Final Flashcards
PRS
P- segment has gone posterior
R- segment has gone to the right
S- segment has gone superiorly
PRI
P- segment has gone posterior
R- segment has gone to the right
I- segment has gone inferiorly
PLS
P- segment has gone posterior
L- segment has gone to the left
S- segment has gone superiorly
PLI
P- segment has gone posterior
L- segment has gone to the left
I- segment has gone inferiorly
PLI-L. What does the -L mean? Which part of the spine are we on?
the -L means that we need to adjust on the lamina of the segment because the spinous is NOT on the side of convexity. We are in the cervicals.
PRI-T. What does the -T mean? Which part of the spine are we on?
the -T means that we need to adjust on the trasverse process because the spinous is NOT on the side of convexity. We are in the throacics.
PLI-M. What does the -M mean? Which part of the spine are we on?
the -M means that we need to adjust on the mammilary body because the spinous is NOT on the side of convexity. We are in the lumbars.
PRS. What motion palpation would we do to test it?
P- P-A extension
R- right rotation
S- right lateral bend
PLI. What motion palpation would we do to test it?
P- P-A extension
L- left rotation
I- right lateral bend
spinography
used in technique to create a conscientious line of correction
biochemical analysis
study of chemical substances and vital processes occurring in living organisms
What are the benefits of X Ray?
it is very insightful show postural distortions show palpation findings help identify pathologies facilitates safer/consientious care qualifies and quantifies misalignments allows for more specific adjustments
What are the risks of X Ray?
radiation exposure static picture of dynamic spine limited sensitivity to pathologies exposure risk vs benefit financial start up costs maitenence portability
Who and how are X rays used?
It’s used in most techniques and are generally taken weight bearing
How are X rays typically taken?
A-P
How are X rays read?
P-A (functional view)
What must you consider when deciding to take an X Ray?
- Pain or neurologic symptoms?
- trauma to the spine?
- Does the patient plan on having surgery?
- follow up on surgery?
- looking for neoplastic lesions?
- looking for congenital anomalies?
- looking for previously detected anomaly?
- looking for alignment abnormalities?
- looking for infection?
- looking for degenerative disorders?
- looking for arthropathy?
- looking for spine instability?
- looking for osteoporosis?
Which parts of the VSC and PART system are X rays insightful about?
Kinesiopathology
Histopathology
A (asymmetry/misalignment)
R (range of motion, flexion/extension views)
How is X ray kinesiopathology?
shows the relative position of the vertebrae
can do flexion/extension views to see motion
What are the types of X rays you can take for cervicals?
A-P open mouth, P-A cervical, lateral cervical
Vertebral bodies
used to find endplate tips
superior/inferior endplate tips
to determine posteriority of segments
disc space
can show pathologies, avoid drawing lines here
occipital condyle
used w/ C1 line to determine listing for occiput
What do you draw a line along to make the C1 line?
anterior tubercle of C1 and posterior arch of C1
What do you draw a line along to make the odontoid line and odontoid perpendicular line?
tip and base of odontoid process, then draw a perpendicular line from that line
How do you draw the transverse condylar line?
occipital condyles and foramen magnum
How do you tell if a vertebrae is rotated?
Draw lines from laminar junction to uncinate process, shorter one is the side its rotated on
What can we determine from the inferior aspect of vertebral bodies?
tells us whether a vertebrae has laterally bent superiorly or inferiorly
In the thoracic view, where can you draw lines?
endplate tips and avoid disc spaces
On an A-P thoracic view, what parts can you see?
junction of laminae, pedicle shadows, vertebral waist, endplate tips
On a pelvic view, what lines can you draw?
femur head line
horizontal plane line
sacral center line
What other lines/dots do you draw on the pelvic view?
inferior aspect of ischial tuberosities
superior aspect of ilia
S2 tubercle
sacral lines
What findings can you see in a pelvic view?
IN/EX, P-L, P-R, PI/AS
What are the advantages of motion palpation?
it’s used in all chiropractic
not specific to a certain technique
good reliability if there is good protocol and experience
kinematic inforamtion
can be changed for different types of people
can be correlated with X ray findings
What are the disadvantages of motion palpation?
unreliable as an only tool
poor reliability with bad protocol and no experience
acute presentations interfere with outcomes
requires patient interaction with can take time
has become the “major indicator” for most practitioners
Which parts of the VSC and PART system go with motion palpation?
Kinesiopathology
P (pain and tenderness)
A (asymmetry/misalignment
R (ROM)
How does motion palpation work with kinesiopathology?
relative postition, global ROM, intersegmental fixation
What does the listing system require (from the doctor?)
proficiency in rotation, lateral bend and P-A extension of the cervicals, thoracics and lumbars
What is the listing system derived from? What does the listing system do?
spinographic analysis, qualifies misalignments found in X Rays and facilitates the adjustment w/ appropirate technique
What does the listing system require?
