Full deck Flashcards
1
Q
Cervical superior facet orientation?
A
Backward, upward, medial
2
Q
Thoracic superior facet orientation?
A
Backward, upward, lateral
3
Q
Lumbar superior facet orientation?
A
Backward, medial
4
Q
Isotonic contraction?
A
Muscle contraction that results in tension remaining the same while muscle length shortens; operator’s force is less than patient’s force
5
Q
Isometric contraction?
A
Muscle contraction that results in the increase in tension without a change in muscle length; operator’s force is equal to patient’s force
6
Q
Isolytic contraction?
A
Muscle contraction against resistance while forcing the muscle to lengthen; operator’s force is more than patient’s force
7
Q
Concentric contraction?
A
Muscle contraction that results in the approximation of the muscle’s origin and insertion
8
Q
Eccentric contraction?
A
Lengthening of muscle during contraction due to an external force
9
Q
Myofascial release?
A
Direct and indirect, active and passive
10
Q
Counterstrain?
A
Indirect, passive
11
Q
Facilitated positional release?
A
Indirect, passive
12
Q
Muscle energy?
A
Direct, active
13
Q
HVLA?
A
Direct, passive
14
Q
Cranial?
A
Direct and indirect, passive
15
Q
Lymphatic treatment?
A
Direct, passive
16
Q
Chapman’s reflexes?
A
Direct, passive
17
Q
In type I dysfunction, what motion precedes what?
A
SB precedes rotation (OSR)
18
Q
In type II dysfunction, what motion precedes what?
A
Rotation precedes SB (TRS)
19
Q
What is the only subjective component of TART?
A
Tenderness
20
Q
2 types of isotonic contraction?
A
1) Concentric (shortening)2) Eccentric (lengthening)
21
Q
Upward mvt of a bicep curl?
A
Concentric contraction
22
Q
Downward mvt of a bicep curl?
A
Eccentric
23
Q
Contraction in which tension remains the same?
A
Isotonic
24
Q
Which vertebra has no spinous process or vertebral body?
A
C1
25
Which vertebrae have bifid spinoud processes?
C2-6
26
What portion of the cervical vertebrae lies bt the superior and inferior facets?
Articular pillars (or lateral masses)
27
What is located posterior to the cervical transverse processes?
Articular pillars
28
What is used by DO's to evaluate cervical vertebral motion?
Articular pillars
29
What vertebrae do the vertebral arteries pass thru?
C1-6
30
What do the vertebral arteries pass thru?
Foramen transversarium
31
Where do the scalenes originate?
Posterior tubercle of the transverse processes of the cervical vertebrae
32
Where does the anterior scalene insert?
Rib 1
33
Where does the middle scalene insert?
Rib 1
34
Where does the posterior scalene insert?
Rib 2
35
What are the actions of the scalenes?
Sidebend to same side with unilateral contraction, flex with bilateral contraction (also aid in respiration)
36
Where would you find a scalene tenderpoint in a rib dysfunction?
Posterior to clavicle at base of neck
37
Where does the SCM originate?
Mastoid and lateral half of superior nuchal line
38
Where does the SCM insert?
Medial 1/3 of clavicle and sternum
39
What are the actions of the SCM?
With unilateral contraction, will sidebend ipsilaterally and rotate contralaterally; bilateral contraction flexes head
40
Shortening or restrictions within the SCM results in what?
Torticollis
41
What ligament extends from the sides of the dens to the lateral margins of the foramen magnum?
Alar ligament
42
What ligament attaches to the lateral masses of C1 to hold the dens in place?
Transverse ligament of the atlas
43
What syndromes can weaken the alar and transverse ligaments resulting in AA subluxation?
Down's and RA
44
What are uncinate processes?
Superior lateral projections originating from the posterior lateral rim of the vertebral bodies of C3-7
45
What is the joint of Luschka (unconvertebral joints)?
The articulation of the superior uncinate process and superadjacent vertebrae
46
What is the most common cause of cervical nerve root pressure?
Degeneration of the joints of Luschka plus hypertrophic arthritis of the intervertebral synovial (facet) joints
47
Where does C8 nerve root exit?
Between C7 and T1
48
What nerve roots make up the brachial plexus?
C5-T1
49
What is the primary motion of the OA?
Flexion and extension--50% of flexion/extension of cervical spine occurs at OA
50
How does sidebending occur at OA?
Opposite rotation
51
What is the primary motion of the AA?
Rotation--50% of rotation of cervical spine occurs at AA
52
What are the mvts of C2-7
Sidebending and rotation occur to the same side
53
Main motions of C2-4?
Rotation
54
Main motions of C5-7?
Sidebending
55
Lateral translation to the right will cause what motion?
Left sidebending
56
What if you feel a deep sulcus on the right at the OA joint?
Rotated right, sidebent left
57
How do you evaluate the AA?
Flex cervical spine to 45 degrees to lock out rotation of typical cervical vertebrae
58
An acute injury to the cervical spine is best treated how?
MFR or counterstrain
59
How does cervical foraminal stenosis present?
Neck pain radiating to upper extremity
60
What are the S/S of cervical foraminal stenosis?
Increased pain with neck extension, posiive Spurling's, paraspinal muscle spasm, posterior and anterior cervical tenderpoints
61
Which vertebra actually rotates, the atlas or axis?
Atlas rotates on axis
62
Which cervical segment is best assessed by flexing neck to 45 and rotating?
C1
63
T1-3 rule of 3's?
SP is located at level of corresponding TP
64
T4-6 rule of 3's?
SP is located one-half a sefment below the corresponding TP
65
T7-9 rule of 3's?
SP is located at level of TP of vertebrae below
66
Follows same rules as T7-9?
T10
67
Follows same rules as T5-7?
T11
68
Follows same rules as T1-3?
T12
69
Spine of scapula is at what level?
T3
70
Inferior angle of scapula corresponds with what?
Spinous process of T7
71
Sternal notch is at what level?
T2
72
Sternal angle (angle of Louis) attaches to which rib and what level is it?
2nd rib, level of T4
73
What is the main motion of the thoracic spine?
Rotation
74
Upper and middle thoracic spine motion?
Rotation \> flexion/extension \> SB
75
Lower thoracic spine motion?
Flexion/extension \> SB \> rotation
76
Primary muscles of respiration?
Diaphragm, intercostals
77
Rib attachments for diaphragm?
Ribs 6-12 b/l
78
Vertebral attachments for diaphragm?
L1-3
79
Anterior attachment for diaphragm?
Xiphoid
80
Action of intercostal muscles?
Elevate ribs during inspiration and prevent retractions during inspiration
81
Secondary muscles of respiration?
Scalenes, pec minor, serratus anterior/posteiror, quadratus lumborum, latissimus dorsi
82
What makes a typical rib typical?
Contains Shaft, Head, Angle, Neck, Tubercle (SHANT)
83
What is the difference bt head and tubercle of rib?
