AK Cranial Faults Flashcards
Cruciate Suture
Indications: TMJ involvement; failure to swallow with mouth partially open
Palpable Tenderness: tenderness at masseter BL,
mid-cervical over spinal intrinsics. May complain of decreased mouth opening or constant neck tightness. Tenderness over the suture in the area of involvement.
Therapy Localization: fingers placed on midline of the hard palate and PIM is tested for weakening.
Challenge Correction: separate and approximate for negation of positive TL. Correct in that direction (usually separation). Start at alveolar arch and proceed posteriorly and finally to anterior portion next to canines.
Special Muscle Tests: Richard Schroeder, DC - weak coracobrachialis BL is associated with need for approximation of suture. Upper portion of mid trap and lower portion of upper trap (place extended arms with palms rotated medially at a 45 degree angle and test by applying medial pressure as the patient attempts to adduct the arm) indicates need for separation of suture.
Inspiration Assist
Indications: weak muscle strengthens on inspiration or a strong muscle weakens on expiration.
Palpable Tenderness: on the frontal bone along
mid-pupillary line.
Therapy Localization: occipital-temporal junction or the mastoid process.
Challenge: Gently, with 2-3 pounds pressure, push the mastoid anterior and check for strengthening of the weak indicator muscle. Vary the vector of force until maximal strengthening is achieved.
Correction: For 4-5 respirations, push the mastoid in the direction that achieved maximal strengthening of weak muscle with 2-3 pounds pressure during inspiration.
Sacral associated faults: a sacral inspiration assist fault is many times present with this fault pattern. It is corrected by anterior pressure on the lower 1/3 of the sacrum during inspiration.
Test for a weakening of the hamstrings. If one is found weak, have the patient inspire and test for strengthening. Correct as above, for 5-6 respirations using 5-6 pounds of pressure.
Expiration Assist
Indications: a weak muscle strengthens on expiration or a PIM weakens on inspiration
Palpable Tenderness: on the frontal bone along the
mid-pupillary line.
Therapy Localization: at the occipital-temporal junction or the mastoid process.
Challenge: push the mastoid posteriorly and check for strengthening of a weak muscle. Find vector of force that causes maximal strengthening.
Correction: push mastoid posteriorly on expiration.
Special Muscle Tests:
Temporal Bulge
Indications: a weak muscle strengthens on 1/2 breath in or pim weakens on 1/2 breath out.
Palpable Tenderness: tenseness is found along the parieto-temporal junction.
Therapy Localization: patient’s fingers are placed over the temporal bone.
Challenge: pressure is applied anteriorly and posteriorly as if to exaggerate the bulge. Find the vectors causing the greatest amount of weakening of a pim. Allow for possible torque of the temporal bone by challenging with one thumb superior as the other moves inferior.
Correction: contact the occipital bone near asterion and the frontal bone near pterion and attempt to exaggerate the bulging with the maximum force being applied during the middle of inspiration. No force is applied during expiration.
Sacral associated fault: a category I pelvic torque condition may exist in association with the temporal bulge.
SphenobasilarExpiration
Indications: a weak muscle strengthens when additional air is forced out after full expiration or a PIM weakens after forcing more air in after a full inspiration.
Palpable Tenderness: many times there is tenderness over the wing of sphenoid.
Therapy Localization: the patient’s thumbs are placed on the hard palate on the cruciate suture.
Challenge: thumbs are placed as in the TL position and patient is asked to forcibly inhale. Alternatively, a separate challenge man be done with one hand at the mastoid and one behind the central incisors to find the optimum vector for correction.
Correction: contact is made posterior to the central incisors and on the anterior margins of the mastoids. During expiration, the incisors are pulled anteriorly and the mastoids are pushed posteriorly. Repeat 4-5 times.
Sacral associated faults: check for fixation between the sacrum and the coccyx that is corrected on expiration. Correction involves moving the sacral apex posterior while the coccyx is move anterior.
Parietal Decent
Indications: a weak muscle strengthens when 1/2 breath is let out or a pim weakens when 1/2 breath is inspired.
Palpable Tenderness: Tenderness is localized to an area superior to the ear on the temporal bone.
Therapy Localization: one hand touches the anterior scalene and the other on the parietal bone on the same side.
Challenge: lift the parietal bone, separating its junction with the temporal bone and test for a change in muscle strength.
Correction: use thumbs or heel of hand to protect sagittal suture by bracing the opposite parietal bone and pull the parietal bone superiorly, separating and raising it from the temporal bone on expiration with the maximum force applied during mid-breath.
Pelvic associated fault: many times a category I pelvic torque condition exists in association with the parietal descent.
Glabella
Indications: breathing through either the nose or the mouth weakens a strong muscle. This is almost always found on oral respiration. Nasal findings are usually associated with trauma to the nose or surrounding structures.
