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OMM Exam 1
LECOM Yr 1
238
Other
Graduate
08/30/2011

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Term
what is palpation?
Definition
Application of variable manual pressure to the surface of the body for the purpose of determining the shape, size, consistency, position, inherent motility, and health of the tissues beneath
Term
what is somatic dysfunction?
Definition
Impaired or altered function of related components of the somatic system: skeletal, arthroidal and myofascial structures and related vascular, lymphatic, and neural elements
Term
what are the 3 steps that define the process of palpation?
Definition
Detection
Internal amplification of magnification
Analysis and Interpretation
Term
where are the majority of nerve endings in the hand located?
Definition
the pads of the fingers; Generally agreed the thumb and 2nd/3rd finger pads rather than tips are the most sensitive part to train for palpation
Term
what are some common errors in palpation?
Definition
Lack of concentration.

Too much pressure.

Excessive movement
Term
how is temperature evaluated prior to palpation?
Definition
evaluated by using the volar aspect of the wrist or the dorsal hypothenar eminence of the hand. The physician does this by placing the wrists or hands a few inches above the area to be tested and using both hands to evaluate the paravertebral areas bilaterally and simultaneously. Changes in heat distribution may be palpated paraspinally as secondary effects of metabolic processes, trauma, and so on (acute versus chronic fibrotic inflammation). Heat radiation may also be palpated in other areas of the body (e.g., extremities, abdomen). If unable to determine the thermal status of the region in question, the physician may at this point make slight physical contact with the appropriate area of the palpating hand.
Term
what are the steps in the examination sequence process?
Definition
Observation
Temperature
Skin topography and texture
Fascia
Muscle
Tendon
Ligament
Erythema friction rub
Term
what is passive motion?
Definition
movement done by the physician
Term
what is active motion?
Definition
deliberate, conscious movement by the patient
Term
what is inherent motion?
Definition
activity unconsciously generated within body
Term
individuals can perceive tissue movement as small as ___ mm
Definition
1
Term
what is the osteopathic diagnostic criteria for somatic dysfunction?
Definition
TART; tissue texture abnormality, asymmetry, restriction of motion, tenderness
Term
what are some signs of acute somatic dysfunction?
Definition
increased temperature, boggy/rough texture, increased moisture, tenderness, edema, venous congestion, redness lasts in erythema test, recent injury, acute/cutting/sharp pain, skin is warm/moist/red, local vasodilation, increased muscle tone/contraction and spasm
Term
what are some signs of chronic somatic dysfunction?
Definition
slight increase or decrease in temperature (cooling), smooth/thin or ropy/stringy texture, dry, tenderness, neovascularization, redness fades quickly or blanching occurs in erythema test, long standing, chronic/dull/aching pain, paresthesias (crawling, itching, burning), cool/pale skin, vasoconstriction due to hypersympathetic tone, decreased muscle tone, limited range of movement
Term
what was the Thomsonianism Reform Movement?
Definition
Founded in early 19th century by Samuel Thomson (known as the “puke doctor”)
Used botanic medicines and did not believe in physicians
By 1840s the Thomsonianians had managed to strike down the laws to license physicians in all but three states.
Beginning of the patent medicine shows The largest and most popular were the Kickapoo Remidies and the Kickapoo Indian Medicine shows.

From the Thomsonian Movement came both the eclectic physicians in 1830s and the physiomedical physicians in the 1840s.
Term
who was the founder of osteopathic medicine in 1874?
Definition
andrew taylor still
Term
who founded the american school of osteopathy in 1892?
Definition
andrew taylor still
Term
who was a medical officer in the Union Army during the Civil War?
Definition
andrew taylor still
Term
describe the osteopathic philosophy
Definition
The structure & function of the human body is interrelated forming a single dynamic unit.
The healthy body possesses self-regulatory mechanisms that are self-healing in nature
Illness or injury in one part of the body can affect other parts, therefore you must treat the whole person
Rational treatments, based on these principles, are to include all scientifically proven therapies
Term
what is the difference between OPP, OMT, and OMM?
Definition
OPP:
Osteopathic Principles and Practice
A medical philosophy

OMT:
Osteopathic Manipulative Treatment
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

OMM:
Osteopathic Manipulative Medicine
The application of osteopathic philosophy, structural diagnosis and use of OMT in the diagnosis and management of the patient
Term
what is the difference between osteopathy and osteopathic treatment?
Definition
application
Term
what is the art of medicine?
Definition
A trade or craft that applies a system of principles and methods
Skill that is attained by study, practice, or observation
Skill arising from the exercise of intuitive faculties
Term
describe the OMT clinical perspective
Definition
emphasis on both the host and the disease in determining cause of illness; allopathic mainly focus on disease aspect
Term
what are the four osteopathic principles?
Definition
1. The person is a unit of body, mind, and spirit
2. The body is capable of self-regulation, self-healing, and health maintenance
3. Structure and function are reciprocally interrelated
4. Rational treatment is based upon an understanding of these principles
Term
describe self regulation and self healing
Definition
Body is capable of self regulation as seen in homeostasis of normal physiology (such as thermal regulation).

Self healing and health maintenance is demonstrated with normal immune response and wound healing
Term
what is dynamic homeostasis?
Definition
Internal environment adapts to the external environment
Feed forward, and feedback mechanisms maintain balance
Antibodies develop in response to antigens
Joints, tissues, viscera are constantly having old cells replaced
Muscles hypertrophy from lifting weights
Term
what are some applications of the osteopathic principles?
Definition
Osteopathic principles should direct all forms of patient care
Osteopathic principles should direct physician-patient interactions
Osteopathic principles should direct medical research and discovery
Term
the osteopathic concept allows what 3 forms of treatment?
Definition
medication, OMT, and surgery
Term
at what spinal level is the suprasternal notch?
Definition
T2
Term
at what spinal level is the angle of louis?
Definition
T4
Term
at what spinal level is the xiphoid process?
Definition
T9
Term
at what spinal level is the spine of scapula?
Definition
T4
Term
at what spinal level is the inferior angle of scapula?
Definition
T7
Term
describe kneading
Definition
A soft tissue technique that utilizes an intermittent force applied perpendicular to the long axis of the
muscle.
Term
describe stretching
Definition
Separation of the origin and insertion of a muscle and/or attachments of fascia and ligaments
Term
describe resistance
Definition
when a physician passively moves a patient’s joint from the limit of the active range through the physiologic barrier toward the anatomic barrier

gradual, palpable, increase in tension until the endpoint of the range of passive motion is reached.