Head--articulates with vertebra above and corresponding vertebra; tubercule--articulates with corresponding TP
84
Typical ribs?
3-10
85
Atypical ribs?
1, 2, 11, 12 (ribs with "1" and "2"), sometimes 10
86
Reason why rib 1 is atypical?
Articulates only with T1 and has no angle
87
Reason why rib 2 is atypical?
Has large tuberosity on shaft for serratus anterior
88
Reason why ribs 11 and 12 are atypical?
They articulate only with corresponding vertebrae and lack tubercles
89
Reason why rib 10 may be atypical?
May articulate only with T10
90
True ribs?
1-7 (attach to sternum thru costal cartilages)
91
False ribs?
8-12 (connected by its costal cartilage to the cartilage of the rib superior)
92
Floating ribs?
11, 12
93
Rib motions?
Pump handle, bucket handle, caliper
94
Move primarily in pump handle?
Ribs 1-5
95
Move primarily in bucket handle?
Ribs 6-10
96
Move primarily in caliper?
Ribs 11 and 12
97
Rib appears to be "held up", will not move caudad?
Inhalation dysfunction
98
Rib appears "held down", will not move cephalad?
Exhalation dysfunction
99
Rib elevated anteriorly?
Pump handle inhalation dysfunction (depressed anteriorly for exhalation dysfunction)
100
Rib elevated laterally?
Bucket handle inhalation dysfunction (depressed laterally for exhalation dysfunction)
101
Anterior narrowing of intercostal space above dysfunctional rib?
Pump handle inhalation dysfunction (opposite for exhalation dysfunction)
102
Lateral narrowing of intercostal space above dysfunctional rib?
Bucket handle inhalation dysfunction (opposite for exhalation dysfunction)
103
Superior edge of posterior rib angle is prominent?
Pump handle inhalation dysfunction (opposite for exhalation dysfunction)
104
Lower edge of rib shaft is prominent?
Bucket handle inhalation dysfunction
105
What is the key rib responsible for group inhalation dysfunctions?
Lowest rib
106
What is the key rib responsible for group exhalation dysfunction?
Uppermost rib
107
Where is tx directed for a group dysfunction?
Key rib
108
Reason why lumbar spine is more susceptible to disc herniation?
Narrowing of posterior longitudinal ligament
109
Comparison of posterior longitudinal ligament at L1 and at L4-5?
Is 1/2 the width at L4-5 than at L1
110
Location of where spinal cord terminates?
L1-2
111
Location of where nerve roots exit in lumbar spine?
Below corresponding vertebrae, but above the IV disc
112
Origin of iliopsoas m?
T12-L5 vertebral bodies
113
Insertion of iliopsoas m?
Lesser trochanter
114
Erector spinae mm from lateral to medial?
Iliocostalis, Longissimus, Spinalis (I Love Spine)
115
Level of iliac crest?
L4-L5
116
T10 dermatome at umbilicus is anterior to which IV disc?
L3-L4
117
Most common anomaly in lumbar spine?
Facet trophism--predisposes to early degenerative changes
118
What is facet trophism?
Lumbar facet joints are aligned in coronal plane (instead of sagittal)
119
What is sacralization?
TPs of L5 are long and articulate with sacrum--predisposes to early degenerative changes
120
What is lumbarization?
Failure of fusion of S1 with other sacral segements
121
What is spina bifida?
Defect in closure of limina of vertebral segment
122
3 types of spina bifida?
Occulta, meningocele, meningomyelocele
123
Alignment of lumbar facets?
Backward and medial for superior facets
124
Major motion of lumbar spine?
Flexion and extension (small degree of SB, limited rotation)
125
Sidebending of L5 will cause what sacral motion?
Sacral oblique axis will be engaged on same side
126
Rotation of L5 will cause what sacral motion?
Sacrum will rotate toward opposite side
127
Ferguson's angle?
Lumbosacral angle--formed by intersection of a horizontal line and the line of inclination of the sacrum (25-35 degrees)
128
98% of disc herniations occur where?
Between L4-5 or L5-S1
129
A herniation bt L4-5 will exert pressure on which nerve root?
L5 (the nerve root below)
130
Positive test seen in disc herniation?
Straight leg raising test
131
What is relatively CI in herniation?
HVLA
132
OMT for herniation?
Initially indirect techniques, then gentle direct
133
Positive test seen in psoas syndrome?
Thomas test
134
Tender point seen in psoas syndrome?
Medial to ASIS
135
Dysfunctions seen in psoas syndrome?
Nonneutral dysfunction of L1-2, positive pelvic shift test to contralateral side, sacral dysfunction on an oblique axis, and contralateral piriformis spasm
136
When do you stretch psoas m in psoas syndrome?
Chronic spasms
137
OMT for psoas syndrome?
Counterstrain to anterior iliopsoas tenderpoint followed by ME/HVLA to high lumbar dysfunction
138
Causes of spinal stenosis?
Hypertrophy of facet joints, Ca deposits within ligamentum flavum and posterior longitudinal l, loss of IV disc height
139
Radiology for spinal stenosis?
Osteophytes and decreased IV disc space, foraminal narrowing on oblique views
140
What is spondylolisthesis?
Anterior displacement of one vertebrae in relation to one below due to fractures in the pars interarticularis
141
Where does spondylolisthesis occur?
L4 or L5
142
What are the neuro deficits in spondylolisthesis?
None
143
What is a positive vertebral step-off sign?
Palpating the spinous process there is an obvious forward displacement at the area of listhesis
144
S/S of spondylolisthesis?
Pain with extension-based activities, tight hams b/l, stiff-legged, short stride, waddling gait
145
Goal of tx for spondylolisthesis?
Reduce lumbar lordosis and somatic dysfunction
146
What is CI in spondylolisthesis?
HVLA
147
Grading for spondylolisthesis?
1 = 0-25%; 2 = 25-50%; 3 = 50-75%; 4 = \>75%
148
What is spondylolysis?
Defect of pars interarticularis WITHOUT anterior displacement of vertebral body
149
Radiology for spondylolysis?
Scotty dog on oblique view--fracture of pars interarticularis
150
What is spondylosis?
Radiological term for degenerative changes within IV disc and ankylosing of adjacent vertebral bodies
151
How do you dx spondylolisthesis vs. spondylolysis?
Spondylolisthesis = lateral x-ray; sponylolysis = oblique x-ray
152
Cause of cauda equina syndrome?
Massive central disc herniation
153
S/S of cauda equina syndrome?
Saddle anesthesia, decreased DTRs, decreased rectal sphincter tone, loss of bowel/bladder control
154
Result of delay in surgery for tx cauda equina?
Irreversible paralysis
155
Epidemiology of scoliosis?
5% of school-aged children develop it before 15
156
Percentage of children with actual sxs related to their scoliosis?
10%
157
Female: Male ratio for scoliosis?
4:01
158
Dextroscoliosis?
Curve that is SB left = scoliosis to the right
159
Levoscoliosis?
