Exam 1 Flashcards
1
Q
For any disease state, the patient must be ____ before performing OMT
New onset of ____ or ____ is not a time for OMT
A
Stable
Chest pain
SOB
2
Q
Somatic dysfunction can occur anywhere in the body at:
____
____
____
A
Sympathetic levels
Parasympathetic levels
Some (not autonomic related)
3
Q
Viscerosomatic reflexes occur at
____
____
A
Sympathetic levels
Parasympathetic levels
4
Q
Facilitated segments ONLY occur at ____
A
Sympathetics
5
Q
Treatment for temporal arteritis is ____
A
Steroids
6
Q
Sometimes muscle hypertonicity, contraction, spasm can be caused by ____ of what is overlaying the muscle
A
Direct irritation
7
Q
If there is a renal lithiasis, it may cause the ____ to become hypertonic and you would have a positive ____ test
A
Psoas
Thomas
8
Q
If there is appendicitis, it may cause the ____ to become hypertonic and you would have a positive ____ test
A
Psoas
Thomas
9
Q
If there are inflamed lymph nodes, this may make the muscle they are touching to become hypertonic such as ____
A
SCM
10
Q
After obtaining a history, you perform a physical exam: ____ is one of the first things you do in a physical exam
A
Observation
11
Q
A reversible dextroscoliosis or levoscoliosis means there is no ____ component present so it follows Fryette type ___ mechanics
A dextroscoliosis would have the convex side pointing to the ____, therefore indicating a ____ pattern for the vertebrate
A
Sagittal
1
Right
NSLRR
12
Q
A left lateral convexity means the vertebrae are sidebent ____
A right lateral convexity means the vertebrae are sidebent ____
A
Right
Left
13
Q
When treating a group dysfunction with OMT, go for the ____ of the group curve
A
Apex
14
Q
Type II dysfunction would usually occur at the ____ of the group curve. However, reversible dextro/levoscoliosis that do not have a ____ component and would not have a type ____ mechanics present
A
Apex
Sagittal
II
15
Q
The body is a unit; the person is a unit of mind, body, and spirit
I.e. gastric ulcer causes thoracic tissue texture changes
A
Principle 1
16
Q
The body is capable of self-regulation, self-healing and health maintenance
I.e. healed fracture
A
Principle 2
17
Q
Structure and function are reciprocally interrelated
A
Principle 3
18
Q
Rational treatment is based upon an understanding of the basic principles of body unity, self-regulation, and the inter-relationship of structure and function
A
Principle 4
19
Q
Anatomy of muscles, spine, extremities; posture, motion
OMT directed toward normalizing mechanical somatic dysfunction, structural integrity, physiological function, homeostasis
A
Biomechanical (structural, postural)
20
Q
Emphasizes CNS, PNS, and ANS that control, coordinate and integrate body functions
Proprioceptive and muscle imbalances, facilitation, nerve compression disorders, autonomic reflex, and visceral dysfunctions, brain/CNS dysfunctions
A
Neurological
21
Q
Emphasizes pulmonary, circulatory, and fluid (lymphatic, CSF) systems
Lymphatic techniques
A
Respiratory/Circulatory
22
Q
Regulates through metabolic processes
A
Metabolic/Nutritional
23
Q
Focuses on mental, emotional, social, and spiritual dimensions related to health and disease
A
Behavioral (Psychobehavioral)
24
Q
Localized somatic stimuli producing patterns of reflex response in segmentally related somatic structures
I.e. rib somatic dysfunction from an innominate dysfunction
A
Somatosomatic reflex
25
Localized somatic stimulation producing patterns of reflex response in segmentally related visceral structures
I.e. triggering an asthmatic attack when working on thoracic spine
Somatovisceral reflex
26
Localized visceral stimuli producing patterns of reflex response in segmentally related somatic structures
I.e. gallbladder disease affecting musculature
Viscerosomatic reflex
27
