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OMM M1 CB > E2 > Flashcards

E2 Flashcards

1
Q

What is the root of the mesentery vulnerable to?

A

Increased lumbar lordosis
Omental obesity
Scoliosis

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2
Q

What is the transversus aponeurosis vulnerable to?

A 
Abdominal wall weakness
Weak muscles
Hernias
Stretch from pregnancy
Mesenteric obesity
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3
Q

What is the fascia lata vulnerable to?

A 
Leg length inequality
Pelvic side shift
Instability of knee
Ankle sprain
Arch collapse
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4
Q

What is the tension component of fascia lata?

A

IT band and investing fascia of thigh

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5
Q

What is the compression component of fascia lata?

A

Inominate, femur, tibia, fibula, talus, calcaneus

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6
Q

What is the external mechanism that controls tension in the IT band?

A

Fascia lata: tensor fascia lata and gluteus maximus muscles

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7
Q

How does leg length inequality affect the lower limb and pelvis?

A

It creates pelvic side shift and excessive tension on the IT band

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8
Q

How does ankle sprain affect the IT band?

A

It draws the fibular head inferiorly and posteriorly. If held in this position, it increases tension in the ITB, which will result in pelvic side shift.

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9
Q

What is plantar fascia vulnerable to?

A

Longitudinal arch collapse
Plantar fasciitis
Gait abnormalities

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10
Q

What is the function of the subscapular fascia and how is it unique?

A

Allows motion of the scapula against the rib cage

It is a fascial “joint”

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11
Q

What is Scapulo-Thoracic Syndrome?

A

Inflammation of the fascial joint with scarring and condensation of the fascia, loss of shoulder motion, and scraping or grinding sound as scapula is circumducted

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12
Q

What is subscapular fascia vulnerable to?

A

Abnormal tracking of scapula due to other girdle problems
Distortion of the rib cage
Scoliosis
Kyphosis

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13
Q

What are the compression elements of cranial dura?

A

Ethmoid, frontal, parietal, basisphenoid, and petrous temporal bones

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14
Q

What are the tension elements of cranial dura?

A

Falx cerebri
Tentorium cerebelli
Falx cerebelli

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15
Q

What does damage to cranial dura result in?

A

Alteration of cerebral blood flow and tension on the venous sinuses

Change in shape of cranium with the potential for tension or compressive cranial neuropathies

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16
Q

What are some consequences of pelvic side shift?

A

Excessive tension on iliotibial band, which can cause…

Trochanteric Bursitis (ITB rubbing greater trochanter)
Fibular nerve compression
Premature Osteoarthritis of the Hip Joint on longer leg side
Excessive Pronation of the foot
Abnormal Ankle & Foot Mechanics

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17
Q

What are some examples of spontaneous fascial contractures?

A 
Dupuytren disease (palmar fascia)
Plantar fibromatosis (plantar fascia)
Frozen shoulder (shoulder capsule)
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18
Q

What does fascia contain that enables it to contract?

A

Myofibroblasts (similar to smooth muscle cells)

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19
Q

What types of fibers can be found in innervating fascia?

A 
Primary afferent (sensory)
Peripheral sympathetic efferent (visceromotor)
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20
Q

How is fascia important to muscle function?

A

It allows it to function by creating a surface on which to glide, and also by coalescing with muscles to form tendons and entheses

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21
Q

What structures create a strong connection between tendon and bone?

A

Sharpey’s fibers

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22
Q

What can be found traveling within fascia?

A

Nerves, arteries, veins, lymphatics

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23
Q

What is a clinical correlate relating to psoas fascia?

A

Osteomyelitis of the lumbar spine can spread down this fascia under the inguinal ligament and present as swelling in the groin

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24
Q

What is the primary goal of STT?

A

RELAX hypertonic musculature
STRETCH shortened, fibrotic, and inelastic fascia

These will have a direct effect of improved ROM

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25
Q

What are the secondary effects of STT?

