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OS3 Test 1 > Cranial Midline Bones > Flashcards

Cranial Midline Bones Flashcards

1
Q

Principles of Treatment for cranial dysfunction

A
  • find greatest restricted pattern of dysfunction (soma, cranium)
  • direct: force into barrier
  • indirect: balanced membranous tension; encourage amplitude of dynamic motion
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2
Q

Qualities of the CRI

A
  • R-RADS

- rate, rhythm, amplitude, direction, strength

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3
Q

Vault hold

A
  • patient supine
  • doc seated at head of table
  • index fingers on greater wings of sphenoid
  • little fingers on occiput
  • long and ring fingers surround the pinna of the ear
  • thumbs off the calvarium
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4
Q

Frontal occipital hold

A
  • patient supine with doc seated to side of table at head
  • one hand contacts greater wing of sphenoid with thumb and long or little finger
  • other hand cups occciput
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5
Q

Normal motion of the SBS: flexion

A
  • greater wings of sphenoid move anterior/inferior
  • squamous portion of occiput moves posterior/inferior
  • SBS moves superior/cephalad
  • cranium changes: shorter A/P and superior/inferior diameters
  • wider in R/L diameter
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6
Q

SBS extension

A

-motions and dimensions are opposite of flexion

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7
Q

Flexion dysfunction of the SBS

A

-freedom of active and passive motion testing is toward flexion with little motion (i.e. restriction) toward extension phase

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8
Q

Extension dysfunction of the SBS

A

-freedom of active and passive motion testing is toward extension with little motion (i.e. restriction) toward flexion phase

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9
Q

Sacral nutation

A

-sacral base moves anterior during SBS extension phase of CRI

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10
Q

Sacral counternutation

A

-sacral base moves posterior during SBS flexion phase of CRI

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11
Q

Balanced Membranous Tension

A
  • indirect cranial manipulative treatment
  • for any dysfunction, determine the extent of range of motion in all directions applicable
  • using a hold, you will place the SBS or other cranial bones/joints in the midpoint of the available ROM
  • the CRI will move against your force but you should resist changing your force
  • the CRI will dampen to the point of you not being able to feel the motion–called still point
  • maintain your concentration and when you feel the CRI return it will return in a more symmetrical motion than before
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12
Q

During the still point

A
  • the membranes that were tight are relaxing and those that were lax are tightening up
  • once this is accomplished, the CRI mechanism “catches up” and starts producing a more even palpation experience of the CRI
  • the dysfunctional motion will be restored to a more normal motion pattern
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13
Q

Motion of sphenoid

A

-greater wings move anterior/inferior during flexion and reverse during extension

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14
Q

Motion of occiput

A

-membranous portion of the occiput moves posterior/inferior during flexion and reverses during extension

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15
Q

Motion of SBS

A

-SBS moves cephalad during flexion and caudad druing extension

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16
Q

Cranial midline or unpaired bones

A
  • Ethmoid
  • Occiput
  • Sphenoid
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17
Q

Facial midline or unpaired bones

A
  • mandible

- vomer

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18
Q

Cranial paired bones

A
  • parietal
  • temporal
  • frontal
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19
Q

Facial Paired bones

A

Inferior nasal concha

  • lacrimal
  • maxilla
  • nasal
  • palatine
  • zygoma
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20
Q

Midline bones motion

A
  • usually rotate about a transverse axis in an anterior/posterior direction (even when it is labeled flexion-extension)
  • in sagittal plane
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21
Q

Paired bones motion

A

-usually move about AP axis in a lateral motion (coronal plane), labeled external/internal rotation (flexion-extension)

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22
Q

Basic motion of the SBS

A
  • inhalation=flexion
  • sphenoid will rotate about a transverse axis so that the alae (wings) will move anteriorly and the motion at the SBS will be superior
  • Occiput will rotate about a transverse axis so that the motion at the SBS will be superior and the bowl of the occiput will move posterior/inferior
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23
Q

Sphenoid rotates

A

on a transverse axis through the center of the body at the level of the floor of the sella turcica

  • greater wings move anterior, slightly laterally and inferiorly, influencing the lateral edges of the frontal bone anteriorly and laterally
  • the pterygoid process move posteriorly and slightly internally
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24
Q

