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136 Cards in this Set
- Front
- Back
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HEENT problems treatable with OMT is approached through?
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Structure
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What is birth trauma to the head called?
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Plagiocephaly
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What cranial bones require cloure after birth?
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Ant Fontanelle (frontal and parietal bones at metopic, coronal and sagital sutures- 20 mo)
Post Fontanelle (lambdoid and sagital sutures-3 mo) Craniosynostosis |
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Can cranial bones still move in adults?
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Yes
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What are problems with the eyes treated with OMT?
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Visual disturbances
Gaze abnormalities Conjunctivitis |
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What innervates the eye?
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CN III (parasym with synapse in the ciliary ganglion)
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What problems with the ears can be treated with OMT?
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Hearing disorders
Infections Tinnitus |
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What problems with the nose can be treated with OMT?
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Colds/URIs
Sinusitis Allergies Post nasal drip Anosmia Thick secretions |
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What problems of the throat can be treated with OMT?
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Pharyngitis
Laryngitis Swallowing problems |
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Application of the Osteopathic Principles?
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Anatomical/functional relationships
Arterial Venous/lymphatic drainage Neuro Reflexes Eliminate pain Immune system Adjunctive therapies Prevent |
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Primary objective of OMT treatment of HEENT?
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Restore Homeostasis
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Osteopathic template
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History
Physical Osteopathic Principles Treatment Plan |
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Chapman's reflex for the ear?
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Above proximal clavicle
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What indicates involvement of the middle ear?
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Gangliform contraction
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Where is the Chapman reflex for the nasal sinus?
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Below prox clavicle
Suprior surface of 2nd rib |
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Where is the Chapman's point for the larynx?
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Upper surface of the second rib (2-3 in from sternum)
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Where is the Chapman's point for the tonsils?
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Between 1st and 2nd rib close to the sternum
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Where is the Chapman's point for sinusitis?
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3.5 in from sternum on upper edge of 2nd rib (1st intercostal space)
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Where is the Chapman's point for the bronchioles?
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Intercostal space between 2nd and 3rd ribs close to the sternum
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What are the first sign of lymphatic congestion?
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Supraclavicular fullness
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Where does the right eustachian ducts drain?
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R.brachiocephalic or junction of R.internal jugular and subclavian veins
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Where does the left Eustachian duct drain?
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Junction of L.internal jugular and suclavian veins
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What does increased venous congestion lead to?
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Cephalgia
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What CN is most likely entraped?
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VI (closest dura)
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Entrapment of CN VI causes?
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Medial strabismus (bc innervates lateral rectus)
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What are the most common causes of EOM dysfunction?
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DM, Aneurysm, SD
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What are the symptoms are CN III, IV, and VI entrapment?
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Blurred vision
Diplopia Nystagmus Eye Fatigue HA |
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Parasympathetic ganglion?
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Ciliary (III)
Otic (IX) Ptrygopalatine (VII) Submandibular (VII) |
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HEENT problems with increased sympathetics?
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Photophobia
Tinnitus Thickened nasopharyngeal secretion Hyperesthesia of pharyngeal tissue Raspy cough Sweating |
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What is decreased in the acute responses in sympathetics?
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Nutrition
Secretion Lymph drainage Immune response |
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What is increased in acute response of the sympathetics?
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Cellular dysfunction
Vasoconstriction Dry, cracked mucous mem Secondary infections |
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What is decreased in chronic response/irritation in sympathetics?
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Columnar cells
Ciliary activivty Visual activity |
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What is increased in chronic response/irritation in the sympathetics?
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Goblet cells
Thick tenacios secretions Pupil dilation Clouding of lens |
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Red engorged mucous membrane with photophobia, pain behind the eye, nose, neck, ear, and temple?
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Sphenopalatine (Pterygopalatine) Syndrome
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What causes Sphenopalatine (Pterygopalatine) Syndrome?
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Irritation of SP ganglion
Somatic dysfuncation at SP ganglion |
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Where does CN VII go after synapse at the SP ganglion?
