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OMM M1T3 > E2 > Flashcards

E2 Flashcards

1
Q

Axis is located anteriorly at the level of S2, near the junction of the long and short arms of the SI joint

A

Middle transverse

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2
Q

Axis on which the sacrum flexes and extends in response to truncal motion

A

Middle transverse

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3
Q

What is the normal motion of the middle transverse axis?

A

Slight truncal F/E –> sacrum flexes and extends with the spine

Further flexion (lumbar lordosis begins to reverse) –> sacrum extends

Further extension –> sacrum flexes

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4
Q

Who demonstrated the mobility of the sacrum on the middle transverse axis radiographically?

A

Kottke in 1962

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5
Q

Who demonstrated the mobility of the sacrum on the superior transverse axis radiographically?

A

Pruzzo in 1971

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6
Q

This axis is located in the posterior superior sacroiliac ligaments, about the level of S2

A

Superior transverse

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7
Q

Axis the sacrum moves upon with ventilation

A

Superior transverse

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8
Q

What is the normal movement of the superior transverse axis?

A

Inhalation –> extension
Exhalation –> flexion
Cranial base flexion –> extension
Cranial base extension –> flexion

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9
Q

Axis upon which motion of the sacrum occurs, synchronous with cranial movement during the cranial rhythmic impulse cycle

A

Superior transverse

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10
Q

Axis at the level of the ILAs

A

Inferior transverse

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11
Q

Axis on which the inominates rotate during the gait cycle

A

Inferior transverse

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12
Q

What are the oblique axes named for?

A

Their superior pole

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13
Q

This is actually an axis of pelvic rotation during the gait cycle, but it appears to be located posteriorly in the vicinity of the sacrum

A

Vertical

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14
Q

Sphinx test –> sacral sulci become more symmetric

A

Anterior dysfunction

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15
Q

What is a torsion?

A

Two parts of an object rotating in opposite directions about a single axis

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16
Q

What is the normal torsional mechanism of L5?

A

L5 is tightly anchored to the iliac crests by iliolumbar ligaments, so L5 moves with the ilia. When you compare L5 to the position of the sacral base, it appears that the two have rotated in opposite directions about a vertical axis.

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17
Q

What is a compensated L5?

A

Normal torsional mechanism of L5

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18
Q

What is a non-compensated L5?

A

When L5 rotates with the sacrum rather than the ilia

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19
Q

What determines the direction of sacral rotation?

A

Motion of the anterior most point on the sacral promontory

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20
Q

What causes an anterior sacral torsion?

A
  1. Truncal sidebending and rotational forces in extension coming down from the lumbar spine
  2. Exaggeration of the gait cycle
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21
Q

What are the symptoms of anterior sacral torsion?

A

Backache, buttock ache

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22
Q

What causes a posterior sacral torsion?

A

Truncal sidebending and rotational forces in flexion coming down from the lumbar spine

(NOT caused by gait cycle)

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23
Q

What are the symptoms of a posterior sacral torsion?

A

Intense low back and hip pain, piriformis pain, patient often walks with a limp

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24
Q

Extra deep sacral sulci

Increased lumbar lordosis

A

Bilaterally flexed sacrum

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25
Q

Really shallow sacral sulci
ILAs very far anterior
Flattening of the lumbar lordosis

A

Bilaterally extended sacrum

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26
Q

What can cause sacral dysfunctions?

A

HIPLSIT dysfunctions

Hip muscles
Inominate
Pubic symphysis
Lumbar dysfunction
Sacroiliac 
Thoracic
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27
Q

What is spondylolysis/listhesis?

A

A forward slippage of one vertebra on the segment below it

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28
Q

Where does spondylolysis most commonly occur?

A

L5/S1

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29
Q

What are the congenital predispositions for spondylolysis?

A

Spina bifida occulta
Genetically weak/thin parts interarticularis
African American heritage
Sacralization of L5

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30
Q

What condition disproportionately affects African Americans?

A

Degenerative spondylolisthesis (usually at L4)

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31
Q

A lytic defect in the pars interarticularis predisposes a person to what condition?

A

Spondylolysis

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32
Q

What has been implicated as a postural fault responsible for spondylolysis/listhesis?

A

Hyperlordosis

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33
Q

Spondylolysis requires…

A

Upright posture and lumbar lordosis

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34
Q

When does spondylolysis develop?

A

Ages 6 to 8, but presents around age 30

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35
Q

What is the main symptom of spondylolysis?

A

Persistent low back pain for more than four weeks

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36
Q

What condition may also be present with spondylolysis?

A

Sciatica

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37
Q

Increased turbulence in spondylolisthesis indicates increased risk for developing…

A

Abdominal aortic aneurysm

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38
Q

What are the physical findings of spondylolysis?

