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OPP IV: Test 1 > All Things Cranial! > Flashcards

All Things Cranial! Flashcards

1
Q

midline bones

A

sphenoid, occiput, ethmoid (median plate), vomer (SOVE)

move into flexion around transverse axis

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2
Q

paired bones

A

temporal, parietal , maxillae, palatine, zygomatic, lacrimal, nasal, inferior conchae, frontals, mandible

externally rotate during flexion

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3
Q

what motion occurs at SBS

A

during craniosacral flexion the SBS moves superiorly - the head expands laterally and gets “wider” and A-P diameter decreases

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4
Q

factors that alter rate of PRM

A

-

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5
Q

5 tenets of PRM?

A

5 Tenets of the Primary Respiratory Mechanism

  1. The inherent rhythmic motion of the brain & spinal cord
  2. Fluctuation of the CSF
  3. Mobility of intracranial & intraspinal membranes (RTM)
  4. Articular mobility of cranial bones
  5. Involuntary mobility of the sacrum between the ilia
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6
Q

RTM

A

intraspinal/dural membranes =
Falx cerebri
Tentorium cerebelli

Formed by dural reflections

Dura is contiguous with periosteum of skull

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7
Q

craniosacral flexion

A

midline bone flexion = paired bone external rotation = inhalation (extension of sacrum) = midline bone cephalad rotation

AP diameter decreases
lateral diameter increases

SBS moves superiorly and midline bones move into flexion around their transverse axes (at level of foramen and body of sphenoid)

flexion at SBS causes dura to be pulled cephalad, moving the sacral base posterior through transverse axis about S3 –> “causing sacral extension” = counternutation = base rotates posterior

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8
Q

craniosacral extension

A

midline bone extension = paired bone internal rotation = exhalation (flexion of sacrum)

midline bones rotate caudad
AP diameter increases
lateral diameter decreases

midline bones (SOVE) move through extension phase - paired bones internally rotate –> causes dura to be pulled caudad, moving the sacral base anterior through a transverse axis about S3 = sacral flexion = nutation = base rotates anterior

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9
Q

dural attachments?

A

foramen magnum
C2, 3
S2

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10
Q

counternutation

A

“causing sacral extension” = counternutation = base rotates posterior

seen in CS flexion

Sacrum influenced by spinal dura/core link
Base moves posterosuperiorly & apex moves anteriorly toward pubes

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11
Q

nutation

A

sacral flexion = nutation = base rotates anterior

seen in CS extension

Base moves anteriorly & apex moves posteriorly

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12
Q

vault hold:

A
  1. index fingers on greater wing of sphenoid - lateral to eye
  2. middle finger on zygomatic process of temporal bone - in front of ear
  3. ring finger on mastoid process oftemporal bone - back of ear
  4. little finger on squamous portion of occipital bone
  5. thumbs crossed over sagittal suture if comfortable
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13
Q

fronto-occipital hold

A

patient supine - one hand supports the occiput, other hand cradles frontal bone

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14
Q

torsion

A

sphenobasilar torsion = rotation of base of sphenoid and base of occiput in different directions around A-P axis

**named for the superior wing of the sphenoid

orbit may be elevated on side of torsion

In the vault hold, the hands appear to rotate in opposite directions. In a left torsion, the left index finger is perceived as moving superior (towards you) and the 5th digit moves inferiorly (away from you). Simultaneously, the right index finger is perceived as moving inferiorly and the 5th digit moves superiorly.

cause: trauma to one quadrant of head - ie upward blow on cheek, downward blow on parietal , occipitomastoid compression

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15
Q

upward blow on cheek

A

torsion

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16
Q

downward blow on parietal

A

torsion

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17
Q

sidebending rotation

A

sidebending through two vertical axises:

  • one through body of sphenoid
  • one through foramen magnum

** sphenoid and occiput rotate in opposite directions around parallel vertical axes to side bend, and the bones rotates around an A-P axis in the same direction so that on the side of the SBS convexity, the cranium moves inferiorly.

**Named by the side of the SBS convexity and the side that moves inferiorly

** In the vault hold, the fingers of one hand spread apart and move inferiorly (the side the strain is named for), while the fingers of the other hand come together and move superiorly.

ex: sidebending left rotation is present if the right side moes superiorly and produces concavity (head feels less full on right side)

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18
Q

rotation

A

occurs about an A-P axis running from nasion to opishtion

  • sphenoid and occiput rotate in same direction - and whole mechanism drops inferiorly on one side
  • named for side of convexity: head will feel fuller on side of convexity during flexion
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19
Q

sacral movement

A

Motion occurs around transverse axis in area of 2nd sacral segment posterior to the canal (respiratory axis)

Flexion (counternutation)

  • Sacrum influenced by spinal dura/core link
  • Base moves posterosuperiorly & apex moves anteriorly toward pubes (sacrum extends)

Extension (nutation)
Base moves anteriorly & apex moves posteriorly (sacrum flexes)

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20
Q

flexion

A

inhalation = extension of sacrum

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21
Q

extension

A

exhalation = flexion of sacrum

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22
Q

flexion motion around SBS?