Curve that is SB right = scoliosis to the left
160
2 types of scoliosis curves?
1) Structural curve2) Functional curve
161
Which curve is fixed and inflexible?
Structural
162
Which curve will NOT correct with sidebending in opposite direction?
Structural
163
Which is assoc with vertebral wedging and shortened ligaments/musccles on concave side?
Structural
164
T/F An uncorrected functional curve may progress to a structural curve?
TRUE
165
When should kids be screened?
10-15 years
166
What is the angle measures the degree of scoliosis?
Cobb angle
167
What is Cobb angle?
Draw horizontal line from vertebral bodies of extreme ends of curve; then draw perpendicular lines from these horizontal lines
168
At what angle is respiratory function compromised?
\>50
169
At what angle is cardiac function compromised?
\>75
170
What are the causes of scoliosis?
Idiopathic, congenital, neuromuscular, acquired
171
Which type is most often progressive?
Congenital
172
What are Konstancin exercises?
A series of specific exercises that has been proven to improve the pt with scoliotic postural decompensation
173
When is bracing indicated?
Moderate scoliosis
174
When i surgery indicated?
Severe scoliosis--if there is resp compromise or if it progresses despite conservative management
175
3 things that cause short leg?
1) Sacral base unleveling2) Vertebral SB and rotation3) Innominate rotation
176
Most common cause of anatomical short leg?
Hip replacement
177
First ligament to be stressed in short leg?
Iliolumbar ligaments, then the SI ligaments
178
Sacral base unleveling compensation?
Sacral base will be lower on short leg side
179
Innominate compensation?
Anterior rotation on short leg side; posterior rotation on long leg side
180
Lumbar spine compensation?
SB away, rotate toward short leg side
181
Lumbosacral (Ferguson's) angle compensation?
Increased 2-3 degrees
182
How to quantify differences in heights of femoral head for short leg syndrome?
Standing x-ray
183
When to consider heel lift?
Femoral head difference \>5mm
184
When should the full lift be administered?
Sudden onset of discrepancy (e.g. fracture, surgery)
185
What should the final lift height be?
1/2 - 3/4 of measured leg length discrpancy
186
What should the "fragile" pt begin with?
1/16" (1.5mm) and increase 1/16" every 2 weeks
187
What should the "flexible" pt begin with?
1/8" (3.2mm) and increase 1/8" every 2 weeks
188
What is the max height that can be applied to INSIDE the shoe?
1/4"
189
What if \>1/4" is needed?
Apply to OUTSIDE of shoe
190
What is maximum heel lift possible?
1/2"
191
How do you prevent pelvis from rotating to opposite side when \>1/2" lift is needed?
Apply an ipsilateral anterior sole lift extending from heel to toe
192
Most common cause of scoliosis?
Idiopathic
193
When do the 3 bones of the innominate fuse?
20 years old
194
Anterior portion of 1st segment (S1)?
Sacral promontory
195
Sacral base?
Top (most cephalad) part
196
In somatic dysfunctions, what can be recorded as shallow (posterior) or deep (anterior)?
Sacral base or sacral sulci
197
How can you record the sacral ILA's?
Shallow (posterior), deep (anterior), superior or inferior
198
The SI joint is an inverted "L" joint with 2 arms converging anteriorly. Where do these arms join?
S2
199
2 types of pelvic ligaments/
True and accessory
200
True pelvic ligaments?
Anterior, posterior and interosseous SI ligaments
201
Accessory pelvic ligaments?
Sacrotuberous, sacrospinous, iliolumbar ligaments
202
What ligament divides the greater and lesser sciatic foramen?
Sacrospinous ligament
203
Which ligament is the 1st to become painful in lumbosacral decompensation?
Iliolumbar ligament
204
Types of pelvic muscles?
Primary and secondary
205
Primary pelvic muscles?
Make up pelvic diaphragm--levator ani, coccygeus
206
Secondary pelvic muscles?
Iliopsoas, obturator internus, piriformis
207
Origin/insertion of piriformis?
ILA, greater trochanter
208
Action of piriformis?
Ext rot, extend thigh, abducts thigh with hip flexed
209
Innervation of piriformis?
S1 and S2 nerve roots
210
What are S/S of sciatica due to hypertonic piriformis?
Pain from buttock radiating down thigh but not past knee
211
Axis upon innominates rotate?
Inferior transverse axis (S4)
212
4 types of sacral motion?
1) Dynamic motion2) Respiratory motion3) Inherent (craniosacral) motion4) Postural motion
213
Location of transverse axis for resp and inherent motion of sacrum?
S2 (superior transverse axis)
214
Craniosacral flexion induces what sacral motion?
Counternutates (rotates posterior)
215
Craniosacral extension induces what sacral motion?
Nutation (rotates anterior)
216
Axis during dynamic sacral motion (walking)?
Oblique axes
217
Axis during postural motion?
Middle transverse axis (S3)
218
When L5 is SB, what sacral axis is engaged and where?
Oblique axis on the same side as side bending
219
When L5 is rotated, the sacrum rotates which way?
Opposite on an oblique axis
220
Where is the seated flexion test positive in sacral SD?
Opposite the oblique axis
221
B/l sacral flexion or extension move around what sacral axis?
Middle transverse
222
What is a common sacral dysfunction in the postpartum patient?
B/l sacral flexion
223
What axis does the sacrum rotate in a sacral margin posterior SD?
Mid-vertical or parasagittal
224
What is treated first, L5 or sacrum?
L5
225
Joints of the shoulder/
Scapulothoracic (pseudo-joint), AC joint, glenohumeral, SC joint
226
Primary flexor?
Deltoid (anterior portion)
227
Primary extensors?
Lat dorsi, teres major, deltoid (posterior portion)
228
Primary external rotators?
Infraspinatus, teres minor
229
Subclavian artery passes bt which 2 muscles?
Anterior and middle scalenes--contracture of these muscles affects arterial supply but not venous drainage
230
When does subclavian a become axillary a?
Lateral border of 1st rib
231
1st major branch of brachial a?
Profunda brachial a--accompanies radial n in its posterior course of radial groove
232
What becomes the deep palmar arterial arch?
Radial a
233
Tx technique to relieve lymph congestion of UE?
1) Open thoracic inlet2) Redome diaphragm3) Posterior axillary fold technique
234
Degrees of motion during arm abduction?
120 degrees due to glenohumeral motion, 60 degree due to scapulothoracic motion
235
Most common somatic dysfunction of shoulder?
Restriction in internal and external rotation
236
Least common somatic dysfunction of shoulder?
Restriction in extension
237
Most common somatic dysfunction of SC joint?
Clavicle anterior and superior on sternum
238
"Step-off" seen at the AC joint?
Superior and lateral clavicle on acromion
239
Pathogenesis of supraspinatus tendinitis?
Continuous impingement of greater tuberosity against acromion as arm is flexed and internally rotated
240
"Painful arc"?
