The Green Book

Front 1

What is TART?

Back 1

Tissue Texture Change
Asymmetry
Restriction
Tenderness

findings of somatic dysfunction

Front 2

a point at which a pt can actively move any given joint. Ex: a person may actively rotat his head80 degrees to either side...this is an example of?

Back 2

Physiological Barrier

Front 3

Point at which a physician can passively move any joint. Ex: a doc can move a pt head to 90 degrees while the pt can only move 80 on their own

Back 3

Anatomic Barrier

Front 4

Movement beyond the anatomical barrier results in?

Back 4

ligament, tendon or skeletal injury

Front 5

compared to midline, where do physiological, anatomic, and pathologic barriers lie?

Back 5

closest to midline: pathologic

then physiologic

then anatomic

Front 6

pt can turn their head 80 degrees to the right, physician can turn the pt head 90 degrees each way. The pt can only turn their head 70 degrees to the left... what is going on?

Back 6

Restrictive (pathological) barrier

remember this will always be less than the physiologic

Front 7

What is the only subjective component of TART?

Back 7

Tenderness

Front 8

For the following tissue texture change, describe if it is acute or chronic:

Edematous erythematous, boggy, with increased moisture. Mucles are hypertonice

Back 8

Acute

Front 9

For the following tissue texture change, describe if it is acute or chronic:

Decrease or no edema, no erythema, cool dry skin with slight tension. Decreased muscle tone, flaccid, ropy, fibrotic

Back 9

Chronic

Front 10

For the following Asymmetry, describe if it is acute or chronic:

Present

Back 10

Acute

Front 11

For the following Asymmetry, describe if it is acute or chronic:

Present with compensation in other areas of the body

Back 11

Chronic

Front 12

For the following restriction, describe if it is acute or chronic:

Present, painful with movement

Back 12

Acute

Front 13

For the following restriction, describe if it is acute or chronic:

Present, decreased or no pain

Back 13

chronic

Front 14

For the following tenderness, describe if it is acute or chronic:

Severe or sharp

Back 14

Acute

Front 15

For the following tenderness, describe if it is acute or chronic:

dull, achy, burning

Back 15

chronic

Front 16

Describe Fryettes law one

give an example

are the facets engaged or not?

does rotation or side bending come first?

Back 16

if the spine is in the neutral position (no flexion or extension) and if sidebending is introduced, rotation would then occur to the opposite side...applies to more than two vertebral segments

Side bending precedes rotation and the occur in opposite directions

NSLRR

Facets not engaged

usually compensatory

seen in long curves with multiple segments

Front 17

Describe Fryettes law II

give an example

are the facets engaged?

does rotation or side bending come first?

Back 17

rotation and sidebending occur in the same way

Single vertebral segment

Rotation precedes sidebending, and they occur in the same direction

Ex: FRRSR

Facets are engaged

Found at apices and crossovers

Single segment

Front 18

Where do Fryettes laws apply?

Back 18

Thoracic and lumbar only

not Cervical

Front 19

What is Law III?

Back 19

initiating motion at any segment in any one plane of motion will modify the mobility of that segment in the other planes of motion

ex: Forward bending will decrease the ability to sidebend and rotate

Front 20

how are somatic dysfunctions named

Back 20

for their freedom of motions

Front 21

give the somatic dysfunction for:

L2 is restricted in the motions of flexion, sidebending to the right and rotation to the right

Back 21

L2 ERLSL

Front 22

TRIGGER POINT:

what is the superior facet orientation for Cervical, Thoracic, and Lumbar spine?

Back 22

Cervical: Backward, upward, medial--->BUM

Thoracic: backward upward lateral-->BUL

Lumbar: backward, medial-->BM

Front 23

If doing a direct tx for T3 FRRSR how would the practitioner move the joint?

Back 23

Extend

rotate left

Sidebend left

Front 24

TRIGGER POINT

What is the difference in active/passive tx?

what about direct/indirect tx?

Back 24

Active: pt will assist in the tx, usually in the form of isometric or isotonic contraction

Passive: the pt will relax and allow the doc to move the body tissues

Direct: Towards the Barrier
Indirect: away from the barrier

Front 25

For the following, list if the tx is direct/indirect/both and if the motion can be active/passive/both:

MFR
CS
Facilitated postional release
ME
HVLA
Cranial
Lymphatic tx
Chapmans

Back 25

Direct or indirect / Active or Passive

MFR: Both / Both
CS: Indirect / Passive
Facilitated postional release: Indirect / Passive
ME: Direct / Active
HVLA: Direct / Passive
Cranial: Both / Passive
Lymphatic tx: Direct / Passive
Chapmans: Direct / Passive

Front 26

Elderly and hospital pts respond better to what kind of techniques?

Back 26

indirect or gentle direct such as articulatory

Front 27

the use of what kind of tx in a pt with advanced osteoporosis or metastatic dz can lead to a pathologic fracture

Back 27

HVLA

Front 28

Acute neck strain/sprains are often treated with what kind of techniques to prevent further strain?

Back 28

indirect

Front 29

discuss how frequently you can tx the following pts with OMT:

Sicker pts
Pediatric
Acute cases

Back 29

Sicker pts: limit to a few key areas

Pediatric: more frequent tx allowed (geriatrics need more time btw tx)

Acute cases:shorter interval btw tx (increase frequency)

Front 30

pt has rib problem, upper thoracic spine problem, and cervical spine...which should you tx first?

Back 30

Ribs and upper thoracic before C spine

Front 31

which do you tx first, thoracic spine or rib?

Back 31

Thoracic spine

Front 32

for extremity problems, what should you tx first?

Back 32

spine, sacrum and ribs first

(axial skeleton b4 periphery)

Front 33

Patient presents with a positive left standing flexion test. Left ASIS is cephalad. Left PSIS is cephalad. What is pelvic diagnosis?

Back 33

Left superior Innominate Shear

Front 34

which vertebrae has no spinous processes or vertebral body?

which has a dens?

Back 34

no spinous: C1

dens: C2

Front 35

Patient has positive ASIS compression test
on the left. Both left ASIS and left PSIS are
caudad. What is your diagnosis?

Back 35

Left inferior innominate shear

Front 36

What muscle will help elevate the first rib during forced inhalation?

2nd rib?

Back 36

1st: anterior/middle scalene

2nd: posterior

Front 37

Positive Standing tests on the left. Positive ASIS compression test on the left. What does this tell you? Left ASIS caudad. Left PSIS cephalad.
What is the diagnosis?

Back 37

Left Anterior Innominate rotation

Front 38

What muscle often has a tender point when the there is 1st or seconds inhalation rib dysfunction?

Back 38

Scalene

Front 39

Positive Standing test left. Left ASIS is cephalad and left PSIS is caudad
What is the diagnosis?

Back 39

Left Posterior Innominate Rotation

Front 40

motion of the SCM?

Back 40

with unilateral contraction the SCM will sidebend ipsilaterally and rotate contralaterally (Think of cracking your neck)

bilateral contraction will flex the neck

Front 41

Positive ASIS compression test on right. Right ASIS closer to midline relative to left. What is the diagnosis?

Back 41

Right innominate inflare

Front 42

shortening restrictions within the SCM result in what?

Back 42

torticollis

(twisted neck in which the head is tipped to one side, while the chin is turned to the other)

Front 43

Patient presents with sacroiliac pain. She has a positive seated flexion test on the right. She has a negative spring test. L2-5 are NRRSL. The right sacral base is anterior and the Left ILA is posterior. What is her sacral diagnosis?

Back 43

Seated flexion test positive on Right:
What does this tell you?
Right SI joint is restricted and has
Left oblique axis if engaged
Negative spring test:
What does this tell you?
L/S junction can flex, ie forward
rotation
L5 rotated right:
Sacrum rotates left
L5 sidebent left:
Left oblique axis
Right base anterior
Left ILA posterior
What is your diagnosis?
Left on Left Sacral Torsion

Front 44

Positive ASIS compression test left. Left ASIS further from midline relative to right. What is your diagnosis?

Back 44

Left innominate outflare

Front 45

Seated flexion test positive on left. Negative backward bending test (findings become more symmetrical). L3-5 are NRLSR. Assuming physiologic motion between lumbar and sacrum, can you give diagnosis?

Back 45

Seated flexion test positive on left:
What does this tell you?
Left SI joint is restricted and has
Right oblique axis if engaged
Negative backward bending test (findings become less asymmetrical):
What does this tell you?
sacrum can flex (ie forward torsion)
L5 rotated Left:
Sacral rotation right
L5 is sidebent to right
Right oblique axis
Left base would be anterior
Right ILA would be posterior
What is your diagnosis?
Right on Right Sacral torsion

Front 46

Rheumatoid arthritis and down's syndrome can weaken what ligaments and lead to A-A subluxation?

Back 46

alar (dens to foramen magnum)

transverse (attaches dens to lateral masses of C1 to hold dens into place)

Front 47

Seated flexion test positive on right with positive spring test. L5 is rotated left. The right sacral base is posterior and the Left ILA anterior. What is the diagnosis?

