Exam 2 Flashcards
Tranverse Processes are always at the level of the ___
vertebral body
The level of the spinous process will ___
change; not always level with vertebral body
Rule of 3s
- T1, 2, 3, 12: spinous process located at the level of the corresponding transverse process
- T4, 5, 6, 11: spinous process located 1/2 a segment below the corresponding transverse process
- T7, 8, 9, 10: spinous process located at the level of the transverse process of the vertebrae one below
Superior Facet Orientation
- cervical: backwards, upwards, medial
- thoracic: backwards, upwards, lateral
- lumbar: backwards, medial
Spinal SD can cause…
- reduce efficiency
- impair flow of fluids
- alter nerve function
- create structural imbalance
Type 1 Mechanics
- In the neutral range, side bending and rotation are coupled in opposite directions
- tends to be a group of vertebra
TONGO
type one neutral group opposite
Type 2 Mechanics
- in flexion/extension, sidebending and rotation are coupled in the same direction
- tends to be a single vertebra
Type 1 Mechanic: naming
- locate the vertebra or group
- indicate position
- indicate sidebending
- indicate rotation
ex. T1-3NSrRl
Type 2 Mechanic: anming
- locate the vertebra or group
- indicate position
- indicate sidebending
- indicate rotation
ex. T9FSrRr
Fryette: 3rd principle
initiating movement of a vertebral segment in any plane of motion will modify the movement of that segment in other planes of motion
Fryette: 1st principel
in the neutral range, side bending and rotation are coupled in opposite directions (only T/L spine)
Fryette: 2nd principel
in sufficient flexion/extension, side bending and rotation are coupled in the same direction
(only T/L spine)
Spinal Landmarks
- Spine of scapula
- Inferior angle of scapular
- Iliac crest
- T3 SP, T3 TP
- T7 SP, T8 TP
- L4
Scoliosis
- lateral curvature of the spine
- named toward the convexity (levo-left, dextro-right)
A cobb angle of 50 degrees or higher can lead to…
respiratory comprise
A cobb angle of 75 degrees or higher can lead to…
cardiac compromise
C Spine Lateral View lines
- Anterior Vertebral
- Posterior Vertebral
- Spinal Laminar
- Posterior SP
The ____ side is the side towards which you’re inducing sidebending…aka the ___ ____.
- fulcrum
2. side-bending side
HVLA Contraindications
- Absolute: Patient consent, Advanced RA, Down’s Syndrome, Vertebral/carotid artery disease
- Inflammatory arthritidies, malignancy, acute radiculopathy, Klippel-Feil syndrome, Chiari malformation, achondroplastic dwarfism
What may be indicative of a burst fracture?
lateral masses of C1 overhang those of C2
In the cervical spine, we should assume SB and rotation are in…
the same direction
Veterbra involved with head and neck
T1-T4
Veterbra involved with heart
T1-5
Veterbra involved with lungs
T2-7
Veterbra involved with esophagus
T2-8
Veterbra involved with upper GI
T5-9
Veterbra involved with mid GI
T10-11
Veterbra involved with lower GI
T12-L2
Veterbra involved with bladder
T11-L2
Veterbra involved with uterus and cervix
T10-L2
Veterbra involved with erectile/LE
T11-L2
Veterbra involved with prostate
T12-L2
Veterbra involved with appendix
T12
Veterbra involved with adrenal medulla
T10
Veterbra involved with lower GU
T12-L2
Veterbra involved with upper GU
T10-11
What is the lymphatic structures come from mesoderm? endoderm?
- lymphatic vessels, lymph nodes, the spleen, and myeloid tissue
- thymus, parts of the tonsils
When does lymph development begin? when does it mature?
- week 5 (significant presence by week 20)
2. immature at birth; tissue increases until puberty, and then begins to regress
3 anatomical components of lymph
- Organized lymph tissues/organs
- Lymph fluid
- lymph vessels
What is the largest single mass of lymph tissue? what drives its movement? what is its function?
- Spleen
- pressure-sensitive (movement of diaphragm drives splenic fluid movement)
- destroy damaged RBCs, synthesizes Igs, clear bacteria
*beneath ribs 9-11 on the left; shouldn’t be palpable
What do the spleen and liver have in common?
they are both pressure sensitive (movement of diaphragm drives hepatic/splenic fluid movement)
*liver is palpable at right costal margin
What is the role of the liver in relation to lymph?