characteristics of this sensed tension is called end feel
Term
what is physiologic motion?
Definition
changes in position of body structures within the normal range
Term
what is translatory motion?
Definition
motion of a body part along an axis
Term
what is inherent motion?
Definition
spontaneous motion of every cell, organ, system, component of the body
Term
what is a 'direct method' in terms of osteopathic treatment strategy?
Definition
any osteopathic treatment strategy by which the restrictive barrier is engaged and a final activating force is applied to correct somatic dysfunction
Term
what is an 'indirect method' in terms of osteopathic treatment strategy?
Definition
a manipulative technique where the restrictive barrier is disengaged; the dysfunctional body part is moved away from the restrictive barrier until tissue tension is equal in one or all plane and directions
Term
what is the neutral point or position?
Definition
The point of balance of an articular surface from which all the motions physiologic to that articulation may take place
Term
what is an anatomic barrier?
Definition
the limit of motion imposed by anatomic structure; the limit of passive motion
Term
what is an elastic barrier?
Definition
the range between the physiologic and anatomic barriers of motion in which passive ligamentous stretching occurs before tissue disruption
Term
what is a pathologic barrier?
Definition
permanent restriction of joint motion associated with pathological change of tissue ( e.g. contracture, osteophytes)
Term
what are physiologic barriers the limit of?
Definition
the limit of active motion
Term
what is a restrictive barrier?
Definition
a functional limit within the anatomic range of motion, which abnormally diminishes the normal physiologic range
Term
how is somatic dysfunction named?
Definition
named for the freedom or potential for motion

somatic dysfunction is a diagnosis of motion

also called the osteopathic lesion: Impaired or altered function of related components of the somatic/ body framework system: skeletal, arthrodial, myofascial and the related vascular, lymphatic and related neural elements
Term
_______ loss is a result of and maintained by a restrictive barrier.
Definition
motion; the restrictive barrier is a result of somatic dysfunction
Term
describe forward bending
Definition
anterior motion in a sagittal plane around a transverse axis in any region of the spine
Term
describe backward bending
Definition
posterior motion (backward bending) in a sagittal plane around a transverse axis in any region of the spine
Term
describe rotation
Definition
motion around a vertical axis

vertebral rotation

movement in its horizontal plane around its anatomic(vertical axis)
Term
describe sidebending
Definition
right or left motion of one or more vertebral segments in a coronal plane around an anterior-posterior axis (AP axis) (concavity in direction of motion)
Term
what happens if you go beyond the anatomic barrier?
Definition
damage is caused

absolute limit of motion imposed by the anatomic structure of a joint
Term
_____ & _____ serve as finals limits of motion
Definition
bone; ligament
Term
is the physiologic barrier changeable?
Definition
yes, can be moved allowing a greater range of active motion, by doing warm up exercises for the joint
Term
True or False: more motion is possible in passive range of motion than in active range of motion.
Definition
true
Term
what is the effect of myofascial shortening on passive and active range of motion?
Definition
Increases passive range of motion

decreases active range of motion

EX: body builders who do not stretch
causes build up of fibrous CT
Term
what is the purpose of warm-up stretches?
Definition
move the physiologic barrier so that active ROM will be increased
Term
what is the difference between major and minor motion loss?
Definition
Major motion loss
easy to find
“patient went to sleep and awoke unable to straighten head.”

Minor motion loss
requires more palpatory perception
must develop a palpatory sense of normal
end feel - increasing resistance in PROM as the D.O. approaches the anatomical barrier
Term
what does the "end feel" indicate?
Definition
the endpoint of motion as you approach the anatomic barrier (fights you as you approach the anatomic barrier)
Term
which type of motion occurs in the elastic barrier range?
Definition
passive motion (involuntary)
Term
is there an end feel in minor motion loss?
Definition
no, no ligamentous resistance
Term
true or false: minor motion loss moves the neutral point (resting point)
Definition
true
Term
is a pathologic barrier a permanent change?
Definition
yes
Term
when the expected symmetry of motion is not found in an individual, what is assumed?
Definition
somatic dysfunction
Term
true or false: in somatic dysfunction, the new midline is shifted away from the restrictive barrier
Definition
true
Term
are the structure and function of the spinal column the same over its length?
Definition
no, varies significantly
Term
natural kyphosis and lordosis of the spine add to which type of resistance?
Definition
add to elastic resistance to disc loading by redistributing weight
Term
which spinal level is in the approximate center of load bearing with ideal posture?
Definition
L4
Term
what is a vertebral unit?
Definition
Two adjacent vertebrae, their joints, and the intervertebral discs between them.
The vertebral unit is given the name of the superior member of the unit.
Ex: motion or somatic dysfunction of “C2” means the motion of C2 on C3.
Ex: motion or somatic dysfunction of “L3” means the motion of L3 on L4.
Term
what is a spinal unit?
Definition
two vertebrae and associated soft tissues
Term
true or false: capsular ligaments for facet articulations also contribute to stability and limitation of motion
Definition
true
Term
the bony structure of which segment of the vertebrae is a primary determinant of intervertebral ranges of motion
Definition
posterior segment
Term
which types of movements are allowed in the cervical vertebrae?
Definition
flexion, extension, sidebending and rotation
Term
what types of movement are allowed and restricted in the thoracic region of the spine?
Definition
rotation permitted; sidebending inhibited
Term
what types of movement are permitted and inhibited at the lumbar region of the spine?
Definition
flexion/extension permitted; rotation inhibited
Term
what is the facet orientation of the cervical region of the spine?
Definition
backward, upward, medial (BUM)
Term
what is the facet orientation of the thoracic region of the spine?
Definition
backward, upward, lateral (BUL)
Term
what is the facet orientation of the lumbar region of the spine?
Definition
backward, medial (BM)
Term
what is Fryette's 1st principle?
Definition
When sidebending is attempted from neutral (anatomical) position, rotation of vertebral bodies follows to the opposite direction

When the spine is in a neutral position (easy normal) and sidebending is introduced, the bodies of the vertebrae will rotate toward the convexity.

