMT of upper cervical in patients with what disorders?

Back 53

- rheumatologic disorders
(especially RA)

- Down’s syndrome.

**Weakened Cruciate and Odontoid ligaments**

Front 54

This is a Connective tissue bridge between posterior
atlanto-occipital membrane (dura) and rectus capitis posterior minor (atlas to occiput).

Back 54

Myodural Bridge

Tx with suboccipital release

Front 55

When to order tests for head pain?

Back 55

• Focal or sudden onset of
neurological symptoms or
signs.

• Progressive headaches

• Symptoms of increasing
intracranial pressure.

Front 56

Young adult who thinks he has
“the flu”:

• headache, hoarseness,
vomiting and difficulty
swallowing.

Physical exam
• Afebrile, Oropharyngeal exam
normal,

• Cranial merve exam yields
decreased gag reflex.

Order MRI
• Cerebellum portion of brain
protruding into spinal canal

Back 56

Arnold Chiari Malformation

Front 57

Order MRI
• Cerebellum portion of brain
protruding into spinal canal

Back 57

Arnold Chiari Malformation

Front 58

Red Flags for headaches?

**EXAM**

Back 58

Sudden, Severe Headaches

• Neck Stiffness and fever

• Association with head
injury

• “First or worst” headache
in one’s life

• Visual Changes

• Headaches accompanied by neurological or personality changes

• Recurrent localized headaches

• Recurrent high intensity or frequency

• Change in nature or frequency of headaches

Front 59

• Overweight, young women with headache, nausea, and vomiting

– Symptoms may be caused
by elevated CSF pressure!

Problem? Clinical Exam you NEED TO DO...

Back 59

Pseudotumor Cerebri

**Fundoscopic exam**
look for papilledema, evidence of subarachnoid hemmorhage, optic neuritis

Front 60

-Primary motion is
flexion and extension

– 50 % of cervical flexion and extension occurs here

– When sidebending is
introduced, rotation will occur in OPPOSITE direction (SLRR)

Back 60

OA (C0-1)

Front 61

Primary motion is rotation

• 50 % of cervical
rotation occurs at this cervical segment

Back 61

AA (C1-2)

Front 62

How should you tx an OA Flexed somatic dysfunction?

Back 62

Treat OA flexion S/D in neutral,
not extension

-decrease risk of vertebral artery
compromise

Front 63

Explain active motion testing to diagnose OA somatic dysfunction

Back 63

-Flex then SB and R

–Extend then SB and R

Front 64

• Usually bilateral

• tightening or vice-like gripping

• “A band of pain from my forehead to the base of my skull.”

• Radiation into trapezius muscle and posterior neck

• Intensity is rated as mild to moderate

• Usually lasts greater than 30 minutes

• Not provoked by low level activity

• Migraine symptoms are usually absent

Back 64

Tension Headaches

Front 65

Episodic- usually 1-2
times/month
• Unilateral

• Prodrome is common

• Aura (classic)

• Lasts 4-72 hours

• Pulsating, Throbbing (50%), Dull, ache type (50%)

• More common in females

• Often relieved by sleep.

Back 65

This is a migraine headache

Front 66

This type of headache may be accompanied with:

• Nausea*

• Vomiting*

• Photophobia*

• Phonophobia*

• Unable to perform usual daily tasks*

Back 66

Migraine

Front 67

_____ is considered the main cause of migraine headaches.

Back 67

**Vascular Tone**

trigger
↓
release of serotonin and NE
↓
Vascular DILATION
↓
Stimulates TRIGEMINAL SYSTEM
↓
Stimulates spinal cord
↓
tightness of mm. in back of head and neck

Front 68

What should be done for EVERY headache patient?

Back 68

Do the cranial nerve exam for every headache patient and do it well.

Front 69

Median nerve origination: ?

Back 69

from C6, C7, and C8 and T1 nerve roots

i. C6 and C7 supply sensory info to the hand

ii. C8 and T1 supply median motor fibers that innervate distal median muscles of forearm and hand

**Median nerve controls FLEXORS!!!**

Front 70

Congestion can cause temporalis tension. What nerve facilitates this?

