Term
| what are the parts of a history for opp |
|
Definition
| o Onset, location, duration, character, aggravating factors, relieving factors, time/temporal, severity |
|
|
Term
Spinal column motion testing
1. if most restricted region is T1-5 screen the...
2. if most restricted region is L1-5 screen the...
3. if it is thoracic area screen the...
4. if it is over SI or innominate screen the...
5. if it is at the occiput screen the... |
|
Definition
if most restricted region is 1. T1-5 think about upper extremity
2. if most restricted region is L1-5 think about lower extremity
3. if it is thoracic think about ribs (if it gets harder as you palpate rib out it is an issue)
4. if it is over SI or innominate screen pelvis and sacrum
5. if it is at the occiput screen the cranium |
|
|
Term
| what should you always rule out before treatment |
|
Definition
always consider worst case scenario
rule out severe injuries
be sure there is no nerve damage with reflexes, neuro screen, and ortho tests |
|
|
Term
| how do you test the A/C and S/C joints |
|
Definition
use thumb as fulcrum at T1
Pinky on A/C
3rd finger on S/C
Posterior lateral motion
Dysfunction: cannot glide posterior |
|
|
Term
| how do you test the A/C joint |
|
Definition
| check level of spine of scapula to determine if restriction is superior or inferior |
|
|
Term
| how do you test the S/C joint |
|
Definition
Palpate medial end of clavicle
Have patient shrug shoulders
S/C should dip inferior and return superior when shoulders drop to normal
Test for anterior and posterior asymmetry |
|
|
Term
| how do you test glenohumeral joint |
|
Definition
|
|
Term
| what are the joints of the upper extremity |
|
Definition
| acromioclavicular, sternoclavicular, glenohumeral, scapulothoracic, radial head, wrist |
|
|
Term
| how do you check for proper radial head placement |
|
Definition
put thumb on distal radius
pronate and supinate arm
note restriction and end feel |
|
|
Term
|
Definition
palpate anterior and posterior
induce flexion and extension over each carpal
feel for restriction |
|
|
Term
| dysfunctions in what other areas can cause upper extremity issues |
|
Definition
cranial at occipital mastoid surface
jugular foramen
cervical dusfunction: brachial plexus
thoracic / rib dysfunction
lower body: latissimus dorsi, thoracolumbar fascia
mind, body spirit |
|
|
Term
| what indications do thoracic and rib dysfunctions give to upper extremity issues |
|
Definition
Rib 1: impede brachial plexus
Rib 1-7: effect pecs and brachial plexus
T3-T6: alter sympathetic function |
|
|
Term
| how can mind, body, and spirit causes upper extremity issues |
|
Definition
Stress causes hormone, cytokine, and autonomic nervous system stimulation
Cortisol and epinephrine: protective and damaging
Emotions take toll of musculoskeletal system (Shouldering your burdens / broken back) |
|
|
Term
| sucscapularis tenderpoint: location and position |
|
Definition
o Anterior lateral border of scapula, pressing from anterior-lateral to posterior-medial
o Shoulder extension and internal rotation |
|
|
Term
| supraspinatus tenderpoint: location, position |
|
Definition
o In belly of supraspinatus above scapular spine
o Flex shoulder, abduct, external rotation |
|
|
Term
| levator scapulae tenderpoint: location, position |
|
Definition
o Superior medial border of scapula (attachment)
o Glide scapula superior and medial |
|
|
Term
| biceps long head tenderpoint: location, position |
|
Definition
Over tendon of bicep in groove
Flex elbow, flex shoulder, abduct, internal rotation |
|
|
Term
| biceps short head / coracobrachialis tenderpoint: location, position |
|
Definition
Infero-lateral coracoid process
Flex elbow, flex shoulder, adduct and internal rotate |
|
|
Term
| radial head tenderpoint: location, position |
|
Definition
o Antero-lateral radial head at supinator attachment
o Extend elbow, supination, slight valgus |
|
|
Term
| medial epicondyle tenderpoint: location, position |
|
Definition
o On common flexor tendon at attachment of pronator teres