In a neutral position, sidebending occurs 1st with rotation 2nd in the OPPOSITE direction.

NSXRY
Term
what is fryette's 2nd principle?
Definition
When sidebending is attempted from non-neutral (hyperflexed or hyperextended) position, rotation must precede sidebending to the same side
Term
what is fryette's 3rd principle?
Definition
Motion introduced in one plane limits and modifies motion in the other planes
Term
what is simple movement?
Definition
pure flexion and extension of a vertebral unit
Term
what is compound movement?
Definition
Physiologically normal movements in any of the primary directions induces additional motion vectors as a consequence of the facet orientation
Term
in which plane does flexion and extension (forward bending and backward bending) occur about a transverse axis?
Definition
sagittal plane
Term
what symbols represent right and left rotation of a horizontal plane about a vertical axis?
Definition
Right rotation = RR
Left rotation = RL
Term
what symbols represent right and left sidebending of the coronal plane about an anterior-posterior axis?
Definition
Right sidebending = SR
Left sidebending = SL

Approximation of transverse processes (TP) on that particular side.
Ex: L TP approximate = SL
Ex: R TP approximate = SR
Term
in the thoracic spine, neutral range occurs with forward bending or back bending?
Definition
forward bending
Term
in the lumbar spine, neutral range occurs with forward bending or back bending?
Definition
back bending
Term
true or false: All spinal and vertebral movements are described in relation to motions of their anterior surfaces
Definition
true
Term
greatest motion of the spine often occurs towards which segments?
Definition
middle segments
Term
true or false: in neutral mechanics, sidebending preceeds rotation
Definition
true

EXAMPLE:
from a neutral position
First sidebending left occurs
As it continues, right rotation must occur to accommodate the continued motion
Therefore: N SLRR
Term
describe the mechanics of sidebending
Definition
Sidebending “X” followed by rotation “Y”
Occur in groups (may be one vertebra though)
Commonly cause discomfort but not pain
Term
what is the notation for someone in the neutral position performing both sidebending and rotation?
Definition
NSXRY
Term
what is the notation for the L3 vertebrae in the neutral position (resting lordosis), sidebent left and rotated right on L4?
Definition
L3 NSLRR
Term
what is the notation for the T2 vertebrae in neutral postion (resting kyphosis) and the individual sidebent right and rotated left?
Definition
T2 NSRRL
Term
describe the mechanics of fryette's 2nd principle
Definition
Non-Neutral Mechanics (extremes of FB and BB)
Rotation “X” followed by sidebending “X”
Occurs at one segment
Commonly cause acute pain
Term
true or false: Type II Fryette mechanics apply only to the T & L spine
Definition
True
Term
what is the difference between physiologic findings and somatic dysfunction?
Definition
Physiologic motion becomes somatic dysfunction if the segments do not return to “normal” after completion of motion. They may be pure sagittal plane dysfunctions, neutral dysfunctions, or flexed or extended non neutral dysfunctions.
Term
do fryette's type I and II mechanics apply to the cervical spine?
Definition
no
Term
fryette's 3rd principle applies to which regions of the spine?
Definition
cervical, thoracic, lumbar spine
Term
what are the 2 divisions of the cervical spine?
Definition
superior and inferior division
Term
what joints occupy the superior division of the cervical spine?
Definition
OA (occipitoatlantal) and AA (atlantoaxial)
Term
describe the articulation between the atlas and the axis
Definition
Vertebral body of C2 is modified superiorly to form the dens(odontoid process)
C1 atlas does not have a body but rotates about the dens
Superiorly it articulates with the atlas at the occipital condyles via bilateral transverse masses
Term
describe the occipitoatlantal joint and its notation in side bending and rotation
Definition
Superior articular processes converge anteriorly and tilt medially. Occiput will sidebend one direction and rotate the opposite during multiple plane motion.
OA SXRY