A

INCREASE circulation

IMPROVE tissue nutrition, oxygenation, and removal of metabolic wastes

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26
Q

What are the tertiary effects of STT?

A

STIMULATE stretch reflex in “hypotonic” muscles
DECREASE abnormal somato-visceral and somato-somatic reflexes
POTENTIATE other techniques

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27
Q

How does cervical direct myofascial release alter sympathovagal balance?

A

It shifts it from sympathetic to parasympathetic dominance

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28
Q

What is fascial creep?

A

Heat causes collagen to alter its structure; as this occurs, any pressure will cause it to stretch, or “creep.”

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29
Q

What is soft tissue end-feel?

A

The sensation provided to palpating fingers near the end of the ROM for the tissue being evaluated

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30
Q

What is the end feel for hypertonic musculature?

A

Soft, but firm

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31
Q

What is the end feel for fascial restriction?

A

The end feel is more abrupt than it is for musculature

32
Q

What are direct and indirect techniques?

A

Direct: moving toward restriction
Indirect: moving away from restriction and toward ease of movement

33
Q

What is the difference between STT and myofascial release?

A

STT is direct

MR can be direct or indirect

34
Q

What are the contraindications for STT and DMRT?

A

There are NO absolute contraindications.

But use caution and alter position or style if needed

35
Q

What specific conditions may warrant alteration of STT/DMRT techniques?

A

Ankle sprain or strain
Osteoporosis
Breast implants

36
Q

What style of technique should be used for ankle sprain/strain?

A

Indirect

37
Q

How should techniques be altered for osteoporosis?

A

For osteoporosis in the thoracocostal region:
Prone pressure techniques are contraindicated.
Switch to lateral recumbent techniques.

38
Q

What style of technique should be used for acute injuries? Chronic injuries? Acute excaerbation of chronic injuries?

A

Acute is a buzzword: use indirect.

For chronic, use direct.

39
Q

What are the differences in pressure for STT vs. MR?

A

STT: intermittent, repetitive, rhythmic
MR: sustained

40
Q

What anomalies can occur in any region of the spine?

A 
Block vertebrae
Other failure of segmentation anomalies
Hemi vertebrae
Spina bifida occulta
Hemangioma vertebra
41
Q

At what age is surgical reconfiguration of the spine for anterior vertebral agenesis no longer an option?

A

> 25

42
Q

How does a block vertebra form? Do these patients have a ROM restriction?

A

Failure of segmentation. No ROM restriction, the body adapts to the abnormality.

43
Q

What is typical treatment for a hemivertebra?

A

Surgical excision during early childhood; OMT

44
Q

Why are hemangioma vertebrae usually incidental findings? What can they be treated with?

A

They are rarely symptomatic.

If symptomatic, treat with radiation therapy

45
Q

What is the characteristic appearance of hemangioma vertebra?

A

Striation

46
Q

Which vertebra is subject to a greater number of anomalies than any other bone?

A

L5

47
Q

What other anomaly is generally associated with lumbar anomalies?

A

Skin anomalies. Common ones are hairy nevus (Faun’s beard), pigmented nevus, lipomatous mass, dermal sinus.

48
Q

What are examples of lumbar anomalies?

A 
Facet tropism
Transitional lumbosacral segment
Spina bifida
Low intercrestal line
Diastematomyelia
49
Q

What is facet tropism?

A

Facet joint has turned away from its normal anatomic position

50
Q

What is the most common anomaly in the lumbar region?

A

Zygapophyseal tropism

51
Q

What is the most common facet tropism?

A

One or both facet joints at L5/S1 turn toward coronal plane

52
Q

What is occult spina bifida?

A

“Hidden” spina bifida. If the spinous process is not there for the supraspinous lilgament to attach to, then the ligament itself may be congenitally absent at that segment.

53
Q

What is diastematomyelia?