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Parasym innervation to the lacrimal gland and the nasopharyngeal mucosa
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What is used to treat Sphenopalatine (Pterygopalatine) Syndrome?
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Muncie Technique (finger surgery)
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When else is Muncie Technique used?
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Chronic ear stuffiness
Pain with altitude changes Vertigo Tinnitus |
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What does the anterior cervical arches (hyoid and cricoid release) treat?
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Laryngitis
Pharyngitis Cough |
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How do you do the anterior cervical arches (hyoid and cricoid release)?
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Grasp hyoid and cricoid cartilege (push on tissues) and gentle alternate lateral pressure while moving up and down the neck
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What is the cervical chain drainage technique used for?
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ENT dysfunction
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What is contraindications to the cervical chain drainage technique?
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Mono
Painful LN |
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How do you do the cervical chain drainage technique?
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Follow SCM down and milk the LN: ant and post to SCM for 2 min
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What do you use the alternating nasal pressure technique for?
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Nasal and sinus congestion
Runny and tenderness of nose Ethmoid sinus |
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How do you perform the alternating nasal pressure technique?
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Push alternating medially on frontal sutures for 30-60 sec for tissue release
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What is the mandibular drainage (Galbreath Technique) used for?
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Submandibular release
E. Tubes |
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How do you perform the mandibular drainage (Galbreath Technique)?
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Turn patient head toward physician
Draw mandible forward to open E. tubes |
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What are the contraindications of mandibular drainage (Galbreath Technique)?
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TMJ
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What is the Auricular Drainage used for?
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OM
OE Congested ear |
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How do you perform the Auricular Drainage technique?
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patient head toward physician
make triangle between ring and middle finger put triangle around patient ear and make circles in both directions |
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What is Effleurage used for?
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Sinus congestion
Maxillary fullness Plugged up URI Eye or Ear dysfuncation Frontal sinus |
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How do you perform Effleurage?
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Put thumbs at midline of forehead and push tissue down off to the side and then around by the ear (push towards heart)
Put thumbs on either side of nose and push tissue laterally and down towards heart |
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What is Trigeminal Stimulation used for?
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Any ENT affected by CN V
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How do you perform Trigeminal Stimulation?
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Find supraorbital foramen, infraorbital foramen, and mandibular foramen: push down on each and do rotation for 10 seconds
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What are the pain sensitive structures?
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Scalp, arteries, muscles, mucous membranes, ears and teeth
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What nerves are for head and facial pain?
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CN V, VI, VII
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What are the crucial areas for headaches?
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suboccipital
upper cervical areas: |
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What are the 3 types of headaches?
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Tension
Migraine Cluster |
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Somatic Dysfunction
Myofascial pain |
Tension type headache
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Most common
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Tension Type
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Three types of tension type headaches?
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Emotional
Postural Muscle hypertonicity or fatigue |
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Characteristics of a tension type headache?
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Bilateral
Band-like tightness No prodrome/aura Not affected by exertion Upper C spine Pericranial muscle tenderness |
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↑ sensitivity CNS / PNS
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Tension Type
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Migraine Headache characteristics?
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Neurovascular
Women Nausea Photophobia/phonophobia Prodromal/aura Aggregated by exertion Triggers |
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Many migraineurs experience vague vegetative or affective
symptoms as much as 24 hours prior to the onset of a migraine attack |
Prodrome
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focal neurological symptoms that persist up to one hour.
Symptoms may include visual, sensory, or language disturbance as well as symptoms localizing to the brainstem. |
Aura
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What is the pathology of migraine headaches?
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Oligemia (def of blood)
Coritcal spreading depression Trigeminal nucleus caudalis activation Sterile neurogenic inflammation |
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What OMT should be used for migraine headaches?
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Gentle indirect myofasial/still
(cranial dys, C1-C3, upper thoracic, thoracic inlet & lymph |
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What are the characteristics of a cluster headache?
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Unilateral
Orbital, supraorbital, and/or temporal Night Ipsilateral autonomics Male Pace, head bang, suicidal |
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How do you treat cluster headaches?
