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OMM Year 1 > Exam 2 > Flashcards

Exam 2 Flashcards

1
Q

what is this test?

A

thomas test:

Positive when there is a contraction or contracture of the psoas muscle

  • norm = extended leg should contact table
  • space = iliopsoas spasm

Test both sides

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2
Q

Tentorium Cerebelli

A

anterio borderr: clinoid processes - cradles pituitary wiht infundibulum piercing fascia

medial border: anterior clinoid

lateral border: posterior clinoid

cranial rhythmic impulse creates motion of “tent”

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3
Q

how to differentiation b/w disc herniation and piriformis syndrome?

A

EMG

disc = N impinge prox to piriformis

piuriformis: abnorm distal to piriformis

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4
Q

Articulations lumbar spine

A

Zygapophoseal joints: (synovial joint).

Intervertebral joints: (Fibrocartilagenous joints.)

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5
Q

interstitial fluid pressure and lymph sys

A

approximately -6.3mmHg and flow at 120cc/hr

incrase in interstitial P –> increases absorption into cap

if P > 0 = collapse lymph caps

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6
Q

IV disc components

A
  • Fibrocartilaginous joint
  • Annulus fibrosis
  • thicker anteriorly and thinner posteriorly.
  • Nucleus pulposus
  • Interlocking crosshatch
  • allows the disc to undergo rotary motions and shearing forces while still maintaining restrictive stability.

•Attachment to anterior & posterior longitudinal ligaments

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7
Q

Extension of a vertebral unit causes what on the IV disc and ligaments

A

Increases pressure on the anterior annulus and ALL

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8
Q

Functional Anatomy-Psoas Major

A
  • Origin –TP/SP/IV discs T12-L5
  • Insertion – lesser trochanter
  • Innervations- L1-L3
  • Actions-Flexes thigh, external rotation, flexes spine on pelvis
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9
Q

taut band

A

hypercontracted extrafusal muscle fibers

pressed = referred pain, motor dysfunction, autonomic phenom

needling/rolling = local twitch response

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10
Q

Pathophysiology – Psoas Syndrome

A

M is position of strain and then suddenly lengthens

CNS senses “overstretch” –> reflex contraction

  • inc in alpha moto output = incr in gamma firing

pain-spasm feedback loop –> psoas syndrome

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11
Q

Pelvic Diaphragm

A

levator ani - 3 M

Coccygeus - 3 M, posterior to levator ani

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12
Q

Piriformis Syndrome
Physical Exam - motion testing, neuro, special tests

A

motion:

  • hip pain with external rotation, passive internal rotation/flex/adduc
  • lumbar spine restricted esp in ext

neuro:

  • NORMAL!!

special tests:

  • SLR (straight leg raising) - painful throughout
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13
Q

gluteus medius: N and spinal lvl

A

sperior gluteal, L4-5, S1

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14
Q

spondylolysis

A

stress fx b/w pars interarticularis b/w facets usu L4/L5

most common low back pain in adol athletes

angle & pull of M —> “slippery slope” spondylolisthesis

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15
Q

diseases that increase interstitial P > 0 mmHg

A

sys htn

cirrhosis

hypoalbuminemia: starvation

toxins

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16
Q

Spondylolisthesis: 80% will present with

A

hamstring hypertonia

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17
Q

Piriformis Syndrome
OMT - indirect techniques

A

used more commonly

counterstain: TP at midpole sacrum, piriformis M, postermedial troch

facilitated positional release (FPR)

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18
Q

thymus

A

loc: superior mediastinum

T-lymphocytes

involution in adulthood

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19
Q

sibson’s fasica

A

prevert fascia + scalene fascia

thoracic duct txverses sibsons –> C7 and then turns around an emptys into L subclavian

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20
Q

Quadratus Lumborum
Trigger Points and Referred Pain Patterns

A
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21
Q

load on L3: in order of increasing load:

bending sideways, standing, twisting

A

standing (700) < twisting (900) < bending sideways (950)