A

Cleft spinal cord - cord is split in two by a mass of fibrous tissue or bone attached to the vertebral body anteriorly and to the lamina or dura posteriorly

54
Q

What is the most common location of diastematomyelia?

A

Lumbar spine, but has been reported as high as T3

55
Q

What are the symptoms of diastematomyelia?

A

Progressive neurologic deficits in the LEs

Child fails to walk normally, or starts normally and then develops a gait disturbance

56
Q

What are the physical findings of diastematomyelia?

A

Congenital deformities of one or both lower extremities
Muscle weakness, atrophy, or even paralysis of the thigh/calf muscles
Urinary incontinence / poor bowel control
Skin ulcerations on the feet

STRONG INDICATOR: CLUB FOOT

57
Q

What is the treatment for diastematomyelia?

A

Surgical repair

58
Q

What are some examples of cervical anomalies?

A 
Swan neck deformity
Transitional cranio-cervical segment
Cervical ribs
Klippel-Feil syndrome
Syringomyelia
Torticollis
59
Q

What are associated symptoms of cervical ribs?

A

There are none. Symptoms are usually a result of postural abnormalities associated with cervical ribs, such as acquired kyphosis.

60
Q

What type of treatment is best avoided with cervical ribs?

A

Direct HVLA

61
Q

Klippel-Feil syndrome

A

Multiple cervical vertebral anomalies (fusions) lead to pterygium colli (webbed neck) with low hairline, very limited ROM, hemivertebrae common

62
Q

What commonly accompanies Klippel-Feil?

A

Sprengel Deformity – high riding scapula

Fused ribs and other thoracic anomalies

63
Q

What is the telltale sign of a transitional lumbosacral segment?

A

Batwing/butterfly vertebra

64
Q

Thoracic outlet syndrome is a cause for concern with what type of congenital anomaly?

A

Cervical ribs

65
Q

What syndrome is associated with numerous vertebral anomalies, which are often the “tip of the iceberg”?

A

Klippel-Feil

66
Q

Hypoplasia or absence of the dens can occur in what condition?

A

Achondroplasia

67
Q

Which somatic dysfunctions can cause increased lordosis?

A 
Cervical extended segments
Thoracic flexed segments
Lumbar extended segments
Anterior inominate rotation
Sacral flexed dysfunctions:
--Bilaterally flexed
--Unilaterally flexed
--Anterior sacral torsion
68
Q

Lateral mid-gravity line

A

Should be straight between L3 and sacral promontory

69
Q

Fergusen’s angle

A

Normal: 30-40 degrees

70
Q

Mitchell’s angle

A

125 to 145 degrees

71
Q

Cobb angle

A

aka lumbosacral lordotic angle

From superior endplate of S-1 to superior endplate of L-2
Normal = 40 to 60 degrees

From superior endplate of L2 to the inferior endplate of L5
Normal = 35 to 55 degrees

72
Q

What is lordosis?

A

An abnormal extension deformity of the spine

73
Q

Colloquial names for increased lumbar lordosis

A

Hollow back
Sway back
Saddle back

74
Q

What is Baastrup syndrome?

A

Kissing spines. Approximation of spinous processes caused by increased vertebral lordosis

75
Q

Rickets

A

Vitamin D deficiency causing deformity of the lumbar vertebrae

76
Q

Somatic dysfunctions that can decrease lumbar lordosis

A 
Cervical Flexed Segments
Thoracic Extended Segments
Lumbar  Flexed Segments
Posterior Innominate Rotation
Sacral Extended Dysfunctions:
Bilaterally Extended Sacrum
Unilaterally Extended Sacrum
Posterior Sacral Torsion
77
Q

Etiologies of decreased lumbar lordosis

A 
Lumbar Sprain & Strain
Acute Lumbar Disc Herniation
Lumbar Spondylosis
Osteoarthritis of the spine
Ankylosing Spondylitis
Psoas Contracture

OMM M1 CB (6 decks)

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