Pain exacerbated by abduction from 60-120 degrees in supraspinatus tendinitis
241
Aggravating factors in bicipital tenosynovitis?
Elbow flexion or supination
242
Location of pain in rotator cuff tear?
Tenderness just below tip of acromion
243
Etiology of frozen shoulder?
Prolonged immobility of shoulder
244
Most common shoulder dislocation?
Anterior and inferior--affects axillary n
245
Most common brachial plexus injury?
Erb-Duchenne's palsy
246
What is paralyzed in Erb-Duchenne's?
Abduction, external rotation, flexion, supination
247
Crutch palsy?
Radial n
248
Saturday night palsy?
Compression of radial n against humerus as arm is draped over back of chair
249
Most common cause of injury to radial n?
Humeral fracture
250
Most commonly affected nerve injured in UE due to direct trauma?
Radial n
251
Erb-Duchenne's?
Upper trunk (C5-6)
252
Pathogenesis of winging of scapula?
Weakness of anterior serratus due to long thoracic n injury
253
When is pain elicited in frozen shoulder?
End of ROM
254
Motions most often affected in adhesive capsulitis?
Abduction, internal and external rotation (extension is preserved)
255
Most commonly affected rotator cuff muscle?
Supraspinatus
256
Pathogenesis of bicipital tenosynovitis?
Inflammation of tendon and its sheath of long head of biceps
257
Site of pain in supraspinatus tendinitis?
Tip of acromion
258
Sites of compression of nv bundle in thoracic outlet syndrome?
1) Bt anterior and middle scalenes2) Bt clavicle and 1st rib3) Bt pectoralis minor and upper ribs
259
Most common somatic dysfunction of AC joint?
Clavicle superior and lateral on acromion
260
Motion of clavicle during internal/external rotation?
Around transverse axis
261
Second most common somatic dysfunction of shoulder?
Restriction in abduction
262
For every 3 degrees of abduction...
Glenohumeral joint moves 2 degrees and the scapulothoracic joint moves 1 degree
263
Nerve roots of brachial plexus?
C5-T1
264
What becomes the superficial palmar arterial arch?
Ulnar a (Ulnar is Up in the palm)
265
Where does brachial a divide into ulnar and radial aa?
Under bicipital aponeurosis
266
When does the axillary a become the brachial a?
Inferior border of teres minor
267
Subclavian vein passes where?
Anterior to anterior scalene
268
Primary internal rotator?
Subscapularis
269
Primary adductors?
Pec major, lat dorsi
270
Primary abductor?
Deltoid (middle portion)
271
Rotator cuff muscles?
Supraspinatus, Infraspinatus, teres minor, Subscapularis (SItS)
272
Bones making up the shoulder?
Clavicle, scapula, humerus
273
Only muscle of thenar eminence NOT innervated by median n?
Adductor pollicis brevis (ulnar n)
274
Innervation of lumbricals?
1st-2nd innervated by median n; 3rd-4th innervated by ulnar n
275
What attaches to the DIPs?
Flexor digitorum profundus
276
What attaches to PIPs?
Flexor digitorum superficialis
277
Carrying angle?
Intersection of 1) longitudinal axis of humerus and 2) line from distal radial-ulnar joint passing thru proximal radial-ulnar joint
278
CA for men?
5 degrees
279
CA for women?
10-12 degrees
280
CA \>15 degrees?
Cubitus valgus OR abducation of ulna in SD
281
CA
Cubitus varus OR adduction of ulna in SD
282
An increase in CA causes what wrist motion?
Adduction of wrist
283
A decreased in CA causes what wrist motion?
Abduction of wrist
284
What motions occur with adduction of ulna?
Lateral glide of olecranon, radius is pulled proximally resulting in abduction of wrist
285
What motions occur with abduction of ulna?
Medial glide of olecranon, radius is pushed distally resulting in adduction of wrist
286
Radial head motion?
Anterior with supination; posterior with pronation
287
Location of reference when naming ulna motion?
Distal ulna
288
Common cause of posterior radial head?
Falling on pronated forearm
289
Common cause of anterior radial head?
Falling backward on supinated forearm
290
Gold standard dx for carpul tunnel?
EMG
291
Swan neck deformity?
Flexion contracture of MCP and DIP, extension contracture of PIP
292
Boutonniere deformity?
Extension contracture of MCP and DIP, flexion contracture of PIP
293
Cause of swan neck?
Contracture of intrinsic mm of hand
294
Cause of boutonniere?
Rupture of hood o extensor tendon at PIP
295
Primary hip extensor?
Gluteus maximus
296
Primary hip flexor?
Iliopsoas
297
Primary knee extensor?
Quadriceps
298
Primary knee flexors?
Semimembranosus and semitendinosus
299
4 ligaments that make up femoroacetabular joint?
1) Iliofemoral2) Ischiofemoral3) Pubofemoral4) Capitis femoris
300
What ligament attaches the head of the femur to the acetabular fossa?
Capitis femoris
301
What are the minor motions of the hip?
Anterior and posterior glide
302
What motion occurs with anterior glide of the head of the femur?
External rotation
303
What motion occurs with posterior glide of the head of the femur?
Internal rotation
304
Etiologies of hip external rotation SD?
Piriformis or iliopsoas spasm
305
Etiologies of hip internal rotation SD?
Spasm of internal rotators
306
3 joints that make up the knee?
1) Tibiofemoral 2) Patellofemoral3) Tibiofibular
307
What is the largest joint in the body?
Tibiofemoral
308
What is the origin and insertion of the ACL?
Originates at posterior aspect of femur, attaches to anterior aspect of tibia
309
Origin and insertion of the PCL?
Originates at anterior aspect of femur and inserts on posterior aspect of tibia
310
Which ligament articulates with the medial meniscus and helps prevent valgus stress at the knee?
Medial collateral ligament
311
Attachments of the lateral collateral ligament?
Femur and fibula
312
Mvt of the tibiofibular joint occurs with what motions of the foot?
Pronation and supination
313
What motion occurs when the fibular head glides anteriorly?
Pronation
314
What motion occurs when the fibular head glides posteriorly?
Supination
315
Pronation motions?
Dorsiflexion, eversion, abduction
316
Supination motions?
Plantarflexion, inversion, adduction
317
Pronation of foot causes what fibular motion?
Causes talus to push distal fibula posteriorly allowing anterior glide proximally
318
Supination of the foot causes what fibular motion?
Causes anterior talofibular ligament to pull distal fibula anteriorly, and allows proximal fibula to glide posteriorly
319
Femoral nerve roots?
L2-4
320
Sciatic nerve roots?
L4-S3
321
Femoral n innervations?
Quads, iliacus, sartorius and pectineus
322
Which foramen does the sciatic n pass thru?
Greater sciatic foramen
323
85% of population, the sciatic n will be in what relation to piriformis?
Inferior to piriformis
324
Innervation of short head of biceps femoris?
Peroneal division of sciatic n
325
Angulation of head of the femur?