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22
Q

QL Spasm/Trigger Point: clinical characteristrics

A

–Unlevel pelvis

–Patient’s trunk leans to 1 side

–Very hypertonic muscles on the concave side

–Short leg on side of QL spasm

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23
Q

Anterior Longitudinal Ligament

A
  • broad
  • Limits extension
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24
Q

anterior cervical fascia

A

attachements: base of skull, mandible, hyoid, scapula, clavicle, sternum

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25
Q

X + 1 rule

A

hernation disc X = X + 1

nerve root X already exited

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26
Q

Gluteus Medius Trigger Points

A

along iliac spine starting posterior

can refer pain to greater troch

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27
Q

lumbar IV disks

A

large

heavy load bearing

named for vert above

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28
Q

—Extrinsic Forces of lymph sys

A

○Osteopathic Manipulative Treatment

○Exercise

○Muscle Contraction

○Adjacent Artery Pulsation

○Increased negative intra-thoracic pressure with respiration

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29
Q

FUNCTIONAL ANATOMY Psoas Minor

A

•Absent in 40% of people

•

•Origin– bodies of T12 and L1 and their disc

•

  • Insertion – tendon attached to pecten pubis, ilippectineal eminence, and iliac fascia
  • Innervations-branch of L1

•

•Action-Weak flexor of thigh and trunk

•

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30
Q

Piriformis Syndrome
OMT - direct techniques

A

Muscle Energy-no absolute contraindication

HVLA-use to treat sacrum and iliac SD (caution with osteoporosis)

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31
Q

Goals of Lymphatic Treatment

A

žImprove respiration and circulation

žImprove lymphatic circulation and decrease edema/congestion

žImprove drug delivery

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32
Q

FUNCTIONAL ANATOMY Iliacus

A

•Origin- superior 2/3 iliac fossa, inner lip of iliac crest, ASIS, and lumbosacral ligaments (sacroiliac , iliolumbar) lateral sacrum

•

  • Insertion-common tendon with p. major to lesser trochanter
  • Innervation-branches of femoral nerve, L1. L2

•

•Action-flexes thigh and moves trunk

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33
Q

what has a very intimate relationship with the lymph of head, neck, thorax, upper extremity?

A

anterior cerv fascia

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34
Q

Examples-Initial Positions of Flexion that result in psoas syndrome

A
  • Sitting with pelvis “tucked under”
  • Desk work
  • Bending over from waist
  • Weeding
  • Repetitive sit-ups
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35
Q

Conditions Associated with TrPs/Myofascial Pain

A
  • Vitamin deficiency/insufficiency (C, D, B12, folate)
  • Hypo:
  • thyroid
  • glycemia
  • Hyperuricemia
  • Iron deficiency
  • Candida albicans infection
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36
Q

Relationship of the Abdominal Diaphragm with the Pelvic Diaphragm

A

should work in synchrony -> optimal mvmt interstitial fluids

  • pump for lymp vess & venous sinuses in pelvis, rectum, perineum

pelvic floor must dissipate P of respiratory cycle

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37
Q

Where does majority of flexion occur

and degrees

A
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38
Q

Iliolumbar ligaments

A
  • Iliac crest just above and lateral to PSIS to transverse process of fourth and fifth vertebra.
  • First ligament to be strained in a lumbosacral imbalance.
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39
Q

Piriformis Anatomy/Action

A
  • Straight lower ext.: External rotation of the thigh at the hip; may contribute to thigh extension
  • Bent lower ext. 90°: Abduction of the thigh at the hip; may also internally rotate thigh
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40
Q

Piriformis Syndrome

A

peripheral neuritis of the sciatic nerve caused by an abnormal condition of the piriformis

can “masq” as other common SD

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41
Q

lymph sys consissts of:

A

—Organized lymph tissue

○Spleen, thymus, tonsils, appendix, visceral lymphoid tissue in the GI and Pulmonary systems and the liver (each with a specific function).

—Collecting ducts

○Beginning with blind endothelial tubes and terminating in the minor & major lymphatic ducts.

—Lymph fluid

○Clear, containing proteins and salts.

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42
Q

Load characteristics on IV discs

A
  • Reabsorption increases thickness
  • Decreased thickness under load
  • age decreases the ability to recover thickness
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43
Q

Functionally the thoracic inlet consists of…

A

T1-4 vertebrae, ribs 1 & 2 plus their costo-cartilages, the manubrium and clavicles

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44
Q

Causes of QL Trigger Points

A
  • Passive- postures that shorten the muscle.
  • Active- trauma, such as MVA; bending over and reaching to one side to pull or lift something
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45
Q

sacralization

A

L5 fused with S1

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46
Q

degrees •of flexion at the L5-S1

what % does this contribute to total flexion

A

45 degrees

75%

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47
Q

Disc Herniation

A

•Posterio-lateral herniation

–narrow posterior longitudinal ligament

•Most common

–L4-L5 95% of herniations

–L5-S1

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48
Q

what does this test fix?

what is this technique calleD?

