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OMM > Fall 2020 Final Exam > Flashcards

Fall 2020 Final Exam Flashcards

1
Q

Chapman: Chapman’s reflexes are a classic modality of diagnosis and treatment in osteopathic medicine. They are palpable as “gangliform” contractions, and thought to be due to hypercongestion of local lymphatics.

Each specific palpatory change relates to a specific disease or condition (anatomic “map”). All are bilateral except for which of the following?

a. stomach (acidity)
b. liver
c. spleen
d. pancreas

A

All of the above

  1. Stomach
    - -acidity (L)
    - -peristalsis (L)
  2. Liver and gallbladder (R)
  3. Spllen (L)
  4. Pancreas (R)
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2
Q

Chapman: Chapman’s reflexes are a classic modality of diagnosis and treatment in osteopathic medicine. They are palpable as “gangliform” contractions, and thought to be due to hypercongestion of local lymphatics.

Each specific palpatory change relates to a specific disease or condition (anatomic “map”). All are bilateral except for which of the following?

a. stomach (acidity)
b. liver
c. spleen
d. pancreas

A

All of the above

  1. Stomach
    - -acidity (L)
    - -peristalsis (L)
  2. Liver and gallbladder (R)
  3. Spleen (L)
  4. Pancreas (R)
  5. Appendix (R)
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3
Q

Chapman: True/False - Chapman’s points were developed in the 1900’s by Frank Chapman during a time when lab testing and imaging was not reliable, and non-toxic medications were not readily avaialble. A book based on these points (Endocrine Interpretation of Chapman’s Reflexes) was published in the 1930’s after his death, and was the first to describe the inter-related neuroendocrine immunity systems.

A

True

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4
Q

Chapman: Chapman’s reflexes are distinct, hyper-congested areas of the lymphoid tissues in the fascia. Each point is associated with a specific organ, each has an anterior and posterior reflex, and they all can can present with soreness/tenderness in acute stages.

What are theoretical causes of Chapman’s reflexes?

a. Lymphatic system
b. ANS
c. Myofascial
d. Endocrine system

A

All of the above

  1. Lymphatics **
  2. ANS: segmentation
  3. Myofascial: histopathology studies of biopsies – no tissue changes
  4. Endocrine: less studied
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5
Q

Chapman: The etiology of Chapman’s reflexes is based on irritation, disease or stress of an organ. This leads to increased ________, which then leads to lymphatic stasis and boggy, ropy, shotty and thickened myofascial nodules

A

inc. sympathetic tone
* lymph vessels innervated by SNS fibers (facilitation from irritation leads to constricted lymph vessels/stasis and accumulation of pro-inflammatory substances)

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6
Q

Chapman: True/False - Palpatory tissue changes are most likely from ANS input and lymphatic congestion. Changes occur most often or are palpable in the intercostal and spinal areas, but may occur in the extremities.

A

True

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7
Q

Chapman: Chapman’s reflexes may be acute or chronic (based on duration of the condition). This aspect of chronicity can be appreciated by its tactile properties.

A patient presents with tender, non-radiating, tapioca (or BB) type points. They are smooth and circumscribed, but firm (dense/not hard). The are discretely palpable, and fixed in one place (may move slightly). The points are located in the deep aponeurosis or fascia.

This describes acute or chronic?

A

Answer: Acute

Chronic:

  1. less tender
  2. less discrete, somewhat confluent
  3. Generalized inc. tension
    - -rubbery nodule, stringy, ropy, firm
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8
Q

Chapman: True/False - In chronic or severe cases, coalescent mats of “string of pearls” may be felt (especially with points on the lower extremities)

A

True

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9
Q

Chapman: How do Chapman’s points differ from other myofascial points?

a. Tenderness is present, but not the sole criteria
b. location, lymphatic congestion and myofascial tissue changes are important criteria
c. they are not counterstrain or trigger points
d. they are counterstrain and trigger points

A

A-C

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10
Q

Chapman: A positive Chapman’s reflex occurs when both the anterior and posterior points are present. They may be in the deep fascia, or periosteum (not only subcu tissue).

Anterior reflexes follow intercostal sympathetic nerves. They are located in the intercostal spaces near the sternum. These reflexes are more discrete than the posterior ones. What are their uses/characteristics?

A
  1. Used for Dx
  2. 1st in Tx sequence
  3. After Tx posterior, use anterior to assess efficacy
    (if no change, it becomes a diagnostic point – pathology is too great, or another factor influencing it)
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11
Q

Chapman: True/False - Posterior reflexes are located between the spinous processes and transverse processes of adjacent vertebrae. They are less discrete than the anterior and tend to present with a more rubbery feel. They often resolve with treatment of the anterior reflex.

A

True

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12
Q

Chapman: Classic uses for Chapman’s reflexes include:

  1. Diagnosis of organ issues or conditions
  2. Treatment to influence lymphatics
  3. Treatment to influence visceral function (via nervous system)

What are the modern uses of Chapman’s reflexes?

A

Constructing differential diagnoses

NOTE: Never make a Dx based solely on a non-tender Chapman’s reflex (Wilson Rule)

NOTE 2: Never ignore or trivialize a tender Chapman’s reflex (Wilson Rule)

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13
Q

Chapman: True/False - Literature has demonstrated that hospitalized patients with pneumonia have a high predictability of presenting with Chapman reflex points classified for lungs. Furthermore, Chapman reflex point examination was proposed to be useful in evaluating patients with a potential diagnosis of pneumonia. This relationship was statistically significant.

A

True

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14
Q

Chapman: Treatment for Chapman reflexes should begin with anterior reflexes. Light massaging in the rotary direction (clockwise or counterclockwise) should be applied for 20-60 seconds until the lymphatic conegestion diminishes or a change in myofascial tissue is detected.

What should be treated next?

A

posterior reflexes

*then re-check anterior side and retreat if still tender and congested

NOTE: do not use excessive pressure – be gentle

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15
Q

Chapman: The appendix is the exception to ID’ing Chapman points. Where is the Appendix located?

A

Anterior: Tip of 12th rib on the R

Posterior: T10-11 spinous process/transverese process (R)

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16
Q

Chapman: To perform an ENT screen, the middle ear, sinuses, tonsils and larynx reflex points should be assessed. Where is the point for the sinuses?

A

Superior aspect of the 2nd rib

posterior: C2 transverse process

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17
Q

Chapman: To perform a pulmonary screen, the larynx, bronchus, upper lung and lower lungs should be assessed. What is the point for the lower lung?

A

anterior: 4th Intercostal space
posterior: T4 - midway between SP and TP

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18
Q

Chapman: To perform a cardiovascular screen, the myocardium, bronchus, esophagus, and thyroid should be assessed. What is the point for the myocardium?

A

Anterior: Between ribs 2 and 3 at sternocostal jx (R)
Posterior: T2/T3

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19
Q

Chapman: To perform an upper GI screen on the left side, the pylorus, stomach (acidity and peristalsis), spleen and SI should be assessed.

On the right, the pancreas and appendix should also be palpated. What are the points for the pancreas and appendix?

A

Pancreas:

  • -anterior: Ribs 7 and 8 at costochondral jxn (R)
  • -posterior: T7-T8 (R)
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20
Q

Chapman: For a lower GI screen, the Ascending colon, Transverse colon, and Descending colon should be assessed. What are the CHapman’s points of each?