A

Basiocciput & basisphenoid move cephalad while occipital

squama & wings of sphenoid move caudally

paired bones externally rotate and the sutures move

  • (lambda and posterior sagittal suture move posterior and caudally)
  • Bregma and anterior sagittal suture/coronal suture move caudally
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23
Q

extension motion around SBS?

A

Basiocciput & basisphenoid move caudad

while occipital squama & wings of sphenoid move cephalad

  • sphenoid rotates posteriorly, occiput rotates anteriorly

lambda/posterior suture move anterior and cephalad

bregma/anterior suture move cephalad with internal rotation

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24
Q

vertical strains

A

Sphenoid and occiput rotate in the same direction about parallel transverse axes (as in flexion/extension) which results in a shearing force at the SBS. One bone is in flexion while the other is in extension

Vertical strains are named by the direction of the base of the sphenoid (basisphenoid).

In the vault hold, a superior vertical strain the hands appear to rotate in the same direction such that index fingers of both hands move inferiorly (the sphenoid base is moving superiorly), while the 5th digits of both hands move superiorly (occipital base is moving inferiorly).

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25
Q

lateral strains

A

Sphenoid and occiput rotate in the same direction about parallel vertical axes, resulting in a shearing force at the SBS.

Lateral strains are named by the direction the basisphenoid moves.

In the vault hold, your hands form a parallelogram. In a left lateral strain, your index fingers shift to the right (sphenoid base turns to the left), while your 5th digits shift to the left (occipital base turns to the right). The reverse is true of a right lateral strain.

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26
Q

SBS compression

A

Approximation of the sphenoid and occipital bases as they compress together along the A-P axis.

In the vault hold, fingers of both hands approximate. The distance between the sphenoid wings and the occipital lateral angles on both sides is reduced. Because this severely limits the resiliency of the SBS, flexion and extension are limited, and often these heads will feel hard and generally limited in movement of any kind (often associated with a decreased Primary Respiratory Rate).

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27
Q

Caudal force applied centrally over the anterior-superior frontal bone.

A

superior vertical strain

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28
Q

-Force to the superior occiput (near lambda) & directed from superior/posterior to anterior.

A

superior vertical strain

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29
Q

Caudal force transmitted to the basisphenoid such as a caudal force transmitted from bregma.

A

inferior vertical strain

30
Q

A cephelad force transmitted to the condylar parts such as a fall on the base of the spine (ie. landing on the buttocks with a force transmitted up the spine).

A

inferior vertical strain

31
Q

A caudal force transmitted over the bilateral posterior-superior parietal bones or along the posterior sagittal suture.

A

inferior vertical strain

32
Q

Force directed along the AP axis leading to longitudinal compression of the SBS. May originate at nasion or at opisthion.

A

SBS compression

33
Q

-Lateral to medial directed force applied over the greater wing of the sphenoid pushing the greater wings to the left or right.

A

lateral strain

34
Q

Lateral to medially directed force applied over the occiput pushing the posterior aspect of the occiput left or right.

A

lateral strain

35
Q

-Force applied to the left mandible in a left to right direction yields a right externally rotated temporal bone rotation and a left internally rotated temporal bone rotation.

A

external rotation of temporal bones

36
Q

-Traction of one side of the mandible due to dental work yields internal rotation on the ipsilateral side as the traction and external rotation on the contralateral side of the traction forces.

A

external rotation of temporal bones

37
Q

traumatic blow to side of head

A

lateral strain

38
Q

traumatic blow on the vertex of head (posterior to plane of SBS)

A

superior vertical strain

39
Q

blow from below or through the mouth (anterior plane of SBS)

A

superior vertical strain

40
Q

traumatic blow to vertex of head (anterior plane)

A

inferior vertical strain

41
Q

blow through below or through mouth (posterior plane)

A

inferior vertical strain

42
Q

trauma to back of head

A

compression

43
Q

physiologic strains?