Back 70

Trigeminal Nerve!!

**V3**

Front 71

Increased cervical lordosis can cause _________

Back 71

**Mouth Breathing**

-Decreased air filtering

-Hypoventilation

-Nasopharyngeal Stasis

Front 72

A patient with frequent upper respiratory infections presents with a congestion headache. Upper cervical OMT will stimulate what nerve to produce watery mucous and help alleviate congestion?

Back 72

Upper cervical treatment stimulates the vagus nerve producing watery mucous

Front 73

A patient with frequent upper respiratory infections presents with a congestion headache. What are some common upper cervical somatic dysfunctions that can be treated to help this patient?

Back 73

Sub-occipital Tension

OA restriction

AA restriction

Treating these areas may stimulate the VAGUS nerve and make WATERY MUCOUS

Front 74

Congestion can affect what levels of the thoracic spine?

Back 74

T1-4

Upper thoracic treatment can reduce
facilitation to thin nasal secretions

Front 75

Name 2 treatments that can promote lymphatic drainage from the head

Back 75

Submandibular Effleurage

Thoracic Pump

Front 76

Trigeminal stimulation triggers _____
mucous

Back 76

watery mucous

Front 77

What are they key areas to check for somatic dysfunction in a patient with congestion headache?

Back 77

T1-5

thoracic inlet

upper cervical

temporalis

Front 78

Chapman's points for respiratory system?

Back 78

T3-4 transverse processes

3rd and 4th intercostal spaces

Front 79

Restriction in what 2 areas may lead to shortness of breath?

Back 79

Structural factors

– Rib restriction
– Diaphragm tension

Front 80

Know this rib Dx stuff

Back 80

Front 81

Should you perform thoracic pump on a COPD patient?

Back 81

No, it's contraindicated...

Thoracic pump rebound can worsen aspiration and COPD

Also, avoid it in patients with:
-pulmonary embolism
-CHF
-unstable arrythmia

Front 82

An 88 yo female is admitted to the hospital with cough and shortness of breath for one week. Decreased breath sounds, and crackles are heard in the lower right lobe. CXR shows right lower lobe consolidation. Which is the most appropriate OMT protocol during her hospitalization?

A) Thoracic soft tissue and rib raising 2x a day

B) Thoracic Pump 4x a day

C) Thoracic & rib counterstrain, MF release, ME and articulatory daily

D) Compression of the 4th ventricle

E) Thoracic and rib thrust every other day?

Back 82

A) Thoracic soft tissue and rib raising 2x a day

Front 83

An 88 yo female is admitted to the hospital with cough and shortness of breath for one week. Decreased breath sounds, and crackles are heard in the lower right lobe. CXR shows right lower lobe consolidation. Which structural exam findings would be present with ACUTE somatic dysfunction?

A) blanching

B) coolness

C) dryness

D) edema

E) ropiness

Back 83

D) Edema

(ropiness, dryness, coolness and blanching are found in CHRONIC somatic dysfxn)

Front 84

An 88 yo female is admitted to the hospital with cough and shortness of breath for one week. Decreased breath sounds, and crackles are heard in the lower right lobe. CXR shows right lower lobe consolidation. Which manipulative treatment would normalize sympathetic tone to her lungs?

A) rib raising

B) sacral rocking

C) subocciptal inhibition

D) superior mesenteric ganglion inhibition

E) thoracolumbar inhibition

Back 84

A) rib raising

Front 85

An 88 yo female is admitted to the hospital with cough and shortness of breath for one week. Decreased breath sounds, and crackles are heard in the lower right lobe. CXR shows right lower lobe consolidation. At which vertebral levels would you expect to find somatic dysfunction?

A) C1-2

B) T4-5

C) T10-11

D) L1-2

E) L5-S1

Back 85

B) T4-5

Front 86

A 55 yo female has had nasal congestion and facial pain for two weeks. Which somatic dysfunction would be most related to difficulty breathing through her nose?