Occiput in flexion

A
  • rotates about a transverse axis directly superior to foramen magnum at the level of confluence of sinuses
  • as it rotates, the basilar part and the condyles move anteriorly and superiorly, directly influencing the temporal bones and the scam moves posteriorly and slightly laterally
  • greatest lateral deviation occurs at the lateral angles
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25
Q

SBS motion–ethmoid

A

-the basiocciput will move vertically in sphenobasilar symphysis (SBS) flexion, causing a rotation of the ethmoid bone

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26
Q

When the SBS is in flexion, the ethmoid will

A

move in the same direction as the occiput

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27
Q

When the SBS is in flexion, the vomer will

A

move in the same direction as the sphenoid

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28
Q

During SBS flexion, the palatines

A

will move in external rotation primarily

29
Q

During SBS flexion the interpalatine suture will

A

move inferiorly with vomer and maxillae

30
Q

Somatic dysfunctions at the SBS

A

-simplest is the strain patterns

31
Q

Lateral strain

A

-named for the position of the base of the sphenoid (basisphenoid)

32
Q

SBS lateral strain azes

A
  • superior-inferior

- 2 vertical axes

33
Q

SBS lateral strain direction

A
  • same for both bones

- label for the motion of the basisphenoid

34
Q

SBS vertical strain

A
  • named for the direction of the basisphenoid

- can have a superior or an inferior vertical strain pattern

35
Q

Superior vertical strain

A

-bones rotate anterior around involved axes

36
Q

Inferior vertical strain

A

-Bones rotate posterior around involved axes

37
Q

Vertical strain axes

A

-2 transverse axes

38
Q

Vertical strain direction

A

-same direction

39
Q

SBS torsion

A
  • named for position of the greater wing of the sphenoid during cranial flexion
  • the greater wing that moves cephalad during cranial flexion
  • right or left torsion
  • 1 AP axis
40
Q

SBS Sidebending rotation

A
  • biplanar dysfunction
  • combined side bending and rotation
  • named for the side of the convexity developed in the cranium
  • 1 AP axis, 2 vertical axis
  • “vrack the egg and pour it”
41
Q

SBS and Sacral motion

A
  • SBS flexion pulls up on the dural sleeve of the cord
  • sacrum moves posteriorly (counternutation)
  • SBS extension–sacral nutation
42
Q

Midline bones rotate about

A

a transverse axis in the sagittal plane

43
Q

Cranial flexion

A
  • SBS superior
  • Occiput inferior/posterior
  • ethmoid mirrors occiput motion/opposite sphenoid
  • vomer same direction as sphenoid
  • palatine: internal rotation
  • interpalatine suture: superior with vomer and maxillae
44
Q

Sacrum moves about a

A

transverse axis through the 2nd sacral segment in the sagittal plane

45
Q

In cranial flexion, sacral base

A

posterior

counternutation

46
Q

In cranial extension sacral base

A

anterior

nutation

47
Q

SBS flexion pulls

A

up on dural sleeve of cord, thus sacral base moves posterior (counternutation)–transverse axis/sagittal plane just like occiput

48
Q

Ethmoid motion influenced by

A

-sphenoid and falx cerebri

49
Q

Ethmoid motion in SBS flexion

A
  • rotates about transverse axis through middle of bone, in same direction as occiput
  • motion is in sagittal plane
  • lateral masses move as paired bones into external rotation during cranial flexion and internal rotation during cranial extension
50
Q

Lateral strain pattern

A
  • sphenoid and occiput rotate about vertical axes in the same direction
  • side to side (lateral) shearing of the SBS
  • usually caused by trauma lateral to one side of anterior cranium or the opposite of the posterior cranium
  • head looks like parallelogram
  • side to side findings are asymmetric?
51
Q

Right lateral strain

A

-basi-sphenoid shears to right around vertical axis, occiput and sphenoid both rotate left around their vertical axis

52
Q

vertical strain pattern

A
  • flexion at the sphenoid is accompanied by extension at the occiput (superior strain) or vice versa for inferior strain
  • rotation on transverse axis with motion in sagittal planes
  • side-to side findings symmetrical
53
Q