Back 47

Seated flexion test positive on Right
What does that tell you?
Left sacral axis
Positive spring test
What does that tell you?
L/S junction is extended (can’t flex) backward torsion
L5 rotated left:
What does that tell you?
sacral rotation right on
oblique axis
Right base posterior
Left ILA anterior
What is the diagnosis?
Right on left torsion

Front 48

What are the Joints of Luschka

Back 48

C3-C7

uncinate process and superadjacent vertebrae

play a major role in sidebending

degenerative change can lead to foraminal stenosis and nerve root impigment

Front 49

Seated flexion test positive on left with positive spring test. L5 is FRSL. Assuming normal mechanics, what is the sacral diagnosis?

Back 49

Seated flexion test positive on Left
What does that tell you?
Right sacral axis
Positive spring test
What does that tell you?
L/S junction is extended (can’t flex) backward torsion
L5 rotated right:
sacral rotation left
L5 sidebent right:
Right oblique axis
What is the diagnosis?
Left on Right torsion

Front 50

what is the most common cause of cervical nerve root pressure?

Back 50

degeneration of the joints of Luschka plus hypertrophic arthritis of the IV joints

Front 51

Seated flexion/ASIS compression test positive on Left.
Negative Backward Bending Test (findings become less asymmetrical) Left base is anterior and left ILA is posterior and inferior. What is your diagnosis?

Back 51

Seated flexion/ASIS compression test positive on Left
What does that tell you?
Left SI restriction
Negative Backward Bending Test (findings become more symmetrical)
What does that tell you?
Sacrum prefers flexion
Left base is anterior
Left ILA posterior and inferior
What does this tell you?
Not a torsion
What is your diagnosis?
Left Unilateral Sacral Flexion

Front 52

how do cervical nerves exit?

Back 52

ABOVE their corresponding vertebrae

thus their are 8

so C7 will be btw C6-C7

Front 53

tx for Left on Left Sacral Torsion (forward)

Back 53

Forward Torsion Muscle Energy

Pt lying on the axis side with the chest down on the table;
Flex the knees and hips until motion is felt at the lumbosacral junction, usually at least 90° hip flexion;
Allow the legs to hang down off the table with thighs supported by your leg
Monitor the anterior sacral base and ask the patient to push the feet toward the ceiling for 3-5 seconds against your equal resistance;
Slowly move the legs toward the floor to a new restrictive barrier;
Repeat 3-5 times or until return of sacral mobility;
Retest sacroiliac motion or sacral symmetry.

Front 54

why does dmg to the lower cervical cord cause problems in the upper extremity

Back 54

C5-T1 = brachial plexus

Front 55

tx for Left on Right torsion

Back 55

Backward Torsion Muscle Energy

Technique (lateral recumbent):
Sit or stand in front of the patient who is lying on the axis side with the upper back on the table;
Extend the leg on the table until motion is felt at the lumbosacral junction;
Flex the top leg and place the foot behind the other knee;
Hold the shoulder to prevent the patient from rolling and allow the flexed knee to hang down off the table;
Ask the patient to push the flexed knee toward the ceiling for 3-5 seconds against your equal resistance;
Slowly move the knee toward the floor to a new restrictive barrier;
Repeat 3-5 times or until sacral mobility returns;
Retest sacroiliac motion or sacral symmetry.

Front 56

What makes up the OA? what is its primary motion(s). How do sidebending and roation occur here?

Back 56

motion of the occipital condyles on the atlas (C1)

flexion and extension

sidebending and rotation occur to OPPOSITE sides

FRRSL

Front 57

tx for Right Unilateral Sacral Flexion

Back 57

Stand facing the patient’s head on the side of the unilateral flexion;
place your thenar or hypothenar eminence on the involved inferior lateral angle and push it anteriorly and superiorly by leaning into it;
Use your other hand to slightly abduct and internally rotate the lower extremity on the involved side;
While the patient takes a deep breath, push the sacrum into extension during inhalation and resist sacral flexion during exhalation;
Repeat 3-5 times or until sacral mobility returns;
Retest sacroiliac motion or sacral symmetry.

Front 58

What makes up the AA? Primary motion?

Back 58

C1 motion on C2

ROTATION

clinically only moves in rotation here

Front 59

Seated flexion test positive on left with positive spring test. L5 is FRSR. Assuming normal mechanics, what is the sacral diagnosis?

Back 59

Seated flexion test positive on Left
What does that tell you?
Right sacral axis
Positive spring test
What does that tell you?
L/S junction is extended (can’t flex) backward torsion
L5 rotated right:
sacral rotation left
L5 sidebent right:
Right oblique axis
What is the diagnosis?
Left on Right torsion

Front 60

how do C2-C7 move?

Back 60

Sidebending and rotation occur in the same way

NO MATTER THE TYPE

SARA CERVICAL (sidebend away, rotate away)

Front 61

Seated flexion/ASIS compression test positive on Left.
Negative Backward Bending Test (findings become less asymmetrical) Left base is anterior and left ILA is posterior and inferior. What is your diagnosis?

Back 61

Seated flexion/ASIS compression test positive on Left
What does that tell you?
Left SI restriction
Negative Backward Bending Test (findings become more symmetrical)
What does that tell you?
Sacrum prefers flexion
Left base is anterior
Left ILA posterior and inferior
What does this tell you?
Not a torsion
What is your diagnosis?
Left Unilateral Sacral Flexion

Front 62

TRIGGER POINT

For the following segments, describe the main motion and how sidebending and rotation occur with respect to each other:

OA:
AA:
C2-4
C5-7

Back 62

OA: Flexion and Extension / opposite sides

AA: Rotation

C2-4: Rotation / Same Sides
C5-7: Side bending / Same Sides

Front 63

Seated flexion/ASIS compression
test positive on Left. Positive Spring test.
Left base posterior (or right anterior) and
Left ILA anterior (or right posterior). What is your diagnosis?

Back 63

Seated flexion/ASIS compression
test positive on Left:
What does that tell you?
Left SI restriction
Positive Spring test:
What does this tell you?
L/S junction is extended (can’t flex)
Left base posterior (or right anterior)
Left ILA anterior (or right posterior)
What is your diagnosis?
Left unilateral sacral extension

Front 64

if you translate the OA to the right and it is restricted, what does this tell you?

Back 64

it is restricted in left sidebending

(and thus in R rotation)

Front 65

tx for unilateral sacral extension?

Back 65

Stand facing the patient’s feet on the side of the unilateral extension;
Place your thenar or hypothenar eminence on the involved sacral base, and push it anteriorly and inferiorly by leaning into it;
Use your other hand to slightly abduct and internally rotate the lower extremity on the involved side.
While the patient takes a deep breath, resist sacral extension during inhalation and push the sacrum into flexion during exhalation;
Repeat 3-5 times or until sacral mobility returns;
Retest sacroiliac motion or sacral symmetry.

Front 66

when you test AA motion, why do you flex the neck to 45 degrees?

Back 66

remember you are testing rotation here

flexing to 45 degrees will lock out rotation of C2-C7

Front 67

suboccipital or paravertebral muscle spasms are usually associated with what?

Back 67

upper thoracic or rib problems on the same side

tx these first

Front 68

There is a rule of threes for where the spinous processes are located... so where are they for

T1-T3:
T4-6:
T7-9:
T10
T11
T12:

Back 68

T1-T3: located at the level of the corresponding transverse process

T4-6: one half a segment below (spinous process of T5 is halfway btw T5/6)

T7-9: Spinous process located at the lvl of the transverse process of the vertebrae below (T8's is at T9)

T10: Spinous process located at the lvl of the transverse process of the vertebrae below

T11:one half a segment below

T12: at the level of T12 transverse process

Front 69

Spine of scapula is where?

inferior angle of scapula=

sternal notch=

nipple=

umbillicus=

Back 69

Spine of scapula is where= T3

inferior angle of scapula=T7

sternal notch=T2

nipple= dermatome of T4

umbillicus= dermatome of T10

Front 70

TRIGGER POINT:

main motion of thoracic spine?

Back 70

ROTATION

upper and middle thoracic: rotation >flexion/extension>sidebending

lower thoracic: flexion/extension>sidebending>rotation

Front 71

innervation of the diaphragm?

Back 71

Phrenic nerve (C3,4 5, keep the diaphragm alive)

remember the diaphragm also returns lymph and venous blood back to the thorax

Front 72

where do the tubercle and head of a rib articulate respectively?

Back 72

tubercle: corresponding transverse process

head: vertebrae above the corresponding vertebrae and its own

Front 73

what are the atypical ribs?

Back 73

They have "1s" and "2s"

1: atypical because it articulates with only T1 and ha no angle

2: has a large tuberosity on shaft for serratus anterior

11: articulate only with corresponding vertebrae and lack tubercles

12 : same as above

(sometimes rib 10: because it articulates only with T10)

Front 74

Trigger point:

What are the differences btw TRUE, FLOATING, and FALSE ribs

what rib set are each of these?

