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131 Cards in this Set
- Front
- Back
The ligament that extends from the sides of the dens to lateral margins of foramen magnum |
Alar
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resolve _____ dysfunction before treating Chapman’s Reflex points
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pelvic
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Attaches the atlas to the lateral masses of C1 to hold the dens in place
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Transverse
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What does TART stand for?
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Tissue Texture Changes
Assymmetry Restriction Tenderness |
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Name tow diseases that weaken the AA ligaments and cause subluxation
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RA
Down's syndrome |
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The “gangliaform contractions” represent ______ _____ reflexes.
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Neurolymphatic Viscerosomatic
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The articulation of the superior uncinate process and the superadjacent vertebrae is
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Joints of Lushka
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What is an anatomic barrier?
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a point in which a Dr can passively move any given joint; any movement beyond this barrier will cause ligament, tendon, or skeletal injury
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_________ are superior lateral projections originating from the posterior lateral rim of the vertebral bodies of C3-C7
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Uncinate Processes
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In current clinical practice, Chapman’s points are used more for diagnosis than for ______.
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treatment
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These joints play an important role in cervical sidebending
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Joints of Lushka
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What is a restrictive (pathological) barrier?
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This barrier lies before the physiological barrier and prevents full range of motion of that joint
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Degeneration or hypertrophy changes in the Joints of Luschka can lead to
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foraminal stenosis and nerve root compression
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Describe the tissue findings in acute somatic dysfunction
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edematous, erthymatous, boggy with increased moisture; muscles are hypertonic
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The most common cause of cervical nerve root pressure is degeneration of _______ plus _______
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Joints of Luschka plus hypertrophic arthritis
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Chapman’s Points are found deep in the subcutaneous tissues, lying on the deep muscular fascia or __________.
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periosteum
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Describe the tissue changes in chronic somatic dysfunction
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decreased or no edema, no erythema, cool dry skin, with slight tension; decreased muscle tone, flaccid, ropy, fibrotic
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Contrast the assymmetry, restriction, and tenderness changes in acute vs/ chronic somatic dysfunction
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Acute: assymmetry is present, restriction is present and there is pain with movement; severe/sharp
Chronic: assymmetry is present with compensation in other areas of the body; there is restriction with decreased or no pain; dull, achy, burning |
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Describe the nodules of Champman's points
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Small
Smooth Firm Discretely Palpable or Grouped in Irregular Patches Approximately 2 to 3 mm in diameter when found alone |
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If AA is rotated right that means that ____ is rotated on _____
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C1 is rotated right on C2
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What is Fryette Law 1?
Fryette law 2? |
Neutral position, sidebending and rotation occur in opposite directions
(One=Opposite) Non-neutral, flexed or extended, rotation and sidebending occur in the same directions (Two=Together) |
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What is the orientation for the superior facets for the cervical, thoracic, and lumbar regions?
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Cervical: backward, upward, medial (BUM)
Thoracic: backward, upward, lateral (BUL) Lumbar: backward, medial (BM) |
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What is the main motion of the OA segment?
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flexion and extension; SB and rotation occur to opposite sides
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For OA motion testing, a right deep sulcus indicates
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left sidebending, which indicates right rotation
B/C sidebending and rotation are opposite in OA |
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What is the main motion of the AA segment?
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Rotation, with SB to the opposite side
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In OA translation motion testing, right translation will =
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Force is from left to right= Left sidebending ie Karate chop
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What is the main motion of C2-C4?
C5 - C7 |
Roation, with SB to the same side
Sidebending, with rotation to the same side |
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What is the main motion of the thoracic spine?
Lumbar spine? |
ROTATION
Flexion and Extension |
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C2-C7 translation motion testing is similar to occiput except that you place your fingers on
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Lateral border of articular pillar
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What is the Rule of 3's mean?
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A useful way to refer to ID the transverse processes of the thoracic vertebra
T1-T3: SP is located at the same level as the TP T4-T6: SP are located 1/2 segment below the TP T7-T9: SP are one segment below the TP T10-SP is one segment below T11-SP is 1/2 segment below T12-SP is even with TP |
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C2-C7 rotational motion testing, you place your fingers over _________. Then rotate the head left and right checking for
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Posterior surface of the articular pillars
Freedom of Resistance |
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Which ribs are considered "atypical" ribs?
True ribs? Floating rib? False Fib |
rib 1, 2, 11, 12 (sometimes 10); REMEBER: atypical ribs have #1 and #2 in them
Ribs 1-7; attach to the sternum through costal cartilages Ribs 8-10; do not attach directly to the sternum; attach via costal cartilage to the cartilage of the superior rib Ribs 11-12; remain unattached anteriorly |
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An acute injury to the cervical spine is best treated with
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Indirect Fascial Treatment or
Counter Strain |
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What are the 3 classifications of rib movement?