- half of the body’s lymph is formed here
- clears bacteria
- “gate keeper” of the shared hepatobiliary pancreatic venus and lymphatic drainage
What is the location/function of the tonsils?
- palatine (lateral pharynx), lingual (posterior 1/3 of tongue), pharyngeal (adenoids at nasopharyngeal border)
- provide cells to influence and build immunity early in life
What is contained in the appendix? what is the function of the appendix?
- lymphoid pulp (degenerates with age)
2. part of GALT
With fluid overload, how does the lymphatic system prevent damage?
clearing the excess
What percentage of drainage through the thoracic duct is associated with respiration?
35-60%
What tissues do not have lymphatic vessels, but use direct diffusion?
- epidermis (hair, nails…)
- endomysium (inner lining of muscle cells)
- cartilage
- bone marrow
What are lymph capillaries made of?
leaky squamous epithelium
what are lymphangions?
- muscular chains that comprise the lymphatic collectors
- work like the heart to contract regularly and move lymph in peristaltic waves
Where does the thoracic duct originate? where does it empty?
- cisterna chyli (L1-2)
- pierces sib son’s fascia and empties into L subclavian/IJ veins
*drains the whole body except the right upper part
Where does the right lymphatic duct originate? where does it empty?
- junction of R jugular and subclavian trunks
2. R subclavian/IJ venous junction
SNS effects lymph valves
increase sympathetic tone–>tight valves–>decrease lymph flow to venous system
SNS effect lymph SM
increase sympathetic tone–>decrease peristalsis–>lymphatic congestion
Chronic states of edema lead to recruitment and activation of…
fibroblasts
What is the purpose of lymphatic OMT?
-to improve the functional capacity of the lymphatic system
Indications for lymphatic OMT
- Edema, tissue congestion, lympahtic stasis
- Infection
- Inflammation
How should we approach chronic conditions?
with caution– gentler techniques, shorter, but more frequent treatment sessions
Principles of Diagnosis from a Lymphatics Approach
- Evaluate risk benefit ratio
- Evaluate fascial patterns of Sink
- Evaluate diaphragms/fascia
- Evaluate for SD
- Evaluate tissue congestion
What is the most common compensatory pattern? uncommon?
- 80% of healthy people are LRLR
2. 20% of healthy people are RLRL
What happens in people with uncompensated patterns?
- they are usually symptomatic
- typically trauma involved
Transition zones/Transverse restrictors of the spine: top to bottom
- Tentorium Cerebelli (OA, C1, C2)
- Thoracic inlet (C7, T1)
- Thoracolumbar (T12, L1) diaphragm
- Pelvic diaphragm (L5, sacrum)
What must always precede a lymphatic treatment?
Thoracic Inlet MFR
Sequence of Treatment: lympahtics
- Open pathways to remove restriction to flow (thoracic inlet)
- Maximize diaphragmatic functions (abdominal and pelvic diaphragms)
- Increase pressure differentials or transmit motion (fluid pumps)
- Mobilize targeted tissue fluids (localize to specific SD)
How does BLT work?
involves the minimization of peri-articular tissue load and the placement of the affected ligaments in a position of equal tension in all appropriate planes so that the body’s inherent forces can resolve the somatic dysfunction.
The ligaments of a joint are normally on a …
balanced reciprocal tension (and seldom completely relaxed throughout normal ROM)
Indications for BLT
- SD that involves ligamentous articular strains
2. Areas of lymphatic congestion or local edema
What biochemical changes occur with immobilization?
- greater amount of fibrofatty infiltrates in capsular folds
- loss of H2O and glycosaminoglycans in the ground substance
- w/o maintenance of interfiber distance, micro adhesions form and new collagen is laid in a haphazard way
- Immboliziation for >12 weeks leads to loss of collagen (degradation»synthesis)
The force needed to move an immobilized joint is ___ x greater than that of a normal joint.
10
*after several reputations, reduces to 3x; and over time joint returns to normal
Steps of BLT treatment
- Position: shifted neutral
- Activating force: inherent respiration
- Reevaluate: for motion improvement
Central Principle of BLT
- Take that which you palpate as hard and make it soft.
* When you feel the flow come through the dysfunctional area, your treatment of that area is complete.