Back 74

Ribs 1-7: Attach to sternum through costal cartilages-->TRUE

Ribs 8-12: do not attach directly to sternum (each is connected by its costal cartilage to the cartilage above)-->FALSE

Ribs 11-12: remain unattached anteriorly-->FLOATING

Front 75

which ribs move by pump handle, bucket handle, and caliper handle

Back 75

Pump: 1-5

Bucket: 6-10

Caliper: 11-12

Front 76

what is an inhalation dysfunction?

Back 76

exhalation dysfunction

dysfunctional rib will move cephalad druing inhalation however:

the dysfunctional rib will not move caudad during exhalation

rib appears to be held up

Front 77

is this an inhalation or exhalation rib? pump handle or bucket handle?

rib elevated anteriorly
anterior part of rib moves cephalad on inspiration and restricted on expiration

anterior narrowing of intercostal space above the dysfunctional rib

superior edge of posterior rib angle is promienent (sublexed)

Back 77

Pump handle (1-5)

inhalation SD

Front 78

is this an inhalation or exhalation rib? pump handle or bucket handle?

rib elevated laterally

lateral part (shaft) of rib moves slightly upward on inspiration and restricted on expiration

lateral narrowing of intercostal space above dysfunctional rib

lower edge of rib shaft is prominent

Back 78

Bucket Handle (6-10)

inhalation SD

Front 79

is this an inhalation or exhalation rib? pump handle or bucket handle?

rib depressed anteriorly

ant part of rib moves caudad on expiration and restricted on inspiration

anterior narrowing of intercostal space below dysfunctional rib

inferior edge of posterior rib angle is prominent

Back 79

pump handle (1-5)

exhalation SD

Front 80

is this an inhalation or exhalation rib? pump handle or bucket handle?

rib depressed laterally

lateral part (shaft) of rib moves slightly downpward on expiration and restricted on inspiration

lateral narrowing of intercostal space below dysfunctional rib

Back 80

bucket handle ribs (6-10)

exhalation SD

Front 81

in inhalation and exhalation dysfunctions what is the key rib

Back 81

key rib is the troublemaker

inhalation: lowest rib

exhalation: upper rib

Front 82

pt has exhalation rib dysfunction from rib 2-5, which do you tx?

Back 82

rib 2

Front 83

what ligament narrows in the lumbar region (at L4 is is half the width of it was at L1)...? What does this lead to?

Back 83

Posterior longitudinal ligament

more susceptible to disc herniation

Front 84

in the thoracic and lumbar region, how do nerve roots exit the IV foramen?

Back 84

BELOW

L4 nerve root will come out btw L4 and L5

Front 85

where does the spinal cord terminate?

Back 85

L1/2

Front 86

What is the primary flexor of the hip?

Back 86

Iliopsoas

Origin: T12-L5 vertebral bodies

Front 87

what makes up the erector spinae group?

Back 87

I Love Spaghetti

Iliocostalis
Longissimus
Spinalis

Front 88

pelvic side shift, positive Thomas Test (checks for exaggerated lumbar lordosis + flexion of hip), and SD of an upper lumbar segment are commonly seen with what?

Back 88

Iliopsoas SD

Front 89

what landmark is at the iliac crest

Back 89

L4-5 IV disc

Front 90

TRIGGER POINT

What are the 3 types of spina bifida

Back 90

Defect in closure of lamina of vertebral segment

Occulta: no herniation through defect, only sigh is normally a patch of hair

meningocele: herniation of meninges

meningomyelocele: meninges and nerve roots herniate (assoc with neurological defects)

Front 91

TRIGGER POINT:

Major motion of the lumbar spine?

Back 91

Flexion extension

(remember for thoracic it was rotation)

Front 92

rotation of the L5 will cause what to happen to the sacrum?

Back 92

it will be rotated toward the opposite side

Front 93

What is the Lumbosacral (Ferguson's) angle?

does an increase or decrease in angle cause back pain?

Back 93

formed by intersection of a horizontal line and the line of the inclination of the sacrum

usually btw 25-35 degrees

increase in angle causes shear stress and causes low back pain

Front 94

Where do 90% of herniated discs occur?

Back 94

between L4 and L5
or
L5 and S1

Front 95

Herniation btw L3 and L4 will affect what nerve?

what movement would make it worse?

Back 95

L4

flexion- moves the pulposis further posterior

Front 96

how can you diagnose a herniated disc?

Back 96

straight leg test

Front 97

tender point medial to the ASIS, nonneutral dysfunction of L1 or L2, and pelvic shift test to the contralateral side can be signs of what?

Back 97

Psoas syndrome

can also be due to sacral dysfunction on an oblique axis and contralateral periformis spasm

note: that for tx, you should get rid of the high lumbar strain first

Front 98

TRIGGER POINT:

A flexion contracture of the iliopsoas is often associated with what?

Back 98

a nonneutral dysfunction of L1 or L2

Front 99

TRIGGER POINT:

What is spondylolisthesis?

what is a spondylolysis?

Spondylosis?

Back 99

spondylolisthesis: Anterior displacement of one vertebrae in relation to the one below

Spondylolysis: defect of the pars interarticularis WITHOUT anterior displacement. Oblique view will show a fracture of the pars (seen as the collar of the scotty dog)

Spondylosis: Degenerative changes within the IV disc and anklosing of adjacent vertebral bodies

Front 100

pt comes to your office complaining of low back pain. They have tight hamstrings, stiffed legged short stride waddling gait. You palpate and feel a positive vertebral step off sign and the pain is increased with extension. What does this pt have?

Back 100

Spndylolisthesis

positive vertebral step-off sing= palpating the spinous processes there is an obvious forward displacement at the area of listhesis

Front 101

TRIGGER POINT:

What view on X ray do you use to diagnose a spondylolisthesis?

what about a spondylolysis?

what where these again?

Back 101

LATERAL XRAY: spondylolisthesis: Anterior displacement of one vertebrae in relation to the one below

OBLIQUE XRAY
Spondylolysis: defect of the pars interarticularis WITHOUT anterior displacement. Oblique view will show a fracture of the pars (seen as the collar of the scotty dog)

Front 102

pt comes in with saddle anesthesia, decreased DTRs, decreased recal sphincter tone leading to loss of bowel and actually bladder control as well...what does he have? Cause? tx?

Back 102

Cauda Equina syndrome

usually due to massive central disc herniation (or use of local anesthetics)

tx: emergent surgical decompression of the cauda equina is imperitive, if surgery is delayed too long paralysis may result

Front 103

What is a dextroscoliosis?

Levoscoliosis?

Back 103

curve that is sidebending left = scoliosis to the right = dextroscolisosis

curve that is sidebent right = socliosis to the left = levoscoliososis

Front 104

What is the difference btw a structural and functional curve?

Back 104

Structural: fixed and inflexible, will not correct

Functional: flexible that is partially or completely corrected with sidebending to the opposite side (uncorrected may become structural)

Front 105

when evaluating for scoliosis, you examine the levelness of the occiput, shoulders, iliac crests, PSIS and greater trochanters. If these are not level, what should you check next?

Back 105

have the pt bend forward, if a group of ribs appear higher on one side as the pt bends forward (rib hump) the pt is likely to have scoliosis

Front 106

What is the Cobb angle

What does 5-15 show? What about beyond that?

Back 106

shows scoliosis

draw horizontal line from the vertebral body of the extreme ends of the curve, then perpendicular lines off the previous 2

5-15: mild scoliosis
20-45: moderate
>50: Severe

Front 107

at what Cobb angles do you see respiratory functioning compromised and CV function compromised respectively?

Back 107

Resp: >50

CV: >75

Front 108

What are the tx for the following scoliosis:

Mild

Moderate

Severe

Back 108

5-15: mild scoliosis
--OMT and Konstancin exercises

20-45: moderate
--above + bracing + spinal orthotic

>50: Severe
--Surgery if resp compromise

Front 109

most common cause of anatomical short leg?

Back 109

hip replacement

Front 110

describe if the following findings will be on the side of the short or the long leg in a person with short leg syndrome:

1. sacral base lower
2. ant inominate roatoin
3. post inominate rotation
4. Lumbar will side bend away and rotate toward the side of the..
5. Iliolumbar followed by the SI ligaments will become stressed on the side of...

Back 110

1. short leg
2. short leg
3. long leg
4. short leg
5. short leg

Front 111

if the difference btw the heights of the femoral head is ____ you should use a ____ ____ for tx

Back 111

>5mm

Heel lift

Front 112

in a fragile pt (elderly, arthritic, osteoporotic, or those in acute pain) you should begin with what size heel lift? How should you increase it?

Back 112

1/16" (1.5mm)

increase 1/16" every 2 weeks

Front 113

in a flexible pt, you should begin with what size heel lift? how should you increase it from there?

Back 113

1/8" (3.2mm)

1/8" every 2 weeks

Front 114

maximum inches heel lift you can add to the inside of the shoe? max total?

Back 114

inside: 1/4" (rest must be added outside)

total: 1/2"

note: final lift should be 1/2 -3/4" original discrepancy

Front 115

TRIGGER POINT:

What divides the greater and lesser sciatic foramen?

Back 115

The sacrospinous ligament

originates at the sacrum and attaches to the ischial spines

Front 116

what 2 muscles make up the pelvic diaphragm?

