First Exam Flashcards
Lumbar flexion
40-90
Lumbar extension
20-45
Lumbar side bending left/right
15-30
Cervical rotation left/right
70-90
Whole motion cervical rotation (R-L)
140-180
Cervical side bending left/right
20-45
whole motion cervical bending
40-90
cervical flexion
45-90
chin to chest
cervical extension
45-90
cervical whole motion flexion/extension
90-180
arm flexion
180
arm extension
60
abduction of arm
180
arm horizontal adduction AROM
40-50, OR 130-140
arm horizontal abduction AROM
130-145 OR 40-55
arm external rotation AROM
90
arm internal rotation AROM
70-90
arm flexed AROM
140-150
arm extended AROM
0-5
forearm pronation/supination AROM
90
wrist flexion AROM
80-90
wrist extension AROM
70
wrist AB/radial AROM
20-30
wrist AD/ulnar AROM
30-40
knee straight hip flexion PROM
90
knee flexed hip flexed PROM
120-135
hip extension PROM
15-30
prone hip external rotation PROM
40-60
prone hip internal rotation PROM
30-40
seated hip internal rotation PROM
30-40
seated hip external rotation PROM
40-60
supine hip internal rotation PROM
30-40
supine hip external rotation PROM
40-60
hip abduction with knee extended PROM
45-50
hip adduction with nine extended PROM
20-30
knee flexion PROM
145-150
dorsiflex PROM
15-20
plantar flex PROM
50-65
ankle inversion AROM
35
ankle eversion AROM
20
What does TART stand rfor
Tissue texture changes
Asymmetry
Restriction of motion
Tenderness
What are the three types of joints?
fibrous- skull articulations
cartilaginous- discs between vertebrae
synovial- extremities
anatomic barrier
limit of motion imposed by anatomic structure; the limit of passive motion
physiologic barrier
limit of active motion
elastic barrier
range between the physiologic and anatomic barrier of motion in which passive ligamentous stretching occurs before tissue disruption
pathologic barrier
permanent restriction of joint motion associated with pathologic change of tissues
restrictive barrier
functional limit within the anatomic range of motion, which abnormally diminishes the normal physiologic range
Be able to discuss a brief history of the life of AT Still
- studied medicine and ministry under his father
- 1849 married Mary Vaugh and continued studying under his father and began farming
- 1855 began studying anatomy on Indian cadavers (cholera epidemic)
- 1859 Mary Vaugh dies
- 1860 marries Mary Wilson: has several kids, she’s dead by 1910
- 1861-1864 survies in Union army (abolitionist), involved in battle of Westport, performed surgeon duties but was recorded as hospital steward
- 1864 THREE OF HIS KIDS DIE OF SPINAL MENINGITIS FOLLOWED BY BABY WHO DIES OF PNEUMONIA
Be able to discuss the historical development of medicine leading up to Dr. Still’s era
- 1855 concept of homeostasis developed
- 1865 introduction of phenol as a disinfectant (reduced surgical mortality 45%-15%)
- 1876-1879 germ theory thanks to Pasteur and Koch
- 1896 x-rays developed
- 1890 sterile rubber gloves developed
- 1905 local anesthetic first used for surgery
Be able to describe the developments that helped shape Still’s new ideas into osteopathy
- if drugs didn’t work, if purgatives and cathartics didn’t work, if medicine didn’t work, what would work…
- he believed God had “certainly placed the remedy within the material house in which the spirit of life dwells”
- “by adjusting the body in such a manner that the remedies may naturally associate themselves together, hear the cries, and relieve the afflicted”
Know the important historical dates in the development of the osteopathic profession
June 22, 1874: Still flings tot he breeze the banner of osteopathy
-1889 coined the term osteopathy
Know when the first school of osteopathy was founded and the faculty associated with it
October 3, 1892
The American School of Osteopathy (ASO)
Faculty- Still and William Smith, MD
Be able to describe the basic tenants of osteopathic philosophy
- the body is a unit; person is a unit of body, mind, spirit
- body is capable of self-regulation, self-healing, and health maintenance
- structure and function are reciprocally interrelated
- rational treatment is based on an understanding of the basic principles of body unity, self-regulation, and the interrelationship of structure and function
Define somatic dysfunction
impaired or altered function of related components of the somatic system: skeletal, arthrodial, myofascial structures, related vascular, lymphatic and neural elements
What does TART stand for
tissue texture changes
asymmetry
restriction of motion
tenderness
What are acute skin changes
warm, moist, red, inflamed (vascular and chemical changes)
What are chronic skin changes
cool, pale (chronic increase in sympathetic tone), dry, scaly, cold, pale, shiny, hairless, pimples, folliculitis
Define tone
normal feel of muscle in the relaxed state. contrast with hypertonicity or hypotonicity
Define contraction
normal tone of a muscle when it shortens or is activated against resistance
Define contracture
abnormal shortening of a muscle due to fibrosis. most often in the tissue itself, often result of chronic condition. muscle is no longer able to reach its full length.
Define spasm
abnormal contraction maintained beyond physiologic need. most often sudden and involuntary muscular contraction that results in abnormal motion and is usually accompanied by pain and restriction of normal function.
Define bogginess
increased fluid in a hypertonic muscle, similar to wet sponge
Define ropiness
hard, firm, rope-like or cord-like muscle tone. usually indicates a chronic condition.