Palpable Tenderness: none
Therapy Localization: one hand contacts the Glabella and the other the eop.
Challenge: pressure against the Glabella and the eop strengthens a weak associated muscle.
Correction: with one hand on the Glabella and the other on the eop, a force is applied with the type of breathing, oral or nasal, that did not cause weakness. After repeating 4-5 times, contact is also made to the upper 3 cervical vertebrae and they are pressed inferiorly while compression of the skull occurs, 4-5 times.
Special Muscle Tests:
Interosseous (Universal)
Indications: a strong muscle is made weak by breathing in through one nostril.
Palpable Tenderness:
Therapy Localization: both hands are placed on the squamous portion of the occipital bone and a strong muscle is tested for weakening.
Challenge: with the patient prone, press one mastoid inferiorly and the other superiorly and the. Test for weakening of a strong muscle. If weakness doesn’t occur, reverse the direction of force and retest.
Correction: this is accomplished in the opposite direction that made the muscle weak on challenge. Contact is made simultaneously to the mastoids bilaterally and to both sides of the occiput. The contacts are then rotated in the appropriate direction, clockwise or counterclockwise, for 4-5 respirations.
Special Muscle Tests:
Sagittal Suture
Indications:weakness of the rectus abdominus.
Palpable Tenderness:
TL: the fingers are placed over the sutures and a muscle is tested for change in strength.
Challenge: the suture can be approximated or separated.
Correction: forceful traction is applied to separate or close the suture during any phase of respiration.
Special Muscle tests:
Lambdoidal Suture
Indications: weakness of the SCM may indicate jamming of this suture ipsilaterally. This fault is common in whiplash injuries.
TL: the fingers are placed over the suture and a muscle is tested for a change.
Challenge: the suture can be approximated or separated.
Correction: forceful traction with the fingers is applied to separate or close the suture during any phase of respiration. Correct in the direction opposite to that which weakened a pim.
Special Muscle Tests:
Zygomatic Suture
Indications: this fault is usually associated with ileocecal valve problems. Local skull trauma, TMJ imbalances and chronic protein deficiencies can relate to this fault.
TL: fingers are placed over each of the 3 zygomatic sutures and a muscle is tested for change in strength.
Challenge: the sutures can be approximated or separated.
Correction: forceful traction with the fingers is applied to separate or approximate the suture during any phase of respiration. Correct in the direction opposite to that which weakened a pim.
Special Muscle Tests:
Squamosal Suture
Indications: pain or discomfort on the side of the skull.
TL: the fingers are placed over the suture and a strong muscle is tested for weakening.
Challenge: the suture can be approximated or separated. A pim is tested for weakening and then a patient is asked to inspire or expire to see which phase of respiration restrenghthens muscle.
Correction: pressure is applied with fingers to either approximate or separate the suture, depending on the challenge direction and phase of respiration that negated challenge.
Special Muscle Tests:
Cruciate Suture
TL: fingers are placed on the midline of the hard palate and pim is tested for weakness.
Challenge: separate or approximate for negation of TL.
Correction: correct in the direction that challenged (usually separation).
Special Muscle Tests:
Naso-sphenoid Fault
A chronic finding that occurs with sphenobasilar faults. Goodheart found that this was associated with pituitary problems.
After using a two hand TL, with one hand on the Glabella and one to various organs to isolate problem, use a respiratory challenge to isolate type of cranial fault.
Usually will be a sphenobasilar fault.
Next, palpate the squamosal suture for tenderness or challenge the fault. Place thumb in upper medial border of the orbit and press toward the opposite sphenoid bone. Test pim for weakening.
If pim weakens, perform correction for cranial fault while patient contacts, with their thumbs, the upper medial border of the orbit. The patient presses toward the opposite sphenoid while the doctor performs the original cranial correction.
Internal Frontal Fault
Indications: anterior neck flexor weakness may indicate this fault. There will be a nares imbalance with the larger on the side of internal rotation of the frontal bone, and the orbit will be smaller.
Palpable tenderness: over the supraorbital notch.
TL: fingers are placed either over the frontal bone or over the maxilla, inferior to the orbit of the eye.
Challenge: pressure is applied to the maxillary bone, inferior to the malar surface of the zygomatic bone. This pressure is applied nasally.
Correction: pressure is applied against the hard palate at the junction of the last premolar and the first molar, on the side of internal rotation. Pressure is applied as to roll superior and laterally against the palate. Repeat 5-6 times.
Check for a high sphenoid by examine the eyeball. The high sphenoid is on the side of the protruding eye. On that side, slide your fingers along the lateral margins of the molars until you reach the pterygoid muscle pocket, lateral and superior to the last molar tooth. This area will be very painful. Press inferiorly. Follow this by pressing the opposite pterygoid pocket superiorly and laterally.