A frame of reference
What must happen after creating a listing system?
It must be reproducible and create understanding
When creating a listing system, you must consider…
anatomical variability, importance of re evaluation, proper positioning, which listing system you are using
What are the two types of listing systems?
Gonstead and Palmer Upper Cervical
What are the listing system components?
P, R/L, S/I
What is global wedging?
scoliosis, lateral wedging, curvature
Which side must you adjust on? Why? Where else can you adjust if the spinous isn’t on the correct side?
The side of convexity so you don’t exacerbate the convexity. If the spinous is on the side of concavity, we need to adjust on the lamina/transverse process/mamillary bodies (depending on where in the spine you are).
In the lateral view of an X ray, what are the listing systems you can find?
Occiput: AS/PS
C1: AS/AI
C2-7: P
In the A-P open mough X ray, what are the listings you can find?
Occiput: RS/LS, RP/LP/RA/LA
In the P-A cervical view, what are the listings you can find?
S/I
In the thoracic view, posteriority is established by what?
atypical disc wedging (A/P)
stacking of continuous segments (loss of curve)
degenerative changes sen on endplate or disc (degenerative disc/joint disease)
In the thoracic view, laterality is established by what?
pedicle shadows show laterality.
If there is laterality in the thoracic view, what do you do?
You add an L to the listing if the left side is smaller. Same is true if it is on the right, just write R instead
How do you determine wedging in the thoracic view?
draw lines just above end plate tips. remember which side you were dealing with in the other listing. If that side is diverging, it is S, converging, I.
In the lumbar view, posteriority is established by what?
atypical disc wedging (A/P)
stacking of continuous segments (loss of curve)
degenerative changes seen on endplate or disc (degenerative disc/joint disease
In the A-P lumbopelvic view, what are the lines and landmarks associated with this view?
femur head line, horizontal plane line, sacral center line, superior/lateral iliac crests, inferior ischial tuberosities, medial/lateral ilia, lateral border of sacrum, S2 tubercle, sacral grooves, pubic symphysis
How do you determine which side of the ilia is PI and which is AS?
Measure the length of both ilia from crest to isch. tube. The shorter one is AS, the longer one is PI
How do you determine which side of the ilia is IN and which is EX?
draw the sacral center line and the center of the pubic symphysis needs a dot. Whichever side it favors is the EX side and the other side in IN.
How can you confirm an IN or EX listing?
measuring the width of the ilia. The thinner one is EX and the thicker one is IN
How do you determine if a sacrum is posterior?
Measure the widest part of the sacrum to the sacral center dot on each side. If the measurements are more than 6mm, then there is a posteriority. The larger side is how we determine if it is P-L or P-R
True or False: warmth receptors are myelinated
False
Before the Lateral Spinothalamic Tract, affeerent sensory input synapses where?
Dorsal Horn
Another name for the Insular Cortex is…?
Isle of Riel
What is released at the Tunica Media causing vascular constriction?
Epinephrine
True or False: Heat Swing is a shift over a neurological field
False
Which is False?
A) Instrument Pitch is always in accordance w/ disc plane line
B) cervical glide speed is 3 sec. with breaks 1/4 inch below mid thermocouple
C) Thoracic glide speed is 2 seconds with breaks 1/2 inch below the mid thermocouple
D) It is important to have equal pressure and an air seal
Thoracic glide speed is 2 seconds with breaks 1/2 inch below mid thermocouple.
It should read 1/2 inch ABOVE mid thermocouple
What is not an advantage of the Tytron? A) charts progress well B) most effective for break analysis C) Highly reproducible D) well researched
most effective for break analysis
True or False: Unlike the Nervoscope, the Tytron barrels never touch the patient.
True
What is the correct fossa reading?
F key, right barrel in right fossa, right barrel in left fossa
The gold standard for establishing a pattern is what?
12 hours apart
What is not a common cause for a stress reading?
Excitement
What are the common causes for a stress reading?
pain, caffeine, drugs
While scanning your patient, you find a break between T1 and T2, what segment is indicated?
T1
You’re palpating your friend when you come across a patch of oily skin, what does this indicate?
Acute VSC
What is the most cost effective way to objectify neurological function?
Instrumentation
When conducting a leg check, what should be used as a reference?
seam of the shoe
True or False: X rays are taken anterior to posterior and analyzed in the surgical view
True
What should the Glide speed for the Tytron?
26 seconds
X Ray does not satisfy which component of the PART system?
P
What kinds of Tytron Scans are there?
Pattern, adaptive, stress
When documenting Nervoscope readings, what must you record?