Back 116

levator ani

coccygeus muscle

Front 117

11% of the population will have either the entire or peroneal portion of the sciatic nerve running through the belly of what muscle? Where can this cause pain? Radiating to?

Back 117

Piriformis

Buttock pain that radiates down the thigh but not below the knee

Front 118

How does the sacral base move in respiratory motion

Back 118

Inhalation-->spine elongates-->sacral base posterior

Exhalation: anterior

Front 119

how will the sacrum move in inherent (craniosacral) motion? (how does the base move in craniosacral flexion/extension)

Back 119

during craniosacral flexion: posterior (counternutates)

during extension: anteriorly (nutates-nods forward)

remember: cranial flexion=fat head

extension= thin head

Front 120

TRIGGER POINT:

What are the axes of the sacrum?

Back 120

DRIP

Dynamic (weight bearing engages sacral axis)

Respiratory (inhale-base goes posterior)

Inherent (cranial): flexion-base goes posterior/counternutates

Postural- as person bends forward sacral base goes anterior

Front 121

ASIS inferior

PSIS superior

same side and positive standing flexion test on that side

Back 121

Anterior inominate rotation

will have longer leg ipsilaterally

Front 122

common etiology of the following:

asis and psis move superiorly ipsilaterally

Back 122

This is a superior inominate sheer

Due to a fall

Front 123

common etiology of the following:

ASIS more superior ipsilaterally
PSIS more inferior ipsilaterally

Back 123

this is a posterior inominate rotation

due to tight hamstrings

Front 124

common etiology of the following:

ASIS's level
PSIS's level
Pubic bone superior ipsilaterally

Back 124

this is a superior pubic shear

due to trauma or tight rectus abdominus muscle

Front 125

common etiology of the following:

ASIS's level
PSIS's level
Pubic bone inferior ipsilaterally

Back 125

this is a inferior pubic shear

due to trauma or tight aDductors

Front 126

TRIGGER POINT:

Sacral Torsion rules:

1. When L5 is sidebent, a sacral oblique axis is engaged on the ____ side as the sidebending

2. When L5 is rotated, the sacrum rotates ____ on an oblique axis

3. The seated flexion test is found on the ___ side of the oblique axis

Back 126

1. When L5 is sidebent, a sacral oblique axis is engaged on the _SAME_ side as the sidebending

2. When L5 is rotated, the sacrum rotates _THE OPPOSITE WAY_ on an oblique axis

3. The seated flexion test is found on the _OPPOSITE_ side of the oblique axis

Front 127

If L5 is FRRSR

where will the seated flexion test be positive?

how will the sacrum be rotated?

Back 127

Positive seated flexion on the LEFT

The sacrum will be rotated to the left on a right oblique axis...or L on R

Front 128

In sacral torsions, L5 will always rotate in the ____ direction of the sacrum

Back 128

OPPOSITE

Front 129

What is a positive spring test? what does it show?

Back 129

Resistance to springing

Sacral extension (posterior)

Backward torsion (R on L or L on R)

Front 130

What is a negative spring test? what does it show?

Back 130

Ease of springing

Sacral flexion

Forward torsion (R on R or L on L)

Front 131

How do a sacral rotation and sacral torsion differ?

--this seems to me to be low yield

Back 131

Rotation: L5 and sacrum rotate to same way

Torsion: rotate in opposite side

Front 132

Findings:
RIght and left sulci (sacral base) deep

ILA's shallow bilaterally

FALSE negative seated flexion test

negative lumbosacral spring test

Diagnosis?

Back 132

Bilateral sacral flexion

the entire sacral base moves anterior about a middle transverse axis

Front 133

TRIGGER POINT:

Bilateral sacral flexion is a common dysfunction in what type of pt?

Back 133

Post-partum

remember:

Findings:
RIght and left sulci (sacral base) deep

ILA's shallow bilaterally

FALSE negative seated flexion test

negative lumbosacral spring test

Front 134

Findings:
RIght and left sulci (sacral base) shallow

ILA's deep bilaterally

FALSE negative seated flexion test

positive lumbosacral spring test

Back 134

Bilateral Sacral Extension

Front 135

Left sulcus deeper
Left ILA significantly inferior
left ILA slightly posterior
Positive seated flexion on the left
motion (springing) at the left sulcus is present

diagnosis?

Back 135

Left unilateral sacral flexion

Front 136

Right sulcus shallow
Right ILA anterior
Positive seated flexion on the right
Positive lumbosacral spring test

Diagnosis?

Back 136

right unilateral sacral extension

Front 137

pt has lumbar and sacral problems..which do you tx first?

Back 137

LUMBAR

so treat L5 first! most sacral problems disappear with this

Front 138

if a person has a flexion contracture of the iliopsoas on the the right, what other findings could you expect to see?

Back 138

L1 or L2 may be FRRSR

Front 139

What is the only bone connecting the upper extremity and the axial spine?

Back 139

Clavicle

Front 140

TRIGGER POINT:

What are the rotator cuff muscles and their actions?

Back 140

SItS

Supraspinatous: abduction of arm

Infraspinatus: external rotation of the arm

Teres Minor: external rotation of the arm

Subscapularus: internal rotation of the arm

Front 141

Muscles of the shoulder...given the action list the muscle:

Primary flexor:
Primary abductor:
Primary extensors:
Primary adductors:
Primary external rotators:
Primary internal rotator:

Back 141

Primary flexor: Deltoid

Primary abductor: Deltoid

Primary extensors: Lat dorsi, teres major, deltoid

Primary adductors: pec major, lat dorsi

Primary external rotators: infraspinatus, teres major

Primary internal rotator: subscapularis

Front 142

given the radial and ulnar arteries, which supplies the deep palmar and superficial palmar arteries?

Back 142

radial: deep palmalr

ulnar: superficial

Front 143

tx for relieving lymph congestion of the upper extremity?

Back 143

open the thoracic inlet

redome the thoracoabdominal diaphragm

posterior axillary fold technique (?? no idea what this is)

Front 144

Draw the Brachial Plexus

Back 144

Front 145

normally the arm can abduct to 180 with active motion...120 is due to glenohumeral motion and 60 is due to scapulothoracic motion. There for for every 3 degrees of abduction, the glenohumeral joint moves __ degrees and the scapulothoracic joint moves __ degrees

Back 145

for for every 3 degrees of abduction, the glenohumeral joint moves _2_ degrees and the scapulothoracic joint moves _1_ degrees

Front 146

describe the Spencer Technique

Back 146

Extension
Flexion
Compression
Traction
Abduction
Internal Rotation
Pump

EVERY FAT CAT TRIES ABDUCTING IN PUMPS

Front 147

Most common SD of the shoulder is in what 2 movements? what muscles are responsible?

Back 147

Internal rotation: subscap

External rotation: infraspinatous and teres minor

Front 148

each end of the clavicle can glide... what are its motions?

Back 148

anterior or posterior

OR

superior or inferior

note: motions at either end of the clavicle are in opposite directions (lateral end of clavicle is superior, medial end is inferior)

Front 149

most common sternoclavicular joint SD?

Back 149

clavicle is anterior and superior on the sternum

clavicle resists posterior and inferior glide

Front 150

What is Thoracic outlet syndrome? What 3 places can this problem occur?

Back 150

Compression of the neurovascular bundle (subclavian artery and vein and the brachial plexus) as it exits the thoracic outlet

Three Places:
1. btw the anterior and middle scalenes
2. Btw the clavicle and 1st rib
3. Btw pec minor and upper ribs

Front 151

pt presents with a positive Adson's test...what is this? what would this show?

What is a Military posture test going to show you?

Hyperextension?

Back 151

All can show you the location of Thoracic outlet syndrome

Adson's: if compression btw scalenes

Military: if compression is btw clavicle and 1st rib

Hyperextension: if compression occurs under pectoralis minor

Front 152

Tx for thoracic outlet syndrome should be targeted where?

Back 152

OMT at C2-C7

T1

Rib 1

Thoracic inlet

Clavicle

Scalenes

Front 153

pain at the tip of the acromion that is exacerbated by abduction especially from 60-120 degrees

Back 153

Supraspinatous tendinitis

Front 154

Pt comes in complaining of shoulder pain. You find a tenderpoint just below the tip of the acromion and see weakness in active abduction. What special test should you apply?

Back 154

Drop arm test (empty can would probably be good too)

this is a rotator cuff tear, likely in the supraspinatous

Front 155

pt comes in complaining of pain in their shoulder and difficulty moving it. You note decreased ROM with active and passive motion. What is the etiology of this problem? OMT Tx?

Back 155

this is Adhesive capsulitis/ Frozen shoulder syndrome

Etiology: prolonged immobility of the shoulder

Tx: main is prevention, but the SPENCER technique is good for improving motion and lysing adhesions

Front 156

You are a sideline doc at a Red Wings game. Kronwall absolutely wrecks Sidney Crosby and it looks like he has a dislocated shoulder. How will the shoulder likely be dislocated? What muscle strength should you make sure to check and why?

Back 156

Anteriorly and inferiorly

Check abduction (deltoid) because the axillary nerve can be damaged

Front 157

Person has a winged scapula...what nerves are involved? muscles?

