Cranial Strains - SS

Question 1

What are the midline bones? (5)

Answer 1

1. –Sphenoid,
2. occiput,
3. ethmoid (median plate),
4. vomer
5. sacrum

Question 2

What are the movement phases of the midline bones?

Answer 2

Flexion and Extension

Question 3

What are the paired bones?

Answer 3

1. –Temporals,
2. parietals,
3. frontals,
4. ethmoid (lateral mass),
5. nasals,
6. lacrimals,
7. maxillae,
8. palatines,
9. zygomae,
10. inferior conchae
11. mandible

Question 4

What are the movements of the paired bones?

Answer 4

External and internal rotation phases

Question 5

Physiologically, flexion occurs in the skull with what accompanying motion?

Answer 5

External rotation. Dr. Ferril advises to remember as “flexternal” rotation

Question 6

So, what motion is paired with extension?

Answer 6

Internal rotation

(since this was directly after the card on flexion, you are forbidden from marking this higher that a two on your first trip through)

Question 7

What are the components of the reciprocal tension membrane?

Answer 7

Falx cerebri

Tentorium cerebelli

Question 8

In the vault hold, where does your index finger go?

Answer 8

On the greater wing of the sphenoid

Question 9

In the vault hold, where does your pinky finger go?

Answer 9

lateral angles of the occiput

Question 10

What is the vault hold used for?

Answer 10

Enables the operator to feel the dysfunction in order to initiate treatment and serves as a starting point for treatment

Question 11

How is cranial motion at the SBS named?

Answer 11

For the motion of the basi-sphenoid on the basi-occiput, through contact with the greater wing of sphenoiand lateral angles of occiput

Question 12

What are the movements this lecture was concerned with? (6)

Answer 12

Flexion/Extension

Torsion

Sidebending rotation

Vertical Strain

Lateral Strain

SBS compression

Question 13

Physiological strains are normal compensatory patterns that happen in response to other motions in the body, except when?

Answer 13

The SBS gets stuck there.

Question 14

What are examples of physiologic strains?

Answer 14

Flexion/Extension

Torsions

Sidebending rotation

Question 15

In flexion and extension, around what axes do the sphenoid and occiput rotate?

In what direction, relative to each other?

Answer 15

Parallel Transverse axes

In opposite directions

Question 16

Flexion includes rotational movement around two transverse axes located at?

Answer 16

1. level of foramen magnum
2. Body of sphenoid

Question 17

When SBS flexion occurs how do the following move?

1. basiocciput
2. basisphenoid
3. wings of sphenoid
4. occipital squama

Answer 17

1. Basiocciput and basisphenoid move cephalad
2. Occipital squama and wings of sphenoid move caudally

Question 18

In extention, the motion is rotational, and occurs aroun two transverse axes located where?

Answer 18

Level of foramen magnum

body of sphenoid

Question 19

When SBS extension occurs how do the following move?

1. basiocciput
2. basisphenoid
3. wings of sphenoid
4. occipital squama

Answer 19

1. Basisphenoid and basiocciput move caudad
2. occipital squama and wings of sphenoid move cephalad

Question 20

You place your hands in the vault hold, and find that your index fingers are superior and slightly approximated.

Your pinkies are superior and approximated also.

What is the patients cranial position?

Answer 20

Extended

Question 21

In the vault hold you find your index fingers move inferiorly and spread apart slightly.

Your pinky fingers also move inferiorly and spread apart somewhat.

What is this patients cranial diagnosis?

Answer 21

Flexed

Question 22

How do the sphenoid and occiput move in torsion?

Around what axis?

Answer 22

In opposite directions

Around an A-P axis

Question 23

How do we name torsions?

Answer 23

By the superior greater wing of the sphenoid

Question 24

In torsions, we name them for the superior greater wing of the sphenoid, which is mirroring the motion of… what?

Answer 24

The basisphenoid

Question 25

Placing your hands on the patients head in the vault hold, you find your right index finger moves superiorly in comparison to the left. Your left pinky moves superiorly in comparison to the right! What is the diagnosis?

Answer 25

Right SBS torsion

Question 26

Placing your hands on the patients head in the vault hold, you find your left index finger moves superiorly in comparison to the right. Your left pinky moves inferiorly in comparison to the right! What is the diagnosis?

Answer 26

Left SBS torsion

Question 27

In sidebending rotation, what axes are involved?

Answer 27

Two parallel vertical axes one a-p axis

Question 28

In sidebending rotation how do the sphnoied and occiput move around the various axes relative to each other?

Answer 28

Around the parallel vertical axes - they move in opposite directions Around the A-P axis - in the same direction

Question 29

How is sidebending rotation named?