Normally 120-135 degrees
326
Coxa vara?
Angulation of femur
327
Coxa valga?
Angulation of femur \>135
328
Q angle?
Formed by intersection of a line from ASIS thru middle of patella, and a line from tibial tubercle thru middle of patella
329
Normal Q angle?
10-12 degrees
330
Genu valgum?
Increased Q angle (knocked-kneed)
331
Genu varum?
Decreased Q angle (bow-legged)
332
What ligament prevents hyperextension of knee?
ACL
333
Posterior fibular head foot positions?
Talus internally rotated causing foot to invert and plantarflex
334
Anterior fibular head foot positions?
Talus externally rotated causing foot to evert and dorsiflex
335
What nerve lies directly posterior to the proximal fibular head?
Common peroneal nerve (injured in posterior fibular head SD)
336
Pathophysiology of patello-femoral syndrome?
Imbalance of musculature of quads (strong vastus lateralis and weak vastus medialis) causing patella to deviate laterally due to larger Q angle
337
S/S of patello-femoral syndrome?
Deep knee pain esp when climbing stairs, atrophy of vastus medialis, patellar crepitus
338
Lower leg compartments?
Anterior, lateral, deep posterior, superficial posterior
339
Which compartment is most commonly affected in compartment syndrome?
Anterior
340
S/S of compartment syndrome (anterior)?
Tibialis anterior m is head and tender to palpation, pulse are present, stretching muscle causes extreme pain
341
O'Donahue's triad (terrible triad)?
ACL, MCL, medial meniscus
342
Portion of talus that artciulates with ankle mortise?
Trochlea of talus
343
Which ankle motion is more stable, plantarflexion or dorsiflexion?
Dorsiflexion--bc talus is wider anteriorly
344
Talocrural joint (tibiotalar joint)?
Hinge joint bt talus and medial malleolus, and lateral melleolus
345
Main motions of talocrural joint?
Plantarflexion and dorsiflexion
346
What motion occurs with anterior glide of talus?
Plantarflexion
347
What motion occurs with posterior glide of talus?
Dorsiflexion
348
80% of ankle sprains occur in plantarflexion or dorsiflexion?
Plantarflexion (due to stability of ankle in dorsiflexion)
349
What joint allows internal/external rotation of leg while foot is fixed?
Subtalar joint (talocalcaneal joint)
350
Arches of foot?
Longitudinal and transverse
351
Medial longitudinal arch?
Talus, navicular, cuneiforms, 1-3 metatarsals
352
Lateral longitudinal arch?
Calcaneus, cuboid, 4-5 metatarsals
353
Tranverse arch?
Navicular, cuneiforms, cuboid
354
Where do most SDs occur in foot?
Transverse arch--often seen in long distance runners
355
Lateral stabilizers of ankle?
ATF, calcaneofibular, posterior talofibular
356
Most common injured ankle ligament?
ATF
357
Type I ankle sprain?
Only ATF
358
Type II ankle sprain?
ATF and calcaneofibular
359
Type III ankle sprain?
ALL 3 lateral ligaments
360
Excessive pronation usually results in what injury?
Fracture of medial malleolus (rather than pure ligamentous injury)
361
Spring ligament?
Calcaneonavicular ligament--strengthens medial longitudinal arch
362
Attachments of plantar aponeurosis?
Calcaneus and phalanges
363
What is the primary respiratory mechanism (PRM)?
CNS + CSF + dural membranes + cranial bones + sacrum
364
What do the brain and spinal cord do during exhalation phase of PRM?
Lengthen and thins
365
What do the brain and spinal cord do during inhalation phase of PRM?
Shortens and thickens
366
What is normal cranial rhythmic impulse (CRI)?
14-Oct
367
What decreases CRI?
Stress, depression, chronic fatigue and chronic infections
368
What increases CRI?
Vigorous exercise, systemic fever, following OMT to the craniosacral mechanism
369
What forms the falx cerebri and tentorium cerebelli?
Dura mater
370
Where does the dura attach?
Foramen magnum, C2, C3, S2
371
The dura is elastic or inelastic?
Inelastic--when the dura moves, the cranial bones move
372
What is the reciprocal tension membrane (RTM)?
Mvt of meninges cause cranial motion--called an automatic, shifting, suspension fulcrum
373
Where does the dura attach to the sacrum?
POSTERIOR superior aspect of S2 (this is where the superior transverse axis runs that allows sacral motion)
374
What is the sphenobasilar synchondrosis (SBS)?
Articulation of sphenoid with occiput
375
Motions of SBS?
Flexion and extension
376
IRE of ERF?
Internal rotation of paired bones occur with extension of midline bones; external rotation occurs with flexion
377
What are the midline bones?
Sphenoid, occiput, ethmoid, vomer
378
What causes counternutation?
SBS flexion
379
Bert head?
Flexion (widen head and decrease AP diameter)
380
Ernie head?
Extension (narrow head and increase AP diameter)
381
What causes nutation?
SBS extension
382
What are the 5 elements of the PRM?
1) Inherent motility of brain and spinal cord2) Fluctuation of CSF3) Mvt of intracranial and intraspinal membranes4) Articular mobility of cranial bones5) Involuntary mobility of sacrum bt ilia
383
Axis/plane of motion in torsion?
AP axis, coronal plane
384
Torsion motions?
Sphenoid rotates one direction about AP axis, occiput rotation in opposite direction
385
How are torsion SDs named?
Named for greater wing of sphenoid that is more superior
386
Axes of motion in SB/rotation?
Rotation about an AP axis thru SBS; sidebending about 2 parallel vertical axes--one passing thru foramen magnum and other thru center of sphenoid
387
SB/rotation motions?
Sphenoid and occiput rotate in SAME direction (unlike torsion) and sidebending about the vertical axes causing deviation of SBS to either right or left
388
Sidebending to left will cause what rotation?
Sphenoid and occiput will rotate so that they are inferior on the left
389
Sidebending causes the SBS to deviate which way?
Right SB causes deviation of SBS to right and vice versa
390
Extension causes what motion of SBS?
SBS will move caudad
391
Flexion causes what motion of SBS?
SBS will move cephalad
392
What is vertical strain?
When sphenoid deviates cephalad or caudad in relation to the occiput
393
Axes of motion in vertical strain?
One tranverse axis thru center of sphenoid, other transverse axis just superior to occiput
394
What is lateral strain?
Sphenoid deviates laterally in relation to occiput
395
Axes of motion in lateral strain?
One vertical axis thru center of sphenoid, one vertical axis thru foramen magnum
396
Compression?
When sphenoid and occiput are pushed together causing decreased amplitude of flexion and extension
397
Cause of compression?
Trauma to back of head--if severe enough can obliterate CRI
398
Site of vagal SD?
OA, AA, C2 dysfunction
399
Cause of poor suckling in newborn?
Condylar compression (CN XII) and dysfunctions of CN IX and X at jugular foramen
400
What drains 85-90% of blood from cranium?