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1. Pump handle: upper ribs 1-5
2. Bucket handle: middle ribs 6-10 3. Caliper motion: Ribs 11-12 |
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Where is the location of pain in cervical foraminal stenosis?
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Pain radiates into the upper extremity
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What is an Inhalation rib dysfunction mean?
Exhalation rib dysfunction? |
The dysfunctional rib will move cephalad during inhation, but will not move caudad during exhalation; rib appears to be "held up"
The dysfunctional rib movs caudad during exhalation, but does not move cephalad during inhalation; rib appears to be "held down" |
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What is the quality of pain for Foraminal stenosis?
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Dull ache, shooting pain or paresthsias
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Pain on Palpation of Chapman's points
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Pinpoint
Located Under the Palpating Finger Non-radiating Sharp Exquisitely Distressing |
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What are the signs and symptoms of Cervical Stenosis?
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Positive Spurling's Test=Increased neck pain with Extension
Paraspinal muscle spasm Tenderpoints |
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What is the "key" rib in an inhalation vs. exhalation dysfunction?
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Inhalation: key rib is the lowest rib of the dysfunction
Exhalation: key rib is the uppermost rib of the dysfunction |
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What is the radiologically finding for cervical foraminal stenosis? AP view?
Oblique? |
Osteophytes formation on AP and Lateral views
Oblique view shows narrowing of intervertebral foramina |
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Name the muscles included in the Erector Spinae group:
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"SILO"
Spinalis, Iliocostalis, LOngissimus |
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What OMT treatment should be used for Cervical Foraminal Stenosis?
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ME
FPR, Myofascial release, counterstrain |
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What does Spina bifida mean?
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a developmental anomaly where there is a defect in the closure of the lamina of the vertebral segment; usually occurs in the lumbar spine
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What are the 3 types of spina bifida?
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1. Spina bifida occulta: no herniation thru the defect; patch of hair over site; rarely has neuro deficits
2. Spina bifida meningocele: herniation of meninges thru the defect 3. Spina bifida menigmyelocele: herniation of meninges and nerve roots thru the defect; neuro deficits |
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What is a flexion contracture of the iliopsoas associated with?
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associated with a non-neutral dysfunction of L1 and L2
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What does Spondylosis refer to?
Spondylolysis? spondylolisthesis? |
A radiographic term for degenerative changes within the intervertbral disc and ankylosing of adjacent vertebral bodies
A defect in the pars interarticularis without anterior displacement of the vertebral body; oblique radiographic views show it as a "collar" on a scotty dog anterior displacement of one vertebra in relation to the one below it; often occurs at L4-L5 |
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How do you name the curves for scoliosis, if it sidebends left vs. if is sidebends to the right?
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Curve that is SB to left with scoliosis to the right= Dextroscoliosis
Curve that is SB to the right with scoliosis to the left= Levoscoliosis |
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What is significant about the sacrospinous ligament?
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It divides the greater and lesser sciatic foramen
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What are the four types of sacral motion?
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"DRIP"
1. Dynamic: motion that occurs during ambulation 2. Respiratory: motion occurs about the superior transverse axis of the sacrum 3. Inherent: same as respiratory; during craniosacral extension the sacrum nutates ("nods forward) and during flexion the sacrum rotates posteriorly ("counter-nutates) 4. Postural: motion occurs about the middel transverse axis of the sacrum |
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What are the rules of L5 on the sacrum?
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1. if L5 is SB, a sacral oblique axis is engaged on the same side as the SB
2. if L5 is rotated, the sacrum rotates opposite on an oblique axis 3. seated flexion tests is found on the opposite side of the oblique axis |
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What is a common dysfuntion in the post partum patient due to birth mechanics?
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bilateral sacral flexion
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How long do you manipulate a Chapman's reflex point?
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Continue this for 10 to 30 seconds
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The sternal angle attaches _____ rib and is at level _____
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Rib 2 and Level T4
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What are the rotator cuff muscles?
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"SITS"
Supraspinatus Infraspinatus Teres minor Subscapularis |
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How do you remember the brachial plexus?
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Roots exit spinal cord to form
Trunks which form Divisions which form Cords which form Branches |
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The motions of the thoracic spine in order
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Rotation> Sidebending> Flexion and Extension
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What is the most common type of brachial plexus injury?
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Erb- Duchenne Palsy: Upper arm paralysis caused by injury to C5 and C6 nerve roots usually during childbirth ("waiter's tip")
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Name the Carpal bones, starting with the proximal row on the radial side:
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Scaphoid, Lunate, Triquetral, Pisiform, Trapezium, Trapezoid, Capitate, Hamate
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What attaches to the Distal Interphalangeal joints (DIP)?