A
  1. Ascending: Proximal Right IT band
  2. Transverse colon: Distal Right and Left IT band
  3. Descending colon: Proximal left IT band

Posterior: Triangle including L2, L3, L4 across to tip of the crest of the innominate (posterior points)

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21
Q

Chapman: What is the Chapman point for the rectum?

A

anterior: lesser trochanter
posteiror: lower edge of iliosacral joint

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22
Q

Chapman: A urinary screen involves the following:

  1. Adrenals (R and L)
  2. Kidney (R and L)
  3. Urethra (midline)
  4. Urinary bladder (midline)
  5. Ureter (R and L)

A genital screen involves:

  1. Ovary (R and L)
  2. Uterus (R and L)
  3. Broad ligament (F); Prostate (M) - R and L

What are the points for the Adrenals, Kidneys, and Ovaries?

A
  1. Adrenal:
    - -anterior: 1” over, 2” above umbilicus
    - -posterior: T11, T12
  2. Kidney:
    - -anterior: 1” over, 1” up
    - -posterior: T12, L1
  3. Ovary
    - -Anterior pubic bone
    - -posterior: T9-T11
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23
Q

Chapman: Chapman’s reflexes can aid in differential diagnosis in conjunction with other findings (correlate with established diagnosis). Treatment of these points may ease the course of the disease process as well as reduce related pain.

True/False - It is important to document as viscerosomatic reflex.

A

True

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24
Q

Lower resp: A patient presents with breathlessness, wheezing, and coughing. He complains of increased sputum production and decreased tolerance to exercise. He has been a smoker for over 40 years. You suspect

A

COPD

  • mucus accumulation/dec. cilia fxn
  • destruction of alveoli; hyperinflation
  • accessory muscle use
  • inflammation (proteinases/ox stress)
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25
Q

Lower Resp: Major systemic co-morbidities of COPD include:

  1. Exercise intolerance
  2. Remodeling of the musculoskeletal system
  3. Anxiety from Dyspnea
  4. Systemic inflammation

_____ is associated with de-conditioning, isolation, depression, and decreased muscle mass from lack of exercise

A

Exercise intolerance

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26
Q

Lower Resp: Major systemic co-morbidities of COPD include:

  1. Exercise intolerance
  2. Remodeling of the musculoskeletal system
  3. Anxiety from Dyspnea
  4. Systemic inflammation

Osteoporosis may be seen in COPD pateients due to inc. steroid use and ____

A

remodeling of the musculoskeletal system

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27
Q

Lower Resp: Major systemic co-morbidities of COPD include:

  1. Exercise intolerance
  2. Remodeling of the musculoskeletal system
  3. Anxiety from Dyspnea
  4. Systemic inflammation

True/False - Systemic inflammation results from a “spill over” of multiple mediators, cytokines, inflammatory cells (from lung), and is associated with inc. oxidative stress. It is also associated with inc. susceptibility to infections, cardiovascular disease, and diabetes.

A

True

*loss of lean body mass – inc. metabolism (cachexia - work hard)

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28
Q

Lower Resp: Musculoskeletal features of COPD patients include expansion and rigidity of the rib cage. The diaphragm flattens with less mobility, reducing efficiency of breathing due to loss of passive recoil.

Patients tend to assume the “tripod” position which features increased kyphosis, forward head posture, and overuse of accessory muscles. What are common TART findings?

A

Varied

*C3-5 (phrenic nerve) effects on diaphragm function

NOTE: Tx diaphragm and neck

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29
Q

Lower resp: OMM may be utilized to improve respiratory symptoms in COPD patients. The following may be treated to improve respiration in COPD patients. List examples of each

a. Parasympathetics (CN X)
b. Sympathetics (T1-6)
c. Musculoskeletal
d. Lymphatics

A
  1. Parasympathetics (CN X)
    - -duboccipital decompression
  2. Sympathetics (T1-6)
    - -soft tissue (paraspinals)
    - -rib raising
  3. Musculoskeletal
    - -doming diaphragm
    - -pectoral traction
  4. Lymphatics
    - -thoracic inlet and lymphatic pump
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30
Q

Lower resp: Neurologic considerations for Tx of COPD focus on viscerosomatic reflexes to help balance the SNS and PNS. These reflexes intersect with biomechanical considerations.

Omm can help to normalize the autonomics. List the Reflexes associated with the lungs

A

T1-6 (SNS)
OA, AA, C2 (Vagus)
Chapman’s (Upper lung: 3rd ICS, T3; Lower lung: 4th ICS, T4)

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31
Q

Lower resp: True/False - High vagal tone (PNS) can lead to bronchoconstriction and inc. watery secretions into the airway. Facilitation of the vagus may occur through OA, AA and C2.

Conversely, Sympathetic firing my increase production of thick, tenacious secretions and lead to bronchodilation (T1-6).

A

True

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32
Q

Lower Resp: True/False - There is a significant association between pneumonia and the presence of chapman’s reflex points for the lung.

A

True

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33
Q

Lower resp: Biomechanical considerations of COPD should include assessing the limitations of the musculoskeletal system as well as its effects on the neurological system. For example, stimulation of intercostal muscle spindles out of phase with breathing may induce breathlessness.

Interventions that improve _____ and ___ mobility, and muscle legnth in the upper quadrant may improve pulmonary function

A

neck and thoracic mobility

  • rib cage
  • diaphragm (dec. work of breathing/inc. intrathoracic pressure)
  • accessory muscles (scalenes, pec minor)
  • thoracic kyphosis (dec. thoracic spine mobility)
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34
Q

Lower respiratory: Venous and Lymphatic flow or lack thereof may have an impact on COPD via

  1. Inc. inflammation
  2. Inc. immune response
  3. Edema and congestion

Treatment of COPD should include considerations on how to improve flow as well as increase ease of respiratory excursion (biomechanical). This can be done by OMM (adjunctive) which may aid in decreasing inflammation and infections while also improving the efficiency of breathing.

A

True

Other Tx: 
--smoking cessation
--medications 
(steroids - fluticasone; LABA - relax SM/formoteral; Anticholinergic muscarinic antagonist -bronchodilation tiotropium)
--provide O2 as needed
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35
Q

Lower respiratory: Metabolic/Energy Considerations -Patients with COPD are at increased risk for developing diabetes and other inflammatory conditions. They may also suffer from fatigue (multi-factorial) and malnutrition. It is important to increase protein intake in COPD patients, as they tend to lose SK muscle mass from chronic pulmonary disease.

True/False - Tx with OMM and pulmonary rehab may improve biomechanical efficiency, resp. mechanics, muscle stregnth, exercise tolerance and posture.

A

True

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36
Q

Lower respiratory - Behavioral - COPD patients tend to have increased risk of developing depression and/or anxiety.

Pulmonary rehabilitation, O2 treatment and self-management programs may help, along with exercise regiments to improve motivation. What are other considerations regarding behavior management?

A
  1. Smoking cessation
  2. Environmental (allergens/pollutants)
  3. Medication compliance/inhaler education
  4. Hydration
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37
Q

Lower respiratory: The sensation of breathlessness is closely related to the sensation of respiratory effort.

It increases when the load on respiratory muscles ______, or when the capacity of respiratory muscles _____, or both.