A 
Laterally flared ilia
Back and abdomen thrust forward
Short waist with transverse abdominal crease at the level of the umbilicus
Flattened, heart-shaped buttocks
Gait changes
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39
Q

What indicates spondylolisthesis greater than Grade II?

A

Stiff-legged, short stride / waddling gait in which the pelvis rotates with each step

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40
Q

Palpation findings for spondylolisthesis

A

Segmental hypermobility
Anteriorly located spinous process (step off)
Rocking of the sacrum into flexion INCREASES symptoms
Paraspinal mucles are boggy/slow to relax

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41
Q

Cauda equina involvement in spondylolisthesis warrants what action?

A

EMG/NCV evaluation

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42
Q

What imaging is essential in diagnosis spondylolysis/listhesis?

A

Standing lateral x-rays of the lumbar spine

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43
Q

Isthmic pars interarticularis defect occurs at what spinal levels?

A

Almost exclusively at L5

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44
Q

Congenital defect in neural arch of L5 or upper sacrum –> insufficiency of lumbosacral facets –> plane of facet joints approaches horizontal

A

Dysplastic spondylolysis

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45
Q

Lytic fatigue fracture of the pars
Most common form under age 50
Rapid progression from ages 9-15
Stress fracture which does not heal

A

Dysplastic spondylolysis, subtype A

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46
Q

Elongated but intact pars

Probably due to repetitive microfracturing with elongation occurring during healing

A

Dysplastic spondyloylsis, subtype B

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47
Q

Acutely fractured pars
History of severe trauma
May heal with immobilization

A

Dysplastic spondylolysis, subtype C

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48
Q

Degenerative spondylolysis accounts for what percentage of all cases?

A

25%

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49
Q

Osteoarthritic changes at apophyseal joints due to long standing segmental instability

A

Degenerative spondylolysis

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50
Q

At what spinal level does degenerative spondylolysis most commonly occur?

A

L4 due to sacralization of L5

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51
Q

Possible causes of pathologic spondylolysis

A 
Arthrogryposis
Kuskokwim disease
Osteogenesis imperfecta
Osteitis deformans
Tuberculous osteomyelitis
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52
Q

Congenital curved joints –> potential for lumbosacral agenesis
Multiple joint contractures
UEs adducted and internally rotated
Diamond-shaped LEs
Skin is very smooth with no skin creases at joints

A

Arthrogryposis

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53
Q

Only occurs in native Eskimos living in a certain region of Alaska
Genetic autosomal recessive disorder
Similar to arthrogryposis

A

Kuskokwim disease

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54
Q

What are the Meyerding grades of spondylolisthesis?

A

Grade I: 0-25% slip
Grade II: 26-50% slip
Grade III: 51-75% slip
Grade IV: 76-100% slip

55
Q

What is the Napoleon Hat Sign?

A

Seen in the AP lumbar x-ray in the presence of severe (Grades III-IV) spondylolisthesis

56
Q

What is the effectiveness of treatment in spondylolisthesis?

A

Works in Grades I and II
Iffy in Grade III
Usually Grades III and IV require surgical fusion

57
Q

What shoes can spondylolisthesis patients not wear?

A

High heels

58
Q

What activities should people with spondylolisthesis avoid?

A

Heavy lifting
Contact sports
Gymnastics
Diving

59
Q

How long before exercise affects spondylolisthesis?

A

8-12 weeks

60
Q

What type of exercises should be performed for spondylolisthesis?

A

Williams Flexion Exercises

61
Q

What are the goals in manipulation of spondylolisthesis patients?

A
  1. Normalize lumbar lordosis
  2. Restore near normal motion to all areas related to the spondylolisthetic segment
  3. Stretch tight hamstrings
  4. Improve respiratory motion of diaphragm and pelvic floor
62
Q

OMT for spondylolisthesis

A

Any technique which does not increase lumbar lordosis or extend lumbosacral junctions

63
Q

What does a levitor do?

A
  1. Exerts pressure between the pubic symphysis and sacral apex
  2. Transfers weight bearing off the posterior elements forward onto the vertebral bodies
  3. By reducing the chronic strain on these tissues, symptomatic relief is obtained
64
Q

No evidence that this treatment is effective in managing chronic spondylolisthesis

A

Bracing

65
Q

Which medications are not helpful in treating spondylolisthesis?

A

Muscle relaxants

66
Q

What treatment is helpful in cases of spondylolisthesis with concomitant ligamentous laxity?

A

Prolotherapy: Injection of proliferant agents into the fibro-osseous junction of the iliolumbar ligaments

67
Q

When is fusion surgery indicated in spondylolisthesis?