A) increased cervical lordosis

B) T2 ESR left

C) Suboccipital tension

D) thoracic inlet restriction

E) first rib restriction

Back 86

A) increased cervical lordosis

Front 87

A 55 yo female has had nasal congestion and facial pain for two weeks. Which of the following general manipulative treatments is recommended as part of her tx?

A) venous sinous drainage

B) upper extremity effleurage

C) rib raising

D) thoracic pump

E) diaphragm myofacial release

Back 87

D) thoracic pump

Front 88

A 55 yo female has had nasal congestion and facial pain for two weeks. Which of the following structural exam components is most pertinent for her evaluation?

A) thoracic outlet/diaphragm rotation

B) typical rib motion testing

C) upper thoracic palpation

D) posterior axillary fold tenderness

E) tempomandibular motion

Back 88

C) upper thoracic palpation

Front 89

Excessive sympathetic activity would be expected to lead to which of the following?

A) vasodilation and thick nasal secretions

B) vasodilation and thin nasal secretions

C) vasospasm and thick nasal secretions

D) vasospasm and thin nasal secretions

E) rhinorrhea and vasomotor instability

Back 89

C) vasospasm and thick nasal secretions

Front 90

What does a positive spring test indicate?

Back 90

sacral extensions or backward torsions

Front 91

Increased sacral base asymmetry in backwards bending test indicates what?

Back 91

sacral extensions
or
backward torsions

Front 92

How does the sacrum move during respiration?

Back 92

– Inhale-spine elongates →sacral base posterior (EXTENSION)

– Exhale- spine recoils →sacral base anterior (FLEXION)

Front 93

What is the movement in the sacrum like during a right heel strike?

Back 93

– Left rotation on left axis

– Lumbar spine sidebends to the left

Front 94

What is the movement in the sacrum like during a left heel strike?

Back 94

– R rotation on R axis

– Lumbar spine sidebends to the R

Front 95

If L5 is sidebent to one side, a
sacral oblique axis is typically
engaged on the ____ side

**EXAM**

Back 95

SAME side

Front 96

If L5 is rotated, sacrum rotates
the _______direction on
oblique axis (torsion).

**EXAM**

Back 96

OPPOSITE direction

Front 97

make sure to do Krib's powerpoint questions for the Sacrum

Back 97

do it...

Front 98

- an acute or chronic painful condition of muscles and their related structures characterized by the presence of myofascial TRIGGER POINTS

• A more general meaning includes a REGIONAL muscle pain syndrome of any soft tissue origin that is associated with muscle tenderness

Back 98

Myofascial Pain Syndrome

Front 99

A _____ is usually an exquisitely tender nodule in the taunt band of skeletal muscle

Back 99

Trigger Point

**The presence of a local twitch response confirms the presence of a trigger point**

Front 100

The presence of a _____ confirms the presence of a trigger point

Back 100

local twitch response

Front 101

Know that trigger points can be mapped from person to person because they are the same from person to person

Back 101

he might ask that...

Front 102

- a transient contraction of those muscle fibers in the taunt band that are associated with the trigger point

- It can be elicited by a “snapping palpation” perpendicular to the muscle fibers

Back 102

local twitch response

Front 103

What's the difference between active and latent trigger points?

Back 103

Active trigger points - produce a clinical complaint (usually pain) which the patient recognizes when the trigger point is digitally compressed (it reproduces their symptoms)

• Latent trigger points
- can produce other effects characteristic of a trigger point including increased muscle tension and muscle shortening (but do not produce spontaneous pain)

**active TP=spontaneous pain at any time

**Latent TP= produce pain only when probed

Front 104

What are some of the differences between trigger points and counterstrain tender points?

Back 104

**Trigger Points**

- Regional!!!
- Treated by STRETCHING the muscle


**Counterstrain Tender Points**

- ***Locally*** tender
- Do not typically refer the pain beyond the area being compressed
- Treated by SHORTENING the muscle

Front 105

This trigger point can activate one or more satellite points.