A
  1. increase

2. decrease

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38
Q

Myofascial: Which of the following is a function of fascia?

a. binds, protects, envelopes and separates tissues
b. connects structures that permits transmission of forces
c. possesses qualities of stregnth, elasticity and energy storage
d. provides protective enzymes and Igs

A

A-C

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39
Q

Myofascial: List the following in order from dense irregular to dense regular

  1. aponeurosis
  2. proper fascia
  3. ligaments
  4. tendons
A
  1. proper
  2. aponeurosis
  3. ligaments
  4. tendons
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40
Q

Myofascial: One of the functions of myofascial tissue is to bind, protect, envelope and separate tissues. Which of the following types of fascia play a role in this?

a. superficial fascia
b. intramuscular fascia
c. aponeurosis
d. tendons

A

A-C

*deep fascia, aponeurosis, intramuscular, superficial

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41
Q

Myofascial: Fascia plays arole in connecting structures permitting the transmission of forces. What types of fascia are involved in this?

a. ligaments
b. tendons
c. aponeurosis
d. deep fascia

A

A and B

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42
Q

Myofascial: Fascia also plays a role in providing stregnth, elasticity and energy storage. Which types of fascia play a role in this?

a. ligaments
b. tendons
c. superficial fascia
d. aponeurosis

A

all of the above

–all types of fascia (superficial, intramuscular, deep, apo, ligaments, tendons)

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43
Q

Myofascial: Fascia is regulated by multiple receptors including:

  1. Golgi tendon organs
  2. Pacini mechanoreceptors
  3. Ruffini mechanireceptors
  4. Interstitial (Type 3 and 4) mechnoreceptors

What are the functions of the above receptors or what do they detect?

A
  1. Golgi tendon organs
    - -active streching movements
  2. Pacini mechanoreceptors
    - -changes in pressure and vibrations
  3. Ruffini mechanireceptors
    - -changes in pressure (rapid/sustained)
  4. Interstitial (Type 3 and 4) mechnoreceptors
    - -sensory
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44
Q

Myofascial: Fascia forms a continuous tensional network throughout the human body, covering and connecting every single organ, every muscle, and every nerve and muscle fiber. There are several properties/studies of fascia including:

  1. Viscoelasticity
  2. Creep
  3. Wolff’s law
  4. Hysteresis

The viscoelastic nature of fascia describes it as being both elastic and shapable. ___1___ enables it to maintain deformed shapes (permanent change in intermolecular bonds), while ___2__ enables fascia to return to its original shape after being loaded (recoil).

A
  1. Viscosity
  2. Elasticity

*fascia exhibits combined properties

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45
Q

Myofascial: Fascia forms a continuous tensional network throughout the human body, covering and connecting every single organ, every muscle, and every nerve and muscle fiber. There are several properties/studies of fascia including:

  1. Viscoelasticity
  2. Creep
  3. Wolff’s law
  4. Hysteresis

____ describes continuous deformation under constant load. The tissue lengthens when it is subjected to load over a prolonged period of time. Continued deformation can lead to dec. ability to resist furture loads.

A

Creep

  • The duration of the load is more important than the amount of force.
  • contributing factor in repetitive strain injuries
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46
Q

Myofascial: Fascia forms a continuous tensional network throughout the human body, covering and connecting every single organ, every muscle, and every nerve and muscle fiber. There are several properties/studies of fascia including:

  1. Viscoelasticity
  2. Creep
  3. Wolff’s law
  4. Hysteresis

______ describes mechanical stressor affecting tissue differentiation and growth characteristics. Examples of dysfunction include increased stress or load that contribute to remodelling (e.g. heel spur – tight plantar fascia). Therapy can involve external forces that reduce stress and restore structure, or improving structure to restore normal functional motion.

A

Wolffs law

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47
Q

Myofascial: Fascia forms a continuous tensional network throughout the human body, covering and connecting every single organ, every muscle, and every nerve and muscle fiber. There are several properties/studies of fascia including:

  1. Viscoelasticity
  2. Creep
  3. Wolff’s law
  4. Hysteresis

_______ is the capacity of the fascia to change length (stretch) in a therapeutic way when loaded and unloaded. Energy (heat) is normally released in the process and it does not return via the same pathway when unloading.

A

Hysteresis

**myofascial release (utilize this property of fascia – tissue feels warmer after Tx)

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48
Q

Myofascial: Myofascial release (MFR) is a system of diagnosis and Tx which engages continual palpatory feedback to achieve release of myofascial tissues.

  1. ______ involves loading the dysfunctional myofascial tissues and engaging them into the restrictive barrier with constant force.
  2. ____ involves loading and guiding the dysfunctional tissue into the position of ease
A
  1. direct
  2. indrect MFR

*light - moderate pressure with complimentary positioning

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49
Q

Myofascial: Fascia is capable of changing length and altering muscle tone and neural facilitation. Thus, application of external forces via MFR can help restore the normal structure and function as well as promote self-healing.

What are the steps of MFR

A
  1. Gentle compression – engage tissue/underlying fascia
  2. Monitor motion in all planes
    - -inferior vs. superiro
    - -medial vs. lat.
    - -clockwise vs. counter
  3. determine ease-bind (direct or indirect)
  4. hold until release is palpated
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50
Q

Myofascial: Relative contraindications of MRF include exercise caution in the case of

a. fractures
b. open wounds
c. acute thermal injury
d. aortic aneurysm

A

all of the above

  • bony/soft tissue infections
  • DVT
  • anticoagulation
  • disseminated/focal neoplasm
  • recent post-operative sites
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51
Q

Compensatory pattern: Dr. Gordon Zink suggested that there’s a recurring compensatory pattern that occurs in patient’s with somatic dysfunction. There are two main types:

  1. Common compensatory
  2. Uncommon compensatory

How do these differ?

A
  1. COmmon compensatory
    - -80% people
    - -L/R/L/R
  2. Uncommon
    - -20% of people
    - -R/L/R/L
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52
Q

Compensatory pattern: True/False - Uncompensated patterns are non-alternating, disparate patterns that are seen in patients who are acutely ill, who fail to respond to ordinary treatment approaches, or who have a history of trauma or chornic illnesses.

A

True

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53
Q

Compensatory pattern: The presence of transition zones (anatomic weak areas) in the body are believed to be influential in the development of compensated patterns. These zones are:

  1. Occipitoatlantal (OA)
  2. Cervicothoracic (CT)
  3. Thoracolumbar (TL)
  4. Lumbosacral (LS)

What are the junctions and diaphragms associated with these transition zones?

A
  1. Occipitoatlantal (OA)
    - -craniocervical jxn
    - -tentorium cerebelli
  2. Cervicothoracic (CT)
    - -cervicothoracic jxn
    - -thoracic inlet/outlet
  3. Thoracolumbar (TL)
    - -thoracolumbar jxn
    - -rep. diaphragm
  4. Lumbosacral (LS)
    - -lumbosacral jxn
    - -pelvic diaphragm

The diaphragm descends on inhalation, and ascend on exhalation.

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54
Q

Compensatory: The respiratory circulatory model focuses on improvement of O2 and waste removal. Treatment goals include removing restriction to lymphatic flow, enhancing the mechanism for respiratory/circulatory homeostasis, and mobilizing lymphatic fluid.

The following is the sequence for treating a patient in respiratory distress with compensatory pattern. Give examples of treatments.

