Clinical Aspects of Cranial osteopathy Flashcards
What are the reflexes that are more common in HENT?
Viscero-viscero reflexes
Optic nerve goes through what foramen?
Optic canal
V2 goes through what foramen? V3?
V2 = Foramen rotundum V3 = ovale
VII goes through what foramen?
Internal acuostic meatus
VIII goes through what foramen?
Internal acoustic meatus
XII goes through what foramen?
Hypoglossal canal
X goes through what foramen?
Jugular foramen
XI goes through what foramen?
Jugular foramen
III goes through what foramen?
Superior orbital fissues
What are the CNs that run through the jugular foramen?
IX, X, and XI
V1 goes through what foramen?
Superior orbital fissure
IV goes through what foramen?
Superior orbital fissure
VI goes through what foramen?
Superior orbital fissure
What are the CNs that have a PNS component?
III
VII
IX
X
Why do we need to know foramina for CNs?
CNs depart through the skull through foramen, which may be important if there is an abnormal growth of the foramen, or a disturbance in the bone
Why is it important that the nerves that leave the head are covered in pia mater?
Any dysfunction of the dura may lead to a dysfunction of the nerves
What is the difference between a stroke and bell’s palsy?
No forehead wrinkling with Bell’s palsy
What are the s/sx of trigeminal neuralgia?
HA in the region of the eyebrows, sinuses, cheek
Taste from the posterior 1/3 of the tongue is mediated via which CN?
IX
What is the treatment for children with colic?
Decompression of the condylar parts to relieve CN X
CN XI is affected with what congenital condition?
Torticollis
What are the sympathetics for the head and neck?
T1-T4
Vasoconstriction or dilation with PNS?
Vasoconstriction
Thick or thin secretions with PNS?
Thick
What happens to lymphatic drainage with SNS?
Decreased drainage
What are the s/sx of increased SNS in the head?
- Tinnitus
- HA
- Dilation of the pupils
What are the ophthalmologic problems that can occur with SNS overstimulation in the head?
- Dilation of the pupils
- Cataracts
What happens to the thyroid with increased SNS?
Increased secretions
Long term upper thoracic and cervical dysfunction with increased SNS is implicated in cataracts 2/2 what?
Congestion
SNS innervation causes thyroid gland secretions how?
Blood vessel constriction causes changes in the cells that secretion T4
What are the PNS effects on CN III? (2)
- pupil constriction
- accommodation
What are the PNS effects on CN VII? (3)
- Lacrimal gland
- Mucosal glands
- Submandibular glands
What are the PNS effects on CN IX? (1)
Parotid secretions
What are the PNS effects on CN X? (2)
- Heart
- Guts to 2/3 along transverse colon
Increased PNS causes what to secretions?
Thinning
What is ganglion that CN VII runs through?
Sphenopalatine (pterygopalatine) ganglia
What is sphenopalatine syndrome?
Redness/engorgement of the mucus membranes, tearing + retro orbital pain
What happens to asthma with sphenopalatine syndrome? Why?
Worsens d/t lowered resistance of the nasal mucosa to foreign protein and adequate conditioning of air
85% of the venous drainage from the head is through what?
Jugular foramen
What is the first sign of congestion in the head?
Fullness in the supraclavicular areas
Should you press on the lymph nodes with venous and lymphatic obstruction in the head
no–painful
Poor drainage from the head leads to what eye problems?
Glaucoma
Poor drainage from the head leads to what ear problems?
Meniere’s disease
External rotation of the temporal bone = what tinnitus sound?
Low pitched roar
Internal rotation of the temporal bone = what tinnitus sound?
High pitched wine
What may cause otalgia in the head?
Dysfunction with the teeth, tongue, esophagus, tonsils , TMJ,
The temporal bones are being moved by what bone?
The occiput movement
How do you treat otalgia?
Temporal rocking and VSD techniques
How do you treat tinnitus?
Temporal rocking
What is the SD that may cause eustachian tube dysfunction?