Some literature sources refer to OA as C0
Term
the OA joint in the cervical spine accounts for what percentage of 90 degree forward and backward bending of the cervical region?
Definition
50%
Term
the OA joint accounts for how many degrees of forward and backward bending of the cervical spine?
Definition
45 degrees
Term
normal motion of the AA joint is how many degrees of rotation in each direction?
Definition
45 degrees
Term
true or false: normal range of rotation for entire cervical spine is 90 degrees in each direction
Definition
true
Term
the AA joint is responsible for what percentage of rotation of the entire cervical spine?
Definition
50%
Term
describe coupled motion in the typical cervical vertebrae
Definition
rotate and sidebend to same side
C2=motion of C2 on C3
C3=motion of C3 on C4
C4=motion of C4 on C5
C5=motion of C5 on C6
C6=motion of C6 on C7
C7=motion of C7 on T1
Term
the inferior division of the cervical spine (C2-C7) accounts for what percentage of forward bending and back bending?
Definition
50% (45 degrees)
Term
the inferior division of the cervical spine (C2-C7) accounts for what percentage of cervical rotation to the right and left?
Definition
50% (45 degrees)
Term
true or false: rotation and sidebending in the inferior division of the cervical spine will occur to the same side regardless of injury
Definition
true; Because of the 10-45 deg angle of the synovial facets in the cervical area, the uncinate processes, the joints of Luschka, and the shape and location of the disks
Term
full flexion and extension of total cervical spine has a combined range of how many degrees?
Definition
180 degrees in the sagittal plane
Term
A patient with a gastric ulcer is found to have the following during an osteopathic structural exam: T5 E RL SL (extended, rotated left, sidebent left). Sidebending occurs in which plane?
Definition
Coronal plane
Term
A patient with a gastric ulcer is found to have the following during an osteopathic structural exam: T5 E RL SL (extended, rotated left, sidebent left). Extension occurs in which plane?
Definition
Sagittal plane
Term
A patient with a gastric ulcer is found to have the following during an osteopathic structural exam: T5 E RL SL (extended, rotated left, sidebent left). Rotation occurs in around which axis?
Definition
Transverse plane
Term
the sagittal plane rotates on which axis?
Definition
transverse (horizontal) axis
Term
the horizontal (transverse) plane rotates on which axis?
Definition
longitudinal (vertical) axis
Term
the coronal (frontal) plane rotates on which axis?
Definition
anteroposterior axis
Term
what type of movement is allowed by a plane joint?
Definition
gliding movement
Term
what type of movement is allowed by a ball and socket joint?
Definition
Permits flexion, extension, adduction, abduction, circumduction, & axial rotation
Triaxial + circumduction
Term
motion occurs in how many planes in a hinge joint?
Definition
one plane, allows only flexion and extension
Term
what is movement limited to in a pivot joint?
Definition
rotation, motion in only one plane
Term
what types of movement are allowed by a condyloid joint?
Definition
Permits flexion, extension, adduction, abduction, & circumduction, but NO axial rotation
Biaxial + circumduction
Term
what type of movement is allowed by a saddle joint?
Definition
Permits flexion, extension, adduction, abduction, & circumduction, but NO axial rotation
Biaxial + circumduction
Term
describe the sternoclavicular joint
Definition
Joins the sternum to the clavicle

Only articulation of the shoulder girdle with the trunk

Movement - limited, but in every direction

Elevation & depression of clavicle on sternum
AP axis

Protraction & retraction of shoulder girdle
Longitudinal axis

Internal & external rotation of shoulder girdle
Transverse axis
Term
what are some examples of plane joints?
Definition
Acromioclavicular
Tibiofibular Joint
Sacroiliac Joint
Term
describe the acromioclavicular joint
Definition
Connects the clavicle with the acromion process of the scapulae

Movement – more limited than SC joint, but in every direction

Elevation & depression of clavicle on acromion process
AP axis

Protraction & retraction of shoulder girdle
Longitudinal axis

Internal & external rotation of shoulder girdle
Transverse axis
Term
describe the tibiofibular joint
Definition
Connected by a synovial joint at the proximal end and a fibrous joint (syndesmosis) at the distal end

Interosseus membrane between

Movement – limited, proximal > distal
Anterolateral & posteromedial glide of fibular head on tibia  no axis
Superior & inferior glide of fibular head on tibia no axis
When foot is pronated & supinated, respectively
Glide is reciprocal between proximal & distal tibiofibular joints
Eg: proximal glides anterolateral, distal glides posterior
Term
describe the sacroiliac joint
Definition
Connection of the sacrum and iliac bones of the pelvis

Movement – Limited (but important)
Slight gliding possible – increased during pregnancy
Anterior & posterior
Superior & inferior
Lateral & medial
Term
describe the glenohumeral joint
Definition
“Shoulder Joint”

Inserts the humeral head into the glenoid fossa of scapula

Movement – full range of motion in every direction

Flexion & extension of humerus
Transverse axis

Adduction & abduction of humerus
AP axis

Internal & external rotation of humerus
Longitudinal axis

Circumduction
Term
describe the femoroacetabular joint
Definition
“Hip Joint”

Inserts femoral head into acetabulum of hip bone

Movement
Flexion & extension of hip
Transverse axis

Adduction & abduction of hip
AP axis

Internal & external rotation of hip
Functional Longitudinal axis

Circumduction
Term
describe the humeroulnar joint
Definition
“Elbow Joint”

True Elbow Joint  direct connection of humerus to ulna

Radius is NOT part of true elbow joint

Movement – approximately 190° of motion
Flexion & extension of ulna on humerus
Transverse axis
Term
describe interphalangeal joints
Definition
Of hands and feet, joints between the phalanges

Proximal interphalangeal joints (PIP) and distal interphalangeal joints (DIP)

Movement
Flexion & extension of distal phalynx about proximal phalynx
Transverse axis
Term
describe the femorotibial joint
Definition
“Knee Joint”- Largest joint in the body
True Knee Joint- connects the two condyles of the femur to the tibial plateau
Two semilunar cartilages (menisci) on each side of joint
The patella is excluded from the true knee joint

Hinge-type Joint with Plane Joint movements as well

Movement – approximately 160° of motion
Flexion & extension of knee
Transverse axis
Six gliding motions of tibia on femur  no axis
Anterior & Posterior
Anteromedial & Posterolateral
Medial & Lateral
Term
describe the temporomandibular joint
Definition
Connects the mandible with the temporal bone of the skull
Fibrous articular disc in between
Modified Hinge Joint with Gliding Joint movements
Movement
Depression & elevation of mandible
Transverse axis
Protraction & retraction of mandible
No true axis
Slight lateral deviation (gliding)
No axis
Term
describe the radioulnar joint
Definition
Connects the radius and ulna
Strengthened by the interosseus membrane

Movement – greater movement distally
Pronation & supination of radius on ulna
Longitudinal axis
Term
describe an ellipsoid joint
Definition
Elliptical convex articular surface that fits elliptical concave articular surface

flexion, extension, abduction and adduction, but no rotation.