Venous sinuses
401
What drains 5% of blood from cranium?
Facial veins and external jugular
402
Venous sinus technique?
Directly spreads apart sutures of cranium that overly occipital, transverse and sagittal sinuses
403
Purpose of CV4 bulb decompression?
Increase amplitude of CRI
404
CV4 technique?
1st resist flexion phase and encourage extension phase until a "still point" is reached, then allow restoration of flexion/extension to occur
405
What is CV4 good for?
Fluid homeostasis and induce uterine contraction in post-date gravid women
406
Purpose of vault hold?
Address strains of SBS
407
Vault hold finger placement?
1) Index on greater wing2) Middle on temporal bone in front of ear3) Ring on mastoid region of temporal bone4) Pinkie on squamous portion of occiput
408
Purpose of V spread?
To separate restricted or impacted sutures and can be applied to any suture
409
Purpose of lift technique?
Frontal and parietal lifts are used to aid in balance of membranous tension
410
Absolute contraindications?
Acute intracranial bleeds or increased ICP, skull fracture
411
Relative contraindications?
Pts with known hx of seizures or dystonia, traumatic brain injury
412
Miosis?
CN III --\> ciliary ganglion --\> pupils
413
Tears and nasal secretions?
CN VII --\> sphenopalatine ganglion --\> lacrimal and nasal glands
414
Salivation via submandibular and sublingual glands?
CN VII --\> submandibular ganglion --\> submandibular and sublingual glands
415
Salivation via parotids?
CN IX --\> otic ganglion --\> parotids
416
Vagus to GU system?
Kidney and UPPER ureter
417
Vagus to repro system?
Ovaries and testes
418
Vagus to GI system?
Everything above 1/2 transverse colon
419
Pelvic splanchnic to GU system?
LOWER ureter and bladder
420
Pelvic splanchnic to repro system?
Uterus, prostate and genitalia
421
Pelvic splanchnic to GI system?
Descending colon, sigmoid and rectum
422
Head and neck?
T1-4
423
Heart?
T1-5
424
Respiratory system?
T2-7
425
Esophagus?
T2-8
426
Anything before ligament of Treitz?
T5-9
427
Spleen?
T5-9
428
Anything after ligament of Treitz and before the splenic flexure?
T10-11
429
Anything after splenic flexure?
T12-L2
430
Greater splanchnic nerve and celiac ganglion?
T5-9
431
Lesser splanchnic nerve and superior mesenteric ganglion?
T10-11
432
Least splanchnic nerve and inferior mesenteric ganglion?
T12-L2
433
Appendix?
T12
434
Kidneys?
T10-11
435
Adrenal medulla?
T10
436
Upper ureters?
T10-11
437
Lower ureters?
T12-L1
438
Bladder?
T11-L2
439
Gonads?
T10-11
440
Uterus and cervix?
T10-L2
441
Erectile tissue of penis and clitorus?
T11-L2
442
Prostate?
T12-L2
443
Arms?
T2-8
444
Legs?
T11-L2
445
Ganglion to kidneys?
Superior mesenteric
446
Ganglion to upper ureters?
Superior mesenteric
447
Ganglion to lower ureters?
Inferior mesenteric
448
Entire GI tract?
T5-L2
449
L3-L5?
NOTHING!
450
How would you describe anterior chapman's points?
Smooth, firm, discretely palpable nodules approx 2-3mm in diameter
451
Where are anterior chapman's points located?
Within deep fascia or on periosteum of bone
452
Where are posterior chapmna's points located?
Bt spinous and transverse processes
453
How would you describe posterior chapman's points?
Rubbery, similar to tissues texture changes assoc with classic viscero-somatic reflexes
454
What will gentle pressure on a chapman's point elicit?
Sharp, nonradiating, exquisitely distressing pain
455
What are chapman's points?
Somatic manifestations of a visceral dysfunction
456
Anterior appendix?
Tip of right 12th rib
457
Posterior appendix?
Transverse process of T11
458
The presence of which particular reflex helps to direct the DDx more toward acute appendicitis?
Posterior appendix chapman's point
459
Anterior adrenal?
2" superior and 1" lateral to umbilicus
460
Posterior andrenals?
Bt spinous and transverse processes of T11 and T12
461
Anterior kidneys?
1" superior and 1" lateral to umbilicus
462
Posterior kidney?
Bt spinous and transverse processes of T12 and L1
463
Bladder?
Periumbilical region
464
Colon?
Lateral thigh within the IT band from greater trochanter to just above knee
465
Cecum?
Right proximal femur
466
Hepatic flexure?
Right distal femur
467
Sigmoid colon?
Left proximal femur
468
Splenic flexure?
Left distal femur
469
What is a trigger point?
May refer pain when pressed
470
What is a tender point?
DOES NOT refer pain when pressed
471
Where will trigger points of the SCM refer pain?
Ipsilateral occipital and temporal regions
472
What trigger point is assoc with supraventricular tachycardias?
Right pectoralis muscle bt 5th and 6th ribs near the sternum
473
What do trigger points represent?
Somatic manifestations of a viscero-somatic, somato-visceral or somato-somatic reflex
474
Methods are used to eliminate trigger points?
Neurological or vascular methods
475
How do you treat myofascial trigger points?
Spray and stretch using vapocoolant spray, injection with local anesthetic
476
What are tenderpoints used for?
Diagnostic criteria and as a treatment monitor for counterstrain
477
What type of technique is MFR?
Direct or indirect, active or passive
478
Applying traction along the long axis of muscle?
Direct technique
479
Applying compression along the long axis of muscle?
Indirect technique
480
What is the MFR procedure?
1) Palpate restriction2) Apply compression or traction3) Add twisting or transverse forces4) Use enhancers5) Await release
481
What are the 2 goals of MFR?
1) Restore functional balance2) Improve lymphatic flow
482
What is the most important diaphragm?
Abdominal
483
What are the 4 diaphragms?
1) Tentorium cerebelli2) Thoracic inlet3) Abdominal diaphragm4) Pelvic diaphragm
484
According to Zink, what are the 4 compensatory curves of the spine?
1) OA junction2) Cervicothoracic junction3) Thoracolumbar junction4) Lumbosacral junction
485
According to Zink, what is the Common Compensatory Pattern?
In 80% of healthy people, OA is rotated left, cervicothoracic is right, thoracolumbar is left, and lumbosacral is right
486
When performing indirect MFR, which barrier is engaged?
Anatomic
487
What are contraindications for MFR?
Malignancy, aneurysm, acute RA, febrile state, healing fracture, osteoporosis, open wounds
488
3 purposes of rib raising?
1) Decrease SNS activity2) Improve lymphatic return3) Encourage max inhalation and provokes a more effective negative pressure
489
Indications for rib raising?
Visceral dysfunction, decreased rib excursion, lymphatic congestion, fever, paraspinal m spasm
490
Contraindications for rib raising?