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Deep Finger Flexors (flexor digitorum profundus)
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Describe the movment of the ulna and wrist if the carrying angle is increased? decreased?
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Increased: ulna is ABducted, wrist ADduction
Decreased: Ulna is ADDucted and wrist is ABducted |
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What are the 3 movement components of Pronation of the ankle?
Supination of the ankle? |
dorsiflexion, eversion, abduction
plantarflexion, inversion, adduction |
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What makes up O'Donahue's Triad? (terrible triad)
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injury to ACL, MCL, and medial meniscus
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In what position is the ankle most stable?
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Dorsiflexion
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NAme the landmarks of a typical rib
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Tubercle
HEad Neck Angle Shaft |
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What is the most commonly injured ligament in the foot?
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Anterior TaloFibular ligament
("Always Tears First") |
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What are the components (5) of the Primary Respiratory Mechanism (PRM)?
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CNS, CSF, Dural membranes, Cranial bones, Sacrum
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The dura projects caudally down the spinal canal and has firm attachments to what 4 things?
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Foramen Magnum, C2, C3, S2
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What are the four components constituting a Craniosacral Flexion?
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1. Flexion of Midline bones
2. Sacral Base Posterior 3. Decreased AP diameter of cranium 4. Ext Rotation of paired bones |
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What are the four components constituting Craniosacral extension?
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1. extension of midline bones
2. sacral base is anterior 3. increased AP diameter of the cranium 4. Int Rotation of paired bones |
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What does a compression strain of the SBS result in?
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A severely decreased C.R.I and is usually due to trauma, especially to the back of the head
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Vagal Somatic dysfunction can be due to what?
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Due to OA, AA, and/or C2 dysfunction
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CV4: Bulb decompression will do what to the C.R.I?
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It will increase it
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SNS: organ and corresponding nerve levels
1. Head and neck 2. Heart 3. Resp system |
1. T1-T4
2. T1-T5 3. T2-T7 |
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SNS: organ and corresponding nerve levels
1. Esophagus 2. Upper GI tract (stomach, liver, gallbladder, spleen, parts of pancreas and duodenum) |
1. T2-T8
2. T5-T9 |
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SNS: Organs and corresponding nerve levels:
1. Middle GI tract (portons of pancreas/duodenum, jejunum, ileum, ascending colon, prox 2/3 of transverse colon) 2. Lower GI tract (distal 1/3 of transverse colon, descending, sigmoid colon, rectum) |
1. T10-T11
2. T12-L2 |
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Condylar Compression causes what in newborns?
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suckling difficulties
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What refers pain when pressed-Trigger points or tender points?
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Trigger points refer pain when pressed, not tender points
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Where is the tenderpoint for L5 located?
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Located 1cm lateral to the pubic symphysis on the superior ramus
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What is a memory tool to help you remember the patient position for forward and backward sacral torsions?
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Forward torsions= patient lies Face down
Backward torsions= patient lies on their back |
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Anterior narrowing of intercostal space above dysfunctional rib
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Inhalation
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What are the absolute contraindications for HVLA?
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Osteoporosis, Osteomyelitis (including Potts Dz), fractures in area of thrust, Bone mets, Severe RA, Downs syndrome
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Superior edge of posterior rib is prominent
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Inhalation dys
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What are the relative contraindications for HVLA?
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Acute whiplash, Preggers, Post-Surgical conditions, herniated nucleus pulposus, pts on anti-coag therapy or hemophiliacs, vertebral artery ischemia
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Chapman point: Stomach acid point
stomach peristalsis point liver point liver, GB point |
left 5th rib space
left 6th rib space right 5th rib space right 6th rib space |
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Motion of occipital condyles on atlas C1
C1 on C2 |
OA
AA |
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Erector spinae group acronym
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I Like Spagetti
Ilocostalis Longisssimus Spinalis |
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What are the typical ribs
Atypical ribs |
3-10
1,2,11,12 sometimes 10 |
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Why is Rib 1 atypical?
Rib 2? Ribs 11 and 12? |
Articulates only with T1 and no angle
A large tuberosity on the shaft for serratus anterior Articulate only with vertebrae and lack tubercles |
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What are the true ribs?
False ribs? Floating ribs? |
Ribs 1-7, attach to the sternum
Ribs 8-12, do not attach directly to sternum Ribs 11, 12 |
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Anterior narrowing of intercostal space above dysfunctional rib
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Inhalation
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The intervertebral disc level at the level of iliac crest
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L4-L5
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T10 dermatome at umbilicus which is anterior to ________disc
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L3 and L4
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A bony deformity where one or both of the transverse processes of L5 articulate with sacrum
Failure of fusion of S1 with other sacral |
Sacralization
Lumbarization |
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A developmental anomaly with a defect in the closure of lamina of vertebral segment
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Spina Bifida
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Herniation of the meninges and the nerve thru the defect. Assoc. w/ neurological deficits.