Localized visceral stimuli producing patterns of reflex response in segmentally related visceral structures
I.e. MI and vomiting
Viscerovisceral reflex
28
____ ganglionic sympathetic fibers lead to tissue texture changes such as hypertonicity, moisture, erythema, etc
Post
29
____ of the spinal cord is where somatic and visceral afferent nerves synapse giving viscerosomatic reflex
Dorsal horn
30
Sharp and severe localized pain
Warm, moist, sweaty skin
Boggy, edematous tissue
Erythematous
Local increase in muscle tone, contraction, spasm, increased muscle spindle firing
Normal or sluggish ROM
May be minimal or no somatovisceral effect
Acute somatic dysfunction
31
```
Dull, achy, diffuse pain
Cool, smooth, dry skin
Possible atrophy
Fibrotic, ropy feeling tissue
Pale/skin pallor
Decreased muscle tone, contracted muscles, sometimes flaccid
Restricted ROM
Somatovisceral effects are more often present
```
Chronic somatic dysfunction
32
Orientation of superior facets:
Cervical:
Thoracic:
Lumbar:
BUM
BUL
BM
33
Orientation of inferior facets
Cervical:
Thoracic:
Lumbar:
AIL
AIM
AL
34
When side-bending is attempted from neutral position, rotation of vertebral bodies follows to the opposite direction
Typically a group of vertebrae
No sagittal component
Side-bending precedes rotation
Side-bending occurs towards the concavity of the curve
Rotation occurs towards the convexity of the curve
Fryette Law 1
| Type I dysfunction
35
When side-bending is attempted from non-neutral position, rotation must precede side-bending to the same side
Typically applies to a single vertebra
Occurs on a sagittal component
Rotation precedes side-bending
Rotation of the vertebra occurs into the concavity of the curve
May be describes as a traumatic injury
Fryette Law 2
| Type II dysfunction
36
If ____ treatment used: exaggerate/augment the dysfunction
| If ____ treatment used: engage the barrier/reverse the dysfunction
Indirect
| Direct
37
SD is exaggerated or augmented
SD is taken the way it likes to go
Restrictive barrier is disengaged
Dysfunction is taken into position of injury
Uses inherent forces
Uses a compressive, tractional, or torsional component
Indirect technique
38
SD is taken the way it does not like to go
Restrictive barrier is engaged
Uses external forces
Direct technique
39
```
Myofascial release
Soft tissue
Articulatory
ME
HVLA
Springing
Cranial
Still technique (ending position)
```
Examples of direct techniques
40
Muscle Energy: ____
| Patient is instructed to gently push AWAY from the barrier
Postisometric relaxation
41
Muscle Energy: ____
| Patient is instructed to gently push TOWARDS the barrier
Reciprocal inhibition
42
A longitudinal or parallel traction technique in which the origin and insertion of the myofascial structures being treated are longitudinally separated
Stretching
43
A perpendicular traction technique in which a rhythmic, lateral stretching of a myofascial structure, where the origin and insertion are help stationary and the central portion of the structure is stretched like a bowstring
Kneading
44
A deep inhibitory pressure, which is a sustained deep pressure over a hypertonic myofascial structure
Inhibition
45
Gently stroking of congested tissue used to encourage lymphatic flow
Effleurage
46
Involves pinching or tweaking one layer and lifting it or twisting it away from the deeper areas
Petrissage
47
Striking the belly of a muscle with the hypothenar edge of the open hand in rapid succession in order to decrease it's tone and arterial perfusion. A hammering chopping percussion of tissues to break adhesions and/or encourage bronchial secretion
Tapotement
48
```
Counterstrain
FPR
BLT
Functional technique
Myofascial release
Cranial
Still technique (initial position)
```
Examples of indirect techniques
49
Root C4
Sensation:
Motor:
Reflex:
Shoulder
None