  1. Thoracic inlet
  2. Maximize diaphragmatic motions
  3. Inc. pressure differential/fluid flow
  4. Mobilize congested tissue
A
  1. Thoracic inlet
    - -direct MFR thoracic inlet
  2. Maximize diaphragmatic motions
    - -Direct MFR diaphragm, OAD, L/S decompression
  3. Inc. pressure differential/fluid flow
    - -Rib raising
  4. Mobilize congested tissue
    - -thoracic/lymphatic pump

lymph > venous > arterial (most resistant)

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55
Q

lower respiratory: True/False - OMT has been shown to improve well being, performance of daily activities and 6MWT in COPD patients.

However, the only thing that has been shown to reduce decline in FEV1 is smoking cessation

A

True

*majority of patients believed they could breathe better after receiving osteopathic manipulation

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56
Q

Lower resp: A study was conducted examining the effects of OMT combined with pulmonary rehab vs. pulmonary rehab alone. What was found?

A

both improved breathing

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57
Q

Lower respiratory: Use of OMT in a patient with a lung infection is meant to encourage immune system function (respiratory/circulatory model).

Examples of OMT include thoracic inlet release, rib raising, thoracic lymphatic pump, pectoral traction, and diaphragmatic myofascial release.

What are techniques that are appropriate for improving the neurological and biomechanical models?

A
  1. Neurologic
    - -OA decompression, Cervical ME (target phrenic nerve), rib raising
  2. Biomechanical
    - -Scalene MFR, pectoral traction, rib raising, rib walking, diaphragm MFR
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58
Q

Lower respiratory: A 75 y/o female with a 2 year history of Cryptogenic organizing pneumonia presents to the OMM clinic for “sciatica”. She had 6 weeks of R buttock pain that radiated down the back of her thigh. She still has shortness of breath but does not need supplemental O2.

Exam showed no neurologic changes or suspicion for a herniated disc. She had R. piriformis and psoas TPs. These did not resolve even with various technique approaches. What should you try next?

A
  • -double check Dx
  • -Check the other side for dysfunction/Tx it
  • -Check for something keeping the system hung up
  • -systemic/metabolic problems? e.g. uncontrolled diabetes
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59
Q

Lower respiratory: CABG requires cutting open the sternum and spreading the rib cage apart, which causes stress on the rib cage and associated soft tissue.

True/False - Do not touch the surgical site 2nd/3rd day following surgery. You can target the biomechanical and respiratory/circulatory system to assist with healing after surgery. It may also be helpful for residual musculoskeletal chest pain months after surgery.

A

True

*OMT thoracic inlet MFR, rib raising w/ paraspinal muscle stretch to L2, soft tissue cervica, OA

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60
Q

GI: An 18 year old male presents to the OMM clinic for a follow up regarding low back pain. He complains of midi back pain in addition to his low back pain. He reports heartburn over the past few months. He states his diet consists of coffee and tacos mainly. Patient denies weight loss or bloody/dark stools.

You suspect?

A

GERD

symptoms: worse lying down or after acidic foods
* dec. peristalsis
* can cause chronic cough/hoarseness
* atypical chest pain, SOB

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61
Q

GI: GERD is associated with poor tone and development of the lower esophageal sphincter. It is due to transient relaxation of the LES and can be affected by:

  1. Foods (coffee, chocolate, etOH, mints)
  2. Drugs (B-agonist, Ca2+ blocker, Nitrates, anti-Ach, nicotine)
  3. Hormones (progesterone, glucagon, VIP)

There may also be an increased pressure gradient between the stomach and esophagus from obesity, pregnancy or gastroparesis.

A
  • inc. acid production (vagal and stomach distension)

* dec. mucosal defense from NSAIDS

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62
Q

GI: The standard medical approach to Tx GERD includes:

  1. Lifestyle modifications (diet, weight loss, raise head)
  2. Meds (antacids, H2 blockers or PPIs)
  3. Screening procedures (EGD’s, Barrett’s)
  4. Refractory – consider surgery (fundoplication)

What are OMT approaches?

A
  1. ANS
    a. SNS: T5-T9
    b. PNS: Vagus (AO, AA, C2)
  2. Diaphragm and attachments to lower thoracics, upper lumbars, and lower 6 ribs (**T12)
  3. Tx viscerosomatic/Chapmans
    acidity: T5
    peristalsis: T6
  4. Linea alba
    - -celiac ganglion

*especially useful when other approaches haven’t helped

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63
Q

GI: What are the risks of Tx with PPI’s?

a. inc. risk fractures (post-menopausal women)
b. Inc. C diff infections (dec. acidity in infants – alters gut flora)
c. inc. vitamin/mineral deficiencies (Mg, B12)
d. Inc. comunity acquired pneumonia (short term)

A

all of the above

*drug interaction with clopidogrel

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64
Q

GI: GERD is a disease of the foregut. The foregut is composed of the esophagus, stomach, duodenum (to ampulla of vater), liver, pancreas, gallbladder and biliary tract).

What is the vacular supply of the foregut? Innervation?

A
  1. Vascular
    - -Celiac artery
  2. SNS
    - -T5-9
    - -celiac ganglion
  3. PNS
    - -vagus nerve

NOTE: superior mesenteric T10-11; inferior mesenetric T12-L2)

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65
Q

GI: What are SNS effects on the GI system?

a. decreased gut motility, constipation and distension
b. contraction of rectal sphincter
c. vasodilation
d. dec. mucosal defenses of the gut

A

A, B, D

*vasoconstriction

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66
Q

GI: What are PNS effects on the GI system?

a. relaxation of sphincters
b. Inc. gut motility and peristalsis
c. vasodilation
d. inc. secretions

A

all of the above

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67
Q

GI: What are the effects of the ANS on the lower esophageal sphincter?

A
  1. SNS
    - -celiac ganglion, T5-T9
    - -contraction of LES
  2. PNS
    - -Vagus
    - -relax LES
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68
Q

GI: Where are the anterior Chapman’s reflexes for GERD?

  1. Stomach acidity
  2. Stomach peristalsis
A
  1. Left 5th intercostal space
    - -same level as armpit
  2. Left 6th intercostal space

**posterior: same distribution of vertebrae

69
Q

GI: the linea alba connects with the transversalis fascia, which then connects to the esophagus via the phrenoesophageal ligament (PEL). What is located in this region?

A

Celiac ganglion

  • -celiac ganglion most superior
  • -sup. mesenteric
  • -inferior mesenteric (near umbilicus)
70
Q

GI: A study was conducted evaluating the effects of oMT on GERD patients. Patients received 2 five-minute Tx one week apart, while the control group received treatment with no pressure.

Results looked at 3 aspects:

  1. Symptoms (GERDQ test) before and after Tx
  2. Pressure pain threshold (C4 spinous process)
  3. Cervical mobility (cervical range of motion tool)

True/False - Results showed improved GERDQ test scores, higher pressure pain threshold values, and increased cervical mobility in the group treated with OMT.

A

True

71
Q

GI: A 16 y/o female presents to your office with complaints of abdominal pain. She states the pain is there most days and has been impacting her daily life for over a year now. The pain improves with bowel movements, which are loose. She has been under stress at school and at home.

