Opp: Test 2 : Garlitz : Review

Front 1

write the 4 principles of Osteopathic Philosophy

look for 4 blank lines...

Back 1

The body is a unit; the person is a unit of body, mind, and spirit
The body is capable of self-regulation, self-healing, and health maintenance
Structure and function are reciprocally interdependent
Rational treatment is based upon an understanding of the basic principles of body unity, self-regulation, and the interrelationship of structure and function

Front 2

define somatic dysfunction

Back 2

the impaired or altered function of related components of the somatic (body framework) system

Front 3

define Osteopathic manipulative treatment (OMT)

Back 3

the therapeutic application of manually guided forces by an osteopathic physician to improve physiologic function and/or support homeostasis that has been altered by somatic dysfunction

Front 4

define Facilitation:

Back 4

the maintenance of a pool of neurons in a state of partial or sub threshold excitation ; in this state, less afferent stimulation is required to trigger the discharge of impulses

Front 5

what is TART

Back 5

Tissue texture abnormalities
Asymmetry
Restriction of motion
Tenderness

Front 6

what are the 3 motion barriers? define them..

Back 6

Anatomic: the limit of motion imposed by anatomic structure; the limit of passive motion
Physiologic : the limit of active motion
Direct: may also see it called the restrictive barrier; a functional limit that abnormally diminishes the normal physiologic range

Front 7

define how you would perform counterstrain

Back 7

Find and label tender point 10/10
Position to relieve tenderness (2/10 or less)
Fine-tune to 0/10 if possible
Hold position for 90 seconds (some schools teach 120 seconds for the ribs)
Slow passive return to neutral
Retest tender point

Front 8

define how you would apply MFR

Back 8

Diagnose restricted motion
Slowly move into position of laxity and follow release until completed (indirect)
Slowly move into restriction and stretch until tissue give completed (direct)
Retest motion

Front 9

what is unique in ME?

Back 9

requires pt activity

Diagnose restriction
Move into restrictive barrier
Isometric contraction 3-5 seconds
Stretch until give stops
Repeat 3-5 times
Retest motion

Front 10

define traction, kneading, inhibition, effleurage, and petrissage

Back 10

Traction – longitudinal muscle stretch
Kneading – lateral muscle pressure
Inhibition – sustained muscle pressure
Effleurage – stroking pressure to move fluid
Petrissage – squeezing pressure to move fluid

Front 11

give the acute vicerosomatic findings for

temp
tissue texture
red reflex

Back 11

hot

Moisture, fullness, edema, tension

Increased or prolonged redness

Front 12

give the chronic vicerosomatic findings for

temp
tissue texture
red reflex

Back 12

cool

thickness, dryness, ropiness, pimples

prolonged blanching

Front 13

write out the autonomic chart

Back 13

Front 14

where is the chapmans point for the appendix

Back 14

tip of the 12th rib

Front 15

what is the difference btw a chapman's point, counterstrain, and triggerpoint

Back 15

Chapman’s point: viscerosomatic reflex
Conterstrain point: locally tender
Trigger point: referred pattern of pain, motor dysfunction, autonomic phenomenon

Front 16

what are the rotatorcuff muscles?

WHEELHOUSE!

Back 16

supraspinatus, infraspinatus, teres minor, subscapularis

Front 17

movements of scapula

Back 17

Front 18

The ulnohumeral joint moves in what direction with flexion/extension?

what will this do to the carrying angle

Back 18

The ulnohumeral joint passively adducts with flexion and passively abducts with extension
This cause the hand to deviate to the mouth during flexion
It is also responsible for the carrying angle

Front 19

describe ulnar abduction

Back 19

Restricted adduction (lateral glide)
Patient may present with pain or restriction at endpoint of flexion
Increases the carrying angle

Front 20

describe Ulnar Adduction

Back 20

Restricted abduction (medial glide)
Patient may present with pain or restriction at endpoint of extension
Decreases the carrying angle

Front 21

With a posterior radial head somatic dysfunction: (give ease and restriction)

how does this normally occur

Back 21

Ease of motion is posterior glide
Restricted motion is anterior glide with supination

A posterior radial head somatic dysfunction is often caused by a fall forward onto an outstretched hand

Front 22

Common elbow and wrist problems

Back 22

Carpal tunnel syndrome
Thoracic outlet syndrome
Double crush syndrome

Front 23

what are thoracic outlet syndrome, carpal tunnel, and double crush syndrome

Back 23

Thoracic Outlet Syndrome
Pain and/or paresthesia in the upper extremity from brachial plexus compression
Neural compression is more common than vascular compression

Carpal Tunnel Syndrome
Median nerve compression in the carpal tunnel associated with numbness, and pain in the arm and hand along the median nerve distribution

Double Crush Syndrome
mixture of above

Front 24

what is the Scalene compression test (Adsons maneuver)? shows the pt has?