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O2 therapy
Pharmacologics Abortive treatment Prophylaxis OMT the same as migraines |
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What nerve is affected by Bell's Palsy?
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VII
(Ass. w/ psychological stress) |
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What are the four important diaphragms in Bell's Palsy?
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thoracic outlet, respiratory diaphragm, suboccipital diaphragm, cerebellar tentorium
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What is the number one concern in Bell's?
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Protect the eye
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What are the osteopathic considerations for Bell's?
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The stylomastoid foramen
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What type of joint is Temporomandibular Joint?
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Ellipsoid, Synovial joint
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What innervates Temporomandibular Joint?
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CN V branch 3
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How does the Temporomandibular Joint move when you open your mouth?
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Mandible glides anterior
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How does the Temporomandibular Joint move when you close your mouth?
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Mandibular head glides posteriorly
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4 motions of the Temporomandibular Joint?
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Depression
Elevation Protraction/retraction Lateral glide |
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Involved in Temporomandibular Joint elevation and retraction?
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Temporalis
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Involved in Temporomandibular Joint elevation and protraction?
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Masseter
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Involved in Temporomandibular Joint protraction, depression, and contralateral glide?
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Lateral Pterygoid
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Involved in Temporomandibular Joint elevation, protraction, contralateral lateral glide
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Medial Pterygoid
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How do you diagnosis TMJ?
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Popping/clicking
Pre-auricular pain Limited jaw movement Deviation to one side when opening |
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What causes TMJ?
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Internal derangement of articular disc
Dental procedure Muscular/nueromuscular Malocclusion Trauma |
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Where is somatic dysfunction common in TMJ?
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in OA, C2 and C3
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Three components of TMJ treatment?
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Identifying and eliminating any treatable cause
OMT Prescribing an exercise regimen for the patient at home |
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OMT for TMJ?
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Muscle energy techniques for the jaw/ muscles of mastication
Stretching the pterygoid muscle/ inhibition of tender points |
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When should you do the masseter technique?
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Somatic dysfx of head/cranium and/or cervical
region. Pt may complain of pain in neck, face, jaw, ear, or TMJ and have difficulty opening mouth fully. Mandible may deviate/shift to side of dysfx |
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Where is the tenderpoint in the masseter technique?
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Just inferior to zygoma in belly of massetter muscle
on side of mandibular deviation |
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How do you treat masseter?
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Doc gently glides pt slightly opened jaw/mandible
laterally toward side of TP |
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Where tenderpoint in Jaw Angle Point/Medial Pterygoid?
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Point 2cm above jaw angle or medial pterygoid point:
On posterior surface of ascending ramus of mandibule about 2cm above angle of mandible on side opposite of deviation |
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How do you treat Jaw Angle Point/Medial Pterygoid?
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Doc gently glides pt slightly opened jaw/mandible
laterally away from side of TP |
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How many bones are in the adult skull?
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29
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What functions as paired bones?
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Frontal and mandible
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Cranial group of bones?
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Occiput
Sphenoid Ethmoid Frontal Temporal (2) Parietals (2) |
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Facial group of bones?
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Vomer
mandible Maxillae (2) Palatines (2) Zygomatics (2) Lacrimals (2) Nasals (2) Inferior conchae |
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What 4 things meet at the pterion?
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Frontal
Parietal (1) Shenoid Temporal |
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What 3 things meet at the asterion?
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Parietal (1)
Temporals Occiput |
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What 2 things meet at the Lambda?
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Parietals (2)
Occiput |
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2 things Sutherland invented?
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Cranial Rhythmic Impulse (CRI)
Primary Respiratory Mechanism (PRM) |
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Cranial Concept 1?
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Inherent motility of the brain & spinal cord
(Coordinated contraction of oligodendroglia) |
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Cranial Concept 2?
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Fluctuation of the cerebrospinal fluid
(the potency of the Tide) |
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Cranial Concept 3?
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Mobility of the intracranial & intraspinal membranes
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Cranial Concept 4?
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Articular mobility of the cranial bones
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Cranial Concept 5?