A
  • Treatment of quadratus trigger points
  • 12th rib technique and passive myofascial release of the quadratus lumborum (both useful during the acute stage).
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49
Q

Multifidus

A

Small Back Muscles

Deep to Erector Spinae

Postural

Bilateral Contraction Local Extension

Intertransversarii muscle Control individual vertebra

type II

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50
Q

•FRYETTE’S SECOND PRINCIPLE (TYPE 2 MECHANICS)

A

•When side bending is introduced into a region of the spine in a non-neutral position, rotation of at least one segment must preceed sidebending. Rotation and side bending occur to the same side.

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51
Q

•Osteoarthritis of the hip is characterized by:

A

–Pain at the actual hip joint anteriorly mid thigh @ level of inguinal ligament

–Decreased extension

–Decreased internal rotation

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52
Q

L4

A

medial side foot, walk on heel

pateller reflex

deep perioneal N: tib anterior

dorsiflex, inversion

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53
Q

Loss of lumbar lordosis due to…

what exercise to “fix”

A
  • Spending time in forward flexion
  • Lumbar kyphotic postures causing elongation of the posterior longitudinal ligamentous, fascial and muscular tissues.
  • disc bulging and posterior herniation.

•Exercises: extension

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54
Q

Hip Drop Test principle

A

knee flexion of one leg result in 20-25 degree drop of the iliac crest on that side (side of non weight bearing) also produce an observed smooth side bending curve of the lumbar spine on the opposite side (side of weight bearing)

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55
Q

Piriformis Syndrome
Etiological Considerations

A

•Primary piriformis syndrome (<15%)

  • –Anatomical cause due to split piriformis, split sciatic n., anomalous sciatic n. path

•Secondary piriformis syndrome-more common

  • – trauma, ischemic mass effect, local ischemia
  • •Macrotrauma to buttocks inflammation and muscle spasm creating nerve compression
  • •Microtrauma due to overuse as in running/walking or direct compression (“wallet neuritis”/sitting on hard surfaces)
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56
Q

right lymphatic duct drains

A

heart

lungs

R upper arm

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57
Q

Function of Lymphatic System

A

žTo transport proteins in the interstitium back to the circulatory system.

žTo present antigens to immune cells to facilitate immune system activation.

žTo drain off inflammatory mediators to allow orderly progression of inflammatory response.

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58
Q

Increase tone (Hypertonicity) of diaphragm =

A

flattens!

motion of lower ribs may stay down with inhalation

  • inhal restriction = exhale SD
  • decrease in transverse diameter of chest cav – > less efficient respir –> decs in P gradient –> less lymph flow and venous return
    • accessory M use during inspiration: scalenes
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59
Q

—Intrinsic Forces of lymphatic sys

A

smooth M contraction, interstitial fluid pressure

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60
Q

A 50-year-old male comes to your office with chronic low back pain. His back pain is a dull ache that radiates into the buttock and thighs bilaterally. The pain is made worse with standing or walking 20 minutes or more and maintaining extension. Pain is relieved completely with sitting. Range of motion of his lumbar spine is decreased. Sensation is decreased in both feet in a stocking like distribution. Percussion on the spinous processes produce no pain. There is no fever, no weight loss and undisturbed sleep. What is the most likely finding this patient will have on radiological studies?

A. A herniated nucleus pulposus on magnetic resonance imaging.

B.Spondylolisthesis of the L1 on L2

C.Spondylosis of the lumbar spine.

D.Loss of definition of a vertebral end-plate and elevation of the periosteum suggestive of vertebral osteomyelitis.

E.Lytic (punched-out lesions) spinal metastases involving the lumbar vertebrae.

A

.Spondylosis of the lumbar spine.

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61
Q

terminal lymph drainage

A

angle!

internal jugular and subclavian

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62
Q

lumbar spine ferguson’s angle

affected by?

A

line paralleling the top of the sacrum and a line drawn horizontally.

Rotational changes in the pelvis and lumbar spine will effect the lumbosacral angle.