Back 24

Positive test = diminished pulse and/or reproduction or exacerbation of symptoms

Thoracic Outlet Syndrome

Front 25

Patient usually complains of pain of the palmar surface of the thumb, index and middle finger

Back 25

Carpal tunnel syndrome

Compression of the median nerve within the carpal tunnel

Front 26

describe fryette type I

Back 26

Law I = when the spine is in neutral (easy normal), sidebending and rotation are in opposite directions. (Type I Mechanics)

Occurs in neutral (facets not engaged)
Found in thoracic and lumbar spines
Forms long curves, multiple segments
Compensatory

Front 27

describe fryette type II

Back 27

Law II = when the spine is flexed or extended (non-neutral), sidebending and rotation are in the same directions. (Type II Mechanics)

Occurs in flexion or extension
Facets engaged
Occurs in thoracic and lumbar spines
Type II-like motion in cervical spine
Usually single segments
Found at apices and crossovers and/or sites of viscerosomatic reflexes
Primary somatic dysfunction
Due to strain or viscerosomatic reflex

Front 28

describe fryette law III

Back 28

Law III = when motion introduced in one plane it modifies (reduces) motion in other two planes

When a segment is brought up to a restrictive motion barrier it will move in the position of greatest ease in the other two planes.
Restriction = direction it won’t go.
Somatic dysfunction = defined by direction it will go with ease.

Front 29

flip for examples of t1 and t2 s/d

Back 29

Front 30

ant lumbar counterstrain points

Back 30

Occur in 2 sets
Midline (T9-T11)
Along the ilium
(T12-L5)
L2, L3, and L4 are all clustered around the AIIS and are differentiated by the direction in which you push
Treated in similar manner

Front 31

what are the key fascial diaphragms?

Back 31

Pelvic diaphragm (L5-S1)
Thoracic diaphragm (T12-L1)
Thoracic inlet (T1, 1st rib)
Suboccipital region (OA, AA)

Front 32

diaphragm compensatory patterns

Back 32

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

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

Back 34

Left inferior innominate shear

Front 35

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 35

Left Anterior Innominate rotation

Front 36

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

Back 36

Left Posterior Innominate Rotation

Front 37

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

Back 37

Right innominate inflare

Front 38

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

Back 38

Left innominate outflare

Front 39

during inhalation, how does the sacral base move

Back 39

sacral base goes posterior

this is the S1 axis

Front 40

during cranial flexion, how does the sacral base move

Back 40

Cranial FlexionSacral base extends/ counter-nutates/posterior
Cranial Extension sacral base flexes/nutates/ anterior

Front 41

what does a positive spring test show you?

negative?

Back 41

Lumbar Spring Test
Positive Test
Resistance to springing sacral extensions (ie LUE) or backward rotation on oblique axis (ie L on R)
Negative Test
Ease of Springing sacral flexions (ie LUF) or forward rotation/torsion (R on R)

Front 42

what does a pos/neg backward bend test show you?

Back 42

Positive Test
increased sacral base asymmetry sacral extensions (ie LUE) or backward rotation on oblique axis (ie R on L)
Negative Test decreased sacral base asymmetry sacral flexions (ie LUF) or forward rotation or torsion (ie L on L)

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

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 44

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 45

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 45

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 46

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

Back 46

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 47

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 47

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 48

tx for Left on Left Sacral Torsion (forward)

Back 48

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 49

tx for Left on Right torsion

Back 49

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 50

tx for Right Unilateral Sacral Flexion

Back 50

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 51

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

Back 51

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 52

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 52

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 53

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 53

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 54

tx for unilateral sacral extension?

Back 54

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 55

what is normal rate and amplitude of CRI

Back 55

Rate = cycles/min (10-14)
Amplitude = distance from flexion to extension (0- 5)

Front 56

how do unpaired and paired cranial bones move?