o Flexion, pronation, slight abduction of forearm, slight flexion of wrist |
|
|
Term
| extension of wrist dorsal tenderpoint: location, position |
|
Definition
o Dorsal 2nd and 5th metacarpal and in extensor carpi radialis and ulnaris
o Wrist extend, slight abduct / adduct |
|
|
Term
| palmar wrist tenderpoint: location, position |
|
Definition
o Palmar base of 2nd and 5th metacarpals of flexor carpi radialis and ulnaris
o Wrist flex, slight abduct / adduct |
|
|
Term
| lateral first cervical tenderpoint: location, position |
|
Definition
o Tip of C1 transverse process. Inferior anterior to mastoid
o Supine exaggerate side bend away |
|
|
Term
| anterior first cervical tenderpoint: location, position |
|
Definition
o Posterior of ascending ramus of mandible at earlobe
o Rotation away, flexion, side bend away |
|
|
Term
| anterior 2-6 cervical tenderpoint: location, position |
|
Definition
o Anterior lateral transverse process
o Flex, side bend towards, rotate away |
|
|
Term
| anterior 7 cervical tenderpoint: location, position |
|
Definition
o On clavicular attachment of SCM
o Flex, side bend towards, rotate away |
|
|
Term
| anterior 8 cervical tenderpoint: location, position |
|
Definition
o At sternal attachment of SCM at mid clavicle
o Flex, side bend toward, rotate away |
|
|
Term
| posterior 1 cervical tenderpoint: location, position |
|
Definition
o Below nuchal line midway between inion and mastoid
o Extend, side bend away, rotate toward |
|
|
Term
| inion / EOP tenderpoint: location, position |
|
Definition
o On nuchal line lateral to inion
o Flex, side bend and rotate away |
|
|
Term
| posterior second cervical tenderpoint: location position |
|
Definition
o Inferior nuchal line at semispinalis capitus attachment
o Extend, side bend and rotate away |
|
|
Term
| posterior second cervical spinous process tenderpoint: location position |
|
Definition
o Superior spinous process C2
o Extend, side bend and rotate away |
|
|
Term
| posterior third cervical tenderpoint: location position |
|
Definition
o Side of inferior-lateral spinous process C2
o Extend, side bend, and rotate away |
|
|
Term
| posterior 4-6 cervical tenderpoint: location position |
|
Definition
o Inferior or inferior lateral tip of spinous process
o Extend, side bend away, rotate toward |
|
|
Term
| wat are 3 unique characteristics of lumbar vertebra, what are they for |
|
Definition
o Tend to be thicker for weight bearing
o Spinous processes thick and blunt
o Wedge shaped disc allow for translation from vertical vertebral column to horizontal sacrum |
|
|
Term
| what should be included in motion testing for the lumbar spine |
|
Definition
o General overview of musculature
o Sidebending: iliac crest height, hip drop test
o Rotation: pelvic roll
o Flexion / extension testing
o Lordotic curve |
|
|
Term
| what is a physologic dysfunction of the inominate, why |
|
Definition
| anterior and posterior rotation because it is part of the gait cycle |
|
|
Term
| what is a pathologic dysfunction of the inominate |
|
Definition
| superior or inferior shear, inflaire or outflaire |
|
|
Term
| what do the ASIS compressions mean |
|
Definition
• Inferior ITA: innominate
• Down MTA: sacrum
• Superior STA: cranial |
|
|
Term
| what are physiologic dysfunctions of the sacrum, why |
|
Definition
| forward rotation (right on right or left on left) is part of gait cycle |
|
|
Term
| what are pathologic dysfunctions of the sacrum |
|
Definition
posterior rotation (right on left, left on right)
unilateral flexion or extension |
|
|
Term
| explain how to name a sacral dysfunction |
|
Definition
o Find side of positive test
o Find anterior / posterior on positive side
o If sacral base is not same level as ILA it is unilateral flexion or extension
o If sacral base is the same level as the ILA there is a torsion
If base and ILA on the side of the positive test are going anterior it is a forward torsion (left on left, right on right)
If base and ILA on the side of the positive test are going posterior it is a backward torsion (left on right, right on left)