FPR indications
Myofascial or articular SD
Steps in FPR
- Setup: monitor SD, and put affected area in neutral
- Activating force: add a facilitating force (compression, torsion, or distraction)
- Positions: indirect and hold 3-5 seconds
- Return and re-evaluate
Indications for Stills
- SD in virtually all tissues of the body
- Its efficacy is only limited by the practitioner’s knowledge of functional anatomy.
- Safe to use for patients of all ages
Steps in Still
- Initial treatment position: indirect (ease)
- Add localizing force: 5lb compression/traction
- Move through RB with force
- Final treatment position: RB
- Release force, return to neutral and reassess
What is a hip abduction SD typically caused by?
Hypertonic IT band
- can also be due to gluteus medius/minimus, and other muscles with some AB functions
- treated with Art/Met/ST/MFR
What is a hip adduction SD typically caused by?
Hypertonic long or short adductors
*treated with Art/Met
What causes IR of the hip? ER?
- tensor fascia lata, gluteus medius/minimus–>MET/ART
- gluteus maximus, piriformis, sartorius, obturator internus/externus, superior/inferior gemellus, quadratus femoris–>MET/ART
A hip extension SD is typically caused by? Flexion?
- hypertonic hamstrings or gluteus maximus
2. Hypertonic hip flexors (iliopsoas)
What happens to the tibia when the knee flexes? extends?
- glides posteriorly
2. glides anteriorly
Anterior Drawer Test: SD positive test
one in which there is a “hard” end-feel and the posterior drawer has a “soft” or “empty” end- feel, but is not greater than 1 mm of slide.
External rotation of the tibiofemoral joint leads to…
anteromedial glide of tibia on femur
*primary restraints: MCL/LCL will be taut; ACL/PCl will be lax
Internal rotation of the tibiofemoral joint leads to…
posterolateral glide of tibia on femur
*primary restraints:
ACL/LCL will be taut; MCL/LCL will be lax
Knee SDs–External rotation with Anteromedial glide:
- External Rotation
- Internal Rotation
- Anteromedial glide
- Posterolateral Glide
- TTA at knee/related muscles
- Tenderness location
- Present
- Restricted
- Present
- Restricted
- Present
- Anteromedial portion of joint line
Knee SDs–Internal rotation with Posterolateral glide:
- External Rotation
- Internal Rotation
- Anteromedial glide
- Posterolateral Glide
- TTA at knee/related muscles
- Tenderness location
- Restricted
- Present
- Restricted
- Present
- Present
- Entire joint line
With foot pronation, the fibular head glides ____? with supination?
- anteriorly
2. posteriorly
What comprises foot pronation? supination?
- dorsiflexion, eversion, AB
2. plantar flexion, inversion, AD
What comprises the longitudinal arch of the foot? transverse arch?
- Plantar aponeurosis, abductor digiti minimi, flexor digitorum brevis IV and V, long/short plantar L.
- Plantar aponeurosis, tibialis posterior T, peroneus longus T, adductor hallucis oblique head
What is the minor motion of dorsiflexion? plantar flexion?
- posterior glide
2. anterior glide
What is the minor motion of eversion? inversion?
- anteromedial glide
2. posterolateral glide
What are the most likely preferences for the cuboid? navicular? cuneiforms?
- eversion glide with plantar glide
- inversion glide with plantar glide
- plantar glide only
Dorsal glide SD of the cuneiforms is often associated with?
hypertonic plantar fascia
what muscles are thought to maintain type II SDs?
rotatores, intertransversarii, and multifidi
Type 1 vs. Type 2
a. onset
b. muscles involved
a. chronic vs. acute
b. long restrictor muscles of the back vs. short segmental muscles of the spine
Can a single unit have type 1 motion?
yes
What do you use as a lever for motion testing of T1-6? T7-12?
a. head and neck
b. trunk
Short lever segmental R/SB motion testing
“Load and Spring”
Visceral Lymphoid Tissue
GALT–>
a. Peyer’s Pathces: ileum
b. Lacteals: small bowel (large chylomicrons travel lymphatic system–>thoracic duct–>venous system)
How much fluid moves from capillaries to interstitial space every day?