Inactivation of this point can also inactivate satellite trigger points

Back 105

Key trigger point

**Target the key trigger point w/ treatment**

Front 106

No matter what modality you
use to treat trigger points, an
essential component in the
treatment is _________

Back 106

HOME STRETCHES

Front 107

What is the hypothetical physiologic cause of trigger points?

Back 107

There is an abnormal ↑ in production and release of ACh from motor nerve terminals this depolarizes the membrane and causes Ca to leak out.

- this creates a sustained shortening (contracting) of the sarcomere

Front 108

What are some of the differences between Myofascial Pain Syndrome and Fibromyalgia?

Back 108

Front 109

The Histochemical environment surrounding trigger points are strongly _____ and full of noxious chemicals

Back 109

ACIDIC

Front 110

What are some factors that perpetuate myofascial pain syndrome?
(reactivate trigger points)

Back 110

The only two he made a big deal about were:

HYPOTHYROIDISM

ALLERGIC RHINITIS

Front 111

OMT for trigger points?

Back 111

ME

MFR

**THESE STRETCH THE MUSCLE***

Front 112

Spray and stretch uses a vapocoolant
spray followed by a stretch to
deactivate a trigger point..

What is the essential part of this treatment?

Back 112

THE STRETCH

Front 113

What's the difference in results between injection and dry needling (accupuncture) for trigger points?

Back 113

Dry needling (acupuncture) is just as effective as injection; there may be more soreness afterwards

Front 114

What are the least and most myotoxic agents for trigger point injection?

Back 114

- Procaine and lidocaine are the least myotoxic

- Bupivacaine (Marcaine) is the most myotoxic

Front 115

Muscle most often found to have trigger points?

Back 115

Trapezius

Front 116

• Easily mistaken for lumbar
radicular pain (coughing or
sneezing may increase the
pain) or piriformis syndrome

• 2 superficial and 2 deep trigger
points

• Activation:
1) simultaneous bending over and reaching to
one side to pull or lift
2) trauma

• Perpetuation: short leg, small
hemipelvis, short upper arms,
a soft bed with a hammock like
sag, leaning forward with poor
elbow support over a desk,
and weak abdominal muscles

Back 116

Quadratus Lumborum

"Joker of Low Back Pain"

Front 117

OMT for trigger point directed to the quadratus lumborum muscle

Back 117

Muscle energy to the 11-12th ribs

Front 118

What's this Trigger Point?

Back 118

***Gluteus Minimus***

- Pain is often attributed “ Pseudo-sciatica”to “sciatica”

• The more anterior the trigger
point, the more lateral the referral zone

• Activation: acute or repetitive
overload (walking too far or too fast), SI joint dysfunctions, nerve root irritation

• Perpetuation: prolonged immobility (esp. driving a car), SI joint dysfunctions, sitting on a wallet placed in a back
pocket

• Corrective exercises: have pt
roll over a tennis ball in the
area of the trigger point; sleeping on side with thighs flexed and pillow between knees

Front 119

Trigger Point?

Back 119

***Iliopsoas m.***

- It serves many important functions but Travell considered it as relatively inaccessible

• Symptoms are aggravated by weight bearing activities and relieved by recumbency

• Activation: prolonged sitting with the hips flexed

• Perpetuation: short leg, small hemipelvis, repetitive vigorous contractions (situps)

• Correction of somatic dysfunctions of the thoracic, lumbar, or sacral areas and avoid prolonged sitting

Front 120

Trigger Point

Back 120

**Scalene Muscles***

- Common source of back,
shoulder, and arm pain

• Often confused with cervical radiculopathy

• Symptoms include myofascial pain or secondary sensory and
motor disturbance due to neurovascular entrapment

• Activation: pulling, lifting, tugging with the arms or overuse of these muscles in respiration

• Perpetuation: tilted shoulder girdle axis

• Corrective exercises: neck stretches or coordinated respiration (piston breathing)

Front 121

OMT for Scalene trigger points?