A

flexion, extension, torsion, sidebending rotation

44
Q

venus sinus technique

A
  • Release the occipital sinus and confluence of sinuses by resting the head at the external occipital protuberance on the fingertips of the middle fingers.
  • Hold this position until you perceive a “melting” of the tissues or “softening” of the bone.
  • Maintain same hand position, move fingers a fingerbreadth down the midline of the occiput.
  • Continue this method until the entire occiput has been released moving toward the foramen magnum.
45
Q

jugular sinus technique

A
  • Decompress the occiput from the atlas by placing your fingertips along the condylar aspect of the occiput. The weight of the head on your fingertips is sufficient force to accomplish the decompression.
  • This “opens” the jugular foramen and allows the drainage of venous blood.
  • Hold this position until you perceive a “melting” of the tissues.
46
Q

transverse sinus technique

A
  • Release the transverse sinuses by resting the occipital ridge on your fingertips.
  • Hold this position until you perceive a “melting” of the tissues.
  • The weight of the patient’s head is sufficient pressure.
47
Q

straight sinus technique

A
  • Release the straight sinus by placing your fingertips on the occipital ridge and crossing thumbs over each other. Rest thumbs gently on the sagittal suture over the vertex of the skull.
  • Focus on directing CSF between your thumbs and fingertips.
  • This is done by directing your attention to create a wave of fluid between your thumbs and fingertips. This is a thought, not an action.
  • Hold this position until you perceive a “melting” of the tissues.
48
Q

sagittal sinus

A
  • Start by placing your thumbs at the external occipital protuberance.
  • Release the superior sagittal sinus by applying gentle pressure with your thumbs crossed on either side of the sinus starting an inch above the external occipital protuberance.
  • When “softening” is noted, move another inch upward.
  • Continue moving upward an inch at a time and hold each position until you perceive a “melting” of the tissues.
  • Work your way anterior along the suture towards bregma.
  • Release the anterior portion of the superior sagittal sinus by resting your fingertips of both hands on either side of the metopic suture of the frontal bone.
  • Hold this position until you perceive a “melting” of the tissues.
49
Q

summary of venous sinus technique

A

1) External occipital protuberance (confluence of sinuses)
2) Down occipital sinus to condylar parts
3) Decompression of condylar parts - open jugular foramen
4) External occipital protuberance, transverse sinus, and straight sinus
5) Sagittal sinus – sagittal suture, metopic suture

50
Q

frontal bone assessment

A

one hand under occiput, one hand across frontal bone

flexion phase: a-d diameter decreases, metopic suture gets deeper (frontal suture)

extension phase: a-p diameter increases, metopic/frontal suture gets more shallow

note: frontal both acts as a midline and paired bone - moves cudal during flexion and cephalad during extension - moves into external rotation during flexion and internal rotation with extension

51
Q

parietal bone assessment

A

supine - spread index, ring and middle and littler fingers over parietal bone inferiorolateral aspects (avoid temporal bones)

during flexion - inferior portions of parietal bones move laterallly, saggital suture moves inferiorly

52
Q

assessment of occipitomastoid suture

A

jugular foramen located b/w temporal and occipital bones along the occiptomastoid suture

compression can reduce drainage from head and affect CN 9,10,11 - compression will affect motion of temporal bone and make it more difiult when using indirect technique

palpation: cradle patients head in hands, gently palpate along occipitommastoid suture, look for one suture that feels firmer - indicates restricted side

motion assessment: hook the distal aspect of your middle fingers around the mastoid processes of temporal bones, apply gentle supieriorly directed traction to each bone one side a time - look for firmness or resistance - that is the side that is most restricted

53
Q

V-spread

A
  • ddx: compressed left occipitomastoid suture
  1. place left index and middle finger on either side of left OM suture
  2. place right thumb, index and middle fingers over the right frontal bone
  3. gently spread your left index and middle finger apart to disengage the OM suture utilizing just enough force to meet the tension that is present
  4. use your right hand to gently introduce fluid wave toward your left hand by very slightly increasing wrist flexion
  5. once fluid wave reaches your left hand, send it back towards your right hand
  6. continue this back-and-forth motion until you feel softening of OM suture
  7. return pt. to neutral
54
Q

frontal lift

A
  • ddx: internally rotated frontal bones
  1. contact lateral edges of frontal bones with hypothenar eminences and interlace fingers above metopic suture (frontal)
  2. rest elbows on table
  3. during cranial extension apply gentle medially directed force with both hands
  4. maintain the medial force, during cranial flexion and lift the frontal bone anteriorly
  5. hold this position until feel equal tension from side to side
  6. release the forces slowly before removing your hands
  7. return pt. to neutral
55
Q

parietal lift

A
  • ddx: internally rotated parietal bones (stuck in the extension phase of SBS)
  1. place 2nd-5th digits b/l over the inferolateral aspects of parietal bones - lift thumbs away from skull
  2. to emphasize cranial extension apply gentle, medially-directed force with fingers
  3. maintain force with fingers during the cranial flexion phase, lift the parietal bones superiorly
  4. hold this position until you feel equal tension from sie to sie
  5. release forces slowly before removing your hands
  6. return patient to neutral
56
Q

compression of fourth ventricle (CV4)