None
50
Root C5
Sensation:
Motor:
Reflex:
Lateral elbow
Biceps
Biceps
51
Root C6
Sensation:
Motor:
Reflex:
Thumb, index finger
Wrist extensors
Brachioradialis
52
Root C7
Sensation:
Motor:
Reflex:
Mid finger
Triceps
Triceps
53
Root C8
Sensation:
Motor:
Reflex:
Ring finger, pinky
Wrist flexors
None
54
Root T1
Sensation:
Motor:
Reflex:
Medial elbow
Interossi
None
55
Head and Neck (Sympathetics)
T1-T4
56
Heart (Sympathetics)
T1/T2-T5/T6
57
Respiratory (Sympathetics)
T1/T2-T6/T7
58
Esophagus (Sympathetics)
T2-T8
59
Upper GI Tract (Sympathetics)
| Stomach, Liver, Gallbladder, Spleen, Pancreas, Duodenum
T5-T9
60
Middle GI Tract (Sympathetics)
| Pancreas, Duodenum, Jejunum, Ileum, Ascending Colon, Right Transverse Colon, Kidney, Upper Ureter, Gonads
T10-T11
61
Lower GI Tract (Sympathetics)
| Left Transverse Colon, Descending Colon, Sigmoid Colon, Rectum, Prostate, Bladder, Lower Ureter
T12-L2
62
Appendix (Sympathetics)
T10-T11
63
Kidneys (Sympathetics)
T10-T11
64
Adrenal Medulla (Sympathetics)
T10
65
Upper Ureters (Sympathetics)
T10-T11
66
Lower Ureters (Sympathetics)
T12-L1
67
Bladder (Sympathetics)
T12-L2
68
Gonads (Sympathetics)
T10-T11
69
Uterus and Cervix (Sympathetics)
T10-L2
70
Erectile Tissue (Sympathetics)
T11-L2
71
Prostate (Sympathetics)
T12-L2
72
Arms (Sympathetics)
T2-T8
73
Legs (Sympathetics)
T11-L2
74
Parasympathetic Levels
Trachea, esophagus, heart, lungs, liver, gallbladder, stomach, pancreas, spleen, kidneys, proximal ureter, small intestine, ascending colon, and transverse colon up to the splenic flexure
Vagus Nerve (OA, AA, C2)
75
Parasympathetic Levels
Distal to the splenic flexure of the transverse colon, descending colon, sigmoid colon, reproductive organs, and external genitalia
S2-S4
76
Parasympathetic Levels
| Variations: Ovaries and Testes
Vagus Nerve
| S2-S4
77
Sympathetic Pre-Ganglionics T5-L2
```
Greater splanchnic (T5-T9)
Lesser splanchnic (T10-T11)
Least splanchnic (T12)
Lumbar splanchnic (L1-L2)
```
78
```
Celiac Ganglionic (T5-T9) Post-Ganglionic to:
(7 organs)
```
```
Distal esophagus
Stomach (epigastric)
Liver
Gallbladder (cholecystitis)
Spleen
Portions of pancreas
Proximal duodenum (foregut)
```
79
Superior Mesenteric Ganglion (T10-T11) Post-Ganglionic to:
| 10 organs
```
Portions of pancreas
Duodenum
Jejunum
Ileum
Ascending colon
Proximal 2/3 of transverse colon (midgut)
Adrenals
Gonads
Kidneys
Upper 1/2 ureter
```
80
Inferior Mesenteric Ganglion (T12-L2) Post-Ganglionic to:
| 8 organs
```
Distal 1/3 transverse colon
Descending colon
Sigmoid
Rectum (hindgut)
Lower 1/2 ureter
Bladder
Prostate
Genitalia
```
81
Greater Splanchnic Nerve (T5-9) synapses at ____ ganglion
```
Synapses at the celiac ganglion
Stomach
Liver
Gallbladder
Pancreas
Parts of duodenum
```
82
Lesser Splanchnic Nerve (T10-T11) synapses at ____ ganglion
Synapses at the superior mesenteric ganglion
| Small intestines and right colon (appendix is found here)
83
Least Splanchnic Nerve (T12) and Lumbar Splanchnic (L1-L2) synapses at ____ ganglion
Synapses at the inferior mesenteric ganglion
| Innervates the left colon and pelvic organs
84
Sympathetic nerve supple to the head and neck
T1-T4
It forms the cervical ganglia (inferior, middle, and superior cervical ganglia), which affects the mid to lower cervical spine
From there, it contributes to other collateral ganglion that govern the sympathetic innervation to the head
85
Increased sympathetic activity
```
Increased goblet cells
Increased thick, sticky secretions
Dries the mucous membranes
Pupillary dilation
Decreased lymphatic/circulatory drainage
Impaired immune response
Tinnitus
Increased intraocular pressure
```
86
Anterior Chapman Reflex Point
| Liver
Anterior: 5th intercostal space near sternum on the right
87
Anterior Chapman Reflex Point
| Stomach (Acid)