30L –> 90% to capillaries and 10% to lympathcis
*half of diffused plasma proteins re-enter through lymph
Order of lymphatic vessels starting with lymphatic capillaries–>
collecting lympahtics–>afferent lymphatic vessels–>efferent lymphatic vessels–>thoracic duct or R lymphatic duct–>venous system
- run with veins
- *ECF is sucked in by the low pressure system
What is the most highly organized lymphoid tissue?
LNs
Types include…
a. Superficial: within subcutaneous tissue
b. Deep: beneath fascia, muscle, organs
Functions include…
a. filtration of lymph fluid
b. maturation of lymphocytes
c. phagocytosis of bacteria and debris
Flow of lymph fluid through a LN
afferent–>sub scapular space (macrophages, dendritic cells)–>outer cortex (b cells)–>deep cortex (t cells)–>medullary sinus (b cells and plasma cells)–>efferent (out through hilum
If a lymph node is swollen, soft, painful, it is probably…
infected (look upstream for the source)
What should you do if you find a Virchow’s Node?
look for malignancy in the thoracic or abdominal cavities
*a large node in the L supra clavicular
What are epitrochlear nodes?
a node associated with secondary syphillis
What nodes can we find in the anterior cervical triangle? posterior?
- Submanibular triangle, mid jugular chain area, jugulodigastric area/node
- Posterior triangle LN, lower jugular chain area
*separated by the SCM
What happens to lymph capillaries when pressures >/= 0mmHg?
they collapse (flow ceases)
How does the thoracic diaphragm help with men of flow?
- with each breath, contraction increases the negative intrathoracic pressure, which pulls fluid centrally
- also exerts a direct force on the cisterna chyli to direct fluid superiorly
How does the pelvic diaphragm help with men of flow?
- helps move fluids from LE and pelvis to thoracic duct
- may be dysfunctional in dysmenorrhea, endometriosis, post labor, BPH..
Effects of Edema: compression of local structures
- Vascular: decreased delivery of O2, nutrients, meds, hormones
- decreased sensation, pain, or paresthesia
- SOB if pulmonary, decreased LOC if cerebral
Effects of Edema: decreased tissue waste removal
- pH of tissues/organs changes
- painful
Effects of Edema: decreased pathogen clearance and immunity
does this too
Effects of Edema: chronic states–>
- fibroblast recruitment and activation
- fibrosis/contractures
End feels:
a. elastic
b. abrupt
c. hard
d. crisp
e. empty
a. rubberband
b. hinge joint, OA
c. SD
d. involuntary stop (like with a pinched nerve)
e. patient guarding
Radiculopathy
-pain with dermatomal distribution
-Neuro function impaired (LE weakness, diminished reflexes)
-typically acute
-work up: MRI
+ straight leg test
Spinal Stenosis
-b/l lower limb pain
-neurogenic claudication
-Neuro function may be impaired (LE weakness, diminished reflexes)
-typically chronic
-work up: MRI
+ straight leg test
Impingement of L5 means what? S1?`
- can’t walk on heels
2. can’t walk on toes
Cauda equina syndrome
- EMERGENCY–traumatic
- impaired neuro function (saddle anethesia, LE weakn ess, diminished reflexes, urinary retention)
- work up: MRI
Sacralization vs. Lumbarization
- one or both TPs of L5 fuse
2. S1 doesn’t fuse
- Spondylosis
- Spondylolsis
- Spondyloesthesis
- bony spurs
- dog fracture
- slipping of vertebra on another
What stage of stress does the doc see?
third–>exhaustion
Clinically evident stress reflects what two things?
- patient’s response to stress inducing events produces biopsychosocial consequences
- patient’s long term stress management style is an important factor determining health or disease, and an area in which the physician must intervene for long term adaptive change
What are four of the most common behavioral consequences of stress?
depression, anxiety, insomnia, substance abus
Why are ligaments used as the main agency for reduction in BLT?
they are primarily involved in the maintenance of the lesion
FPR proposed mxn
- ^gamma motor neurons–>SD (tension in muscles even in neutral)
- Positioning muscle in neutral position results in Inverse spindle output, which eliminates the afferent excitatory input to the spinal cord through the Group 1a & II fibers
• Tension & hypertonicity of the extrafusal muscle fiber is reset
• Unloading the joint, which enables a rapid response to 3- plane therapeutic position
How much weight is added for Stills? FPR? BLT?
- 5lbs
- 1 lbs
- none