Example
Radiocarpal joint.
Term
describe the radiocarpal joint
Definition
True Wrist Joint- Connects the distal radius with the carpal bones
Scaphoid, lunate, triquetral bones
Ulna is excluded from the true wrist joint

Movement
Flexion & extension of wrist
Transverse axis
Abduction & adduction of wrist
AP axis
Circumduction of wrist
No true rotation
Term
true or false: somatic dysfunction is always named for its freedom of motion
Definition
true; named for the directions in which the vertebra or other joint can move more easily
Term
what are TART changes in general?
Definition
part objective and part subjective findings
Term
what categories would one use to test tenderness of a region?
Definition
O: Onset
P: Provocation / Palliation
Q: Quality / Quantity
R: Radiation / Region
S: Severity
T: Time
Term
how can one test asymmetry in an individual?
Definition
Visual observation
Static positional asymmetry, use of landmarks and tissues
Active range of motion
Inspect levelness of horizontal planes

Palpatory observation
Muscle tone, tissue texture, quality of joint motion, etc.
Term
how would one test the restriction of motion in an individual?
Definition
Visual and palpatory inspection
Ease of effort: Difficult? Easy?
Quality: Smooth? Interrupted? Crepitus?
Quantity: Increased ROM? Decreased ROM?
End feel of ROM: Barrier Concept
Term
how would one test tissue texture changes in an individual?
Definition
layer by layer palpation
Term
when rotation occurs towards the convexity of the spinal curve, this is termed what type of somatic dysfunction?
Definition
Type I dysfunction
Term
when rotation of the vertebra occurs into the concavity of the spinal curve, this is termed what type of somatic dysfunction?
Definition
type II dysfunction
Term
it is generally recommended that the physician observe what about the patient first in layer by layer palpation?
Definition
It is recommended the physician begin with general observation of the static posture and then dynamic posture (gait and regional range of motion)

For safety, it is best to begin by observing function and range of motion with active regional motion testing

After examining the patient in this manner, the physician may decide to observe the patient's limits by passive range of motion (ROM) testing

The passive ranges should typically be slightly greater than those elicited during active motion assessment

After identifying any asymmetries or abnormalities at this point, it is reasonable to proceed to the palpatory examination
Term
what is the final step in examination of a patient for somatic dysfunction layer by layer?
Definition
The final step in the examination is to determine whether there is a related articular component to the patient's problem
This involves controlling a joint and putting it through very fine small motion arcs in all phases of its normal capabilities (intersegmental motion testing)

The physician attempts with a three-plane motion examination to determine whether the motion is normal and symmetric or whether pathology is restricting motion, with or without asymmetry in the cardinal axes
For example, the C1 segment may be restricted within its normal physiologic range of rotation and exhibit either a bilaterally symmetric restriction in rotation (e.g., 30 degrees right and left) or an asymmetry of motion with greater freedom in one direction than the other (e.g., 30 degrees right, 40 degrees left). As stated previously, most descriptions of somatic dysfunction relate to the asymmetric restrictions, but symmetric restrictions are seen clinically
Term
what are the common landmarks used to test for horizontal symmetry or asymmetry?
Definition
Landmarks such as the tibial tuberosities, anterior superior iliac spines, posterior superior iliac spines, iliac crests, nipples, shoulders at the acromioclavicular joint, earlobes, and eyes as horizontal levels plane are often used for this purpose
Term
what are some predisposing factors to somatic dysfunction?
Definition
Posture
habitual, occupational

Gravity

Anomalies
vertebra, facets

Transitional areas
occipito-atlantal
C7-T1
T12-L1
L5-S1

Muscle hyperirritability

Physiologic locking of joint

adaptation to stressors

compensation for other structural deficits - stable
Term
the ____ ____ is the organizer of information, which is processed from the brain to other regions
Definition
spinal cord
Term
describe the autonomic nervous system in general and its functions
Definition
Involuntary manager
components: antagonistic vs. cooperative/cooperative effects
Sympathetic Nervous System
Parasympathetic Nervous System

Controls moment-by-moment activity of viscera
Somatic component often thought of as separate system
Somatic component has undeniable effects on the autonomic nervous system, and vice versa
Term
describe the sympathetic nervous system in general
Definition
sympathetic chains
T1 to L2 bilaterally
exit with somatic motor axons via intervertebral foramina
travel with somatic axons for much of their course
inferior to the head and neck of ribs
posterior to pleura

“flight or fight” response
constantly moderated and adjusted reactions
fine tunes visceral function
regulates circulation, metabolism, smooth muscle tone, intestinal motility, cardiac function, pulmonary response
Term
describe the parasympathetic nervous system in general
Definition
cranial portion - ganglia associated with third, seventh, ninth, & tenth cranial nerves
sacral portion - spinal segments S2, S3, S4.
ganglia located close to innervated organ
primary function is internal maintenance, including digestion and excretion
most effective during recovery and rest
Term
describe the somatic nervous system in general
Definition
under voluntary control
some functions are automatic
typical spinal nerve is formed by joining of ventral and dorsal roots inside the vertebral canal.
all skeletal muscle nerves arise or terminate in common origins in the spinal cord and exit via the vertebral foramina
Term
what is a somatic reflex arc?
Definition
Afferent and Efferent fibers pass in the same nerve