Back 157

Long thoracic n.

Anterior serratus muscle

Front 158

TRIGGER POINT:

What is the most common type of brachial plexus injury?

cause?

Back 158

Erb-Duchenne's palsy

upper arm paralysis caused by injury to C5 and C6 nerve roots, usually during child birth (or falling on your shoulder and outstretched neck)

Front 159

What is Klumpke's palsy

Back 159

due to C8-T1 injury

leads to paralysis of the intrinsic muscle of the hand (total claw hand)

Front 160

A man is on crutches for a long time and now is complaining that he his wrist is just flopping around...what does he have? cause?

Back 160

Crutch palsy

compression of the radial nerve

Front 161

Hand bones?

Back 161

Scaphoid
Lunate
Triquetral
Pisiform
Trapezium
Trapezoid
Hamate
capitate

Front 162

nerve that is responsible for:

flexion of the wrist and hand

Back 162

median

Front 163

nerve that is responsible for:

extension of the wrist and hand

Back 163

radial

Front 164

nerve that is responsible for:

supination

Back 164

biceps-->musculocutaneous n.

supinator-->radial

Front 165

nerve that is responsible for:

pronation

Back 165

median

Front 166

where do the flexor digitorum profundus and the flexor digitorum superficialis attach respectively?

Back 166

profundus: Distal interphalengeal joint (DIP)

superficialis: PIP

Front 167

what will the carrying angle be for abduction and adduction of the ulna SD?

Back 167

abduction: carrying angle >15

adduction: <3

Front 168

TRIGGER POINT

An increase in the carrying angle will do what to the ulna (abduct or adduct?)

what will this cause in the wrist?

Back 168

Increased carrying angle-->abduction of the ulna-->Adduction of the wrist

note the converse is also true

Front 169

how will the radial head glide in pronation and supination respectively?

Back 169

Pronation: posterior

Supination: anterior

Front 170

A man falls forward on an outstretched arm.. what would you likely find his radial head to be like? what restrictions would he have?

Back 170

Posterior radial head

Restriction supination
restricted ant glide

Front 171

Man falls backward on to his arm...what would you likely find his radial head to be like? what restrictions would he have?

Back 171

Anterior radial head

restricted in pronation and posterior glide

Front 172

pt comes in complaining of pareshesia on the thumb and first 2 digits, including half of their ring finger. What do they have? Cause? Special Tests?

Back 172

Carpal Tunnel

Entrapment of the median nerve at the wrist

Tinel's, Phalen, prayer test

tx: rib/upper thoracid SD to decrease sympathetic tone

cervical SD to enhance brachial plexus

Direct MFR to wrist

Front 173

A man comes in complaining of elbow pain after a long tennis match. What does he have?

Back 173

Lateral epicondylitis (tennis elbow)

pain over lateral epicondyle that worsens with wrist extension

Front 174

Pathogenesis of golfer's elbow?

Back 174

this is medial epicondylitits

due to overuse of the forearm flexors and pronators

Front 175

What is a Swan-neck deformity? Assoc with?

Back 175

flexion contracture of MCP and DIP
extension contracture of the PIP

assoc with RA

Front 176

What is a Boutonniere deformity?

assoc with?

Back 176

Extension contracture of the MCP and DIP
Flexion contracture of the PIP

RA

Front 177

Describe:

Claw Hand

Ape Hand

Bishops Deformity

Back 177

Claw Hand: extension of the MCP, flexion of the PIP and DIP-->results from median and ulnar injury

Ape Hand: Similar to claw, but wasting of the thenar eminence and thumb is adducted-->due to median n. dmg

Bishops Deformity: Contracture of the last 2 digits with atrophy of the hypothenar eminence due to ulnar n. dmg

Front 178

How does the head of the femur glide with external and internal rotation respectively?

Back 178

External: anterior

internal: posterior

Front 179

pt has a hip that is restricted in internal rotation....SD? Etiology?

pt has a hip that is restricted in external rotation....SD? Etiology?

Back 179

restricted in internal rotation-->External rotation SD-->Piriformis or Iliopsoas spasm

restricted in external rotation-->internal rotation SD-->spasm of internal rotators (gluteus minimus, semimembranous, semitendinous, etc)

Front 180

origin/insertion of the ACL...function?

Back 180

originates at posterior aspect of the femur

attaches to the anterior aspect of the tibia

prevents anterior translation of the tibia on the femur

Front 181

origin/insertion of the PCL...function?

Back 181

originates on the anterior aspect of the femur and inserts on the posterior aspect of the tibia.

Prevents posterior translation of the tibia on the femur

Front 182

How will the fibular head move with pronation and supination of the foot respectively?

Back 182

pronation: fibular head moves anterior

supination: fibular head moves posterior

note:

Dorsiflexion, eversion and abduction=pronation of the anke

Plantarflexion, inversion, adduction= supination of the anke

Front 183

TRIGGER POINT

Dorsiflexion, eversion and abduction= _____ of the anke

Plantarflexion, inversion, adduction= _____ of the

Back 183

Dorsiflexion, eversion and abduction=pronation of the anke

Plantarflexion, inversion, adduction= supination of the

Front 184

person has problem extending their knee, what nerve is dmged? spinal levels?

Back 184

femoral L2-4

Front 185

Spinal levels for sciatic verve

Back 185

L4-S3

Front 186

the normal angle between the neck and shaft of the femur is 120-135

What is coxa vara and coxa valga

Back 186

coxa vara: <120

Valga: >135

Front 187

What are Genu Valgum and Varum

make sure you discuss Q angle

Back 187

The Q angle is formed by the intersection of a line from the ASIS through the middle of the patella and a line from the tibial tubercle through the middle of the patella. Normally is is 10-12 degrees

an Increased Q angle is referred to GENU VALGUM: knocked kneed

A decreased Q angle is genu varum: BOWLEGGED

Front 188

pt has a talus that is internally rotated causing the foot to invert and plantar flex.. what is your diagnosis

anterior fibular head
posterior fibular head
genu valgum
genu varum

Back 188

remember: inversion=plantar flex=supination

Posterior Fibular head

other findings: proximal fibular head resists anterior spring, distal fibula may be anterior and resist posterior spring

Front 189

pt presents witha proximal fibular head that resists posterior spring... what does the pt have:

anterior fibular head
posterior fibular head
genu valgum
genu varum

Back 189

anterior fibular head

could also see: talus externally rotated causing foot to evert and dorsiflex

Front 190

TRIGGER POINT:

What nerve lies directly posterior to the Proximal Fibular head. Therefor a posterior fibular head or fracture of the fibula may disturb the function of this nerve

Back 190

Common peroneal (common fibular)

Front 191

describe a 1-3 degree sprain

Back 191

1st: no tear resulting in good tensile strength and no laxity

2nd: partial tear resulting in a decreased tensile strength with mild to moderate laxity

3rd: complete tear resulting in no tensile strength with mild to moderate laxity (may require surgery)

Front 192

A patient comes to you with severe unrelenting pain. They say it started after working out. You feel the leg and it is rock hard. Which compartment of the leg is most likely to get compartment syndrome?

Back 192

Anterior (ant tibialis muscle is hard and tender to palpation)

note: the lower leg is divided into anterior, lateral, deep posterior, and superficial posterior

Front 193

TRIGGER POINT:

What is the O'Donahue's triad (terrible triad)

note: this varies from what first aid 2011 says

Back 193

according to green book:

ACL, MCL, Medial Meniscus

(FA 2011 says Lateral meniscus)

Front 194

TRIGGER POINT

Is the ankle more stable in dorsi or plantar flexion? Why

Back 194

Dorsiflexion

the trochlea of the talus is wider anteriorly, making the foot more stable in dorsiflexion

80% of ankle sprains occur in plantar flexion!

Front 195

Which arch of the foot will be most likely to have SD? What makes up this arch? What type of pt will have this?

Back 195

Transverse arch

Cubiod, Navicular, Cuneiforms

Long Distance runners

Front 196

TRIGGER POINT:

What is the most common injured ligament in the foot?

Back 196

ATF: Anterior Talofibular ligament

ALWAYS TEARS FIRST

Front 197

What are the 3 types of sprains in the ankle?

Back 197

I: involves anterior talofibular

II: involves ATF and calcaneofibular ligament

III: ATF, CFL, and posterior talofibular ligaments all damaged

Front 198

What ligament of the ankle is the medial stabilizer, preventing excessive pronation?

Back 198

Deltoid ligament

excessive pronation will usually result in a fracture of the medial malleoulus rather than a pure ligamentous injury

Front 199

chronic irritation to this structure may cause calcium to be laid down along the lines of stress, leading to a heel spur

Back 199

plantar aponeurosis (fascia)

Front 200

What is Patello-femoral syndrome? (aka lateral patello-femoral tracking syndrome)

signs/sx?

prevalence?

tx?

Back 200

imbalance of the musculature of the quads (strong vastus lateralis and weak vastus medialis)

deep knee pain especially when climbing stairs

more common in women

strengthen the vastus medialis muscle

Front 201

TRIGGER POINT

What is the primary respiratory mechanism (PRM)

Back 201

CNS + CSF + Dural membranes + cranial bones + sacrum

Front 202

What is normal Cranial Rhythmic Impulse (CRI)?