Spinal/rib fracture, recent spinal surgery
491
Effect of rib raising on SNS activity?
Initial increase in SNS activity, followed by inhibited SNS activity
492
What can be used to reduce incidence of ileus in post-op patients?
Rib raising, soft tissue paraspinal inhibition
493
How can lumbar paraspinal inhibition produce the same effects as rib raising?
Bc upper lumbar (L1-2) SNS ganglia is continuous with that of thoracic paraspinal ganglia
494
Purpose of celiac, SM, and IM ganglia releases?
Decrease SNS activity
495
Indications for GI ganglia releases?
GI dysfunction, pelvic dysfunction
496
Contraindications for GI ganglia releases?
Aortic aneurysm, open surgical wound
497
Purpose of treating Chapman's points?
Decrease SNS tone to assoc visceral tissues
498
Superior cervical paraspinal ganglia?
C1-3
499
Middle cervical paraspinal ganglia?
C6-7
500
Inferior cervical paraspinal ganglia?
C7-T1
501
Purpose of cranial manipulation?
Improve PNS function in head structures innervated by CN III, VII, IX, X
502
How to reach sphenopalatine ganglion?
Manual finger pressure intraorally
503
Purpose of sphenopalatine ganglion technique?
Enhance PNS activity to encourage thin watery secretions
504
Indications for sphenopalatine ganglion technique?
Thick nasal secretions
505
Purpose of condylar decompression?
Help free PNS responses to structures innervated by CN IX and X by freeing passage thru jugular foramen (i.e. occipito-mastoid suture)
506
What can condylar compression cause?
Suckling difficulties in newborns
507
Vagus nerve treatment?
OA, AA, or C2 joint treatment
508
Purpose of sacral somatic dysfunction treatment?
1) Decrease hyperPNS tone in left colon and pelvis2) Reduce labor pain caused by cervical dilation
509
Indications for sacral SD treatment?
Dysmenorrhea, labor pain from cervical dilation, constipation
510
Contraindications for sacral SD treatment?
Local infections or incisions
511
Which lobe of the lung does NOT drain into the right (minor) duct?
Left upper lobe
512
What drains into the right (minor) duct?
Right UE, right hemicranium, heart and lobes of lung (except left upper lobe)
513
Where does the right (minor) duct drain into?
Right brachiocephalic vein OR junction of right IJV and subclavian vein
514
Where does the left (major) duct drain into?
Junction of left IJV and subclavian veins
515
Where does the thoracic duct traverse?
Sibson's fascia of the thoracic inlet up to the level of C7 before turning around and empyting into the left (major) duct
516
Where does the right (minor) duct traverse?
Only traverses the thoracic inlet once
517
Infection of the right toe would drain where?
Left (major) lymphatic duct
518
What drains directly into the thoracic duct and bypasses LNs?
1) Thyroid2) Esophagus3) Coronary and triangular ligaments of liver
519
What has prelymphatics?
Superficial skin, deep portions of peripheral nerves, endomysium, and bones (Haversion canals)
520
2/3 of lymphatic fluid is produced where?
Liver and intestines
521
What is the de facto lymph of the CNS?
CSF
522
What level is the cisterna chyli?
L2
523
Where does the thoracic duct cross the diaphragm?
Aortic hiatus (T12)
524
When is the lymphatic system developed in utero?
By the 3rd month
525
What has more valves, lymphatics or veins?
Lymphatics--semilunar
526
What has "flap valves"?
Terminal lymphatic capillaries--allows fluid to enter
527
How does interstitial fluid enter the terminal lymphatic vessels?
Micropinocytosis
528
What is the lymphatic return to the heart in a day?
Entire volume of serum of body
529
How much extracellular fluid is carried from interstitium to the blood per day?
10-20% or 3 liters
530
What do the intestinal lymphatics absorb?
Long chain fatty acids, chylomicrons, and cholesterol
531
What are the main cells found in lymph?
Lymphocytes
532
What is the innervation of lymphatics?
SNS (just like vasculature)
533
What does SNS stimulation do the lymphatics?
Initially causes increased peristalsis, long term hyperSNS tone decreases overall mvt of lymph
534
What is the SNS control to the lymphatic duct?
Intercostal nerves
535
What innervates the cisterna chyli?
T11
536
What is interstitial fluid pressure and flow rate?
-6.3mmHg, rate of 120cc/hr
537
What if interstitial pressure increases (closer to 0mmHg)?
Increased absorption into lymphatics
538
What happens if pressure gets above 0mmHg?
Lymphatics collapse--decrease in lymphatic drainage
539
What factors increase interstitial pressure above 0mmHg?
1) Systemic HTN2) Cirrhosis (decreased plasma protein synthesis)3) Hypoalbuminemia assoc with starvation4) Toxins such as rattlesnake poisoning
540
What kind of technique is CS?
Passive indirect
541
What is a tenderpoint?
Small tense edematous area of tenderness about the size of a fingertip located near attachments of tendons, ligaments or belly of muscle that do NOT radiate pain
542
How do you determine a tenderpoint is clinically significant?
Compare to same spot on other side
543
Where should you start tx if there are multiple tenderpoints?
Tx the most tender area first
544
Where do you place the pt?
Into position of comfort/ease by shortening the muscle
545
After fine tuning the tx position with small arcs of motion, how much pain should be reduced?
\>70%
546
What is a maverick point?
Tenderpoints that do not improve with fine tuning
547
How do you tx maverick points?
Place the pt in a position opposite of what would be used typically
548
How long must the position be maintained?
90 secs--time takes for proprioceptive firing to decrease
549
How much tenderness should remain after tx?
75-100% better
550
Anterior cervical TP location?
Anterior to or on most lateral aspect of lateral masses
551
Tx position for anterior cervical TP?
SB and rotate head away form side of TP
552
Anterior cervical maverick point (anterior 7th cervical) location?
2-3cm lateral to medial end of clavical at lateral attachment of SCM
553
Anterior cervical MP tx position?
Flex, SB toward and rotate away from side of TP
554
Posterior cervical TP location?
Tip of SP or on lateral side of SP
555
Posterior cervical TP tx position?
Extend, SB (slightly), and rotate away
556
Posterior cervical MP/inion (posterior 1st cervical) location?
At inion (posterior occipital protuberance) or just below
557
Posterio cervical MP inion tx position?
Marked flexion
558
Anterior thoracic TPs location?
T1-6 = located midline of sternum at attachment of corresponding ribsT7-12 = most located in rectus abdominus m about 1 inch lateral to midline on right or left
559
Anterior thoracic TPs tx position?
Flex thorax and add small amount of SB and rotation away
560
Posterior thoracic TPs location?
Either side of SP or on TP
561
Posterior thoracic TPs tx position?
Extend, rotate away and SB slightly away
562
Anterior rib TPs are assoc with what rib position?
Depressed ribs (exhalation dysfunction)
563
Posterior rib TPs are assoc with what rib position?
Elevated ribs (inhalation dysfunction)
564
How long must rib tx positions be held?