An afferent stimulus causes a reflex response via somatic efferent fibers

Responsible for all aspects of T.A.R.T
Term
what is a visceral reflex arc responsible for?
Definition
responsible for visceral dysfunction; same reflex pattern as a somatic reflex arc
Term
during sympathetic activation, what happens to the pupils?
Definition
dilation
Term
during parasympathetic activation, what happens to the pupils?
Definition
constriction
Term
during parasympathetic activation, what happens to the ciliary muscle?
Definition
contraction
Term
during parasympathetic activation what happens to the lacrimal gland?
Definition
secretion
Term
during sympathetic activation, what happens to the mucous, parotid, submaxillary and sublingual glands?
Definition
inhibition
Term
during parasympathetic activation, what hapens to the mucous, parotid, submaxillary and sublingual glands?
Definition
secretion
Term
during sympathetic activation what happens to blood vessels?
Definition
vasoconstriction
Term
during sympathetic activation, what happens to pilomotor muscles?
Definition
contraction
Term
during sympathetic activation, what happens to sweat glands?
Definition
secretion
Term
during sympathetic activation, what happens to the common carotid artery and mucous & thyroid gland?
Definition
vasoconstriction
Term
during parasympathetic activation, what happens to the mucous glands?
Definition
secretion
Term
during sympathetic activation, what happens to the heart?
Definition
excitation
Term
during parasympathetic activation, what happens to the heart?
Definition
inhibition
Term
during sympathetic activation, what happens to bronchial muscle?
Definition
relaxation
Term
during parasympathetic activation, what happens to bronchial muscle?
Definition
contraction
Term
during sympathetic activation what happens to bronchial glands?
Definition
inhibition
Term
during parasympathetic activation, what happens to bronchial glands?
Definition
secretion
Term
during sympathetic activation, what happens to upper body vasculature?
Definition
vasoconstriction
Term
during sympathetic activation what happens to the stomach?
Definition
inhibition
Term
during parasympathetic activation what happens to the stomach?
Definition
secretion and motor function
Term
what occurs in the liver during sympathetic activation?
Definition
glycogenolysis
Term
what occurs in the liver during parasympathetic activation?
Definition
glycogen synthesis
Term
what occurs in the spleen during sympathetic activation?
Definition
vasoconstriction
Term
what occurs in the gallbladder and ducts during sympathetic activation?
Definition
relaxation
Term
what occurs in the gallbladder and ducts during parasympathetic activation?
Definition
contraction
Term
what occurs in the pancreas during sympathetic activation?
Definition
inhibition
Term
what occurs in the pancreas during parasympathetic activation?
Definition
secretion
Term
what are some symptoms of acute hypersympathetonia?
Definition
Stimulation of sweat glands
Increased metabolic activity
Vasoconstriction, but overridden by:
Biochemical inflammation
Bradykinins, Serotonin, Histamine, Prostaglandin
Resulting in vasodilation = warmth, redness, edema/bogginess
Term
what is acute sympathetic hyperactivity?
Definition
Heat produced from bradykinin and substances released during local tissue injury
This is chemical local vasodilation that “hides” the vasoconstriction of acute sympathetic hyperactivity
This local response also will cause redness, “erythema”
“rubor”
Term
what is chronic hypersympathetonia?
Definition
Long-standing
sympathetic
overstimulation

Causes peripheral vasoconstriction
Chronic congestion leads to increased tissue collagen, and fibrosing of tissue
Term
what is the red reflex?
Definition
An area on the skin that responds to stimuli by turning red after stimulation by palpation

Normal response fades fairly rapidly

Response is different for acute somatic dysfunction and chronic somatic dysfunction
Term
what are some acute red reflex findings?
Definition
Palpatory stimulation results in:
Redness which remains longer than the rest of the area tested
Sympathetic response causes vasoconstriction.
However, this response is overridden by local biochemical responses, leading to warmth and redness.
Indicates either acute S/D in that segmental area, or S/D secondary to visceral dysfunction innervating that segment
Term
what are some signs of chronic red reflex?
Definition
Palpatory stimulation results in:
Initial redness followed by blanching of the tissues before the rest of the area blanches
Chronic hypersympathetic tone causes vasoconstriction and decreased blood flow to tissues.
Tissues have been altered for extended time leading to increased fibrosis, decreased circulation, decreased local response, trophic changes
Term
describe the segmental nature of the sympathetic nervous system
Definition
Painful stimuli from the viscera are carried back to the cord via the sympathetics
Less well known than somatic system
Aids in diagnosis
heart - T1 to T5, chest, shoulder, neck, jaw
Asthma- T2
appendix - periumbilical pain
innervation is derived from T10-T11, as is the area around the umbilicus
Prostate -T12-L2
Term
what is a viscerosomatic reflex?
Definition
A viscerosomatic reflex is one in which disruption, irritation, or disease of an internal organ or tissue results in reflex dysfunction of a segmentally related musculoskeletal region
Term
what is the osteopathic goal?
Definition
The goal of manipulation is to restore the whole body to a state of homeostasis. This is not some standardized posture to be rigidly applied in all cases but is individually tailored to the patient
Term
what are somatovisceral reflexes?
Definition
disruption of the function of viscera by somatic dysfunctions
Term
what are some contraindications for soft tissue? (times when you should NOT perform soft tissue palpation)
Definition
Acute sprain or strain.
Fracture or dislocation.
Neurologic or vascular compromise.
Osteoporosis and osteopenia.
Malignancy. Most restrictions are for treatment in the affected area of malignancy; however, care should be taken in other distal areas depending on type of malignancy and/or lymphatic involvement.
Infection (e.g., osteomyelitis).
Laceration
Open wounds
Acute process going on and you are unsure of the exact diagnosis
Medicolegal issues
Term
true or false: one should never apply direct force directly into bone and should limit pressure on the muscle belly
Definition
true
Term
what is effleurage?
Definition
stroking movement used to move lymphatic fluid; motion is towards the heart in most cases
Term
what is petrissage?
Definition
deep kneading or squeezing action; Involves pinching or tweaking one layer and lifting it or twisting it away from deeper areas
Term
what is tapotment?
Definition
striking the belly of a muscle with the hypothenar edge of the open hand in rapid succession in order to increase its tone and arterial perfusion; A hammering, chopping percussion of tissues to break adhesions and/or encourage bronchial secretions
Term
describe the steps involved in performing a suboccipital release of the patient in the supine position
Definition
1. The patient lies supine on the treatment table.
2. The physician sits at the head of the table.
3. The physician's finger pads are placed palm up beneath the patient's suboccipital region, in contact with the trapezius and its immediate underlying musculature
4. The physician slowly and gently applies pressure upward into the tissues for a few seconds and then releases the pressure
5. This pressure may be reapplied and released slowly and rhythmically until tissue texture changes occur or for 2 minutes. The pressure may also be continued in a more constant inhibitory style for 30 seconds to 1 minute
Term
describe the steps performed by the physician in forward bending (bilateral fulcrum) of the patient in the supine position
Definition
1. The patient lies supine on the treatment table.
2. The physician is seated at the head of the table.
3. The physician's arms are crossed under the patient's head and the physician's hands are placed palm down on the patient's anterior shoulder region
4. The physician's forearms gently flex the patient's neck, producing a longitudinal stretch of the cervical paravertebral musculature
5. This technique may be performed in a gentle, rhythmic fashion or in a sustained manner.
6. Tissue tension is reevaluated to assess the effectiveness of the technique.
Term
how would a physician perform contralateral traction on a patient in the supine position?
Definition
1. The patient lies supine on the treatment table.
2. The physician stands at the side of the table opposite the side to be treated.
3. The physician's caudad hand reaches over and around the neck to touch with the pads of the fingers the patient's cervical paravertebral musculature on the side opposite the physician
4. The physician's cephalad hand lies on the patient's forehead to stabilize the head
5. Keeping the caudad arm straight, the physician gently draws the paravertebral muscles ventrally, producing minimal extension of the cervical spine
6. This technique may be performed in a gentle, rhythmic, and kneading fashion or in a sustained manner.
7. Tissue tension is reevaluated to assess the effectiveness of the technique
Term
how would a physician perform cradling with traction (longitudinal stretch) on a patient in the supine position?
Definition
1. The patient lies supine on the treatment table.
2. The physician sits at the head of the table.
3. The physician's fingers are placed under the patient's neck bilaterally, with the fingertips lateral to the cervical spinous processes and the finger pads touching the paravertebral musculature overlying the articular pillars
4. The physician exerts a gentle to moderate force, ventrally to engage the soft tissues and cephalad to produce a longitudinal tractional effect (stretch).
5. This traction on the cervical musculature is slowly released.
6. The physician's hands are repositioned to contact different levels of the cervical spine, and steps 4 and 5 are performed to stretch various portions of the cervical paravertebral musculature
7. This technique may be performed in a gentle rhythmic and kneading fashion or in a sustained manner.
8. Tissue tension is reevaluated to assess the effectiveness of the technique
Term
how would a physician perform a trapezius stretch?
Definition
1. Patient supine, doctor at head of table
2. Stabilize one shoulder with opposite hand
3. With free hand contact same side of head as stabilized shoulder and introduce GENTLE stretch
Term
when would a physician decide to perform effleurage on a patient?
Definition
patient complains of congestion in the face or nose