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Spina bifida meningomyelocele
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What is the alignment of the facets the major motion of the lumbar spine is F/E
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Backward and medial for the superior
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The lumbosacral angle is formed by the intersection of
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Horizontal line
Line of inclination of the sacrum |
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Due to narrowing of the ________ postriolateral herniation of intervertebral disc a common problem
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longitudinal ligament
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Psoas syndrome organic causes
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1. Appendicitis
2. Sigmoid colon dysfunction 3. Ureteral calculi 4. Ureter dysfunction 5. Metastatic carcinoma of the prostate 6. Salpingitis |
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Increased pain when standing or walking, + Thomas test, tenderpoint medial to ASIS, nonneutral L1 or L2, + pelvic shift test to the contralateral
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Psoas Syndrome
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A flexion contracture of iliopsoas is often associated with a
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Nonneutral dysfunction L1 or L2
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A defect of pars interarticularis w/o anterior displacement of the vertebral body. And what would it look like with a oblique x-ray?
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Spondylolysis
Scotty dog with a collar |
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what does a Spondylolisthesis look like on x-ray? What is the most often site for it? What causes it? How do you grade it?
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Anterior displacement of one vertebrae in relation to the one below
L4/L5 Fatigue fractures in pars interarticularis Grade 1= 0-25% Grade 2= 25-50 Grade 3= 50-75 Grade 4 = >75 |
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What is the Tx for Spondylolisthesis?
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Reduce lumbar lordosis
No HVLA |
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Curve that is sidebent left = ____scoliosis
Curve that is sidebent right = ____scoliosis |
Right scoliosis=dextroscoliosis
Left scoliosis= levoscoliosis |
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Cobb angle
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X-ray films:
1. draw horizontal lines from the vertebrae involved 2. Draw perpendicular lines from these horizontal line and measure the acute angle |
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Mild scoliosis, moderate, and severe =
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5-15
20 - 45 >50 |
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Respiratory function is compromised if scoliosis curve is greater than
CV function is compromised if thoracic curve is greater |
50
75 |
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Most common cause of scoliosis
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Idiopathic
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Konstancin exercises
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Tx for Mild Scoliosis
A series of exercise that improve scoliotic curve |
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Tx for Moderate Scoliosis
Severe? |
OMT, Konstancin, and PT + spinal orthotic
Surgery |
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Most common cause of short leg syndrome?
A short keg syndrome results in |
Hip replacement
Sacral base unleveling Vertebral sidebending and rotation Innominate rotation |
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What is the Tx for short leg syndrome?
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OMT directed toward the spine and lower extremity, if leg length still exist get a standing X-ray and consider a heel lift if femoral head diff is >5mm
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Shoulder muscle: Abduction of Arm
External rotation Internal rotation |
Supraspinatus
Infraspinatus Teres Minor Subscapularis |
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Primary flexor of shoulder/arm
Abductor Extensors adductors External rotaters |
Deltoid( Anterior Portion)
Deltoid middle portion Latissimus dorsi, Teres Major, Deltoid Pectoralis major, latissimus Dorsi Infraspinatus, Teres Minor |
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Most common dys of SC joint
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Clavicle, anterior and superior on sternum
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What three ligs. stabilize the AC joint?
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AC ligament
Coracoacromial lig Coracoclavicular lig |
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The most common somatic dys at the AC joint
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Clavicle, superior and lateral on the acromion
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Compression can occur at what three places in TOS?
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1. Tween anterior and middle scalenes
2. Tween clavicle and first rib 3. Tween pectoralis minor and upper ribs |
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______ ligament divides the greater and lesser sciatic foramen
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Sacrospinous ligament
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Umbilicus landmark is
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L3-L4
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What are the common weakened muscles in TOS?
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Serratus Anterior
Middle Trapezius/Rhomboids Lower Trap |
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Decreased ROM that consistently gets worse over one year.
Extension is preserved |
Frozen shoulder
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Internal rotation and adduction limited with
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Tight Anterior CApsule: Apply's Scratch Test
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Tendetpoint lies along the superior angle of the scapula
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Levator scapula
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Group of muscles associated with type II mechanincs
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Rotatores
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Direct HVLA for Abduction Lesion
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Apply traction and carry wrist into ABDUCTION
Apply HVLA in ADDUCTION |
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Anterior Cervical Fasica:Engage the scalenes with
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Medial and Inferior Pressure
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Teres Minor technique Tx
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Contact the Teres Minor and carry it superiorly, medially, and slightly anteriorly
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Coracobrachialis Tx Anterior technique
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Engage anterior shoulder and direct posterior and slightly medial
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