What are acute tissue changes
boggy edema, acute congestion, fluid in area of damage drawn by chemical reactions
What are chronic tissue changes
chronic congestion, doughy, stringy, fibrotic, ropy, thickened, contractures
What are acute vascular changes
inflammation, vessel wall injury, endogenous peptide release
What are chronic vascular changes
sympathetic tone increases vascular constriction
What are acute sympathetic changes
sympathetic activity, but local vasoconstriction overpowered by local chemical release, net effect is vasodilation
What are chronic sympathetic changes
vasoconstriction, hyper sympathetic tone, may be regional
What are acute muscular changes
local increase in muscular tone, muscle contraction, spasm, increased tone of muscle spindle
What are chronic muscular changes
decreased muscle tone, flaccid, mushy, limited range of motion due to contractures
What is acute restriction of motion
range of motion is usually sluggish, may be guarding (to prevent further pain)
What is chronic restriction of motion
limited range of motion, but motion itself feels normal
Define end feel
the placatory experience or perceived quality of motion when a joint is moved to its limit- a barrier is approached
What are three types of normal end feels and examples of each
bone to bone- elbow extension
soft tissue approximation- knee flexion
tissue stretch- ankle dorsiflexion, shoulder lateral rotation, finger extension
What are four types of abnormal end feels and examples of each
early muscle spasm- protective spasm after injury
late muscle spasm- chronic spasm, think chronic tissue changes
hard capsular- frozen shoulder
soft capsular- synovitis (swelling of the knee after injury)
Define tenderness
discomfort or pain elicited by the physician through palpation
a state of unusual sensitivity to touch or pressure
How would a patient describe acute pain
sharp, severe, cutting
How would a patient describe chronic pain
dull, ache, paresthesias (tingling, burning, gnawing, itching)
Are somatovisceral effects common in acute or chronic visceral function?
Common in chronic conditions
What are somatic dysfunctions named for?
“where they like to live”
position of ease
if a body segment freely rotates to the left, but is restricted to the right- the dysfunction is named rotated left
Be able to describe who Dr. Adam Flexner was and summarize his significance to medical education
Authored a report on the state of medical education in the US (including DO schools), resulted in state licensing boards enforcing stricter requirements
Be able to explain what the osteopathic profession contributed in the influenza pandemic in the early 1900s
Osteopathic care: .486% death rate
Medical/osteopathic care: 1.08% death rate
Discuss osteopathy in the military
- 1957 DOs allowed to serve in military
- 1963 DOs accepted as equal to MDs in military
- 1967 DOs drafted as medical officers
- 1969 200 DOs now serving during height of the Vietnam War
- 1977 Association of Military Osteopathic Physicians and Surgeons (AMOPS) formed
- Today 10% of active military medical officers are DOs
Discuss women in osteopathic medicine
- 1892 Still supported women in medicine from the beginning and they were included in first class at ASO, Jeanette Bolles first woman to receive DO degree
- 1920s formation of osteopathic women’s national association (OWNA)
- 1940s decline in women applicants, after WWI scholarships set up for women as incentives
- 1999 National Osteopathic Women Physicians Association established
- Today: 40% of total enrollment is women
- in 2007-2009 academic years more women than men in DO schools
Significant women in osteopathic history
- Louisa Burnes became foremost researcher in osteopathic medicine
- Barbara Ross-Lee first african-american woman to be appointed dean of a US med school, NYCOM dean, NYIT vice president
Discuss minorities in osteopathic medicine
- cuban born Marcelino Oliva first minority-group president of AOA
- William Anderson was first african-american president of the AOA, extensively involved in civil rights movement
- 2009-10 40% of enrolled students represented minority enrollees
Discuss expansion of osteopathic education
- 1892 ASO founded
- 1916 Kansas City College of Osteopathy and Surgery
- 1926 Kirksville COS formed by merging ASO and AT Still COS
- 1929 AOA allowed teaching pharmacology at its colleges
- 1931 student loan fund established
- 1936 first inspection and approval of osteopathic hospitals for intern training programs
- 1938 AOA requires one year pre-professional study
- 1945 low point of enrollment: 556 students
- 1947 first approval of osteopathic hospitals for residency training
- 1955 AMA recommends removal of “cult” label
- 1964 DOs allowed and encouraged to enter AMA approved internships and residencies
- 1986 first DOs accepted for residency training in Canada
Describe the three basic body types
- endomorph: predominantly endoderm (obese with increased fatty tissues)
- mesomorph: predominantly mesoderm (appropriate fat and distribution)
- ectomorph (tall, lanky person)
What factors create asymmetry in patients
bone deformity, joint deformity, kyphoscoliosis, dress, occupation, mental attitude, habit, sacral base unleveling, lower extremity defects, somatic dysfunction
What do you observe for asymmetry in an anterior view
head carriage, eye level, nose angle to midline, ear lobe level, ear prominence, nares size/shape, teeth alignment, shoulder height, clavicle angle to midline, carriage of arms, finger tip level, breast, angle of rib cage, umbilicus, waist crease, greater trochanter, crest of ilium, angle of patella, upper/lower leg, medial/lateral malleolus
What do you observe for asymmetry in a posterior view
iliac crest heights, PSIS, sacral sulcus, greater trochanter, gluteal line, upper leg, popliteal space, medial/lateral malleolus, carriage of head, shoulder level, inferior angle of scapulas, arm carriage, waist crease, deviation of spinous processes from midline
What do you observe for asymmetry in a lateral view
lordosis and kyphosis