when you put your hands on the skin it feels warm or puffy or edematous
Term
how would a physician perform effleurage?
Definition
patient supine, doc seated at head of bed

doctor uses 2 or 3 fingers to firmly contact the forehead between the eyebrows

keeping firm contact, move the fingers upward and outward around the ridge of the eyebrows

as you reach the lateral part of the eyebrows, and still keeping contact, direct your hands down toward the jaw

repeat 3-4 times

reassess
Term
how would a physician perform inhibition on a patient?
Definition
doctor locates an area of TART changes within the thoracic spine

using the thumb or 1 or 2 fingers, press directly on the affected area

maintain firm pressure downward (toward the floor) until the tissue under your finger softens

re-assess
Term
how would a physician perform longitudinal stretching on a patient?
Definition
patient lying face down doctor stands at side of table, on same side as the dysfunction doc crosses forearms heels of hands are resting on the skin, about 3 inches apart bring the heels together, bunching up the skin keeping your arms straight, drop your body weight onto your arms and hands – this will bring you into contact with the muscle layer separate your hands repeat in a rhythmic fashion re-assess
Term
how would a physician perform tapotement?
Definition
patient face down

doctor standing on side of dysfunction

doctor positions hands with pinky side toward floor and thumb side toward ceiling

doctor lightly and quickly taps the patient’s paravertebral musculature repeatedly with the pinky side of the hand