Level involved, direction, amplitude
Instrumentation is designed to tell ___ and not ___a subluxation occurs.
when, where
Select all that are false about palmer gonstead system
A) comparison to segment below
B) transverse is preferred contact
C)contact on side of concavity
D) Designed to have listings for the entire spine
Transverse is preferred contact
contact on side of concavity
True or False: Pathophysiology contains no components of the PART system.
True
Where does a nervoscope break occur for L3?
lower 25% of involved segment
While nervoscoping a patient, a break occurred between T8 and T9, which segment was indicated?
T8
True or False: Proper leg check uses consistent hand placement applying slight headward pressure, flattening the foot while refraining from twisting the tibia and then release and visualize the deficient side.
False. you do not release and then visualize the deficient side
There is a love/hate relationship with which intelligence?
Educated Intelligence
True or False: the living body is created by innate intelligence and regulated by universal intelligence
false
Decreased P-A extension, decreased left rotation, and decreased left lateral bend results in what listing?
PLS
The SCP for T4 decreased extension, increased right rotation, and decreased right lateral bend is what?
Transverse
True or False: instrumentation indicates where a neuro vascular dysfunction occuring
true
Nervoscope break occurs between T2-T3, what segment does this indicate?
T2
Which ones can you use to rationalize to take an X ray? Spine Trauma Pain or Neuorlogical symptoms cobb angle new patient
Spine trauma
pain or neuological symptoms
Decreased right lateral bend, increased right rotation, decreased extension, and stacking on right bending will result in what listing?
PLI-T
When performing a prone leg check, always check for asymmetry in what? Inversion Eversion foot flare plantar flexion dorsiflexion
All
Choose the misalignment that cannot be obtained from the APOM view. C1 laterality C2 rotation Occuput wedging C2 posteriority
C2 posteriority
True or False: a larger pedicle shadow on the right indicates the spinous has deviated further to the left.
True
Which is not visual indicator of posteriority? atypical disc wedging bright pedicle shadows stacking of continuous segments degenerative changes to endplate or disc
Bright pedicle shadows
What is the final component of the atlas listing?
Rotation on side of laterality
During patient examination, you find decreased P-A extension of T4-T5, decreased right rotation and no change in lateral bend. What is the listing?
T5 PR
True of False: Static palspation satisfies all the compnents of the VSC.
True
Which portion of the vertebral subluxation complex satisfies the R in the PART system?
Kinesiopathology
Which is not a sign of scoliosis? skin fold asymmetry relative height of scapular inferior angles scoliometer reading of 10 degrees cobb angle reading of 5 degrees
cobb angle reading of 5 degrees, it should be 10
Who do you need to be most concerned with for increased scoliosis?
young females
True or false: medial malleolus is the perfect location for checking leg length
false
Which of the following causes tissue prominency? turgidity muscle spasm osseous misalignment tonicity
osseous misalignment
True or False: your pateint leans overall to the right. this is recorded as a right lean.
False. Right list.
Divergence of APL and OPL lines result in..?
AS C1
T7 exhibits extension malposition, left body malposition, decreased right lateral flexion. What is the listing?
PRS
Which chiropractic principle talks about the germ theory of disease?
Principle 30
A 63 year old female patient in a wheelchair comes into your office with an ankle sprain and broken wrist. after your initial consult, you inform the patient that this will take ten weeks or longer to heal. she seems upset at the news as she has a big bridge tournament to participate in. which chiropractic principle might you refer to that best explains the time it takes it to heal?
24
Jeff comes into your office complaining of pain in his right hand. You take the proper x rays and notice a fractured left phalange.
Kinesiopathology, Neuropathology, Sclerotogenous
Aaron is your new patient that is in pain after falling off a balcony. While gathering the whole story, he stated how he was heavily drinking with his friends. The pain is in his thigh after landing on a chair and hiting his left quadriceps, which is swollen and has been spasming since.
Myopathology, Neuropathology, Myotogenous
Fred wants to run a marathon tomorrow, so he is in for a tune up to fix his “neck pain” when you notice a break at C5, decreased cervical range of motion, and palpatory tenderness on C5 spinous.
Kinesiopathology, Neuropathology, Sclerotogenous
A patient comes in with pain from a biceps strain, decreased cervical rotation to the left and nervoscope shows a break to the right at C5
Kinesiopathology, Neuropathology, Myotogenous
A 40 year old woman is kicked in the leg by a horse, she has bruising, pain and muscle dysfunction.
Myopathology, Histopathology, Myotogenous, Neuropathology
Bailey is a volleyball player that comes to your office with a dislocated 3rd proximal phalange on her right hand. It is swollen and painful
Kinesiopathology, Histopathology, Neuropathology, Myotogenous (because it is dislocated, not broken)
Tim presents with right decreased patellar reflex, quadriceps atrophy and a right limp
Kinesiopathology, Neuropathology, Myopathology
PS-RS-RA What does this mean?
decreased alanto occipital glide, decreased right lateral bend, C1=ASRP