Internal rotation, torsion, or sidebending dysfunctions of the SBS, which leads to temporal bone dysfunctions
How do you treat OM?
Temporal rocking
What CN may cause OM?
CN X
What is the treatment for sinusitis? Why?
Frontal lift and intraocular techniques to address CN V (press on each part of CN V)
What is the treatment for pharyngitis? (3)
- Hyoid bone technique
- Submandibular drainage
- Effleurage of tissue
What is the effect of coughing in the elbow n the etiology of pharyngitis?
Torqueing of the neck fascia
What is the effect of SBS SDs with the endocrine system?
SBS restrictions can cause strains in the vasculature surrounding the pituitary and hypothalamus
How do you treat neural-endocrine problems?
Any SDs of the VSD
What is the most common, general, cause of HAs?
Vascular or other cause
What are the OMM causes of HAs? (3)
- Venous sinuses SDs
- Dura
- Dural arteries
What are the nerve roots that contribute to HA? (5)
V VII IX X C2-C3
True or false: a truly psychogenic cause of HA is rare
True
True or false: in the vast majority of cases, the physical exam of the head is WNL, including the OMM exam
False–OMM is always positive
What is Kernig’s sign?
Flex the hip, can’t extend at the knee
What is Brudzinski’s sign?
Flexion of the neck causes flexion at the hips and knees
What are the s/sx of acute angle glaucoma?
Prominent eye pain, dilated pupils, narrow chamber
What are the three major recurrent HAs?
- Tension
- Migraine
- Cluster
What are the 2 types of migraines?
Classic = aura Common = no aura
Caffeine is a vaso constrictor or dilator?
Constrictor
Tyramine in wine causes what effect on vessels?
Dilation
What are cluster HAs?
Neurogenic inflammation affecting the vascular plexus of the cavernous sinus
In whom are cluster HAs more common in?
20-40 aged men
What is the pain like with cluster headaches? (onset, intensity)
Explosive onset and very sharp in intensity
What is the associated syndrome with cluster HAs?
Horner’s syndrome
Are tension HAs usually unilateral or bilateral?
bilateral
What are the characteristics of the pain with tension HAs?
Dull, achy pain/pressure
Is there an aura with tension HAs?
No
What are the associations with tension HAs?
Stress
Anxiety
Depression
What is the effect of physical activity on tension HAs?
Not worsened
C1 supplies motor innervation to what? How do you treat if these are involved?
Suboccipital triangle muscles
Treat OA
C2 and C3 provide sensory innervation to what?
Cranial vault, back of the head, and suboccipital pain
What are the areas that should be assess with HA 2/2 musculoskeletal pain
Upper cervs
Suboccipital muscles
What are the borders of the suboccipital triangle?
- Rectus capitus posterior major
- Oblique capitis inferior
- Oblique capitis superior
What tender point should be treated with frontal or orbital HAs? Where is this, and how is it treated?
C1
Posterior surface of the ramus of the jaw–rotate head away
What tender point should be treated with periorbital HAs? Where is this, and how is it treated?
C2
Flex the spine and rotate away from the TP
What tender point should be treated with occipital HAs? Where is this, and how is it treated?
C4
SARA
What is the blood supply to the dura and calvaria?
Middle meningeal artery
How does the sphenoid relate to the side of the HA?
Greater wing is low on the side of the HA (I/e/ left torsion)
HAs caused by temporal bone problems are usually due to what?
Internal rotation restriction
Which usually has more sinusitis, and which has more migraines: flexion or extension heads?
Flexion = sinusitis Extension = migraines
What type of joint it the TMJ?
Diarthrodial joint
The mandible hands from what bones? What SDs, then, can cause problems with the TMJ?
- Mandible hangs from the temporals
- Occiput
How is the Galbreath maneuver performed?
Effleurage from behind the ear, down into the neck
What is the ganglion that should(n’t) be manipulated with throat s/sx?
Sphenopalatine