re-assess
Term
how would a physician perform a rhomboid stretch on a patient?
Definition
1. patient lying face down 2. doc standing at head of bed 3. doc crosses forearms 4. heels of hands are resting on the skin, about 3 inches apart 5. bring the heels together, bunching up the skin 6. keeping your arms straight, drop your body weight onto your arms and hands – this will bring you into contact with the muscle layer 7. separate your hands 8. repeat in a rhythmic fashion
Term
describe how to perform prone pressure (kneading) in the thoracic region on a patient
Definition
1. The patient is prone, preferably with the head turned toward the physician. (If the table has a face hole, the head may be kept in neutral.)
2. The physician stands at the side of the table opposite the side to be treated.
3. The physician places the thumb and thenar eminence of one hand on the medial aspect of the patient's thoracic paravertebral musculature overlying the transverse processes on the side opposite the physician
4. The physician places the thenar eminence of the other hand on top of the abducted thumb of the bottom hand or over the hand itself.
5. Keeping the elbows straight and using body weight, the physician exerts a gentle force ventrally (downward) to engage the soft tissues, and then laterally, perpendicular to the thoracic paravertebral musculature.
6. This force is held for a few seconds and is slowly released.
7. Steps 5 and 6 can be repeated several times in a gentle, rhythmic, and kneading fashion.
8. The physician's hands are repositioned to contact different levels of the thoracic spine, and steps 5 to 7 are performed to stretch various portions of the thoracic paravertebral musculature.
9. This technique may also be performed using deep, sustained pressure.
10. Tissue tension is reevaluated to assess the effectiveness of the technique.
Term
describe the steps taken by a physician performing lateral recumbent kneading on the middle/lower thoracic region of a patient
Definition
1. Patient on left side; doctor facing patient
2. Doctor’s fingers in PVM sulcus lateral to spinal processes
3. Stabilize forearms on patients shoulder and hips
4. Pull tissues toward you while simultaneously pushing elbows toward floor
Term
describe the steps taken by a physician performing lateral recumbent kneading in the upper thoracic region of a patient
Definition
1. Patient on left side; doctor facing patient 2. Let patient’s arm fall over caudad arm 3. Grasp PVM with fingers and pull toward you 4. Flip patient’s arm over cephalad arm and work behind rhomboid muscles
Term
describe how a physician would perform supine kneading on a patient's thoracic region
Definition
1. Patient supine, doctor sitting at either side
2. Slide hands under patient until pads of fingers touch PVM near you
3. Leaning onto elbows create a fulcrum and press fingers up into tissues and draw them near to you
Term
describe how a physician would perform supine kneading in a patient's lumbar region
Definition
1. Patient supine, doctor sitting at either side
2. Slide hands under patient until pads of fingers touch PVM near you
3. Leaning onto elbows create a fulcrum and press fingers up into tissues and draw them near to you
Term
what are the steps involved in performing petrissage on a patient?
Definition
1. patient lying face up
2. doctor seated at side of table
3. palpate by placing fingers into the tissues above the muscle layer and moving gently to locate an area that doesn’t move as well as the other areas
4. grasp the skin and subcutaneous tissues between your fingers and thumb
5. move the tissues until tension is felt
6. lift the tissue and move it further in the direction of tension – a kind of rolling motion
8. repeat as necessary
9. re-assess
Term
how would a physician perform longitudinal stretching on a patient?
Definition
1. patient lying face down
2. doctor stands at side of table, on same side as the dysfunction
3. doc crosses forearms
4. heels of hands are resting on the skin, about 3 inches apart
5. bring the heels together, bunching up the skin
6. keeping your arms straight, drop your body weight onto your arms and hands – this will bring you into contact with the muscle layer
7. separate your hands
8. repeat in a rhythmic fashion
9. re-assess
Term
describe how a physician would perform prone pressure with counterleverage (kneading) on a patient's lumbar region
Definition
1. The patient is prone with the head turned toward the physician. (If the table has a face hole, keep the head in neutral.)
2. The physician stands at the side of the table opposite the side to be treated.
3. The physician places the thumb and thenar eminences of the cephalad hand on the medial aspect of the paravertebral muscles overlying the lumbar transverse processes on the side opposite the physician.
4. The physician's caudad hand contacts the patient's anterior superior iliac spine on the side to be treated and gently lifts toward the ceiling.
5. To engage the soft tissues, the physician's cephalad hand exerts a gentle force ventrally and laterally, perpendicular to the lumbar paravertebral musculature.
6. This force is held for several seconds and is slowly released.
7. Steps 4 to 6 are repeated several times in a slow, rhythmic, and kneading fashion
8. The physician's cephalad hand is then repositioned to contact different levels of the lumbar spine and steps 4 to 6 are performed to stretch various portions of the lumbar paravertebral musculature.
9. This technique may also be performed using deep, sustained pressure.
10. Tissue tension is reevaluated to assess the effectiveness of the technique.
Term
what is the scissors technique used by physicians in the lumbar region?
Definition
1. The patient is prone, with the head turned toward the physician. (If the table has a face hole, keep the head in neutral.)
2. The physician stands at the side of the table opposite the side to be treated.
3. On the side to be treated, the physician's caudad hand reaches over to grasp the patient's leg proximal to the knee or at the tibial tuberosity.
4. The physician lifts the patient's leg, extending the hip and adducting it toward the other leg to produce a scissors effect.
5. The physician's caudad hand may be placed under the far leg and then over the proximal leg so that the patient's leg can support the physician's forearm.
6. The physician places the thumb and thenar eminence of the cephalad hand on the patient's para-vertebral musculature overlying the lumbar trans-verse processes to direct a gentle force ventrally and laterally to engage the soft tissues while simultaneously increasing the amount of hip extension and adduction.
7. This force is held for several seconds and is slowly released.
8. Steps 6 and 7 are repeated several times in a slow, rhythmic, and kneading fashion.
9. The physician's cephalad hand is then repositioned to contact other levels of the lumbar spine and steps 6 to 8 are performed to stretch the various portions of the lumbar paravertebral musculature.
10. This technique may also be performed using deep, sustained pressure.
11. Tissue tension is reevaluated to assess the effectiveness of the technique
Term
how would a physician perform combined kneading and stretching on a patient?
Definition
1. patient lying on side with knees bent
2. doc standing facing patient
3. place the forearm of the arm nearest the feet in the iliac fossa
4. place the other forearm in the patient’s axilla
5. the hands should now be cupping the paravertebral muscles
6. lean your body weight onto your forearms – this accomplishes 3 motions at once
a. the forearm in the iliac fossa comes closer to the doctor
b. the forearm in the axilla moves away from the doctor
c. the hands move toward the patient’s side and the doctor’s chest
7. a + b creates a stretch – the ends of the muscle get further apart
8. c creates a kneading motion – the hands are moving perpendicular to the long axis of the muscle
9. repeat in rhythmic fashion
10.re-assess
Term
define an indirect method
Definition
A manipulative technique where the restrictive barrier is disengaged
The dysfunctional body part is moved away from the restrictive barrier until tissue tension is equal in one or all planes and directions
Simply put: Take the dysfunction the way it “likes” to go!
Term
true or false: muscles tend to tighten with inhalation and relax with exhalation
Definition
true
Term
what occurs in the thoracic vertebrae during inhalation?
Definition
external rotation, spinal curves tend to flatten
Term
what occurs in the thoracic vertebrae during exhalation?
Definition
internal rotation, spinal curves tend to increase
Term
what year was osteopathic medicine founded?
Definition
1874
Term
what year was the american school of osteopathy founded?
Definition
1892
Term
during what years was A.T. Still alive?
Definition
1828-1917
Term
T3 likes to sidebend to the left side, right lateral pillar is prominent. what is the diagnosis?
Definition
T3 SLRL
Term
what is isometric muscle contraction?
Definition
maintains constant muscle length
Term
what is isotonic muscle contraction?
Definition
tension remains unchanged, muscle length changes
Term
what is isolytic muscle contraction?
Definition
forcing the muscle to lengthen
Term
what is concentric muscle contraction?
Definition
contraction that results in shortening of muscle
Term
what is eccentric muscle contraction?
Definition
lengthening of muscle during contraction (due to external force)
Term
when should one use indirect techniques?
Definition
Acute painful situations, hospitalized patients
Metastatic CA, arthritis
Osteoporosis, autoimmune
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