**remember axis is opposite to the positive seated flexion test |
|
|
Term
| explain how L5 and the sacrum are integrated |
|
Definition
o L5 rotation is opposite sacral rotation
o If sacral base is posterior L5 is usually extended
o If sacral base is posterior L5 is usually flexed |
|
|
Term
| how are the inominate and sacrum integrated |
|
Definition
| o In gait cycle sacrum alternates between right on right and left on left forward torsions in conjunction with anterior innominate rotation on that site |
|
|
Term
| how are the pelvis and L spine integrated |
|
Definition
|
|
Term
| what do you treat first, how do you determine if the dysfunction qualifies |
|
Definition
| worst dysfunction first: treat with comparison of motion and restriction characteristics |
|
|
Term
| what do you do if there isn't a worst area, what do you treat first |
|
Definition
| sacrum! then innominate, L2, T12, other L spine... |
|
|
Term
| explain muscle energy for sacrum for forward torsion, backward torsion, and unilateral flexion |
|
Definition
forward sacral torsion: use both legs patient pushes down, patient supine deep sulci down with hips sideways and shoulders toward ceiling
backward sacral torsion: patient supine deep sulci down with hips sideways and shoulders toward ceiling, lift one leg, localize motion of the lumbosacral junction
unilateral sacral flexion : Abduct and internally rotate ipsilateral lag to gap the SI joint, pressure on posterior ILA |
|
|
Term
| explain how to do HVLA on the sacrum |
|
Definition
| SI articulation: Patient hugs table with dysfunctional hip up. Bend knee, bring forward and around to straight |
|
|
Term
| explain how to to BLT on the sacrum |
|
Definition
Patient supine, physician hand on sacrum other on L5
Ease sacrum into nutation and counternutation for ease of motion
Patient breathes with motion
Hold in position of ease and feel for shifting of sacrum
Adjust to new positions of ease until it stops moving |
|
|
Term
| explain how to fix a flare with muscle energy |
|
Definition
| • Leg and hip bent and in external rotation, patient pushes knee up |
|
|
Term
| explain how to do HVLA on an anterior innominate |
|
Definition
• Patient on side, Flex hip and knee on affected side
• Physician facing patient, forearm on ischial tuberosity
• Roll patient towards you
• Thrust directed anteriorly and towards the floor |
|
|
Term
| explain how to do HVLA on a posterior innominate |
|
Definition
• affected hip up, knee flex with foot in popliteal fossa
• physician facing patients, forearm on ischial tuberosity
• roll patient towards you
• thrust anterior and toward floor |
|
|
Term
| explain how to do BLT on an innominate |
|
Definition
One hand under pelvis fingers on SI joint other on ASIS
Rotate anterior and posterior to find position of ease
Decompress and hold until strain is corrected
Augment with respiration
If standing cross effected leg over |
|
|
Term
| what are some common dysfunction patterns in the lumbar spine |
|
Definition
o Prone to type 1 movement
o Treat at base L5: Usually in type 2 mechanics
o Treat at top T12: Usually in type 2 mechanics |
|
|
Term
| explain how to do muscle energy on a type 2 flexed at T12, type 2 flexed at L5, and a type 1 lumbar issue |
|
Definition
Two step technique for T12 flexed: Translate to put T12 into barrier, extend at T12
Flexed dysfunction type: Patient lays on side to flatten side bend, lower leg straight. Flex knee until motion is felt at restricted segment. Rotate shoulders back towards table to induce rotation
Type 1: Patient lays on side to flatten curve. Use knees as fulcrum to monitor apex of curve for movement |
|
|
Term
| explain two ways to to HVLA on a type 1 lumbar dysfunction |
|
Definition
• Lumbosacral junction technique. Brings lower sacral base cephalid. Lay on side to flatter curve
• Thoracolumbar junction technique: Brings upper sacral base caudad. Lay on side to not flatten curve |
|
|
Term
| explain how to do function for L5 |
|
Definition
Translate to localize segment
Apply compression towards segment and wait for unwinding |
|
|