Back 56

Unpaired bones move in flexion and extension.
Paired bones move in external rotation and internal rotation.
Flexion of unpaired bones - external rotation of paired bones.
Extension of unpaired bones - internal rotation of paired bones

Front 57

flip to see Conventions in naming cranial strain patterns

Back 57

Torsions are named for the superior greater wing of the sphenoid.
Sidebending rotations are named for the side of head convexity.
Sphenobasilar strains are named for the direction of basisphenoid movement (which is opposite to greater wing movement).

Front 58

in a lateral static postural exam, what are the 6 points The weight bearing line should normally pass through?

Back 58

1) just anterior to lateral malleolus;
2) middle of tibial plateau;
3) greater trochanter;
4) body of L3 (center of body mass);
5) middle of humeral head;
6) external auditory meatus;

Front 59

describe the hip drop test

Back 59

Ask the standing patient to shift weight onto one leg, allowing the other knee to bend which induces lumbar sidebending toward the weight bearing leg;
Observe lumbar sidebending and amount of hip drop which is normally ≥ 25°;
Hip drop < 25° (positive test) indicates restricted lumbar sidebending toward the side of the weight bearing leg.
Test is named for the bent leg side (+ right hip drop test indicates restricted left lumbar side bending)

Front 60

define scoliosis

Two reversible causes of idiopathic scoliosis?

Back 60

Scoliosis is defined as a curve > 10°

Short leg syndrome with compensatory scoliosis (scoliotic posture)
Trauma to the spine causing strain & resultant deformity in immature skeleton, if treated before skeletal maturity

Front 61

what are the most reliable Prognostic Indicators for scoliosis?

Back 61

Most reliable
Future growth potential
Age at diagnosis
Menarche in females
Risser sign
Curve severity at diagnosis

Front 62

Functional impairment with thoracic curves
Possible respiratory impairment >?
Possible cardiac impairment >?

Back 62

Functional impairment with thoracic curves
Possible respiratory impairment >50 °

Possible cardiac impairment >75 °

above 50, tx is surgery

Front 63

heel lift protocal?

Back 63

1/8 inch lift and lift at a rate no faster than 1/16 per week or 1/8 inch every 2 weeks

Fragile patients (arthritic, osteoporotic, aged, acute pain) 1/16 lift and lift no faster than 1/16 every 2 weeks

Start low and go slow

Front 64

Mix & Match “Rib Basket”

Rib 1

Ribs 2-5

Ribs 6-10

Ribs 11-12

with the following:

caliper motion

bucket handle

pump handle

elevated or depressed

subluxation

inhalation or exhalation

Back 64

Rib 1: elevation/ depressed

Ribs 2-5: pump handle

Ribs 6-10 :bucket handle

Ribs 11-12: inhale/exhale

Front 65

What is the key rib?-

inhalation?
Exhalation?

Back 65

What is the key rib?- refers to the rib in a group
Inhalation- the bottom rib is the key rib
Exhalation- the top rib is the key rib

Front 66

Reminders on Sequencing Trx

Back 66

First treat thoracic
type II, then type 1
Treat subluxed rib before a respiratory rib
For a group of respiratory ribs, treat the key rib:
top rib for exhaled ribs
bottom rib for inhaled ribs
may still have to treat individually

Front 67

Palpatory findings:
right ribs 2-4 exhalation dysfunction
left ribs 5-9 inhalation dysfunction
left rib 5 posterior rib subluxation
T4-8 N S left R right
T8 Flexed R left S left

What is the sequence of treatment?

Back 67

in order:

t8
T4-8 N S left R right
left rib 5 posterior rib subluxation
then inhalation/exhalation

Front 68

of is C2-C7 diagnosed

Back 68

not fryettes

ex: rotate left sidebend left

Front 69

50% of cervical flexion and extension occurs at the

50% of cervical rotation occurs at the

Back 69

50% of cervical flexion and extension occurs at the OA joint

50% of cervical rotation occurs at the AA (C1-2) joint

Front 70

please list C5-T1 DTRs/Strength test

Back 70

C5 DTR-biceps, strength- biceps
C6 DTR-brachioradialis, strength- wrist extensors
C7 DTR-triceps, strength- wrist flexors
C8 DTR-none, strength- finger flexors
T1 DTR-none, strength- interossei