She denies bloody stool, tar-like stool or weight loss. You suspect

A

Irritable bowel disease

  • MC females
  • < 45 y/o
  • stress/emotional upset
  • altered bowel habits, pain, cramping
  • small stool volume; no blood
  • diarrhea or constipation
72
Q

GI: ROME IV criteria defines IBS as recurrent abdominal pain that leasts at least 1 day per week during the previous 3 months. It is associated with two or more of the following:

  1. related to defecation (inc. or unchanged by defecation)
  2. change in stool frequency
  3. change in tool form/appearance

What is the standard medical approach for Tx IBD?

A
  1. Inc. fiber (can inc. bloating)
  2. Remove food triggers (gluten, fermentable sugars)
  3. probiotics/prebiotics
  4. antispasmodic meds (dicyclomine/Bentyl)
  5. psychologic
  6. screening (stool studies/colonoscopy)
73
Q

GI: A study was conducted analyzing the effects of OMT on irritable bowel syndrome. There were 2 arms to the study:

  1. Patients received 5 OMT 1x/2-3 weeks with techniques determined by provider
  2. Standard care group received fiber rich diet, reassurance, laxatives, meds for cramps

True/False - Results demonstrated overall improvement in symptoms at 6 months following Tx with OMM. 5% were free of all symptoms at the end of the study. Only 3 standard care patients noted improvement.

A

True

74
Q

GI: Where are the Chapman’s reflexes for IBS?

  1. Small intestine
  2. Colon
A
  1. Intercostal space of ribs 8-11 (bilateral)

2. bilateral IT band

75
Q

GI: Where are the Sympathetic autonomic ganglia associated with IBS?

  1. Superior mesenteric ganglion
  2. Inferior mesenteric ganglion
A
  1. SMG
    - -T10-11
    - -distal duodenum, portion of pancreas, jejunum, ascending colon, proximal 2/3 transverse
  2. IMG
    - -T12-L2
    - -distal 1/3 of transverse colon, descending colon, sigmoid colon, rectum
76
Q

GI: Where are the Parasympathetic autonomic ganglia associated with IBS?

A
  1. Vagus
    - -upper GI to splenic flexure
  2. S2-S4
    - -splenic flexure to sigmoid and rectum
77
Q

GI: The ENS contains 95% of 5HT in the body. 5HT’s main function is to increased tone (vasoconstriction). The ENS also contains 50% of dopamine in the body.

True/False - The ENS is related to the ANS, but can function without its input.

A

True

78
Q

GI: OMM should not be performed directly on viscera where there is or may be

a. visceral rupture
b. abscess
c. internal hemorrhage
d. friability (acute inflammation) or infections

A

all of the above

  • open wounds
  • foreign objects (wire mesh)
79
Q

GI: True/False - Remember to always get consent to Tx. The goal of OMM in the GI system is to promote venous/lymph flow; dec. congestion; optimize arterial flow and tissue perfusion

*OMM supplement medical Tx (NOT stand alone)

A

True

80
Q

GI: List the SNS innervation and PNS innervation for the

  1. Foregut
  2. Midgut
  3. Hindgut
A
  1. Foregut:
    –SNS: T1-T9
    –PNS: Vagus
    (Viscerosomatics: ~T3-T8; Occiput)

**FINISH

81
Q

ENT: The ear, nose and throat are adjacent, connected structures that share similar lining (upper respiratory mucosa). These structures are associated with special senses and also serve as the 1st line of defense for external pathogens.

The upper respiratory mucose is composed of pseudostratified, columnar ciliated cells, with goblet and submucosal glands. What is the function of this epithelium?

A
  1. Goblet and glands
    - -mucous blanket
    - -covers/protects epithelium
  2. Cilia
    - -beat to move outer layer
  3. Mucociliary clearance **
82
Q

ENT: The respiratory mucosa plays a role in immunological defense against pathogens. It contains __1__ and __1__ which are protective. Furthermore, it functions in mucociliary clearance. This is done by _2____ action, movement of the mucous blanket, and clearing debris.

A
  1. Lysozymes, IgA
  2. Ciliary action

*drainage of maxillary sinus requires active mucous transport

83
Q

ENT: There are two main sinus drainage patterns:

  1. Anterior
  2. Posterior

Where are these found?

A
  1. Anterior (osteomeatal unit under middle turbinate)

2. Posterior (sphenoethmoid recess)

84
Q

ENT: Ciliary activity may be affected by the presence of

  1. Primary ciliary dysfunction
  2. Secondary ciliary dysfunction
  3. Inflammation and viscosity of mucous (NS)

Primary ciliary dysfunction is associated with a genetic cause (e.g. Kartagener’s). However, secondary is often associated with

A
  1. Tobacco/pollutants
  2. Antihistamines
    - -dec. ciliary activity
  3. Cocaine
  4. Afrin
85
Q

ENT: Rhinosinusitis is inflammation of the mucous membranes (congestion/swelling) causing obstruction of the sinuses. The MC etiologic agents are viral and bacterial agents. Either type of infection can affect ciliary action.

There is an allergic component that also plays a role…

A
  • neurogenic inflammation

* Non-allergic rhinitis (ANS dysfunction – Hypoactive SNS)

86
Q

ENT: Which of the following is a factor that plays a role in airway patency?

a. anatomic obstruction via polyps or deviated septum
b. hypoactive SNS increases nasal airway resistance
c. URI/inflammation
d. overuse of topical decongestants (rhinitis medicamentosa - Afrin)

A

all of the above

*lymphatic congestion

87
Q

ENT: Sinusitis may be treated with antibiotics in accordance with the following guidelines:

  1. Signs/symptoms of acute sinusitis that do not improve within 7 days
  2. sinusitis that improves and then gets worse
  3. temperature of 101F or higher
  4. Moderate - severe pain
  5. Immunocompromised

What if they do not meet criteria?

A

OMM

Techniques:

  • -OA decompression: frees passage of vagus – normalize PNS
  • -cervical: relax cervicals, aid in drainage of cervical lymph nodes
  • -thoracic inlet release: removes myofascial restriction - allows lymph drainage (and improves upper rib motion)
88
Q

ENT: When is it appropriate to order imaging (CT of sinuses) for cases of chronic sinusitis?

a. recurrent or refractory symptoms
b. suspicion for complicated infection (fungal), abscess, or neoplasm
c. there are no restrictions to imaging for sinusitis

A

A and B

89
Q

ENT: Symptoms that last > 5 days and are moderate to severe in nature can be treated with analgesics, topical steroids, decongestants, antibiotics and OMT.

True/False - Sinister signs require an immediate referral. These include swelling, redness of the eyelids, displaced globe, acute reduction in visual acutity, meningeal signs, focal neurologic signs.

A

True

90
Q

ENT: The autitory tube (eustachian tube) connects the middle ear to the nasopharynx. It plays a role in balancing pressure in the middle ear and ambient noise. It also function to clear debris and secretions from the pharyns, and protect middle ear from noxious agents.

1/3 of the eustachian tube occurs in the ______ bone, 2/3 in the _____. It is the narrowest at the juncture. It courses between the petrous temporal bone and sphenoid. Muscles influence its patency

A
  1. 1/3 temporal

2. 2/3 cartilage

91
Q

ENT: Respiratory mucosa in the nasal cavity can lead to congestion of the ears.

In newborns, the tube is 1/2 the legnth of adults, and does not become adult length until 7 years of age. This anatomy predisposes children to more ear infections. What are other anatomic contributors?