35

normal = 35-55

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63
Q

Initiation of Quadratus Problems:

A

Posture: low back pain.

dmg by overload or prolonged malposition

constant state of stretch

(a) weakness,
(b) pain
(c) sometimes spasm.

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64
Q

do disc herniations need sx usu?

A

no. most will resolve with conventional tx

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65
Q

how are the lumbar bones oriented?

what type of mvmt is greatest ROM? least?

A

sagittal plane orientation of facents

flex/extend = greatest ROM

rotation = least ROM

SB = inb/w

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66
Q

piriformis anatomy: origin, insertion, innervation

A

—Origin: sacrum @ level of S2-S4, sacrotuberous ligament

—Insertion: greater trochanter

—Innvervation: S1,S2, occasionally L5

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67
Q

conservative tx spinal stenosis

A

elong spine

unkink enclosed cauda equina

pelvic tilt/OMT

corset

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68
Q

releiving factors of spinal stenosis

A

20-3min rest

sitting/flexed/leaning over (shopping cart)

side-lay with knees to chest

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69
Q

ultimate goal of lymph OMT

A

decrease work of breathing

increase lymph drainage

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70
Q

Abdominal Diaphragm

A

žDome shaped muscle with two lateral hemi-diaphragms.

žIts shape is influenced by the viscera below.

žThe primary function is respiration.

žSecondary functions include; circulation of blood, lymphatic pumping, speech, micturition, defecation and parturition.

—

—

—

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71
Q

tentorium cerebelli is formed by

A

intracranial meningeal dura

sella turcica “saddle shaped” sphenoid region b/w clinoid processes (houses pituitary)

  • covered by diaphragma sella (dura mater) - continuation of tentorium cerebelli
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72
Q

Diseased vs. healthy disc under load

A
  • diseased or aging disc can be more compressible & annulus tears.
  • Decreased disc thickness causes an increased weight load on the facet joint

decreased flex!!!

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73
Q

meralagia paresthetica

A

P on lateral fem cut N - through inguinal lig

upper ant-lat thigh pain

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74
Q

Typical Posture of psoas syhndrome

A

–Flexion at hip and sidebending of lumbar spine to side of most hypertrophied psoas

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75
Q

Referred Pain Patterns from Trigger Points of what M?

A

psoas

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76
Q

this is showing what test?

A

standing side bending test

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77
Q

Kernig’s sign

A

supine, hip flexed to 90, then try to extend leg

pain in hamstring = meningeal irritation

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78
Q

spondylolisthesis

A

forward “slippage” - “spotty dog”

“palpable shelf” - gap

able to be asymp in physically active pt

can be retro

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79
Q

rectus abdominus TrP

A

lower ipsi = mimic appendincitis

lower bilat = menstrual

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80
Q

•Sciatic Nerve

A

–Formed by the ventral rami of L4-S3

–Converge on the anterior surface of the piriformis muscle

–Largest nerve in the body (2 cm in width)

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81
Q

SCM TrPs

A
82
Q

Where do the nerves of the diaphragm exit?

A

C3-5

83
Q

The lymphoid tissue is the ________ is the most organized

A

GI tract: peyers patches, lacteals

controlled by ENS

proximity of the ENS (Auerbach & Messiner’s plexi) and Peyer’s Patches and Lacteals suggest the potential benefit of lymphatic treatment for functional bowels disorders.

84
Q

Posterior Longitudinal Ligament

A
  • Narrow
  • Limits flexion
85
Q

position of body and load

  1. laying supine
  2. laying lateral
  3. standing
  4. flex (slumping) while standing
  5. sitting in chair
  6. slumped over while sitting in chair
A
86
Q

To achieve full flexion ….

A

•proportionate rotation of the pelvis about the hip joint will occur.

87
Q

S1

A

superficial peroneal N: peroneus longus and brevis

plantar flex, eversion

achilles

lat/sole of foot

88
Q

Functional leg length discrepancy

A

hypertonic QL (shorter M length) = appears like short ipsi leg = sidebending to ipsi side

89
Q

tensor fascia lata: N and spinal lvl

A

superior gluteal, L4-5

90
Q

Function of the Iliopsoas

A
  • Walking
  • Flexion of femur, pelvis, and lumbar spine
  • Maintains erect posture at the hip joints
  • Maintain postural balance with the pelvis in the midline

•

91
Q

Lordosis develops during

A

childhood

forms as result of spine extending

restricted by iliopsoas

92
Q

What is a Trigger Point (TrP)?