Anterior: 5th intercostal space near sternum on the left
| Think ulcers/NSAIDs use/steroid use
88
Anterior Chapman Reflex Point
| Liver and gallbladder (Cholecystitis)
Anterior: 6th intercostal space near sternum on the right
89
Anterior Chapman Reflex Point
| Stomach (Peristalsis)
Anterior: 6th intercostal space near sternum on the left
| Think of emptying time
90
Anterior Chapman Reflex Point
| Pancreas (Amylase/Lipase/Blood Glucose)
Anterior: 7th intercostal space near sternum on the right
91
Anterior Chapman Reflex Point
| Spleen
Anterior: 7th intercostal space near sternum on the left
92
Anterior Chapman Reflex Point
| Appendix
Anterior: Tip of the right 12th rib
93
Chapman Reflexes
5th IC space
Right:
Left:
Right: Liver
Left: Stomach acid (gastritis/NSAID use)
94
Chapman Reflexes
6th IC space
Right:
Left:
Right: Liver, gallbladder (cholecystitis)
Left: Stomach peristalsis (may have delayed stomach emptying time, food may not pass quickly through system)
95
Chapman Reflexes
7th IC space
Right:
Left:
Right: Pancreas (glucose, amylase, lipase)
Left: Spleen
96
Chapman reflex points are also known as
Ganglioform nodules or tissue
97
Chapman Reflexes
Sinuses
Anterior Points:
Posterior Points:
Anterior Points: lie 7 to 9 cm lateral to the sternum on the upper edge of the second rib
Posterior Points: upon C2 midway between the spinous process and the tip of the transverse process
98
Chapman Reflexes
Pharynx
Anterior Points:
Posterior Points:
Anterior Points: lie upon the first ribs 3-4 cm medial to where the ribs emerge from beneath the clavicles
Posterior Points: upon C2 midway between the spinous process and the tip of the transverse process
99
Chapman Reflexes
Larynx
Anterior Points:
Posterior Points:
Anterior Points: lies upon the second ribs, 5-7 cm lateral to the sternocostal junction
Posterior Points: upon C2 midway between the spinous process and the tip of the transverse process
100
Chapman Reflexes
Tonsils
Anterior Points:
Posterior Points:
Anterior Points: between the first and second ribs adjacent to the sternum
Posterior Points: midway between the spinous process** (posterior tubercle) and the tip of the transverse process
101
```
Chapman Reflexes
Middle ear (also TM)
Anterior Points:
Posterior Points:
```
Anterior Points: lie upon the superior anterior aspect of the clavicles just lateral to where they cross the first ribs
Posterior Points: upon the posterior aspect of the tips of the transverse processes of C1
102
Chapman Reflexes
Eyes (Retina/Conjunctiva)
Anterior Points:
Posterior Points:
Anterior Points: lie upon the anterior aspect of the humerus at the level of the surgical neck
Posterior Points: lie upon the squamous portion of the occipital bone below the superior nuchal line
103
Parasympathetic cranial nerves:
CN III, VII, IX, X
104
Oculomotor Nerve (CN III)
Ciliary ganglion
105
Glossopharyngeal (CN IX)
Otic ganglion
106
Facial Nerve (CN VII)
Pterygopalatine ganglion
| Submandibular ganglion
107
Although CN V conveys no presynaptic parasympathetic (visceral efferent) fibers from the CNS, ________ are associated with the divisions of CN V
All four parasympathetic ganglia
108
Postsynaptic parasympathetic fibers from the four parasympathetic ganglia join branches of CN V and are:
carried to their destinations along with the CN V sensory and motor fibers
109
Short ciliary nerves to
ciliary body and sphincter pupillae
110
Branches of CN V2 to
lacrimal, oral, palatal, nasal, and pharyngeal mucous glands
111
Lingual nerve to
submandibular and sublingual glands
112
Auriculotemporal nerve to
parotid gland
113
Increased parasympathetic activity
Increased clear, thin, watery secretions of glands
Pupillary constriction
Improved/increased drainage
114
Dry mouth (xerostomia) can be caused by CN VII
Lacrimal glands, sublingual and submandibular glands.