A
  1. tube is more horizontal

2. tensor veli palatini - less efficient in kids

92
Q

ENT: OMT was studied as an adjuvant therapy in children with recurrent acute otitis media. The objective was to study the effects of osteopathic manipulative treatment as an adjunctive therapy to routine pediatric care in children with acute otitis media.

Outcome measures analysed included: frequency of episodes, antibiotic use, surgical interventions, tympanometric and audiometric performance. What were the results of the study?

A
  • OMT potentially beneficial as adjuvant therapy in recurrent AOM
  • OMT may prevent or decrease surgical intervention or antibiotic overuse
93
Q

ENT: There are modifiable and non-modifiable risk factors for developing AOM. Non-modifable risk factors include:

  1. genetic predisposition
  2. male gender
  3. ethnic (Native Americans Inc.)
  4. Carniofacial abnormalities

Which is an example of modifiable RF’s?

a. low birth weight
b. not breastffed
c. high frequency pacifier use
d. bottle feeding while supine

A

all of the above

  • exposure to pathogens (day care)
  • breastfeeding: 3 mos breastfeeding reduces OM
  • smoking exposure
  • low socioeconomic status
94
Q

ENT: Sympathetic effects in the sinuses include vasoconstriction and mucosal drying secondary to vasoconstriction.

The SNS increases the airway patency, but overdrying can put the mucosa at risk of breach by pathogens. What is the sympathetic innervation of the nasal mucosa?

A

T1-T4

  • superior cervical ganglia (C2-3)
  • OMT: achieve balance – not too little, not too much

NOTE: sympathetic in lungs - bronchodilation, thicker secretions, vasoconstriction

95
Q

ENT: PNS stimulation increases goblet cell secretions. Neuromediatiors (substance P) can also influence mucosal gland function.

Among the neuropeptides associated with the PNS in the nose is ______ which is up and down regulated in response to inflammation and infection. Lower levels are associated with primary ciliary dyskinesia.

A

NO (nitric oxide)

NOTE: PNS in lungs: bronchoconstrict, thinner secretions, vasodilation

96
Q

ENT: What are the Parasympathetics associated with mucous production?

A

CN 7

  • pterygoid canal (sphenoid)
  • -pterygopalatine ganglion (suspended in pterygopalatine fossa)
97
Q

ENT: The goals of OMT in ENT conditions includes:

  1. Decreasing lymphatic and vascular congestion (dec. pain, and speeds up healing)
  2. Improve drainage from sinuses
  3. “supportrive care” for self-limited viral conditions in conjunction with saline washes, humidifier, tylenol, ibuprofen

List the Tx structure involves in ENT problems

A
  1. Lymphatics
    - -thoracic outlet (upper thoracic and ribs)
    - -abdominal diaphragm release
    - -thoracic pump
  2. Cervicals
    - -myofascial (others)
  3. OA release
  4. Specific sinus/otitis media techniques
98
Q

ENT: To improve lymphatic drainage in the head and neck, start centrally and work peripherally.

Where should you start?

A

Thoracic inlet

*lymph enters jxn of subclavian and internal jugular

99
Q

ENT: What are the structures of the thoracic inlet?

a. Ribs 1 and 2
b. Thoracic 1 and 2
c. SC
d. AC

A

all of the above

+fascia and scalenes

100
Q

ENT: What are points of treatment in the cervical area?

A
  1. cervical muscles (soft tissue, ME)
  2. Cervical facet joints (sympathetic ganglia)
  3. Cranial base (OA decompression)
101
Q

ENT: Other forms of treatment for ENT include Effleurage over the sinuses may be performed as. well as infraorbital and supraorbital pressure point Tx

A

True

102
Q

ENT: ______ is a technique designed to assist in opening the auditory tube and decrease lymphatic congestion.

It may be taught to parents, and you can do this to yourself (airplanes).

A

Galbreath technique

alternative: “ear circles”
- -2 fingers in front of ear, 2 in back (clockwise/counter); myofascial release

103
Q

ENT: OMT to balance the SNS and PNS includes focusing on

  1. SNS (T1-4, C2-3 ganglia)
  2. PNS (cranial and OA)
A

other ENT conditions where OMT is helpful: URI, pharyngitis, eustachian tube dysfxn (post-viral/airplane)

104
Q

ENT: True/False _ OMM is helpful in symptomatic care for common ENT conditions. It helps to:

  1. restore normal ANS balance
  2. improve lymphatic, vein and eustachian tube draiange (dec. pressure from tight muscles and fascial strains)
  3. aid with chronic AOM
  4. Provides immediate relief (compared to antibiotics which can take time)
A

True

105
Q

Brachial Plexus: The Spencer technique has 7 steps:

  1. Extension
  2. Flexion
  3. Circumduction with compression
  4. _________
  5. Adduction and External rotation
    5b. abduction
  6. ________
  7. Distraction – gentle traction on glenohumeral joint
A
  1. Circumduction with traction

6. Internal rotation

106
Q

CCP (compensatory): Treatment goals for CCP include

  1. Removing restrictions to lymphatic flow
  2. Enhancing mechanisms for respiratory and circulatory homeostasis
  3. augmenting and mobilizing lymphatic fluid.

What is the treatment sequence in a patients with severe respiratory dysfunction/distress?

A
  1. Open thoracic inlet
    - -direct MFR
  2. Maximize normal diaphragmatic motions
    - -direct MFR diaphragm, OAD, L/S decompression
  3. Inc. pressure differential and fluid flow
    - -rib raising
  4. Mobilize congested tissue
    - -thoracic lymphatic pump
107
Q

CCP (compensatory): The postural model of CCP demonstrates changes in gait as a result of compensation.

Patients with a R-L-R-L compensatory pattern, tend to have what dysfunctions?

A
  1. Short Rt. leg
  2. Left leg upslip
  3. Rt. anterior innominate
  4. L/L sacral torsion
108
Q

CCP (compensatory): A patient sparins their ankles, and presents with knee problems on the right side. Based on your understanding of the CCP model, which hip is most likely affected?

A

Left side

(Left - R - Left (hip) - Right leg

109
Q

Visceral Manipulation: _______ is a collection of techniques directed at treating the viscera and/or supporting structures diagnosed with dysfunction. It is used to improve physiological dysfunction.

This is accomplished by restoring normal organ mobility and motility and removing obstructions.

A

Visceral Manipulation

*resolution of abnormal tension on organs, nerves and vessels allows improved circulation and neuronal transmission

110
Q

Visceral Manipulation: _______ is impaired or altered mobility or motility of the visceral system and combines fascias, neurologic, vacular, skeletal and lymphatics.

A

Visceral dysfunctions

  • scars after surgery
  • abdominal ptosis - pregnancy
  • structural changes (scoliosis)
111
Q

Visceral Manipulation: _______ is impaired or altered mobility or motility of the visceral system and combines fascias, neurologic, vacular, skeletal and lymphatics.

NOTE: A restriction may arise at the level of any of these sliding surfaces, as well as in relation to the many connective tissues attached to the viscera.

A

Visceral dysfunctions

  • inflammation
  • scars after surgery
  • abdominal ptosis - pregnancy
  • structural changes (scoliosis)
112
Q

Visceral manipulation: Oragns are suspended by fascial structures in the body. They glide to accomodate normal body and breathing movements.

