Exam #3 Flashcards
Somatic dysfunction can occur anywhere in the body at
Sympathetics levels
Paraysmpathetic levels
Soma (not autonomic related)
Viscerosomatic reflexes occur at
Sympathetics levels
Parasympathetics levels
Facilitated segments ONLY occur at
Sympathetics
…. with respiratory assist is CONTRAINDICATED in a patient with Asthmatic Flare Up or COPD exacerbation
Thoracic Pump
Diaphragm neurological
neurological: phrenic nerve (C3, C4, C5)
Where the thoracoabdominal diaphragm attaches
lower ribs, thoraco-lumbar junction, T10-L3 are examples
splenic rupture pain referral
shoulder
Young males should not get recurrent urinary tract infections: must do
imaging studies of the uro-genital anatomy
Great for treating otitis media, fluid in the ear, Eustachian tube somatic dysfunction
Galbreath Technique
high-pitched ringing in the ear
Internal rotation of the temporal bone
perception of a low-pitched roar
External rotation of the temporal bone
A parallelogram-shaped head in an infant is associated with
lateral strain cranial pattern
what can cause a positive psoas test
renal lithiasis
appendicitis
inflamed lymph nodes, this may make the muscle they are touching to become hypertonic such as sternocleidomastoid causing
torticollis
If someone has a nocturnal cough at night it could be bc
asthma (pulmonary issue) or reflux (GI issue)
…would think more pulmonary issue and maybe albuterol might be answer choice
T2
…would think this is more GI and maybe omeprazole might be answer choice
T8
could be either pulmonary or GI and you would need more information to get correct answer
T5
Treating a facilitated segment would help avoid excessive neurologic impulse through the
viscerosomatic reflex arc
Later stages of chronic facilitation is associated with loss of
inhibitory neurons
RVU means
relative value unit
Lumbar spine will side-bend towards the …. and rotate towards the…
side-bend towards the long leg side and rotate towards the short leg side
Most commonly used form of contraction in muscle energy is
isometric contraction
Take a history prior to
physical examination
Isometric contraction used in muscle energy tenses the … causing a reflex inhibition of the muscle allowing an increase in muscle length
Golgi Tendon organs
A heel lift for a leg length difference may help prevent
osteoarthritis
Orientation of Superior Facets
cervical: BUM
thoracic: BUL
lumbar: BM
Orientation of Inferior Facet
cervical: AIL
thoracic: AIM
lumbar: AL
flexion and extension are on a … plane
sagital
OA is
AA is
C2-C7 are
Type I like
rotation only
Type II like
Rule’s of three
T1-3: spinous processes project posteriorly therefore the tip of the spinous process is in the same plane as the transverse process of that vertebra
T4-6: spinous processes project slightly downward, therefore the tip of the spinous process lies in a plane halfway between that vertebra’s transverse processes and the transverse processes of the vertebra below it
T7-9: spinous processes project moderately downward, therefore the tip of the spinous process is in a plane with the transverse process below it
T10 follows rules of T7-9
T11 follows rules of T4-6
T12 follows rules of T1-3
Indirect Technique
Dysfunction is taken into position of injury
Uses inherent forces
Uses a compressive, tractional, or torsional component
Direct Technique
Uses external forces
Postisometric Relaxation
Patient is Instructed to GENTLY Push AWAY From the Barrier
Reciprocal Inhibition
Patient is Instructed to GENTLY Push TOWARD the Barrier
pancreatitis and vomiting or myocardial infarction and vomiting
viscerovisceral reflex
post ganglionic sympathetic fibers lead to tissue texture changes
hypertonicity, moisture, erythema
KNOW sympathetics and parasympathetics
Ganglions
CN foramens
…
Sympathetic Supply to Upper Extremity Vasculature
T2-T8
Sympathetic Supply to Lower Extremity Vasculature
T11 to L2 levels
Thoracic inlet/outlet components
Supraclavicular space
1st rib
adrenal glands
anterior
posterior
Anterior: 1” lateral and 2” superior to umbilicus ipsilaterally
Posterior: intertransverse spaces of T11 and T12 ipsilaterally midway between spinous and transverse processes
kidney
anterior
posterior
Anterior: 1” Lateral and 1” Superior to Umbilicus Ipsilaterally
Posterior: Intertransverse Spaces Midway Between Spines and Transverse Tips of T12-L1
urinary bladder
anterior
posterior
Anterior: Umbilical Area (Periumbilical)
Posterior: Intertransverse Spaces Midway Between Spines and Transverse Tips of L1-L2
urethra
anterior
posterior
Anterior: Along superior margin of the pubic ramus about 2 cm lateral to the symphysis
Posterior: L3 transverse processes
Treatment examples include:
Anterior cervical fascia release
Thoracic inlet myofascial release
Pectoral Traction
heart sympathetics
T1-6 with synapses in upper thoracic and cervical chain ganglia
Right- sinoatrial (SA) node and right deep cardiac plexus– predisposes to
supraventricular tachyarrhythmias. Sinus tach, A-fib, A-flutter, PACs
Left-atrioventricular (AV) node and left deep cardiac plexus- predisposes to