Remember CN VII is associated with the sphenopalatine (pterygopalatine) ganglion and exits through the stylomastoid foramen
115
Dry mouth (xerostomia) can be caused by CN IX
Parotid gland.
| Remember CN IX is associated with the otic ganglion and exits through the jugular foramen
116
Treating Lymphatics
Thoracic inlet/outlet has to be cleared/opened/treated BEFORE any other lymphatic treatment
117
Thoracic inlet/outlet components:
Supraclavicular space
| 1st rib
118
Lymphatic treatment examples include
Anterior cervical fascia release
Thoracic inlet myofascial release
Pectoral traction
119
Approximately 85% of the venous drainage from the head occurs via the internal jugular veins
They pass through the jugular foramina, located along the occipitomastoid suture between the occipital and temporal bones
Altered temporal bone motion and occipitomastoid compression may impair venous flow through the jugular foramen and may lead to congestion in the head
120
Sphenopalatine Ganglion Technique
Myofascial release to the pterygoid fascia can be used to treat maxillary sinusitis by stimulating the parasympathetic supply to the nasal mucosa, which is CN VII
121
Mandibular Drainage: Galbreath Technique
| Indications:
This technique is indicated for any dysfunction or lymphatic congestion in the ENT or submandibular region, especially dysfunction in the Eustachian tubes. Can be taken in patients with active TMJ dysfunction with severe loss of mobility and/or locking
Great for treating otitis media, fluid in the middle ear, Eustachian tube somatic dysfunction
122
Mandibular Drainage: Galbreath Technique
You are pulling traction on the mandible and the goal is decongestion of fluid in the middle ear
123
Eustachian Tube
| Internal rotation
Internal rotation of the temporal bone partially or completely closes the Eustachian tube and may result in the perception of a high-pitched ringing in the ear
124
Eustachian Tube
| External rotation
External rotation of the temporal bone may open the Eustachian tube and result in the perception of a low-pitched roar
125
CN Dysfunction/Entrapment
| CN I
Anosmia
126
CN Dysfunction/Entrapment
| CN V
Headache, trigeminal neuralgia
127
CN Dysfunction/Entrapment
| CN VII
Altered taste, Bell's palsy
128
CN Dysfunction/Entrapment
| CN VIII
Vertigo, tinnitus, labrynthitis
129
CN Dysfunction/Entrapment
| CN IX and X
Poor suckling, failure to thrive (FTT)
130
CN Dysfunction/Entrapment
| CN III, IV, VI
Petrosphenoidal ligament
| Symptoms: blurred vision, diplopia, nystagmus, eye fatigue, HA
131
Cranial Nerve Entrapment
| CN III, IV, VI
Pass under petrospenoidal ligament (formed by the tentorum cerebelli) can get trapped here
Increased dural strain has adverse affect
Temporal/sphenoid bone attachments
132
Cranial Nerve Entrapment
| CN III, IV, VI Symptoms
Blurred vision, diplopia, nystagmus, eye fatigue, headache
| CN VI is closest to the dura, most likely affected- result is medial strabismus
133
Cranial Somatic Dysfunction Affects Function
| Ophthalmologic
CN II, III, IV, VI
134
Cranial Somatic Dysfunction Affects Function
| GI
CN IX, X, XII
135
Cranial Somatic Dysfunction Affects Function
| Respiratory
CN X
136
Cranial Somatic Dysfunction Affects Function
| Musculoskeletal
CN XI
137
CN Parasympathetics
III, VII, IX, X
138
Cribriform plate
CN I
139
Optic Canal
CN II
140
Superior Orbital Fissure
CN III, IV, V1, VI
141
Foramen Rotundum
CN V2
142
Foramen Ovale
CN V3
143
Internal Acoustic Meatus
CN VII, VIII
144
Jugular Foramen
CN IX, X, XI
145
Hypoglossal Canal
CN XII
146
Difficulty nursing/latching
CN XII
147
Colic
CN X
148
GERD
CN X
149
Nausea/Vomiting
CN X
150
Torticollis
CN XI
151
Asthma
CN X
152
Otitis media/tinnitus/vertigo/labrynthitis
CN VIII
153
CN I
Anosmia
| Cribiform plate through ethmoid bone