Organs have visceral articulations which enable sliding movements and attachment to other organs. The liver has superior, anterior and inferior articulations. What are these?

A
  1. Superior
    - -Coronary ligament
    - -R and L triangular
  2. Falciform
  3. Inferior impressions
    - -impression of hepatic flexure of colon
    - -impression of right kidney
    - -impression of stomach
113
Q

Visceral manipulation: Organs are suspended by fascial structures in the body. They glide to accomodate normal body and breathing movements.

Organs have visceral articulations which enable sliding movements and attachment to other organs. The liver has superior, anterior, and posterior articulations.

A
  1. Superior
    - -Coronary ligament
    - -R and L triangular
  2. Anterior
    Falciform
  3. Posterior
    - peritoneum
    - -bare area
    * *laproscopic procedures – air elevates liver – “can’t get a good breath in”
114
Q

Visceral manipulation: Organs have visceral articulations which enable sliding movements and attachment to other organs.

The liver inferiorly has 3 major impressions. List them

A
  1. Inferior impressions
    - -impression of hepatic flexure of colon
    - -impression of right kidney
    - -impression of stomach
115
Q

Visceral manipulation: There are two ways of describing motion of visceral structures:

  1. _____ describes movement of the viscera in response to voluntary movement, or to movement of the diaphragm in respiration.
  2. _____ describes inherent motion of the viscera themselves.
A
  1. Visceral mobility

2. Visceral motility

116
Q

Brachial plexus: List the reflexes of the brachial plexus

  1. Biceps
  2. Brachioradialis
  3. Triceps
A
  1. Biceps
    - -C5
  2. Brachioradialis
    - -C6
  3. Tricepts
    - -C7
117
Q

Brachial plexus: What is the Innervation for the supraspinatus?

A

C4-C6 supraspinatus

118
Q

Brachial plexus: What is the muscle innervation for the

  1. Teres minor
  2. Deltoid
A

Both: C5-C6

**axillary nerve

119
Q

Brachial plexus: What is the Innervation for the

  1. Latissimus dorsi
  2. Biceps brachii
  3. Brachialis
  4. Brachioradialis
A
  1. Latissimus dorsi
    - -C6-8 thoracodorsal nerve
  2. Biceps brachii
    - -C5-6 musculocutaneous
  3. Brachialis
    - -C5-7 musculocutaneous and radial
  4. Brachioradialis
    - -C5-6 radial nerve
120
Q

Brachial plexus: List the muscle innervations for the:

  1. Triceps
  2. Pronator teres
  3. Supinator
A
  1. Triceps
    o C6-8 (radial n)
  2. Pronator teres
    o C6-7 (median n)
  3. Supinator
    o C6-7 (radial n)
121
Q

Brachial plexus: List the muscle innervations for the:

  1. Abductor pollicis longus
  2. Abductor pollicis brevis
  3. Adductor pollicis
A
  1. Abductor pollicis longus
    o C7-8 (radial n)
  2. Abductor pollicis brevis
    o C8-T1 (median n)
  3. Adductor pollicis
    o C8-T1 (ulnar n)
122
Q

Brachial plexus: List the muscle innervations for the:

  1. Abductor pollicis longus
  2. Abductor pollicis brevis
  3. Adductor pollicis
A
  1. Abductor pollicis longus
    o C7-8 (radial n)
  2. Abductor pollicis brevis
    o C8-T1 (median n)
  3. Adductor pollicis
    o C8-T1 (ulnar n)
123
Q

Brachial plexus: List the muscle innervations for the:

  1. opponens pollicis
  2. Flexor carpi radialis
  3. Flexor pollicis longus
A
  1. Opponens pollicis
    o C8-T1 (median n)
  2. Flexor carpi radialis
    o C6-7 (median n)
  3. Flexor pollicis longus
    - - C7-8 (median n)
124
Q

Brachial plexus: List the muscle innervations for the:

  1. Flexor carpi ulnaris
  2. Extensor carpi radialis longus
A

• Flexor carpi ulnaris
o C8-T1 (ulnar n)

• Extensor carpi radialis longus
o C6-7 (radial n)

125
Q

Brachial plexus: List the muscle innervations for the:

  1. Extensor digitorum
  2. Interosseous muscles
A

• Extensor digitorum
o C7-8 (radial n)

• Interosseous muscles
o C8-T1 (ulnar n)

126
Q

Brachial plexus: Innervations of

  1. Median
  2. Ulnar
  3. Radial
  4. Axillary
  5. Musculocutaneous

and Tests for each

A
  1. Median
    - -C5-T1
  2. Ulnar
    - -C8-T1
  3. Axillary
    - -C5, C6
  4. Radial
    - -C5-T1
  5. Musculocutaneous
    - -C5 - C7
127
Q

Visceral motion: Factors that influence mobility include:

  1. Voluntary motion
  2. Diaphragmatic motion
  3. Cardiac motion
  4. Peristaltic motion
  5. Craniosacral rhythm

________ passive motion during walking, running, flexion of trunk and other gross skeletal movements.

A

Voluntary motion

128
Q

Visceral motion: Factors that influence mobility include:

  1. Voluntary motion
  2. Diaphragmatic motion
  3. Cardiac motion
  4. Peristaltic motion
  5. Craniosacral rhythm

Diaphragmatic motion involves piston-like action on the thoracic and abdominal cavity. Alternatively, ____ motion is direct motion on the lungs, esophagus, mediastinum and diaphragm

A

Cardiac

*120,000xdaily

129
Q

Visceral motion: Factors that influence visceral mobility include:

  1. Voluntary motion
  2. Diaphragmatic motion
  3. Cardiac motion
  4. Peristaltic motion
  5. Craniosacral rhythm

Diaphragmatic motion involves piston-like action on the thoracic and abdominal cavity. Alternatively, ____ motion is direct motion on the lungs, esophagus, mediastinum and diaphragm

A

Cardiac

*120,000xdaily

130
Q

Visceral motion: Factors that influence visceral mobility include:

  1. Voluntary motion
  2. Diaphragmatic motion
  3. Cardiac motion
  4. Peristaltic motion
  5. Craniosacral rhythm

_____ involves contractile waves, stirring and circulating the visceral contents.

A

peristaltic motion

131
Q

Visceral motion: Factors that influence visceral mobility include:

  1. Voluntary motion
  2. Diaphragmatic motion
  3. Cardiac motion
  4. Peristaltic motion
  5. Craniosacral rhythm

True/False - Craniosacral rhythm is usually 8-12 cycles per minute.

A

True

132
Q

Visceral motion: Visceral mobility depends on the circulations. How does the liver move in the:

  1. Sagittal Plane
  2. Coronal Plane
  3. Transverse plan
  4. Combined
A
  1. Sagittal
    –anterior inferior motion
    (horizontal axis through triangular ligaments)
  2. Coronal
    –counterclockwise
    (AP axis at L. triangular ligament)
  3. Transverse plane
    - –R to L motion
    - -vertical axis through IVC
  4. Combined:
    - -anterior inferomedial
133
Q

Visceral motion: Indications for Hepatic release include:

  1. General listening
  2. Metabolic liver problems
  3. Chronic hepatitis
  4. Intrahepatic cholestasis
  5. Depression
  6. Dysfunction of immune system
  7. Somatic dysfxn of R. and L. shoulder

General listening is a screening tool used to assess restriction. The physician stands behind the patient with their hand at the top of the head (vertex). They are guided by the direction of “pull.” What is affected in the case of anterior pull? Inferior? Lateral?