ectopic PVCs and V fib and V tach
Right vagus-via SA node and hyperactivity predisposes to sinus
bradyarrhythmias
Left vagus- via AV node where hyperactivity predisposes to
AV blocks
Vagus nerves have fibers course to them from the
C-1 & C-2 nerve roots
Sinus Bradyarrhythmia will cause
OA, AA (C1), C2 will rotate towards the right
1st, 2nd, 3rd degree AV Blocks will cause
OA, AA (C1), C2 will rotate towards the left (Left side is AV node)
Sinus Tachyarrhythmia, Atrial Fibrillation, Atrial Flutter, Premature Atrial Contractions (PAC) cause
Upper thoracic spine (T1-T5) will rotate towards the right (Right side is SA node)
V-fib, V-Tach, Premature Ventricular Contractions (PVC) cause
Upper thoracic spine (T1-T5) will rotate towards the left (Left side is AV node)
occipitomastoid suture is made up of
temporal bone
occiput
atrial flutter Thoracic vertebrae should be rotated to the
right
Dry mouth can be caused by (cranial nerve and foramen)
Can be caused by Cranial Nerve VII - stylomastoid foramen
Can be caused by Cranial Nerve IX - jugular foramen
what treatment position is used for AT1-6
flexed
ant cervical tender point 7
location
position
location: On the clavicular (lateral) attachment of the SCM
position: F STRA
Sternocleidomastoid muscle (SCM) refers pain
lateral and behind the eye
Splenius Capitus muscle refers pain to the
vertex of the head
CNI
Anosmia
Cribiform plate through ethmoid bone
CNV
Trigeminal Neuralgia/Tic Douloureux
May complain of sudden, severe facial, ear, and/or jaw pain
CNVII
Exits stylomastoid foramen
Bell’s Palsy
CNVIII
Labyrinthitis, Tinnitus, Vertigo ** Temporal bone is associated with tinnitus, labyrnthitis, vertigo
CNX
Exits jugular foramen (formed by occipitomastoid suture)
Can cause Nausea/Vomiting
CNXI
Exits jugular foramen (formed by occipitomastoid suture)
Can cause Torticollis
CNXII
Hypoglossal canal
Can cause nursing/latching problems in infants
Complaints associated with CN X Impingement
Colic – CN X
GERD – CN X
Vomiting – CN X
Asthma – CN X
Complaints associated with CN XII Impingement
Difficulty nursing/latching
Complaints associated with CN VIII Impingement
Otitis Media
Pump-Handle motion
1-5
Bucket-Handle motion
6-10
Caliper motion
11-12
Exhaled ribs are prominent
post
Inhaled ribs are prominent
ant
Anterior Rib Counterstrain Points are associated with
Exh
Posterior Rib Counterstrain Points are associated with
Inh
Rib HVLA 2-10
Place thenar eminence (fulcrum) on posterior aspect of rib angle
goal measure of heal lift
4MM
Standing Flexion Test positive side
PSIS moves more cephalad at the end range of motion
“Gold Standard” Test for iliosacral SD
Standing Flexion Test
Anterior Innominate Rotation muscles used
biceps femoris, semitendinosus, and semimembranosus
Posterior Innominate Rotation muscles
vastus lateralis, vastus medialis, vastus intermedius, and the rectus femoris
An inferior pubic shear is treated like an Anterior Innominate rotation with the addition of
ABduction
A superior pubic shear is treated like a Posterior Innominate rotation with the addition of
ABduction
Sacral Torsion Rules
L5 Side-bends Towards the Oblique Axis
L5 Rotates Opposite of Sacral Rotation
Unilateral Sacral Flexion: ME
Ask patient to inhale and hold breath, while you push anterior and superior on the ILA
Unilateral Sacral Extension: ME
Ask the patient to exhale and hold breath, while you push anterior and caudad on the superior sulcus
right psoas tightness
sideband to right
strains left piriformis
Bragard Test
Herniated Lumbar Disc (L1-L5, S1)
Thomas Test
Hip Flexion Contracture (Psoas Muscle Hypertonicity)
Babinski Reflex
Upper Motor Neuron Pathology
Hoover Test
Malingerer
Sympathetic Innervation
ovaries/testes
T10-T11
Sympathetic Innervation
fallopian tuve/vagina
T11-12
Sympathetic Innervation
uterus/cervix
T10-L2
Parasympathetic Innervation to Uterus, cervix, vagina, clitoris, walls of the urethra
S2-S4
Direct MFR (Myofascial release) of pelvic diaphragm form
With thumbs medial to the tuberosities gently apply cephalad pressure while maintaining contact with tuberosities at all times
Direct MFR (Myofascial release) of pelvic diaphragm is good for
Great for lymphatics/addressing hypertonic pelvic floor musculature
Absolute contraindications to OMT during pregnancy
Abruptio placenta
Ectopic pregnancy
Placenta previa
Undiagnosed vaginal bleeding
Occipital Condylar Compression
The “most important” or most clinically significant somatic dysfunction which should be addressed in all newborns is occipital condylar compression.
….is useful in treating condylar compression.
OA decompression
…. plays a role in erectile dysfunction
S2 – 4
Decreased Ureteral Peristalsis may cause
Ureteral Spasm (Ureterospasm)
…is the maximum number of regions you can treat with OMT in a single encounter
9-10
Pump-handle ribs position
flex head and neck
Bucket-handle ribs position
Flex the patient’s head and neck and side-bend the patient toward dysfunctional rib
… muscles attach to rib 1
Anterior and middle scalene
Ejaculation symp level
T12 – L2