A
  1. Neurologic deficits
  2. Grade III+ displacement
  3. Progression of spondylolisthesis as an adult
  4. Significant postural deformity
  5. Symptomatic Grades 1-2 unrelieved by good conservative care
68
Q

A 69-year-old male exhibiting flexed posture with head tilted forward, loss of muscle strength, and increasing episodes of tripping and falling would also be expected to show which of the following signs?

a. decreased muscle tightness
b. extension deformities
c. flaccid muscles
d. increased kyphosis of the lumbar spine
e. slow shuffling gait

A

E

69
Q

A 42-year-old female presents to your office complaining of increasing inability to maintain balance. Your physical exam reveals tremors during movement, postural abnormalities, and ataxia. She most likely has a disorder in which of the following?

a. Basal Ganglia
b. Brainstem
c. Cerebellum
d. Cerebral Cortex
e. Spinal Cord

A

C

70
Q

You diagnose a 61-year-old female with stress incontinence. She most likely has somatic dysfunction of which of the following?

a. L3
b. L4
c. S1
d. S3
e. S5

A

D

71
Q

A 30-year-old right-handed female presents to your office with a 7-month history of fatigue and weight loss. For the past 10 weeks, she had noted progressive difficulty walking, slurring of speech, and weakness in both upper extremities. She reported difficulty combing her hair, writing, and climbing the stairs. Magnetic resonance imaging reveals diffuse plaques without evidence of hemorrhage or neoplasm. Which of the following BEST describes the most likely prognosis of this patient’s condition?

a. Anticholinesterase agents control progression of the disease
b. Levodopa will alleviate symptoms of bradykinesia and rigidity
c. The disease is progressive
d. The disease is remitting with periods of relapse
e. The disease is terminal due to metastatic process

A

C

72
Q

You enter the exam room in your office to evaluate a 45-year-old male and observe that he has tremors while sitting in the chair. Your physical exam reveals that his right arm moves forward when he steps forward on his right foot, his hand and arm muscles are rigid, and he cannot stand up straight. He most likely has a disorder in which of the following?

a. Basal Ganglia
b. Brainstem
c. Cerebellum
d. Cerebral Cortex
e. Spinal Cord

A

A

73
Q

A 19-year-old male presents to your office complaining pain, numbness, and tingling in his legs, radiating from his hips down to his toes, bilaterally, since “horseplay” at a fraternity party last night. He states that he is having incontinence of bowel and bladder and admits to impotence last night. Which of the following Osteopathic Manipulative Treatment (OMT) techniques would be indicated for this patient?

a. OMT is contraindicated until further evaluation by neurosurgery has ruled-out Cauda Equina Syndrome
b. Using gentle techniques
c. Using High-Velocity/Low Amplitude (HVLA)
d. Using Muscle Energy techniques
e. Using techniques that will decrease venous flow, but increase lymphatic return

A

A

74
Q

Spondylo = ____

A

Vertebral

75
Q

Which muscles/ligaments typically contain trigger points in spondylolisthesis patients?

A 
QL
Glutes
Piriformis
Iliolumbar ligaments
Posterior sacroiliac ligaments
76
Q

What position must be maintained during Williams Flexion Exercises?

A

Flattened lumbar lordosis

77
Q

What are some examples of Williams Flexion Exercises?

A 
Pelvic tilt
Knee to chest
Bent knee sit ups
Seated forward bending
Straight leg raises
78
Q

Which OMT should not be used for spondylolisthesis?

A

Any prone techniques

79
Q

Conservative treatment is successful in what percentage of adolescents with spondylolisthesis?

A

50%

80
Q

The presence of Napoleon’s Hat Sign indicates which grade of spondylolisthesis?

A

Grade III

81
Q

A 68% spondylolisthesis by Taillard method is equivalent to which of the following Meyerding grades?

A

Grade III

82
Q

A 39-year-old woman with an L-5 spondylolisthesis due to a pars interarticularis defect presents to your office with increasing low back pain. This pain is most likely being generated by which ligament?

A

Iliolumbar

83
Q

Of the seven axes of sacral motion, on which does anterior sacral torsion occur during the gait cycle?

A

Oblique

84
Q

What is not considered a cause of traumatic spondylolisthesis?

A

Pars interarticularis fracture

85
Q

Which muscle is the most likely source of back pain in spondylolisthesis patients?

A

QL

86
Q

Dysmenorrhea is associated with which dysfunctions?

A

Bilaterally flexed sacrum

Anteriorly translated sacrum

87
Q

A posterior torsion on a left oblique axis is also called….

A

Right on left sacral torsion

88
Q

A grade II spondylolisthesis patient would most likely develop trigger points in which ligament?

A

Iliolumbar

89
Q

Which conditions might cause pathologic spondylolisthesis?

A

Dysplasia of the posterior elements of L5 or S1

Osteogenesis imperfecta

90
Q

What kind of force is used during muscle energy for torsions?