A

a hyperirritable spot in skeletal muscle that is associated with a hypersensitive palpable nodule in a taut band

93
Q

seq of lymph txp

A

single layer “leaky” –> lymph vessel *lymphangion) –> trunk –> ducts –> R/L angles

94
Q

trigger points and ATP

A

ATP usually inhib Ach release and powers Ca+ pump

deplted = cycle increased Ach release and impaired Ca2{ uptake –> inc contractile activity of M

95
Q

ethyl chloride vapocoolant spray

A

(spray and stretch)

just a distraction - over Trp and referral area

stops pain cycle –> allows strech of M and Trp

96
Q

babinski test

A

heel and curve up towards big toe

should cause plantar flex

dorsiflex in babies and neuro problems in adults

97
Q

trunks of the abdomen, pelvis and lower extremities drain in to

A

cysterna chyli

anterior and R of L1/L2, posterior to crus

98
Q

appendix

A

medial surface of the cecum

99
Q

During side bending to the right the nucleus moves toward the concavity or convexity?

A

convexity

100
Q

popliteal diaphragm

A

potential space - hinders mvmt of fluids distally

lymph caps can be croweded by soleus arch and adductor canal

101
Q

aggrevating factors of spinal stenosis

A

walking, extension

102
Q

Flexion of a vertebral unit does what to the annulus and ligaments?

A

Increases pressure on posterior annulus and posterior longitudinal ligament

103
Q

How Many Diaphragms does the body have?

A

ž1. Tentorium Cerebelli (diaphragma sella)

ž2. Cervical –Thoracic or Thoracic inlet

ž3. Abdominal – Respiratory diaphragm: largest

ž4. Pelvic diaphragm

ž5. Popliteal

  • žControversial
    • —Palm of the Hand (aponeurosis)
    • —Plantar of the Foot (aponeurosis)

ž

104
Q

•strongest flexor of the thigh?

A

Iliopsoas

105
Q

tonsils

A

a ring of lymphoid tissue at the posterior oropharynx

palatine, lingual, phryngeal

produces immune cells

106
Q

this is an xray showing…

A

OA of lumbar spine

107
Q

Active TrPs:
Symptoms

A

clinical pain complaint

always tender - prevent full elngth of M: weakens M –> pt-recog pain patter with direct compression

referred motor/autnomic pain & tenderness

108
Q

Piriformis Syndrome-
Physical Exam - observation

A

–Altered painful gait

–Leg externally rotated

–Increased flexion spine

109
Q

žColles’ fascia

A

—fascia of the urogenital diaphragm

110
Q

žChronic Diseases associated with restricted thoracic cage mechanics

A

—Chronic obstructive pulmonary disease (COPD)

—Asthma

—Obesity

—Kyphosis

  • ○Ankylosing spondylitis
  • ○Osteoporosis
111
Q

lymph channels traverse all tissues of the body except

A

CNS, epidermis & endomysium

These areas are perfused by small interstitial conduits

112
Q

which fascia surrounds the trachea and esophagus

A

anterior cerv

113
Q

lymph cap and SNS tone

A

acute: contraction & peristalsis

prolonged = decreased! - hyper SNS

114
Q

formation of a trigger point involves

A

contraction of sacromere that does not norm relax –> forms contraction knot

group dev near each other = palpable nodule

115
Q

Embryologic development of the lymphatic and immune systems begins at

A

20 weeks

116
Q

How to treat not based on a technique specifically directed at the muscle with the trigger point?

A

Treat the origin and insertion of the muscle with the TrP

117
Q

Lumbar Structural Screening

A
  • Standing Sidebending Test
  • Looking for presence of a smooth lateral curve
  • Feet shoulder width-apart; ask patient to slide his hand down the lateral aspect of thigh while keeping feet on ground

Normal = 20-25 degrees

118
Q

žScarpa’s fascia

A

—subcutaneous abdominal fascia

119
Q

psoas attaches to what part of the diaphragm?