Back 202

10-14 cycles per minute

Front 203

What will effect will the following factors have on CRI (rate/quality):

Stress (emotional/physical)
Depression
Chronic Fatigue
Chronic Infections

Back 203

Decrease the rate/quality

Front 204

What will effect will the following factors have on CRI (rate/quality):

Vigorous physical exercise
Systemic Fever
Following OMT to the crainosacral mechanism

Back 204

Increase the rate/quality

Front 205

TRIGGER POINT:

What are the Dura Matter's attachments

Back 205

Foramen Magnum, C2, C3, S2

Front 206

What is the reciprocal tension membrane (RTM)

Back 206

connection of dura to the cranial bones, making them move

Front 207

During flexion, how do the paired bones of the cranium move?

what about during extension?

Back 207

flexion: external rotation of paired bones

extension: internal rotation

Front 208

During Fexion of the SBS, how does the pelvis move?

Back 208

dura will be pulled cephalad, moving the sacral base:

POSTERIOR (sacral extension or COUNTERNUTATION)

Front 209

widening the head slightly and decreasing its anterioposterior diameter =

Back 209

cranial flexion

Front 210

TRIGGER POINT

Craniosacral Flexion:
1. Flexion of the ____ bones
2. Sacral base _____ (_____)
3. ___ AP diameter of the cranium
4. _____ rotation of the paired bones

Also, is the movement of the sacrum equivalent to inhalation or exhalation?

Back 210

Craniosacral Flexion:
1. Flexion of the _midline_ bones
2. Sacral base _Posterior_ (_Counternutation_)
3. _Decreased_ AP diameter of the cranium
4. _External_ rotation of the pair bones

Also, is the movement of the sacrum equivalent to inhalation or exhalation? INHALATION

Front 211

TRIGGER POINT

Craniosacral Extension:
1. Extension of the ____ bones
2. Sacral base _____ (_____)
3. ___ AP diameter of the cranium
4. _____ rotation of the paired bones

Also, is the movement of the sacrum equivalent to inhalation or exhalation?

Back 211

Craniosacral Extension:
1. Extension of the _Midline_ bones
2. Sacral base _Anterior_ (_nutation_)[remember nod forward]
3. _Increased_ AP diameter of the cranium
4. _Internal_ rotation of the paired bones

Also, is the movement of the sacrum equivalent to inhalation or exhalation? EXHALATION

REMEMBER: EXHALATION=CRANIOSACRAL EXTENSION (with respect to direction of the pelvis)

Front 212

Describe a cranial torsion

Back 212

sphenoid rotates one way, the occiput rotates the opposite

named for the greater wing of sphenoid that is more superior

Front 213

sphenoid is rotate so that the greater wing of the sphenoid is more inferior on the right...

what is this?

Back 213

Left cranial torsion

remember you name for the greater wing that is more SUPERIOR

Front 214

what are the pathologic and physiologic strain patterns in cranial?

Back 214

pathologic:
Flexion/extension
Vertical strain
Lateral strain
Compression

Physiologic:
Right/left Torsion
Sidebending/Rotation (L or R)

Front 215

if the SBS deviates caudad what type of strain do you have?

Back 215

Extension

Front 216

if the SBS is deviated cephalad

Back 216

flexion

Front 217

how can you tell the difference btw a superior and inferior vertical strain?

Back 217

Superior: sphenoid base deviates cephalad in relation to the occiput (greater wings point down)

Inferior: sphonoid base deviates caudad in relation to the occiput

Front 218

if the greater wing of sphenoid deviates left what is the strain pattern?

right?

Back 218

Left: left lateral strain

right: right lateral strain

Front 219

TRIGGER POINT

this type of strain occurs when the sphenoid and occiput have been pushed together..... what will your CRI be like? Cause?

Back 219

Compression

Decrease in the amplitude of flexion and extension components of the CRI

due to trauma to the back of the head

Front 220

Where do V1 V2 and V3 exit the cranium respectively?

Back 220

V1: Superior orbital fissure

V2: Foramen Rotundum

V3: Ovale

Front 221

Where does CN VII exit the cranium?

Back 221

enters internal acoustic meatus and exits the stylomastoid foramen

Front 222

TRIGGER POINT:

What 3 nerves can lead to suckling dysfunction in the newborn? What is the tx?

Back 222

CN IX
CN X
CN XII

Occipital/condylar decompression

Front 223

TRIGGER POINT:

Vagal somatic dysfunction can be due to dysfunction at what 3 places?

Back 223

OA

AA

C2

Front 224

TRIGGER POINT:

Dysfunction of CN __ can cause tinnitus, vertigo, or hearing loss

Back 224

CN VIII

Front 225

What is venous sinus drainage

Back 225

Operator spreads apart the sutures of the cranium that overly the occipital, transverse, and sagittal sinuses

Front 226

This tx can be used to enhance the amplitude of the CRI by resisting the flexion phase and encouraging the extension phase of the CRI until a still point is reached, then allowing restoration of normal flexion and extension. It has been reported to be helpful in fluid homeostasis and help induce uterine contractions

Back 226

CV4: Bulb decompression

Front 227

TRIGGER POINT:

What tx will increase the amplitude of the CRI? (and fluid homeostasis and uterine contractions)

Back 227

CV4

Front 228

Where do you put your fingers in the vault hold?

Back 228

Index: greater wing of sphenoid
Middle: Temporal bone in front of the ear
Ring Finger: Mastoid region of the temporal bone
Little finger: squamous portion of the occiput

Front 229

what technique is used to separate restricted or impacted sutures?

which is used to aid in the balance of membranous tension?

Back 229

Vspread

Lift (frontal or parietal)

Front 230

Dentistry, newborn babies, or car accidents can all be times to do what?

Back 230

cranialsacral tx

Front 231

absolute contraindications of cranial? 3

Back 231

acute intracranial bleed or increased intracranial pressure (CNS malignancy or infection)

Skull fracture

Relative:
seizure history or traumatic brain injury

Front 232

What are the unpaired bones? 5

how do they move?

Back 232

Unpaired bones move in flexion/extension

Ethmoid
Mandible
Occiput
Sphenoid
Vomer

Front 233

In a sidebending rotation how do the sphenoid and occiput move in relation to each other?

Back 233

they rotate the same way!!

remember: in torsion they rotate opposite ways...this can help you pick btw these 2

Front 234

What is Facilitation?

Back 234

the maintenance of a pool of neurons (like those in a ganglion) in a state of partial or sub threshold excitation

this makes it so less afferent stimulation is needed to trigger the discharge of impulses

A facilitated segment can lead to TART (tissue texture change, asymmetry, restriction, tenderness)

Front 235

what is the difference btw a viscero-somatic reflex and a somato-visceral reflex

Back 235

viscero-somatic: cholecystitis refers pain to the thoracic region at the tip of the right scapula

somato-visceral: trigger point in the right pectoralis major can cause arrhythmia

Front 236

Make sure you are aware of the parasympathetic and sympathetic functions of organs

Back 236

this is a table on p.102, it is pretty straight forward but if you are shaky go look at it

Front 237

What 2 parasympathetic ganglion does CNVII travel to, and what are their functions

Back 237

Sphenopalatine: lacrima and nasal glands

Submandibular: Submandibularand sublingual glands

Front 238

What is the name of the PARAsympathetic nerve that comes off at S2/3/4

Back 238

Pelvic splanchnic

note: Lumbar/Sacral are SYMPATHETIC

Front 239

Please give the sympathetic and parasympathetic spinal reflex levels for:

Head and neck

Back 239

Symp: T1-4

Para: Vagus

Front 240

Please give the sympathetic and parasympathetic spinal reflex levels for:

Cardiovascular

Back 240

Symp: T1-5

Para: Vagus

Front 241

Please give the sympathetic and parasympathetic spinal reflex levels for:

Respiratory

Back 241

Symp: T2-T7

Para: Vagus

Front 242

Please give the sympathetic and parasympathetic spinal reflex levels for:

Stomach

Back 242

Symp: T5-T9

Para: Vagus

Front 243

Please give the sympathetic and parasympathetic spinal reflex levels for:

Liver

Back 243

Symp: T5-T9

Para: Vagus

Front 244

Please give the sympathetic and parasympathetic spinal reflex levels for:

Gall bladder

Back 244

Symp: T5-T9

Para: Vagus

Front 245

Please give the sympathetic and parasympathetic spinal reflex levels for:

Small intestine

Back 245

Symp: T9-11

Para: Vagus

Front 246

Please give the sympathetic and parasympathetic spinal reflex levels for:

Ovary

Back 246

Symp: T9-10

Para: S2-4

Front 247

Please give the sympathetic and parasympathetic spinal reflex levels for:

Testicle

Back 247

Symp: T9-10

Para: S2-4

Front 248

Please give the sympathetic and parasympathetic spinal reflex levels for:

Kidney

Back 248

Symp: T10-11

Para: S2-4

Front 249

Please give the sympathetic and parasympathetic spinal reflex levels for:

Ureter

Back 249

Symp: T10-11


Para: S2-4

Front 250

Please give the sympathetic and parasympathetic spinal reflex levels for:

Bladder

Back 250

Symp: T10-11

Para: S2-4

Front 251

Please give the sympathetic and parasympathetic spinal reflex levels for:

Large intestine

Back 251

Symp: T8-L2

Para: Vagus and S2-4

Front 252

Please give the sympathetic and parasympathetic spinal reflex levels for:

Uterus

Back 252

Symp: T10-11

Para: S2-4

Front 253

Please give the sympathetic and parasympathetic spinal reflex levels for:

Prostate

Back 253

Symp: L1-2

Para: S2-4

Front 254

What sympathetic level is the Adrenal Medulla at?