A
  • this technique helps “reset” the primary respiratory and circulatory centers in medulla oblongata and - floor of fourth ventricle : helps improve function in the entire system
  • make sure hands are medial to OM suture and do not compress this region

NOTE: this has been linked to onset of labor - use with precaution in pregnancy, especially pre-term

ddx: decreased cranial motion throughout body

  1. approximate hands with fingers overlapping each other and make a flat surface with your thenar eminences for occiput to rest on
  2. place thenar eminences under occuput just inferior to external occipital protuberance
  3. during cranial extension apply a gentle superior force by leaning back with your body - maintain this force and continue to encourage cranial extension even when cranial flexion begins
  4. during cranial extension take up slack
  5. the rate of flexon and extension may slowly increase and the amplitude may decrease until you reach a “still point” when flexion and extension cease - may feel a softening of occiput and pt. may sigh or breathe more slowsly – flexion and extension will then resume with improved amplitude and motion
  6. slowly release pressure before removing hands, return pt. to neutral
57
Q

rate of PRM?

A

8 to 14

increased rate - seen in exercise, fever fever, OCF tx

decreased rate: SD, stress, fatigue, infection, psych disorders

58
Q

any force directed upward to inferior surface of zygoma

A

causes torsion

trauma to right zygoma –> right sphenoid to move up –> right torsion

59
Q

any downward force over bilateral posterior-superior parietal bones or over posterior sagittal suture

A

inferior vertical strain

60
Q

fall on base of spine –>

A

upward force to condylar parts or the occiput –> inferior vertical strain

61
Q

lateral to medial directed force over greater wing of sphenoid

A

pushes greater wings to the left or right –> lateral strain

62
Q

vaginal birth causes?

A

SBS compression

63
Q

blow to left madible in left to right fashion

A

yields left externally rotated temporal bone and right internally rotated

64
Q

dental work?

A

traction to one side of mandible causes internal rotation on ipsilateral side of traction applied

65
Q

what can be troubled by compression of occipitomastoid suture?

A

everything passing through jugular foramen - i.e. Glossopharyneal nerve and vagus nerve (no gag reflex) IX and X

i. e. accessory nerve XI –> shrugging of shoulders, moving of head
i. e. internal jugular vein - venous stasis

66
Q

what can cause onset of labor?

A

compression of the fourth ventricle (CV4)

67
Q

steps to venous sinus release

A

opens the terminal drainage points first, before the more distal sinuses - thus allowing the venous blood to exit the cranium more freely

ddx: headache, congestion
1. suboccipital release

  1. confluence of sinuses and occipital release (pads of fingers on external occipital protuberance- hold until feel melting - move fingers down the occiput until softens- continue until entire occipital sinus has ben released moving toward the foramen magnum)
  2. jugular sinus release
    - place fingertips along condylar aspects of occiput
    - hold until feel a melting - will decompress jugular sinus and facilitate venous flow into the internal jugular vein
  3. transverse sinus release
    - rest the occipital ridge (lateral to occipital protuberance) on fingertips
    - hold
  4. straight sinus release:
    - leave fingers on occipital ridge and place thungs on sagittal suture at vertex of skul - don’t apply any pressure - focus on directing CSF fluid wave between our thumbs and fingertips as a thought
    - continue to direct fluid waves b/w fingers until feel melting
  5. sagittal sinus release
    - cross thumbs and place them gently at external occiital protuberance
    - apply gentle pressure w/ thumbs in lateral-inferior direction until feel a melting of tissues
    - move thumbs anteriorly along sagittal sinus and repeat, until you reach coronal suture
    - in order to release anterior portion of sagittal sinus, rest your fingertips on either side of metopic suture and apply the same pressure as done with your thumbs
68
Q

tx for internally rotated frontal bones

A

frontal lift

69
Q

tx for internally rotated parietal bones

A

parietal lift

70
Q

tx for compressed left OM suture

A

V-spread

71
Q

tx for h/a and congestion?

A

venous sinus release

72
Q

tx for decreased cranial motion?

A

CV4

OPP IV: Test 1 (4 decks)

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