3. Osteopathic screening and Evaluation of Somatic Dysfunction Flashcards by Robert Garrett

What is somatic dysfunction?

impaired or altered function of related components of the somatic (body framework) system; skeletal, arthrodial, and myofascial structures; and related vascular, lymphatic and neural elements.

How well did you know this?

Not at all

Perfectly

How do you name a somatic dysfunction?

for what it “likes” to do. If your neck likes to flex, it is flexed.

How well did you know this?

Not at all

Perfectly

True or false: the WHY is what we are trying to figure out as doctors.

True. Ask yourself why is this different.

How well did you know this?

Not at all

Perfectly

Postural exam. what are you looking for?

Standing or sitting?

Comparing alignment in all 3 planes (saggital, coronal, transverse.

Standing upright in weight-bearing position so the effects of gravity can be considered.

How well did you know this?

Not at all

Perfectly

What is the theoretical center of gravity in an upright weight-bearing adult?

body of L3

How well did you know this?

Not at all

Perfectly

Plumb line:

external auditory meatus
tip of accordion
through the femoral trochanter
just in front of medial malleolus

How well did you know this?

Not at all

Perfectly

With deviation from plumb line comes compensation , what is compensation?

“compensation is defined as the counterbalancing of any defect of structure of FUNCTION

How well did you know this?

Not at all

Perfectly

Swayback (posture dysfunction)

Head forward
Increased cervical lordosis and thoracic kyphosis
Decreased lumbar lordosis
Posterior tilt of pelvis
Hip and knee joints hyper extended

See picture

How well did you know this?

Not at all

Perfectly

Rotary posture

Body rotated right or left
Lateral view appears different side to side in scoliotic positions
rotation primarliy in the thorax directed towards the scoliotic convexity

How well did you know this?

Not at all

Perfectly

Posterior postural deviation

Entire body leans backward, deviating posteriorly from the plumb line
Marked lordosis from mid thoracic spine down

How well did you know this?

Not at all

Perfectly

Military-bearing

Chest out, stomach in
Head tilted slightly posterior, normal cervical and thoracic curves
Chest elevated
Increased lumbar lordosis
Anterior pelvic tilt
Knees extended, Ankles plantar flexed.

How well did you know this?

Not at all

Perfectly

Kypholordotic

Head forward
Increased cervical and lumbar lordosis and thoracic kyphosis
Anterior pelvic tilt
Knees extended, ankled plantar flexed
Abdomen bulging anteriorly

How well did you know this?

Not at all

Perfectly

Flat back

Head forward
slightly increased cervical lordosis
Slightly kyphotic upper thoracic spine
Flattened lower thoracic spine, lumbar spine
Extended hips and knees

How well did you know this?

Not at all

Perfectly

Anterior postural deviation

Entire body leans forward
Deviating anteriorly from the plumb line
Weight supported by metatarsals

How well did you know this?

Not at all

Perfectly

10 step screening

Do you use active and passive ROM?

postural analysis/palpating paired landmarks
Gait analysis
Screening of LE
Dynamic Trunk Sidebending
Dynamic Trunk flexion/Extension & Scoliosis
Screening of UE (SEATED)
Trunk and Neck mobility
Seated Breath Observation
TART
Area of Greatest Restriction (AGR)

Use both active and passive

How well did you know this?

Not at all

Perfectly

Postural analysis/palpating paired landmarks

What do you observe from the front?

What about the back side?

Sides?

front: Observe from front evaluating weight distribution, head carriage, shoulder level and foot placement.

Back: Observe back evaluating head carriage, shoulder height, level of pelvis, and weight distribution on the feet.

side: plumbline posture

Postural analysis/Palpating paired landmarks

What bony landmarks should you palpate and observe?

Accordion process

Iliac crest

Greater trochanters

Gait analysis Screen

From what side should you watch them walk?

Observe gait with patient walking towards you.
Walking away
Walking from the side

Observe from different planes, eyes should be level to the plane being observed.

Gait analysis screen

What are you looking for?

length of stride, swing of arm, heel strike, toe off, tilting of the pelvis, and adaptation of the shoulders.