Appendix?

Back 254

Medulla: T10

Appendix: T12

Front 255

What is the parasympathetic innervation of the GI system

Back 255

entire small intestine: vagus

Proximal large intestine (ascending and transverse)= Vagus

Distal half= descending and recto-sigmoid= Pelvic Splanchnic

Front 256

What are the sympathetic innervations of the upper extremities?

Back 256

T2-T8

Front 257

in the GI, what is the sympathetic innervation after the splenic flexure?

Back 257

T12-L2

Front 258

What is the purpose of Rib raising?

Back 258

Normalize (decrease) sympathetic activity and improve lymphatic return as well as encourage maximum inhalation

will help thin mucous secretions
reduce post surgical ileus

Front 259

What is the purpose of soft tissue paraspinal inhibition ? use?

Back 259

normalize (decrease) sympathetic activty

ileus prevention (has same effect as rib raising)

Front 260

purpose of celiac ganglion, superior mesenteric, inferior mesenteric release?

Back 260

normalize (decrease) sympathetic activity

Front 261

how do you tx Chapman's points? Purpose?

Back 261

Soft circular manipulation over the point itself

decrease sympathetic tone to associated visceral tissues

Front 262

Person has thick nasal secretions...what is a potential treatment targeted at parasympathetics?

Back 262

Sphenopalatine ganglion technique

manual finger pressure intraorally
leads to thin watery secretions

Front 263

TRIGGER POINT:

A newborn is having difficulties suckling, what treatment could you do to help this? what was the cause

Back 263

the kid may have condylar compression

tx with Condylar decompression!

Front 264

If you want to treat parasympathetics for autonomic issues, where are you going to target your tx?

Back 264

at the OA, AA, C2

Front 265

Sympathetic innervation to gonads?

Back 265

T9-10

Front 266

Draw out the Foundations autonomic chart

Back 266

Front 267

smooth, firm, discretely palpable nodules, approximately 2-3mm in diameter, located within the deep fascia or on the periosteum of a bone. This describes?

Back 267

a Chapman's Point

Front 268

Gentle pressure here will elicit a sharp nonradiating and exquisitely distressing pain

Back 268

a chapman point

Front 269

do chapman's points show somato-visceral or viscero-somatic reflexes?

Back 269

Viscero-somatic

they are a somatic manifestation of a VISCERAL DYSFUNCTION

Front 270

Where is the chapman point for the Appendix?

Back 270

Anteriorly: tip of the right 12th rib

Posterior: transverse process of T11

Front 271

Where is the chapman point for the Adrenals?

Back 271

ant: 2" superior and 1" lateral to the umbilicus

posterior: between the spinous and transverse processes of T11 and L1

Front 272

Where is the chapman's point for the kidneys?

Back 272

Ant: 1" superior and 1" lateral to umbilicus

Post: btw the spinous and transverse processes of T12 and L1

Front 273

Where is the Chapman's reflex point for the bladder?

Back 273

Periumbilical region

Front 274

Where are the chapman's points for the colon?

Back 274

lateral thigh, within the IT band from greater trochanter to just above the knee

Front 275

Where is the Chapman point for the middle Ear?

Back 275

ant: superior to medial clavical

post: C1 post rami

Front 276

Where is the Chapman point for the sinuses

Back 276

ant: inferior to medial clavicles

post: C2 articular pilars

Front 277

Where is the Chapman point for the ovaries?

Back 277

ant: pubic tubercles

post: T10 transverse process

Front 278

Where is the Chapman point for the urethra?

Back 278

ant: pubic tubercles

post: L3 transverse process

Front 279

Where are the Chapman's points for the prostate?

Back 279

ant: lateral IT bands

post: PSIS

Front 280

Where is the Chapman's point for the Gall Bladder?

Back 280

ant: Right medial 6th intercostal space

post: Right T6 transverse process

Front 281

This is a hypersensitive focus usually within a taut band of skeletal muscle or in the muscle facia. It is painful upon compression and can give rise to a characteristic referred pain tenderness and autonomic phenomena

Back 281

Trigger Point

Front 282

Tx for trigger points?

Back 282

Spray and stretch
Injection with local anesthetic
ME
MFR

Front 283

TRIGGER POINT:

Which may refer pain when pressed, a trigger point or a tenderpoint?

Back 283

Trigger points may refer pain when pressed

Tenderpoints DO NOT refer pain when pressed

Front 284

direct and indirect MFR are done via moving towards a barrier or away. But additionally, compression or traction can be done. Which of the above applies to direct and indirect respectively?

Back 284

Traction: Direct

Compression: indirect

Front 285

TRIGGER POINT:

list the 5 steps of MFR

Back 285

1. palpate restriction
2. Apply compression (indirect) or traction (direct)
3. Add twisting or transverse forces
4. Use enhancers
5. Await release

Front 286

restoring functional baland and improving lymphatic flow are the goals of what tx?

Back 286

MFR

Front 287

Where are the 4 compensatory curve locations?

Back 287

OA
Cervicothoracic junction
thoracolumbar junction
Lumbosacral junction

80% have OA rotated left, CT right, TL left, and LS right

Front 288

what is the Common compensatory pattern of fascia?

Back 288

80% have OA rotated left,
CT right,
TL left, and
LS right

Front 289

When performing indirect MFR what barrier is engaged?

Back 289

anatomic

Front 290

What lymphatic tx is particularly useful for pediatric pts?

Back 290

pedal pump

improves total body lymphatic movement

Front 291

when treating a pt for lymphatic problems, what do you tx first?

Back 291

Thoracic inlet

unless contraindicated (rib fracture)

Front 292

what is the goal of rib raising?

Back 292

to normalize hypersympahtetic activity

Front 293

osseous fractures
bacterial infections with temp greater than 102
abcess
carcinoma

are all realtive contraindications to what type of tx?

Back 293

Lymphatic

Front 294

the right extremity and right hemicranium and what 2 other organs drain to the right minor lymphatic duct? (everything else drains to the left)

Back 294

heart and lungs (minus upper left lobe)

Front 295

restriction in sibson's fascia can produce edema where?

Back 295

entire body

this is the thoracic inlet

Front 296

what is attributed to Alpha-Gamma regulation:
trigger point or tenderpiont?

Back 296

tenderpoint

found at origin, insertion, or belly of striated muscle

Front 297

where are most maverick points located? how do you tx them

Back 297

Cervical region

position opposite of what is used typically

Front 298

why do you hold a counterstrain point for 90 seconds?

Back 298

this is the time required for the proprioceptive firing to decrease in frequency and amplitutde

Front 299

for an anterior cervical tenderpoint how do you position the pts head?

Back 299

side bend and rotate AWAY from the side of the tp

Front 300

for cervical and thoracic tenderpoints how do you sidebend and roate?

Do you flex or extend when treating an anterior tp? posterior?

Back 300

Rotate and sidebend away

for anterior flex
posterior extend

Front 301

on the ribs, anterior tenderpoints are associated with depressed or elevated ribs? posterior?

how long do you hold?

Back 301

anterior: depressed ribs
posterior: elevated ribs

120s

Front 302

TRIGGER POINT:

where is the anterior tenderpoint for L5 located?

Back 302

one cm lateral to the pubic symphysus on the superior ramus

Front 303

where is the iliacus TP?

Back 303

7cm medial to the ASIS

Front 304

what type of contraction is done in ME? when this occurs, what senses the change in tension and gives a reflex relaxation?

Back 304

Isometric contraction (distance btw origin and insertion stays the same)

Golgi tendon organs

Front 305

Post surgical pts and intensive care pts should not undergo this active technique

Back 305

ME

Front 306

how do you diagnose the OA

Back 306

triplanar

rotation and sidebending occur in different directions

Front 307

What is the key rib in an inhalation dysfunction?

if you are treating ribs 1-5, what kind of rib is this? do you flex or sidebend?

Back 307

Lowest in the group

1-5: pump handle--flex

6-10: bucket handle--sidebend

Front 308

given the following ribs, match the muscle that corresponds with their inhalation dysfunction:

Rib 1
Rib 2
Ribs 3-5
Ribs 6-9
Ribs 10-11
Rib 12

Match With:
Quadratus lumborum
Posterior scalene
Serratus anterior
Latissimus Dorsi
pectoralis minor
Anterior and middle scalene

Back 308

Rib 1: Anterior & Middle scalene
Rib 2: Posterior Scalene
Ribs 3-5: Pectoralis Minor
Ribs 6-9: Serratus anterios
Ribs 10-11: Latissimus Dorsi
Rib 12: Qudratus Lumborum

Front 309

Osteoprosis
Osteomyelitis
Fractures
Bone metastisis

are all what for what tx?

what are 2 more (one is a autoimmune dz, another is a genetic problem)? reason?