A

Maximal sustainable force

91
Q

A 19-year-old is discovered to have a Grade II spondylolisthesis. Which type does he most likely have?

A

Isthmic

92
Q

Spondylolisthesis patients have increased/decreased PIs for their age.

A

Increased

93
Q

The sacral sulcus on the side of dysfunction is shallow. Which dysfunction is likely present?

A

Unilateral extended sacrum

94
Q

Which side of the table do you stand on to treat unilateral dysfunctions?

A

Opposite the side of dysfunction

95
Q

Anterior sacral torsion treatment

A

Modified Sims; lie on side of axis

96
Q

Posterior sacral torsion treatment

A

Lateral recumbent; lie on side of axis

97
Q

Bilateral flexed sacrum treatment

A

Halloween cat maneuver

98
Q

Bilateral extended sacrum treatment

A

Hyperextension maneuver

99
Q

Anterior sacral torsions indicate what type of dysfunction at L5?

A

Type I (opposite)

100
Q

Posterior sacral torsions indicate what type of dysfunction at L5?

A

Type II (same)

101
Q

Vertical axis motion

A

Rotation

102
Q

A/P axis motion

A

Sidebending

103
Q

Oblique axes motion

A

Torsion (right and left)

104
Q

Transverse axes motion

A

Flexion/extension

105
Q

What is the motion of the sacrum during the gait cycle?

A

Normal motion about oblique axes occurs during the cycle. As leg comes forward, sacral sulcus on that side swings forward and the contralateral ILA moves posteriorly and inferiorly.

106
Q

Dysfunction involving the AP axis is always _____.

A

traumatic

107
Q

At age 20, the prevalence of spondylolisthesis in the population is about ___%.

A

5

108
Q

PI for spondylolisthesis

A

0.8-1.15

109
Q

What PE finding indicates spondylolisthesis greater than grade II?

A

Gait changes: stiff-legged, short stride, waddling gait

110
Q

When would you do a SSEP/DEP?

A

Only if there are sensory deficits and the EMG/NCV is normal

111
Q

What is the etiology of traumatic spondylolisthesis?

A

Fractures in other parts of the vertebrae other than pars interarticularis

112
Q

Treatment for traumatic spondylolisthesis

A

Heals with immobilization

113
Q

What is the success rate of conservative treatment in adult spondylolisthesis patients?

A

85-90%

114
Q

Positive spring test indicates

A

Posterior torsion or unilateral extension

115
Q

Where is the hand placed for unilateral flexed muscle energy?

A

On the dysfunctional ILA

116
Q

Where is the hand placed for unilateral extended muscle energy?

A

On the dysfunctional sacral sulcus

117
Q

Tenderpoint on superior surface of iliopectineal (iliopubic) eminence

A

Low ilium/psoas minor

118
Q

Tenderpoint on lateral aspect of the pubic tubercle

A

Inguinal/pectineus

119
Q

Tenderpoint on superior medial aspect of PSIS between L5 spinous process and PSIS

A

Upper pole L5

120
Q

Tenderpoint on lateral aspect of ILA

A

High ilium/coccygeus

121
Q

Tenderpoint medial to PSIS at level of S1

A

PS1 bilateral

122
Q

Tenderpoint midline on sacrum

A

PS2-PS4

123
Q

Tenderpoint just medial and superior to ILA

A

PS5 bilateral

124
Q

Counterstrain: low ilium/psoas minor

A

Supine
Stand on side of point
Flex hip

125
Q

Counterstrain: inguinal/pectineus

A 
Supine
Stand on side of point
Flex hips and knees and rest on thigh
Place good leg over bad leg
Pull patient's ipsilateral lower leg internally to induce adduction and internal rotation of hip
126
Q

Counterstrain: upper pole L5

A

Prone
Stand on opposite side of point
Extend and adduct hip
Rotation if needed

127
Q

Counterstrain: high ilium/coccygeus

A

Prone
Stand on opposite side of point
Extend and adduct hip to cross over contralateral leg

128
Q

Counterstrain: PS1

A

Prone
Stand on side of point
Press down on ILA opposite of tenderpoint

129
Q

Counterstrain: PS2

A

Prone
Stand on side of point
Press down on apex of sacrum –> extension

130
Q

Counterstrain: PS3

A

Prone
Stand on side of point
May require flexion or extension

131
Q

Counterstrain: PS4

A

Prone
Stand on side of point
Press down on base of sacrum –> flexion

132
Q

Counterstrain: PS5

A

Prone
Stand on side of point
Press down on sacral base opposite the point

133
Q

Counterstrain: lower pole L5

A

Prone
Sit on side of point
Hip flexed 90 degrees
Slight internal rotation and adduction

134
Q

Tenderpoint on the ilium just inferior to PSIS pressing superiorly

A

Lower pole L5

OMM M1T3 (2 decks)

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