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Involuntary mobility of the sacrum between the ilia
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“Three sickle shaped agencies”
of dural membranes? |
Falx cerebri
Falx cerebelli Tentorium cerebelli |
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What is the common origin of the dural membranes?
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Straight sinus
AKA: “Sutherland fulcrum” |
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What are the dural attachments?
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Foramen magnum, C2, C3, and S2
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What is meant by Mobility of the Dural Membranes?
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Reciprocal Tension Membrane (RTM):
The intracranial and spinal dural membrane including the falx cerebri, falx cerebelli, tentorium, and spinal dura* |
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What are the sutures?
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Joints
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What is meant by Involuntary Mobility of the Sacrum Between the Ilia?
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Superior transverse axis of S2
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What are the two phases of Cranial Rhythmic Impulse Mechanism?
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Flexion
Extension (Palpable wave of CSF) |
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What is Sphenobasilar Synchondrosis (SBS)?
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Articulation between sphenoid and occiput
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Why is the SBS important?
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The Angle of the SBS defines Flexion phase and Extension phase
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What are the 5 things that happen during flexion?
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Ant rotation of sphenoid
Basiocciput moves anterosuperiorly Foramen magnum moves ↑ ↑ in transverse diameter ↓ in the anteroposterior diameter Sacral base drawn posteriorly |
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What are the 2 overall movements of flexion?
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Midline Structures:
“FLEX” Paired Structures: EXTERNALLY ROTATE |
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Extension "Bert"?
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Restricted? Flexion
Head diameter? Longitudinal Forehead? Vertical Eyes? Receded Paired bones? Internally rotated Ears? Close to head |
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Flexion Ernie?
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Restricted? Extension
Head diameter? Transverse Forehead? Wide Eyes? Prominent Paired bones? Externally rotated Ears? Protruding |
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How many flexion-extension cycles per minute?
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8-12 (amp of 2 phases equal)
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What are the 5 rules of motion?
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Midline bones follow flexion/extension
Paired bones follow internal/external rotation Sacrum follows the occiput Temporals follow the occiput Facial bones follow the sphenoid |
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A pause in the CRI
Therapeutic and within typical motion |
Still point
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What is the Bregma?
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where frontal and parietal bones meet
(Follow metopic suture up until you feel a soft spot) |
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What is the coronal suture?
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between frontal and parietal bones (go laterally from bregma)
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What is the sagitial suture?
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between parietal bones
(Posterior in line w/ bregma) |
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What is the Lambda suture?
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where parietal bones meet the occiput
(follow sagittal suture back until you feel a soft spot) |
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What is the Lambdoid suture?
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between parietal bones and occiput
(from lambda, follow the suture to just behind the mastoid process) |
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What is Pterion suture?
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where frontal, parietal, temporal and sphenoid bones meet
(follow coronal suture laterally to soft spot) |
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What is the asterion suture?
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(where parietal, temporal and occiput meet): follow lambdoid suture laterally and inferiorly to just behind the mastoid process
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Where do you put your fingers for the vault hold?
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A. 2nd finger: On greater wings of sphenoid, posterior to orbit
B &C 3rd and 4th fingers: anterior and posterior to ear D 5th finger: Squamous portion of occiput Thumbs: off cranium or touching lightly |
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What happens in flexion to the patient and the dr. fingers?
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Pt: Coronal diameter widens
AP diameter decreases Height decreases Dr: Fingers spread apart, hands move laterally and inferiorly |
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What happens to the patient and the dr. in extension?
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Pt: Coronal diameter narrows
AP diameter increases Height increases Dr: Fingers approximate, hands move medially and superiorly |
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The keystone of all cranial movement
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Sphenobasilar Syncondrosis
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What do you do the frontal lift for?
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Frontal bone dysfunction
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What does gently extending the fingers cause in teh frontal lift?
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Apply compressive force medially
Apply anterior force on frontals Disengage frontals from parietals Internally rotate frontals |
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When is the frontal lift held until?
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This position is held until the physician feels the lateral angles of the frontal bones move into external rotation (expansion under the hypothenar eminences).
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