154
CN V
Trigeminal neuralgia/tic deloureaux
| May complain of sudder, severe facial, ear, and/or jaw pain
155
CN VII
Exits stylomastoid foramen
| Bell's palsy
156
CN VIII
Labyrinthitis, tinnitus, vertigo
| Temporal bone associated with tinnitus, labrynthitis, vertigo
157
CN X
Exits jugular foramen
| Can cause nausea/vomiting
158
CN XII
Hypoglossal canal
| Can cause nursing/latching problems in infants
159
Jugular Foramen
Formed by temporal bone and occiput, which make the occipitomastoid suture
CN IX, X, XI exit from the jugular foramen
CN XI is involved with torticollis. There is usually compression at the occipitomastoid suture/jugular foramen
CN X is involved with nausea/vomiting
160
Trigeminal Stimulation or Inhibition
| The foramina which are contacted:
```
Supraorbital foramen (frontal sinusitis)
Infraorbital foramen (maxillary sinusitis)
Mandibular (aka mental) foramen
```
161
Indications and Contraindications for techniques
If a patient is too young or is not able to follow commands, you can not do techniques such as ME
If a patient has lax ligaments such as RA or trisomy 21, you do not want to do HVLA, or any type of articulatory techniques in the upper cervical spine
162
Tension Description
Bilateral pressure
| No aura, nausea
163
Migraine Description
Unilateral, triggers, may have aura, nausea/vomiting, photophobia/phonophobia
164
Cluster Description
Unilateral, severe
165
SCM refers pain
lateral and behind the eye
166
Splenius capitus muscle refers pain
to the vertex of the head
167
TMJ Masseter Counterstrain
| Indication for treatment
SD of the head/cranium and/or cervical region
The patient may complain of pain in the neck, face, jaw, ear or TMJ and have difficulty opening mouth fully, Mandible may deviate or shift to the side of dysfunction
168
TMJ Masseter Counterstrain
| Tender Point Location
Masseter: just inferior to the zygoma in the belly of the masseter muscle typically found on the side of mandibular deviation
169
TMJ Medial Pterygoid Counterstrain
| Indication for Treatment
SD of the head/cranium and/or cervical region
The patient may complain of pain in the neck, face, jaw, ear or TMJ and have difficulty opening mouth fully, Mandible may deviate or shift to the side of dysfunction
170
TMJ Medial Pterygoid Counterstrain
| Tender Point Location
Jaw angle point or medial pterygoid: on the posterior surface of the ascending ramus of the mandible about 2 cm above the angle of the mandible on the side opposite of mandibular deviation
171
Occipital Condylar Compression
The most important or most clinically significant SD which should be addressed in all newborns is occipital condylar compression
Affecting CN IX, X, XI, XII; it can be the cause of poor suckling, swallowing difficulties, colic, emesis/vomiting, hiccups, congenital torticollis
OA decompression is useful in treating condylar compression
172
One gait cycle
Considered from heel contact of one foot through heel contact of that same foot again
173
Two phases of gait cycle
Stance and swing 60/40%
174
Subdivision of Stance
```
Single legged (40%)
Double legged (10% each side of the single legged stance)
```
175
Phases of Gait
```
Heel strike
Loading response
Midstance
Terminal stance
Preswing
Initial and Mid-swing
Terminal swing
```
176
Tight iliopsoas contralateral to short leg provides ____
compensation for lumbar curve
177
Recognize and interpret innominate, sacral, and lumbar rotational biomechanic during gait cycle
L5/S1 tordion is normal biomechanics
Oblique axis on weight bearing side
Forward rotation of sacrum around axis
Normally produces lumbar sidebending to axis side due to type 1 neutral mechanics of lumbars in gait and L5/S1 torsion
178
Anterior Cervical 7 (AC7) Treatment
FSTRA
179
Anterior Cervical 8 (AC8) Treatment
FSARA