Back 309

ABSOLUTE contraindications of HVLA

Rheumatoid arthritis (transverse ligament of the dens is weak and cervical manipulation can lead to AO sublux and neuro damage)

Downs Syndrome (same as above)

Front 310

Acute whiplash
Pregnancy
Post-surgical
Herniated nucleus propulsus
anticoagulant therapy
vertebral artery ischemia

Are all what for what tx?

Back 310

Relative contraindications

HVLA

Front 311

When treating a flexed lesion with the Kirksville Krunch, what segment do you treat? What direction is the thrust aimed at?

What about for an extended segment

Back 311

Flexed: treat the dysfunctional vertebrae; thrust aimed at floor

Extended: vertebrae below, thrust aimed 45 degrees cephalad

Front 312

articulatory techniuqes use what kind of motion

Back 312

springing

good for elderly and post op pts

rib raising is an example of articulatory

Front 313

this technique is good for pts with inactivity or adhesive capsulitis following an injury

Back 313

Spencer Technique

Front 314

What is the spurling test?

Back 314

extend and sidebend C-spine to side being tested and push down

test is positive if pain radiates into ipsilateral arm

normally due to narrowing of the neural foramina

Front 315

What is the Wallenberg test?

Back 315

test vertebral artery insufficiency

rotate/side bend neck to each side

positive test results when pt is dizzy or visual change, etc

shows problem on other side

Front 316

What is Adson's Test

Back 316

test for thoracic outlet syndrome

arm extended at elbow, shoulder is extended, externally rotated and slightly abducted. Pt bends head toward ipsilateral arm

test is positive with a severely decreased or absent radial pulse

due to tight scalene muscles

Front 317

What is the Wright Test?

Back 317

neurovascular bundle test

as it passes under the pectoralis minor muscle at the coracoid process

hyperabduct the arm above the head with extension

Front 318

What is the costoclavicular syndrome test? (military posture test)

Back 318

checks compression of the neurovascular bundle btw the clavicle and 1st rib

palapate radial pulse while depressing and extending the shoulder

Front 319

What does the Apley scratch test show

Back 319

ROM of the shoulder

Front 320

Drop arm test shows what

Back 320

tear of the rotator cuff

have pt slowly lower the arm

positive test if the pt cannot lower smoothly

Front 321

What is the Speed's Test?

Back 321

tests biceps tendon in bicipital groove for pain

have pt flex against resistance

Front 322

What is the Yergason's Test?

Back 322

determines the STABILITY (vs pain in the Speed's test) of the biceps tendon in the bicipital groove

have pt flex while you pull down on the elbow and externally rotate

pain due to biceps tendon popping out of the groove

Front 323

What is the Allen's test?

Back 323

tests blood supply to hand

occulde ulnar and radial arteries at wrist

let go of one and see if blood goes into hand. repeat w/ other artery

Front 324

What is the Finkelstein test?

Back 324

test for tenosynovitis in the abductor pollicis longus and extensor pollicis brevis tendons at the wrist (De Quervain's dz)

tuck thumb into fist, ulnar deviate, look for pain

Front 325

Phalens test?

Back 325

test for carpal tunnel

flex wrists, look for tingling

Front 326

Tinnel test

Back 326

tap over the volar aspect of the pts transverse carpal ligament

postive test cuases tingling or paresthesia into thumb index, middle and lat half of ring finger

Front 327

TRIGGERPOINT:

What is the purpose of the hip drop test?

How is it done? What is the important degree change you must see for a positive test?

Back 327

elvauates side bending of the lumbar spine

have pt bend one knee without lifting the heel from the floor. Normall the spine should sidebend toward the side contralateral to the bending knee producing a convexity on the ipsilateral side

the ipsilateral crest should drop 20-25 degrees

positive test is indicated by anything less than a smooth convexity in the lumbar spine or a drop of the iliac crest less than 20-25 degrees

Front 328

What is the straight leg test? How can you distinguish the 2 things it shows

Back 328

pt lies down. lift leg to 70 degrees

if pain, it is either hamstring tighness or sciatic n.

dorsiflex the foot (Braggards test)-->if painful then it is sciatic

Front 329

What do the Seated flexion test and standing flexion test show respectively?

COMBANK has a hard on for this

Back 329

seated: sacroiliac

standing: iliosacral

Front 330

What is the pelvic side shift test? what is it often seen in?

Back 330

determines if the sacrum is midline

test is positive on the side of freer translation, this indicates the pelivis is shifted to that side

often seen in a flexion contracture of the iliopsoas (psoas syndrome)

Front 331

What is the Trendelenberg test?

Back 331

assesses the gluteus medius muscle strength

pt picks one leg off the floor. normally you should have a even pelvis supported by the glut med.

positive test occurs when the pelvis falls, which indicates weakness in the glueus medius muscle

positive right trendelenberg indicates left gluteus medius weakness

Front 332

TRIGGER POINT:

The lumbosacral spring test will be (positive/negative) in all the dysfunctions in which the sacral base moves posterior

Back 332

POSITIVE

Front 333

What is the Ober's test?

Back 333

detects tight tensor fascia lata and IT band

pt lies on side opposite that being tested.

Flex knee to 90, abduct the hip as far as possible. Slightly extend the hip while stabilizing the pelivs to keep from rolling

Test is positive if the thigh remains abducted as the physician allows the leg to fall to the table

Front 334

What is the Patrick's Test (FABERE)

Back 334

tests pathology of SI and hip joint (especially osteoarthritis of the hip)

FABERE=Flexion Abdution External Roation Extension

so a figure four position (indian style but with 1 leg)

any pain shows pathology of that hip joint

Front 335

What is the Thomas test?

Back 335

tests a flexion contracture of the hip (iliopsoas)

pt lies down on back, flex hip so knee hits abdomen

if other leg lifts off table-->positive test and contracutre of the iliopsoas

Front 336

difference btw anterior draw test and Lachmans?

Back 336

ant: 45 degrees flexion

lach: 30 degrees and more accurate

both test ACL

Front 337

What is the Bounce Home test?

Back 337

evaluates problems with full knee extension looking for meniscal tears or joint effusions

pt supine, grab heel and flex it, drop it and let it go to extension

knee should "bounce home" into full extention

positive test if it doesn't

Front 338

What is the Apley Compression ad Distraction test?

Back 338

Compression: Maniscus tear
-press down, and internal/external rotate-->pain=positive test

Distraction: MCL/LCL test
-pull up, internal/external roate the tibia->pain=positive

Front 339

What is McMurray's Test?

Back 339

detects tears in the posterior aspect of menisci

flex knee, external rotate to valgus position, extend knee. If click= positive test=tear of posterior medial meniscus

same is done with varus stress for lateral

Front 340

you push the knee medial, what test is this?

Back 340

lateral force is the valgus stress test

if gapping occurs you have MCL tear

Front 341

you push the knee laterally, what are you testing for

Back 341

LCL tear

varus stress testing

Front 342

the trendelenberg test will assess which of the following muscle groups:

hip extensors
flexors
aBductors
aDductors
external rotators

Back 342

aBductors

remember this tests the gluteus medius muscle

Front 343

describe how you would position a patient for ME to treat an anterior and posterior innominate rotation

supine/prone
flex leg or extend

etc

Back 343

ANTERIOR: with patient supine, flex patient's right knee and hip, ask patient to push against you for 3-5 seconds, re-engage the barrier; repeat 3-5 times

POSTERIOR: with patient supine, extend patient's right leg and innominate off the table, ask patient to push leg anteriorly for 3-5 seconds, re-engage the barrier; repeat 3-5 times

Front 344

Click to toggle an attachment list
A young mother brings in her 2 week old infant concerned that the baby still has not “gotten the hang of feeding” You evaluate the infant and discover that she has a very poor suck reflex. To correct the identified dysfunction you first perform:
( A ) CV4 technique Cross/Uncross out this answer

( B ) Condylar decompression Cross/Uncross out this answer

( C ) Balancing of the temporals Cross/Uncross out this answer

( D ) SBS decompression Cross/Uncross out this answer

( E ) Correction of the sphenoid strain pattern Cross/Uncross out this answer

Back 344

( B ) Condylar decompression

When the XIIth cranial nerve is compressed and causing poor sucking in an infant condylar decompression should be performed. Compression of the 4th ventricle (CV4) technique has value to stimulate the newborn, but this infant has a clear cut problem which should be corrected before moving on to other techniques. Balancing of the temporals would help with nerve dysfunction of the cranial nerves that have some association with the temporal bones which are CNIII through XI. This child has no indication of having an SBS compression and therefore the necessity of decompression is unlikely. Correction of the sphenoid strain pattern should help with nerve dysfunction of related nerves which includes: CNI-CNVIII.