A

medial arcuate lig

120
Q

special tests of psoas syndrome

A

thomas

straight leg

well leg

121
Q

recurrent nerve of Luschka

A

innerv ALL, PLL, nerve sheath dura

122
Q

Latent TrPs:
Symptoms

A

more common that active TrPs

clinically quiescent with spont pain

painful ONLY when palp - may not recog pain as familiar

taut band in M –> incr M tensions/ restricts ROM –> stiffness

has all features of active TrPs – pain referral, motor dysfunc, auton phenom

123
Q

S2 S3 S4

A

•Intrinsic musculature of the foot

bullseye around anus

bladder

124
Q

Trunk Rotation test

A

determine the rotational ability and its range in the thoracolumbar spine.

125
Q

What is the sequence of lymph transport

A

žWhat is the sequence of lymph transport?

—Single layer “leaky” epithelial

—Arterial lymphatic capillaries

—Peripheral lymphatic capillaries

—Trunks

—The Right Lymphatic Duct or Left (Thoracic) Lymphatic Duct.

—The ducts then drain into major veins.

○RLD-Brachiocephalic or jct of Right Internal Jugular and Right Subclavian veins.

○LLD- jct of the Left Internal Jugular and Left Subclavian veins.

126
Q

Short leg syndrome on diaphragm

A

can cause lateral spinal cuves –> asymm pull on diaphragm –> impinge thoracic duct

127
Q

locations of superficial and deep lymph nodes

A

superficial = subcut connective tissue accompanies veins

deep = beneath fascia and M

128
Q

•Superior + Inferior Articular Processes of lumbar spine

A

–Superior articular facets

  • concave
  • face medially and backward
  • rotated 45 degrees from the sagittal plane.

–Inferior articular facets

  • convex
  • face laterally and forward
129
Q

Structural Integrity of spine depends on:

A

Anterior Longitudinal Ligament

Posterior Longitudinal Ligament

Intraspinal Ligament

Supraspinous ligaments

130
Q

the QL attaches to what part of the diaphragm

A

lateral arcuate lig

131
Q

Gluteus Maximus/Hamstrings on lordosis

A

•pull pelvis posteriorly, reduced lordosis Hypolordotic.

132
Q

Iliolumbar Ligament Syndrome

A

palp of lig –> referred pain into groin on ipsilateral side

SD on same side

133
Q

•FRYETTE THIRD PRINCIPLE

->

A
  • When motion occurs in any one plane within a joint or region, motion in all other planes of that joint will be influenced.
  • Example: If a vertebral unit was flexed, its range of sidebending and rotation would be reduced.
134
Q

kemp’s test

what does this test?

A

lumbar extension with rotation

30 sec –> pain radiates below butt

spinal stenosis

135
Q

Abdominal Diaphragm
Attachments

A

žSternum/xiphoid

žRibs 6-12, the internal surface circumferentially

žT12

žCrura

—L1/L2 LEFT

—L1-L3 RIGHT

fibers converge to common central tendon = NO BONY ATTACHMENTS

136
Q

Psoas Syndrome-Etiology

A
  1. chronic shortening of psoas (flex stress) followed by sudden lengthening
  2. ppt by overuse
  3. neuro imbal due to hypertrophy

can be avoided with slow txition from shortened position

137
Q

fascia of psoas, QL, and arcuate lig are attached to….

A

tip of 12th rib

138
Q

Psoas Syndrome
Full-Blown Left

A

Where to begin the OMT treatment?

Key somatic dysfunction L1-L2

139
Q

Fixation of the central tendon causes

A

želevation of the lower ribs.

140
Q

Dysfunctional motor end-plates causes

A

excess Ach release

sustained depol of postjx memb –> continued release of Ca2+ from SR

sustained shortening of sacromere

compresssed local sens N –> reducing inhib of Ach release

compressed local bv –> reduced O2 supply

result: depletes ATP, fav anaerobic metab

141
Q

90% of back pain =

A

mechanical

142
Q

Abdominal muscles on lordosis

A

Flatten

143
Q

sensory N for the diaphragm are from what nerves?

A

Sensory of central portion-phrenic

Sensory of peripheral-intercostals T5-T11 and subcostals T12

144
Q

When a person with a shortened psoas muscle stands….

A

•femur is fixed and the psoas pulls the lumbar spine into extension (increased lordosis)

can pull secral base foward

anterior rotate pelvis

145
Q

Thoracic Inlet

A

bordered by:

  • 1st rib
  • T1
  • manubrium
  • clavicle

traverses sibson’s fascia to C7 –> turns around and empties to L subclavian vein

146
Q

spleen

A

largest mass of lymphoid tissue

deep to ribs 9-11 on left, inferior to ab diaphragm

func: destroys dmg RBC, synth immunoglobins, clearing encap bac

147
Q

lumbar spine gets ________ as it descends

why?