Back 121

OMT should directly address
the scalene muscles

• Cervical kneading – p. 203

• Cervical stretching – p. 204

• Scalene ligamentous articular strain –p. 205

• Scalene stretch – p. 206

• Cervical long restrictor muscle energy – p. 216

• Cervical sidebending or rotational
ME/HVLA

Front 122

Trigger Point?

Back 122

**Trapezius m.**

- Muscle most often found to have trigger points

• Frequently overlooked source of temporal and cervicogenic headache

• Activation: commonly results from the stress of sustained elevation of the shoulders and trauma

• Corrective exercises: trapezius tension release exercises

• OMT would be very similar to those for the scalenes

Front 123

History of WIDESPREAD PAIN - pain is considered widespread when all of the following are present:
- Pain in the right and left side of the body***
- Pain above and below the waist***

- In addition, AXIAL SKELETAL PAIN (cervical spine, anterior chest, thoracic spine, or low back) must be present.

**THIS IS ON THE EXAM**

Back 123

Criteria for Fibromyalgia Dx

(American College of Rheumatology)

Front 124

What is the cornerstone of fibromyalgia treatment?

Back 124

****Exercise is the cornerstone of Treatment****

Front 125

American College of Rheumatology requires Pain on digital palpation of 11-18 of the following tender points for Dx of Fibromyalgia:

Back 125

Front 126

FEMALE patient presents with:

- Pain lasts much longer into the day (compared to RA)

- Bialteral Tender Points
- Fatigue--> may be debilitating
- Depression-->d/t chronic pain

Back 126

Fibromyalgia

Front 127

Treatment recommendations for fibromyalgia?

Back 127

First recommendations = exercise and NO ASPIRIN (b/c it is not inflammatory process)

Front 128

60% of delta wave time is interrupted by alpha type sleep in _____ patients

Back 128

Fibromyalgia

**Poor sleep predicts pain the next day**

Front 129

What must you always rule out before making a diagnosis of fibromyalgia?

Back 129

**OCCULT MALIGNANCY**

Front 130

OMT for Fibromyalgia?

Back 130

• Patients respond best to gentle indirect OMT

• MFR → Treat Transverse Diaphragm restrictions first THEN Longitudinal Fascial Restrictions

Front 131

Burning pain in the upper or lower extremities associated with:

– Swelling
– Decreased range of motion
– Vasomotor instability
– Trophic skin changes
– Patchy bone demineralization

Back 131

**Reflex Sympathetic Dystrophy**

Front 132

- Continuing pain, allodynia or hyperalgesia; pain is disproportionate to the inciting event

- Abnormal sweating in the affected region (sweat a lot)

Back 132

**Reflex Sympathetic Dystrophy**

Front 133

What's the big deal about stage III RSD?

Back 133

Stage III is IRREVERSIBLE!

Front 134

What is the best tx for RSD?

Back 134

PREVENTION!!

Aggressively treat somatic dysfxn

Front 135

What's so special about neural blockade in a pt. with RSD?

Back 135

**Neural blockade - diagnostic and therapeutic**

(Stellate ganglion block or Epidural block)

Front 136

Garlitz, Lecture 14...

Know slides 17-22

Back 136

THIS WILL BE ON THE EXAM

Front 137

Where does nerve C5 exit the cervical spine?

Back 137

between C4 & C5

Cervical nerve roots exit above the
vertebral body that bears its name

Front 138

How can a pateint's posture cause neck pain?

Back 138

Forward Head Carriage puts a lot of stress on the cervical spine

Front 139

Should you diagnose a cervical radiculopathy with a CT or MRI?

Back 139

**Never should the diagnosis be made merely upon CT or MRI interpretation**

Use your H&P!!!

Front 140

When should surgery be done to treat dengenerative cervical discs?