When is the best time to watch a patients gait?

When they are unaware of how you are walking.

Screening of lower extremities

Standing or sitting and how do you do this?

Ask them to squat maintaining heels on the floor.

Why do you want them to squat for screening of lower extremities?

What if they can’t?

requires mobility of foot ankle, knee, and hip joints bilaterally.

If they can’t perform squat you need further evaluation of lower extremity.

Dynamic trunk sidebending.

What do you ask them to do? Where do you observe from? What are you looking for?

Ask them to side bend…. with no forward bending

observe from back

Looking for symmetry of range of motion bilaterally

During side bending what is a good body part to watch to see how far they go?

Look at fingertips and if they go further on the down the lateral leg.

5. Dynamic Trunk flexion/extension what does this screen for? How is this preformed? (standing sitting?, where is physician?, where are patient's arm?)

Thoracic and lumbar spines. patient stands with feet a comfortable width apart and weight evenly distributed. Operated stands behind patient (eyes at the level you are evaluating) Have patient bend forward, arms relaxed and in front, hanging down.

Dynamic trunk flexion/extension Does HNP and disc disease patients prefer? extend/flex? What about spinal stenosis/arthritis patients?

HNP and disc disease prefer extension stenosis and arthritis patients prefer flexion

Dynamic Trunk flexion/extension and scoliosis What is next step if you see a scoliotic curve? how do you tell if it's functional or structural?

support patient's shoulders and sidebend (passive) upper body TOWARDS the convexity.

If scoliosis is a functional curve how will you tell? What about structural?

When side bending the patient the curves will improve When side bending the patient the curves will not improve.

6. Screening of Upper Extremity standing or seated? What should you ask the patient to do? How should there hands come together? Observe from front or behind? What joints are involved in this motion?

Seated Ask patient to fully abduct both upper extremities in the coronal plane, reaching for the ceiling and turn back of the hands together. Observe from both front and behind because this requires mobility of the SC, AC, glenohumeral, elbow and wrist joints.

7. Trunk and Neck Mobility testing patient standing? how is trunk portion done?

Patient sitting with doctor behind patient. grasp shoulders, induce passive trunk rotation and side bending through the shoulders, feeling for range, quality of movement and end feel. Compare movement with both left and right rotation of the trunk

Trunk and Neck mobility How is the neck portion done? How much normal motion is there in extension, flexion, side bending, and rotation? (degrees)

First have patient do ACTIVE ROM. then passive Extension- 75-85 degrees Flexion- 45-60 sidebending 40-45 rotation- 80-90

8. Seated breath observation which angles do you view? what are you looking for?

view from front back and side Looking for: Does chest rise and fall evenly? Abdominal breathing/Chest breathing? Is the patient using accessory muscles?

9. TART What does it stand for?

T- tissue texture A- Asymmetry R- Restriction of motion T- Tenderness

9. Tissue texture abnormalities Acute vs Chronic changes

Acute (<3 months)- warm, moist, red, inflamed, hypertrophy, increased muscle tone Chronic(>3 months) - Cool, pale, decreased muscle tone, flaccid and mushy

9. TART Assymetry Asymmetry can either be ___A___ or ____B___. What bones might you see asymmetry in?

A. Structural B. Functional examples: shoulder heights, iliac crest levels, contour of spine.

9. TART- restriction of motion. Motion may either _A_mobile or _B_mobile. You can identify restrictions by __C___ and __D___ testing using both active and passive patient cooperation.

A. HYPERmobile B. HYPOmobile C. Observation D. Palpation

9. TART Tenderness Sensation of pain or soreness elicited during ___A__.

A. Palpation May be associated with other subjective symptoms such as numbness, tingling, restriction of motion, weakness, etc.

10. AGR AGR is best done with patient (standing or sitting)? Why? What is the grading system for AGR?

Best done standing because seated would eliminate lower extremity influences. 1-3, 1 being slightly restricted, 3 being stuck.

10. AGR Once the area of greatest restriction has been treated what should you do?

Repeat the exam again. Were all the findings that were positive before, still positive? Are some gone as they were just compensation?