A

larger

accomodate stab/mobility

L5 = largest in height and circumference

148
Q

what hsould be considered before specific TrP treatment.

A

•Consider common innervation levels and check for SD at these levels

149
Q

Stages of TrP Development

A
  1. hyperirritability: local tenderness
  2. increased metab/reduced circ: local pain, possible twitch response
  3. taut band: referred pain pattern, satellite trigger pts in func related M
150
Q

What is the innervation of the diaphragm

A

Phrenic

151
Q

•The quadratus lumborum is the key M in stabilizing the spine in a _______ direction.

A

side-to-side

152
Q

Spasm of the quadratus lumborum on one side causes

A

trunk imbalance

innominate (un-named) compensation: superior on side of QL spasm

153
Q

psoas synd ROM

A

Increased hip flexion

decreased extension

154
Q

back pain time length

acute, subactue, chronic

A

6 weeks

6-12 weeks

3 months

155
Q

Milgram Test

A

intratheal P - hold up for 30 s

space occupying lesions: disc/tumor

156
Q

Thoraco - abdominal Diaphragm
Mechanics

A

žDuring inspiration, the diaphragm descends as it contracts.

žMotion is limited by the mediastinal contents and resistance of the abdominal organs.

žThis descent & contraction decreases intrathoracic pressure and increases the volume of the thoracic cavity.

žThe pressure gradients improve movement of lymph and blood toward the heart creating efficient respiration and circulation.

157
Q

Factors that increase interstitial pressure >0mmHg

A

—Systemic hypertension

—Cirrhosis (decreased plasma protein synthesis)

—Hypoalbuminemia as seen with starvation

—Toxins

158
Q

absolute contraindications to lymph techniques

A

DVT

splenic pump for mono

local fx

anuria in pts not on dialysis

159
Q

what M is this stretching

A

Gluteus Medius Stretch

160
Q

visceral lymphoid tissue found in the

A

Respiratory and GI tracts

161
Q

Psoas Syndrome Stages
Clinical Progression

A

1.Initial somatic dysfunction – B/L Psoas Spasm

•

  1. Unilaterally Dominant Spasm/Sacral Torsion

•

  1. Contralateral Piriformis Spasm

•

  1. Sciatica Dysfunction

•

162
Q

Typical Pain Pattern of psaos syndrome

A

Low back pain with pain on lateral/anterior aspect of the lower extremity no further than knee

163
Q

Definition of diaphragm

A

thin partition separating adjacent regions

164
Q

Gluteus Medius OMT-
Counter strain

A

location: upper outer portion of gluteus medius

tx pos: hip ext, abd, lat rotation

165
Q

žBuck’s fascia

A

—deep fascia of the penis, continuous with Colles & Scarpa’s

166
Q

•FRYETTE’S FIRST PRINCIPLE (TYPE 1 MECHANICS)

A
  • When motion is introduced into the spine from a neutral position, sidebending preceeds rotation, with rotation occuring to the side opposite sidebending.
  • Example: L1-4 NSlRr
167
Q

gluteus max: N and spinal lvl?

A

inferior gluteal: L5, S1-2

168
Q

ROM lumbar spine

A

–Flexion: 40-50°

–Extension: 20-30°

–SB: 30°

169
Q

funtional lumbar spine

A

T11-L5

170
Q

Trapezius TrPs

A

upper: temple, posterior neck
lower: neck, interscap/suprascap regions

171
Q

•Typical Associated Somatic Dysfunctions : Psoas Syndrome-

A

–Upper lumbar flexion dysfunctions (L1, L2)

–L5 extended

–Variable sacral and innominate dysfunctions

–Contralateral piriformis tenderpoints

172
Q

One of the major causes of increased lumbar lordosis

A

hypertonicity of the psoas muscle

173
Q

Femoral Cutaneous Nerve

dermatome

A
174
Q

lumbarization

A

S1 independent of rest of sacrum

175
Q

what location do Most back problems occur

A

Multifidus Triangle

176
Q

Hip Drop Test how to

A
  • This is a screening test to determine lumbar and lumbothoracic side bending ability.
  • To do this: Operator’s finger on superior and lateral aspect of iliac crest act as indicators of levelness of the iliac plane. The patient is told to bear all the weight on one leg by flexing at the knee and let the opposite drop inferiorly to its full extent.
177
Q