Answer 29

For the side of the convexity and inferior motion

Question 30

In the vault hold you find your right index finger and pinky fingers move inferiorly and spread apart slightly in comparison to the left. What is the dysfunction?

Answer 30

Right SBS sidebending and rotation

Question 31

In the vault hold you find your right index and pinky fingers move superiorly and approximate slightly in comparison to the left. dx?

Answer 31

Left SBS sidebending rotation

Question 32

What are the non-physiologic strains?

Answer 32

Lateral Strains Vertical Strains SBS compression

Question 33

What axes does movement occur around in lateral strains? In what direction do the sphenoid and occiput move relative to each other?

Answer 33

In the same direction, around parallel vertical axes

Question 34

What type of force do lateral strains result in at the SBS?

Answer 34

lateral shearing force

Question 35

In what manner are lateral strains named?

Answer 35

The direction the basisphenoid moves

Question 36

What will your fingers form in a lateral strain?

Answer 36

A parallelogram!

Question 37

In the vault hold you find that both your index fingers are shifted to the left, and both your pinky fingers are shifted to the right. What is the diagnosis?

Answer 37

Right lateral strain

Question 38

In the vault hold you find both your index fingers are shifted right and your pinky fingers are shifted left. What is the diagnosis?

Answer 38

Left lateral strain

Question 39

What axes are involved in a vertical strain?

Answer 39

2 parallel transverse axes (just like in flexion and extension)

Question 40

In what direction do the sphenoid and occiput rotate in vertical strains?

Answer 40

In the same direction about parallel transverse axes.

Question 41

In what manner are vertical strains named?

Answer 41

By the direction of the basisphenoid, superior or inferior

Question 42

In vertical strains, one bone is in flexion while the other is in?

Answer 42

Extension

Question 43

In the vault hold for a vertical strain, how will the index fingers move relative to the direction of the basisphenoid?

Answer 43

Index fingers will move in the opposite direction to the basisphenoid

Question 44

In the vault hold you find both index fingers shift inferiorly, and both pinky fingers shift superiorly. What is the diagnosis?

Answer 44

Superior vertical strain

Question 45

In the vault hold you find both index fingers shift superiorly and both pinky fingers shift inferiorly. What is the diagnosis?

Answer 45

Inferior Vertical Strain

Question 46

What is SBS compression?

Answer 46

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

Question 47

In the vault hold, you find that the fingers of both hands approximate, and the head feels hard with limited movement in any direction. What is the diagnosis?

Answer 47

SBS compression

Question 48

Name some causes of cranial SD. Slides listed 7 specifically, see how many you can get.

Answer 48

1. –Birth trauma 2. –Intrauterine position 3. –Head trauma 4. –Falls on the buttock 5. –Surgical trauma 6. –Somatic dysfunction from other areas of the body 7. –Viscero-somatic Reflexes

Question 49

Name two potential traumatic forces that could cause a superior vertical strain.

Answer 49

- Caudal force applied centrally over the anterior-superior frontal bone. - superior force to the inferior occiput, driving the basiocciput inferiorly

Question 50

Name three forces that could cause an inferior vertical strain.

Answer 50

- Caudal force transmitted to the basisphenoid such as a caudal force transmitted from bregma. - 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 caudal force transmitted over the bilateral posterior-superior parietal bones or along the posterior sagittal suture.

Question 51

What is an example of a force that could cause and SBS compression?

Answer 51

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

Question 52

What are two examples of forces that could cause a lateral strain?

Answer 52

- Lateral to medial directed force applied over the greater wing of the sphenoid pushing the greater wings to the left or right. (ie a medially directed force to the left greater wings will drive the basisphenoid in the OPPOSITE direction) - Lateral to medial directed force applied over the occiput pushing the posterior aspect of the occiput left or right.

Question 53

What are two examples of forces that could cause external rotations of the temporal bones?

Answer 53

- 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. - 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.

Question 54

™A patient comes in for evaluation after hitting her head on the ice while playing hockey. Osteopathic evaluation reveals minimal motion at the SBS. What is your cranial diagnosis?

Answer 54

SBS compression

Question 55

™A patient comes to you complaining of headache after a box fell on the top of his head, close to the forehead. Osteopathic evaluation reveals both index fingers move inferiorly, both pinky fingers move superiorly. What is the SBS diagnosis?

Answer 55

Superior Vertical Strain

Question 56

™In the vault hold, your right index and pinky fingers are superior to the left, while the index and pinky fingers on the left spread apart and move inferiorly. Diagnosis?

Answer 56

Left sidebending rotation

Question 57

™In the vault hold, your index fingers have shifted to the left, your pinky fingers have shifted to the right. Diagnosis?

Answer 57

Right lateral strain