Back 140

Surgery if:
– Intractable pain
– Progressive neurological impairments

Front 141

Thoracic outlet syndrome consists of pain and parathesia in the upper extremity due to compression of the _________

Back 141

brachial plexus

Front 142

Which portion of the brachial plexus does Thoracic Outlet Syndrome affect?

Back 142

Usually involves lower brachial plexus.

– C8-T1, Ulnar nerve distribution

Front 143

What type of tumor should be ruled out when diagnosing thoracic outlet syndrome?

***

Back 143

Pancoast Tumor

Front 144

What test has been noted to be highly sensitive for thoracic outlet syndrome?

Back 144

elevated arm stress test

Front 145

What creates optimum success of double crush syndrome treatment?

******

Back 145

Treatment must be directed at both lesions for optimum results

Front 146

When observing gait, normal least motion should be around what spinal level?

Back 146

L3

this is going to be the ONLY fucking card from the Gait Lecture... Have fun with that..

Front 147

The sicker the patient, the less time spent treating the patient, but the treatment is more _______

Back 147

frequent

Front 148

- One thing + another = disease

- i.e. Pneumonia is caused by an infection

- We are taught to think this way (everything is separate)

Back 148

Cause and Effect

Front 149

- Different factors all contribute to the outcome of disease

- Need to change our train of thought to this perspective

- i.e. Pneumonia results from a susceptibility to an infection

• What is the susceptibility

Back 149

Holistic Logic

Front 150

- Pediatric patients respond slowly/quickly

- Geriatric patients respond more slowly/quickly

(to OMT)

Back 150

- Pediatric patients respond quickly

- Geriatric patients respond more slowly

Front 151

If a patient is receiving their first ever OPP treatment, what should you warn them about?

********

Back 151

Soreness!

-They may be sore for 24-48 hours!

-This pain is DIFFERENT than the pain caused by their somatic dysfunction. (more of like pain after you work out)

Front 152

Should you see patients with chronic problems more often or less often for OMT?

Back 152

More often = weekly/ 10 days

Front 153

Pediactric patients respond best to ____ treatment (type of OMT tx)

Back 153

direct technique

Front 154

You should use ______ techniques for sicker or older or patients with acute injuries..

Back 154

indirect techniques

Front 155

***Stiles***

If the area of greatest resistance is in the upper nuchal ligament or if there is a horizontal noncontracting
(rubbery) band of tightness over C1
and C2 a _____ restriction is suspected

Back 155

dural restriction

Front 156

**STILES**

If the area of greatest
resistance is in the upper
cervical area or there is a
horizontal, contracting
band of tightness over C1
and C2 an ______ or ______
dysfunction is suspected

Back 156

OA or AA

Front 157

**Stiles**

If a thoracic segment dysfunction is present, the restriction will be localized around 1 or 2 segments and will have a hard end-feel which will decrease as the clinician palpates ___________

Back 157

Toward the rib

Front 158

**Stiles**

If the key somatic dysfunction is in the upper extremity, the restriction will present as a unilateral, diffuse,
vertical band of tightness ________

Back 158

Medial to Scapula

Front 159

**STILES**

If the key somatic dysfunction is in the ribs, the restriction worsens as you palpate ___________

Back 159

laterally

Front 160

**Stiles**

If the area of greatest resistance is below T12 do _____ and _____

Back 160

Do a standing and seated flexion test

Front 161

What's the difference between cervicogenic headaches and tension headaches?

Back 161

Cervicogenic:

- UNILATERAL
- Triggers: Neck Movement. Digital pressure over C1-3 facets


Tension Headaches:

- BILATERAL
- Triggers: Stress, jaw clenching, TMJ Syndrome

Front 162

Define mind body medicine

**EXAM*

Back 162

An approach of medicine factoring in the relationship of psychological and physical dimensions of the person in health and illness

Front 163

Who developed the psychosocial model:

-Physical/psychological/social component of any illness

*COMEAUX*

Back 163

Engle

Front 164

• Who developed empirical biomedical science?

*COMEAUX*

Back 164

Hopkins/Flexner