Multifidus Triangle

A

: spine L4 to iliac crest and tip of the sacrum

contains:

  • multifidus
  • L4/L5 : most completely ruptured lumbar disc
  • intertxverse lig
  • iliolumbar lig
  • facet syndromes
  • sacroiliac jt
178
Q

OMT to the cervical fascia helps

A

decrease intrathoracic congestion and facilitate lymphatic drainage from the head and neck

179
Q

which fascia has an intimate relationship with the lymphatics of the head, neck, thorax and upper extremity.

A

anterior cervical fascia

surrounds: larynx, pharynx, thyroid, carotid, trachea, esophagus (last 2 through prevert fascia)

180
Q

pretracheal fascia

A

suspended from hyoid

contin with percardial fascia and daphragm

attaches at T2

181
Q

flu epidemic

A

1918

182
Q

Consider “referred pain” in the absence of

A

significant tissue texture changes at the site of pain.

183
Q

Where does the diaphragm insert

A

Diaphragm-attaches to lower ribs and sternum

Crura anchors at L1, L2, L3

184
Q

L5

A

deep peroneal N: EHL

no refelx

lat leg, dorsum foot

185
Q

Psoas muscles affect on lordosis

A

•pull on upper vert.-Inc. Lordosis ( think arching back )

186
Q

Apertures of the Diaphragm

A

8: vena cava
10: esophagus
12: aorta, thoracic duct

187
Q

Characteristics of a Muscle with a Trigger Point:

A
  • Pain in the muscle & referred
  • Decreased contractility (weakness) of the muscle
  • Decreased flexibility of the muscle (hypertonic)

secondarily: restricted ROM –> reflex reduced firing thresholds of M within referral zone

188
Q

Quadratus Lumborum

A
  • Origin-12th rib and TP’s of L1-L4
  • Insertion-ilioolumbar ligament and posterior iliac crest
  • Actions-stabilizes 12th rib, lateral flexion of lumbar unilateral) and extension of lumbar(b/l)
189
Q

exercises to help with Lordotic Low Back Pain

A
  • Pelvis tilt –supine method
  • Active resistive Lsp in flexion exercise.
  • Extension inducing for loss of lumbar lordosis.
  • We will discuss in the lecture groups
190
Q

referred pain patterns

A
191
Q

Subscapularis TrPs activated by:

A
  1. forceable internal roation of upper extremity: pitching, crawl stroke
  2. flumped forward-head posture
  3. prolonged immob of shoulder in adducted and internal rotated position
192
Q

cerv fascia moves _______ with exhalation and __________ with inhalation

A

anterior, posterior

193
Q

hx and risk fac of low back pain

A

age: <20, >55
activities: drugs, manual labor, trauma

smoker

h0ormone replacement

sys corticosteriods use

ca hx

194
Q

Psoas Somatic Dysfunction

A

ureter courses over the psoas muscle - affected by psoas spasm

passing of kidney stone = cause psoas dysfunc

others: I C(see) UFOs

  • irritable bowel
  • crohns
  • ulcerative colitis
  • fibroid tumors
  • ovarian disease
195
Q

lymph sys flow

A

m layer & 1 way valves: UNIDIRECTIONAL

each seg contracts onafter other prox –> distal

once lymph enters main txp vessels = propellby by lymph vessel itself

196
Q

cauda equina syndrome

A

altered sens b/w legs

anal/urinary sphincter weakness

most = secondary to disc hern

197
Q

Psoas Syndrome

A

A painful low back condition characterized by hypertonicity of psoas musculature

198
Q

batwing deformity

A

unilateral sacralization/lumbarization

199
Q

Sciatica

A

pain or discomfort associated with the sciatic nerve

•sharp or burning pain that radiates from the lower back or hip, possibly following the path of the sciatic nerve to the foot.

set of symptoms

200
Q

relative contraindications to lymph techniques

A

unstaged ca

coaguopathies/anticoagulants

abscess

201
Q

Piriformis Syndrome
Treatment

A

•Early conservative treatment effective in 79% patients

–NSAIDS

–ICE

–Rest

–Muscles relaxants

OMM Year 1 (5 decks)

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