Cranial Strains - SS Flashcards
What are the midline bones? (5)
- Sphenoid,
- occiput,
- ethmoid (median plate),
- vomer
- sacrum
What are the movement phases of the midline bones?
Flexion and Extension
What are the paired bones?
- Temporals,
- parietals,
- frontals,
- ethmoid (lateral mass),
- nasals,
- lacrimals,
- maxillae,
- palatines,
- zygomae,
- inferior conchae
- mandible
What are the movements of the paired bones?
External and internal rotation phases
Physiologically, flexion occurs in the skull with what accompanying motion?
External rotation. Dr. Ferril advises to remember as “flexternal” rotation
So, what motion is paired with extension?
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)
What are the components of the reciprocal tension membrane?
Falx cerebri
Tentorium cerebelli
In the vault hold, where does your index finger go?
On the greater wing of the sphenoid
In the vault hold, where does your pinky finger go?
lateral angles of the occiput
What is the vault hold used for?
Enables the operator to feel the dysfunction in order to initiate treatment and serves as a starting point for treatment
How is cranial motion at the SBS named?
For the motion of the basi-sphenoid on the basi-occiput, through contact with the greater wing of sphenoiand lateral angles of occiput
What are the movements this lecture was concerned with? (6)
Flexion/Extension
Torsion
Sidebending rotation
Vertical Strain
Lateral Strain
SBS compression
Physiological strains are normal compensatory patterns that happen in response to other motions in the body, except when?
The SBS gets stuck there.
What are examples of physiologic strains?
Flexion/Extension
Torsions
Sidebending rotation
In flexion and extension, around what axes do the sphenoid and occiput rotate?
In what direction, relative to each other?
Parallel Transverse axes
In opposite directions
Flexion includes rotational movement around two transverse axes located at?
- level of foramen magnum
- Body of sphenoid
When SBS flexion occurs how do the following move?
- basiocciput
- basisphenoid
- wings of sphenoid
- occipital squama
- Basiocciput and basisphenoid move cephalad
- Occipital squama and wings of sphenoid move caudally
In extention, the motion is rotational, and occurs aroun two transverse axes located where?
Level of foramen magnum
body of sphenoid
When SBS extension occurs how do the following move?
- basiocciput
- basisphenoid
- wings of sphenoid
- occipital squama
- Basisphenoid and basiocciput move caudad
- occipital squama and wings of sphenoid move cephalad
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?
Extended
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?
Flexed
How do the sphenoid and occiput move in torsion?
Around what axis?
In opposite directions
Around an A-P axis
How do we name torsions?
By the superior greater wing of the sphenoid
In torsions, we name them for the superior greater wing of the sphenoid, which is mirroring the motion of… what?
The basisphenoid
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?
Right SBS torsion
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?
Left SBS torsion
In sidebending rotation, what axes are involved?
Two parallel vertical axes
one a-p axis
In sidebending rotation how do the sphnoied and occiput move around the various axes relative to each other?
Around the parallel vertical axes - they move in opposite directions
Around the A-P axis - in the same direction
How is sidebending rotation named?
For the side of the convexity and inferior motion
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?
Right SBS sidebending and rotation
In the vault hold you find your right index and pinky fingers move superiorly and approximate slightly in comparison to the left. dx?
Left SBS sidebending rotation
What are the non-physiologic strains?
Lateral Strains
Vertical Strains
SBS compression
What axes does movement occur around in lateral strains?
In what direction do the sphenoid and occiput move relative to each other?
In the same direction, around parallel vertical axes
What type of force do lateral strains result in at the SBS?
lateral shearing force
In what manner are lateral strains named?
The direction the basisphenoid moves
What will your fingers form in a lateral strain?
A parallelogram!
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?
Right lateral strain
In the vault hold you find both your index fingers are shifted right and your pinky fingers are shifted left. What is the diagnosis?
Left lateral strain
What axes are involved in a vertical strain?
2 parallel transverse axes (just like in flexion and extension)
In what direction do the sphenoid and occiput rotate in vertical strains?
In the same direction about parallel transverse axes.
In what manner are vertical strains named?
By the direction of the basisphenoid, superior or inferior
In vertical strains, one bone is in flexion while the other is in?
Extension
In the vault hold for a vertical strain, how will the index fingers move relative to the direction of the basisphenoid?
Index fingers will move in the opposite direction to the basisphenoid
In the vault hold you find both index fingers shift inferiorly, and both pinky fingers shift superiorly. What is the diagnosis?
Superior vertical strain
In the vault hold you find both index fingers shift superiorly and both pinky fingers shift inferiorly. What is the diagnosis?
Inferior Vertical Strain
What is SBS compression?
Approximation of the sphenoid and occipital bases as they compress together along the A-P axis
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?
SBS compression
Name some causes of cranial SD. Slides listed 7 specifically, see how many you can get.
- Birth trauma
- Intrauterine position
- Head trauma
- Falls on the buttock
- Surgical trauma
- Somatic dysfunction from other areas of the body
- Viscero-somatic Reflexes
Name two potential traumatic forces that could cause a superior vertical strain.
- Caudal force applied centrally over the anterior-superior frontal bone.
- superior force to the inferior occiput, driving the basiocciput inferiorly
Name three forces that could cause an inferior vertical strain.
- 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.
What is an example of a force that could cause and SBS compression?
-Force directed along the AP axis leading to longitudinal compression of the SBS. May originate at nasion or at opisthion.
What are two examples of forces that could cause a lateral strain?
- 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.
What are two examples of forces that could cause external rotations of the temporal bones?
- 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.
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?
SBS compression
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?
Superior Vertical Strain
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?
Left sidebending rotation
In the vault hold, your index fingers have shifted to the left, your pinky fingers have shifted to the right. Diagnosis?
Right lateral strain