A
  1. Anterior
    - -visceral
  2. Inferior
    - -cranial or dura
  3. Lateral
    - -arms/legs or lateral structures

feel for dragging

134
Q

Visceral motion: The sequence of Treatment involves

  1. General listening
  2. _____ listening
  3. Screening and scanning
  4. ________
  5. Diagnosis of dysfunction
  6. Treat and re-check
A
  1. Local

4. Movement test for mobility

135
Q

Visceral motion: Visceral manipulation of the liver is an extension of myofascial with a focus on the visceral organs (e.g. liver). Treatment can be focused anterior, lateral and posterior with the following borders:

  1. Superior border
  2. Inferior border
  3. Left border

What structures are located at these borders

A
  1. 5-6th rib
  2. lower rib cage
  3. left mid clavicular line

*hepatic release - MFR with compression
(light-moderate pressure with complimentary positioning)

136
Q

Visceral motion: Which of the following are General Indications for Visceral manipulation?

a. viscerosomatic reflexes
b. constipation
c. GERD
d. IBS

A

all of the above

  • cystitis
  • post-op ileus
137
Q

Visceral motion: Which of the following are General Contraindications for Visceral manipulation?

a. active infections
b. active bleeding
c. tumor
d. pregnancy

A

foreign bodies with risk of obstruction

common sense

138
Q

Ribs:

  1. ______ are the true ribs. They articulate directly to the sternum via costal cartilage and the synovial joint.
  2. ____ are the false ribs. they articulate indirectly via the cartilage of the superior ribs. They share costal cartilages and are a synovial joint.
  3. 11 and 12 are floating ribs
A
  1. 1-7
    - -true
    - -synovial except R1
  2. 8-10
    - -false
139
Q

Ribs: Ribs 1 and 2 are atypical ribs:

  1. Rib 1 is the ____. It is the site for anterior and middle scalene attachment. It articulates with T1, has no angle or groove.
  2. Rib 2 is the site for the ___ muscle and posterior scalene attachment. There is no non-articular tubercle
A
  1. shortest

2. serratus and posterio scalene

140
Q

Ribs: Ribs 10, 11 and 12 are atypical ribs

  1. Rib 10 articulates only with rib 10
  2. Rib 11 has a single articular facet but no ___ or ___
  3. Rib 12 has a single articular facet with nothing else. Tapered
A
  1. neck, tubercle
141
Q

Ribs: Inhalation involves external intercostals, internal interchondral intercostals and diaphragm, while exhalation occurs by

A

passive recoil

*diaphragm - phrenic nerve c3,4,5

NOTE: exhalation - anteriorly is downward motion of sternum and ribs, posteriorly upward motion, laterally is downward and medial motion of ribs

142
Q

Ribs:

  1. Pump handle ribs are associated with ____ motion, increased AP diamter and are best palpated on the anterior chest wall.
  2. Bucket handle ribs are associated with ____ motion, increased transvese dimension and are palpated on the lateral chest wall.
A
  1. anterior motion
    - -ribs 1-5
  2. lateral motion
    - -6-10
  3. 11 and 12
    - -caliper
    - -horizontal plane
143
Q

Ribs: Inhaled rib is caught _____. It appears higher (anterior/lateral/cephalad) than the other side. As the patient inhales, the rib moves up, but will not go down on exhalation.

It may be pump or bucket handle. Not spring

A

Inhaled position

Tx: Key rib is the bottom rib (Tx 1st!)

144
Q

Ribs: An exhaled rib is caught in exhalation. It appears lower (caudad, medial, posterior) and will not move into exhalation. It may be pump or bucket handle. It will spring easily.

How is it treated?

A

Treat top rib 1st

**biTE

145
Q

GLossary: The capacity of fascia and other tissue to lengthen when subjected to constant tension load resulting in less resistance to a second load application

A

creep

146
Q

Glossary: Decreased physiologic response to repeated stimulation

A

habituation

147
Q

Glossary: Striking the skin with cupped palms to produce vibrations with intention of loosening material…

A

Klapping

148
Q

GLossary: Spinal curve pattern combining kyphosis and scoliosis

A

kyphoscoliosis

kyph - AP deviation
Scolio - lateral

149
Q

Glossary: specific, non repetitive articulatory method that is indirect, then direct

A

Still technique

150
Q

Glossary: pathological or functional lateral curvature of the spine or lateral deviation

A

scoliosis

151
Q

Glossary: striking belly of a muscle with hypothenar edge of open hand in rapid succession to inc. tone/arterial perfusion

A

tatopotement

152
Q

GLossary: technique in which person voluntarily peforms osteopathic practitioner-directed motion

A

active method

153
Q

Glossary: a system of indirect MFR. the component region of the body is placed in neutral, diminishing tissue and joint tension in all planes, and an activating force (compression/torsion is added)

A

Facilitate positional release

*stanly shiowitz

154
Q

Glossary: Procedure of high or low amplitude in which the parts are stretched or separated along long. axis with continuous intermittent force

A

traction

155
Q

Glossary: antergrade movement of substances from the nerve cell along the axon toward the terminals, and the retrograde movement from the terminal s to nerve cell

A

axoplasmic transport

156
Q

GLoss: system of reflex points that present as predictable anterior and posterior fascial tissue texture abnormalities (plaque like changes or stringiness) of involved tissues. Assumed to be reflections of visceral dysfunction

A

chapman reflex

157
Q

maintenance of static or constant conditions in internal env. Level of well-being (internal physiologic harmony)

A

homeostasis

158
Q

localized somatic stimuli from patterns of reflex response in segmentally related somatic structures

A

somatosomatic reflex

159
Q

localized somatic stimulation producing patterns of reflex response in visceral structures

A

somatovisceral

160
Q

maintenance of a pool of neurons in a state of partial or suthreshold excitation; less afferent stimulation is required to trigger discharge).

A theory regarding neuophysiologic mechanisms underlying neuronal activity.

  1. due to sustained increase in afferent input, abberant patterns of afferent input…..
A

spinal facilitation

161
Q

a small, hypertensive site that, consistently produces a reflex mechanism that gives rise to referred pain and/or other manifestations in a consistent reference zone….

  1. points most extensively documented by Travell and SImons
A

trigger point

162
Q

nutritional function or relation. natural tendency to replenish the body stores that have been depleted

A

trophicity

163
Q

impaired or altered mobility or motility of the visceral system and releated fascial, neurological, vascular, lymphatic elements

A

visceral dysfunction

164
Q

when a painful stimulus is applied to a body part of low sensitivity, that is in close central connection with a point of higher sensitivty, the pain is felt at higher sensitivity

A

head law

165
Q

rhythmic compression applied over liver for purpose of increasing blood flow through the liver

A

hepatic pump

166
Q

technique in which tension is taken off attachment of root of mesesntery to posterior body wall

A

mesenteric release

167
Q

rhythmic compression applied over spleen

A

splenic pump

168
Q

system of diagnosis and Tx directed to viscera to improve function. moved toward fascial attachments to point of fascial balance

A

visceral manipulation

OMM (11 decks)

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