Inferior vertical strain

A
  • sphenoid extended, occiput flexed

- thumbs point to doc

54
Q

SBS torsion

A
  • rotation of SBS around an AP axis
  • axis runs from nasion to opisthion, motion in coronal plane
  • sphenoid and occiput rotation in opposite directions
  • torsion named for the side of the more cephalad greater wing of sphenoid
55
Q

Left torsion

A
  • abnormal flexion/extension while sphenoid twists R (freater wing elevates on L), occiput twists L at SBS, L basisphenoid
  • hands twist on each other with left thumb pointing to doc and right thumb moving away
56
Q

SBS torsion: changes in other bones

A
  • temporal and parietal bones: relative external rotation on the side of the torsion
  • mandible: shifted toward the side of the torsion
    orbit: smaller on side of torsion
  • falx cerebri: anterior end rotates with sphenoid, posterior end rotates with occiput
  • tentorium cerebelli: sidebent same direction as occiput rotates
  • spinal dura: inferior on side of low occiput
57
Q

SBS side bendng

A
  • occurs by rotation around 2 vertical axes in the transverse plane
  • through the center of the body of the sphenoid and through the center of the foramen magnum on occiput
  • the sphenoid and occiput rotate in the opposite directions on these axes causing side bending at the SBS
58
Q

SBS rotation

A
  • occurs on the same AP axis as torsion; however, the sphenoid and occiput rotate (coronal plane) in the same direction
  • rotation occurs toward the side of convexity, which is relatively inferior/caudad
59
Q

SBS side bending and rotate dysfunctions are named for

A

convexity (wider side) of side bending motion

60
Q

Right SBS rotation

A
  • sphenoid SB L, rotated R and occiput SB R rotated R

- right hand over down and spreads out with left hand moving up and in

61
Q

SBS side bending and rotation changes in other structures

A
  • temporal and parietal bones externally rotated on convex
  • frontal bone and orbit anterior on convex side
  • mandible shifted to convex side
  • falx cerebri: SB following convexity of SB of SBS
  • tentorium cerebelli: follows occipital motion
  • spinal dura: inferior on convexity
62
Q

SBS compression

A
  • result of pressure or trauma to front of head or face, to back of head or entire periphery (i.e., infant cranium in birth)
  • manifests as a restriction (mile to severe) of all motions at the SBS
  • with severe compression, cranium feels rigid
63
Q

SBS flexion dysfunction

A
  • extension restricted
  • increased in transverse dimension
  • forehead wide and sloping
  • eyes prominent
  • paired bones externally rotated
  • ears protruding
64
Q

SBS extension dysfunction

A
  • flexion restricted
  • increased in longitudinal dimension
  • vertical forehead
  • eyes receded
  • paired bones internally rotated
  • ears close to head
65
Q

SBS torsion dysfunction: side of high sphenoid wing

A

-frontal lateral angle anterior
-orbit wide
-frontozygomatic angle increased
-eyeball protruded
-zygomatic orbital rim everted and externally rotated
symphysis menti to this side
-mastoid tip posteromedial

66
Q

SBS torsion dysfunction: side of low sphenoid wing

A

-posterior frontal lateral angle
-narrow orbit
frontozygomatic angle lessened
-eyeball retruded
-zygomatic orbital rim inverted and internally rotated
-mastoid tip anterolateral
-ear close to head

67
Q

SBS rotation/Side-bending dysfunction: convexity

A
  • lateral frontal angle posterior
  • orbit narrow
  • frontozygomatic angle lessened
  • eyeball retruded
  • zygomatic orbital rim prominent
  • symphysis menti to this side
  • mastoid tip posteromedial
  • mastoid portion anterolateral
  • ear protruding
68
Q

SBS rotation/side bending dysfunction: concavity

A
  • lateral frontal angle anterior
  • orbit wide
  • frontozygomatic angle increased
  • eyeball protruded
  • zygomatic orbital rim flat
  • symphysis menti away from this side
  • mastoid tip anterolateral
  • mastoid portion posteromedial
  • ear close to head

OS3 Test 1 (7 decks)

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