120 secs--allows pt extra time to relax
565
Anterior rib 1 TP location?
Just below medial end of clavicle
566
Anterior rib 2 TP location?
6-8cm lateral to sternum on rib 2
567
Anterior ribs 3-6 TP locations?
Along mid-axillary line on corresponding rib
568
Anterior rib tx position for ribs 1 and 2?
Flex head, SB and rotate towards
569
Anterior rib tx position for ribs 3-6?
SB and rotate thorax toward, encourage slight flexion
570
Posterior rib TP location?
Angle of corresponding rib
571
Posterior rib TP tx position?
Tx with minimal flexion, SB and rotate away
572
Anterior lumbar TP L1 location?
Just medial to ASIS
573
Anterior lumbar TP L2-4 location?
On the AIIIS
574
Anterior lumbar TP L5 location?
1cm lateral to pubic symphisis on superior ramus
575
Anterior lumbar TP tx position?
Most treated with pt supine, knees and hips flexed and markedly rotated away
576
Posterior lumbar TP location?
Either side of SP or on TP; L3-4 may be on iliac crest; L5 may be on PSIS
577
Posterior lumbar TP tx position?
Most treated with pt prone, extended and SB away (rotation may be towards or away)
578
Posterior lumbar MPs (lower pole 5th lumbar) location?
Inferior to PSIS as much as 1 cm
579
Posterior lumbar MP tx position?
Pt prone, hip and knee flexed, leg internally rotated and adducted
580
Iliacus TP location?
~7cm medial to ASIS
581
Iliacus tx position?
Pt supine with hip flexed and externally rotated
582
Piriformis TP location?
In the piriformis m 7cm medial to and slightly superior to greater trochanter
583
Piriformis TP tx position?
Pt prone, hip and knee flexed, thigh abducted and externally rotated
584
What percentage of TPs are maverick?
5%
585
What region is assoc with the greatest number of MPs?
Cervical spine
586
What type of technique to FPR?
Indirect myofascial release
587
What are the basic steps of FPR?
1) Straighten AP curvature2) Apply compression3) Shorten muscle by placing into position of ease
588
How long must the position be held?
3-4 secs
589
What can FPR be used to treat?
Superficial mm, deep intervertebral mm to influence vertebral motion
590
Purpose of straightening AP curvature?
Decrease kyphosis (thoracic spine) or lordosis (cervical or lumbar spine)
591
Where must the head be when treating cervical spine?
Off the table
592
What kind of technique is ME?
Active direct or active indirect (rarely)
593
Where does the physician initially place the pt for ME?
Directly into the barrier
594
What is isometric contraction?
Distance bt origin and insertion of muscle remais the same as the muscle contracts (but internal CT will stretch)
595
What does this isometric contraction cause the golgi tendon to do?
Change tension and causes reflex relaxation of agonist muscle fibers allowing the doc to further engage the barrier
596
What is reciprocal inhibition?
When antagonist muscles contract, the agonist muscles will reflexively relax
597
How can reciprocal inhibition be done?
Directly or indirectly
598
How would you tx a biceps m spasm using direct reciprocal inhibition?
Extend elbow to restrictive barrier, have pt contract triceps against resistance
599
How would you tx a biceps in spasm using indirect reciprocal inhibition?
Fully flex elbow (away from restrictive barrier), have pt contract triceps against resistance
600
What is teh oculocephalogyric reflex?
Uses EOM contraction to reflexively effect the cervical and truncal musculature
601
What is the crossed extensor reflex?
When reflex occurs, the flexors in withdrawing limb contract and extensors relax, while in the other limb the opposite occurs
602
How long is ME maintained?
3-5 secs
603
How many times is ME repeated?
3-5 times
604
What is more important, localization of force or intensity of force?
Localization
605
What barriers must be engaged during ME?
The restrictive barrier in ALL planes of motion
606
When is ME contraindicated?
Post-surgical pts and intensive care pts
607
Tx position for pump handle inhalation dysfunction?
Flex pts forward while supine
608
Tx position for bucket handle inhalation dysfunction?
SB towards while supine
609
Initial tx position for exhalation dysfunctions?
Pt places forearm on affected side across forehead with palm up
610
Where does pt monitor exhalation dysfunctions during tx?
Posteriorly at rib angle
611
Isometric contraction for rib 1?
Pt raises head directly toward ceiling
612
Isometric contraction for rib2?
Pt turns head 30 degrees away from dysfunctional side and lift head toward ceiling
613
Isometric contraction for ribs 3-5?
Pt pushes elbow of affected side toward opposite ASIS
614
Isometric contraction for ribs 6-9?
Pt pushes arm anterior
615
Isometric contraction for ribs 10-12?
Pt adducts arm
616
Rib 1 muscles being tx?
Anterior and middle scalenes
617
Rib 2 muscle being tx?
Posterior scalene
618
Ribs 3-5 muscle being tx?
Pectoralis minor
619
Ribs 6-9 muscle being tx?
Serratus anterior
620
Ribs 10-11 muscle being tx?
Lat dorsi
621
Rib 12 muscle being tx?
Quadratus lumborum
622
Unilateral sacral flexion?
Place hypothenar eminence on pt's ipsilateral ILA, push anterior on ILA during inhalation; resit any posterior mvt during exhalation
623
Unilateral sacral extension?
Place hypothenar eminence on ipsilateal sacral sulcus, push anterior and caudad on superior sulcus during exhalation; resist anterior superior mvt during inhalaiton
624
Forward sacral torsion pt position?
Lateral sims position (face down, axis side down) with flexed legs off table
625
Forward sacral torsion pt activating force?
Lifting legs toward ceiling against equal counterforce
626
Backward sacral torsion pt position?
Lateral recumbent with face up, axis side down, legs off table
627
Backward sacral torsion pt activating force?
Lifting legs toward ceiling against equal counterforce
628
Anterior innominate position?
Flex hip and knee into barrier
629
Posterior innominate position?
Drop hip and leg off table inducing extension
630
Pt position for superior pubic shear?
Drop ipsilateral leg off table and abduct until resistance is felt, stabilize opposite ASIS
631
Pt activating force for superior pubic shear?
Bring ipsilateral knee to opposite ASIS (flexion and adduction)
632
Pt position for inferior pubic shear?
Flex and abduct pt's ipsilateral hip and knee until resistance is felt, stabilize pt's opposite ASIS
633
Pt activating force for inferior pubic shear?
Push ipsilateral knee to opposite foot (extension and adduction)
634
Pt position for anterior fibular head?
Pt prone, knee flexed, hand on lateral side of foot cupping ankle, plantarflex and invert foot, externally rotate tibia
635
Pt activating force for anterior fibular head?
Dorsiflex
636
Pt position for posterior fibular head?
Pt prone, knee flexed, hand on lateral side of foot cupping ankle, plantarflex and invert foot, internally rotate tibia
637
Pt activating force for posterior fibular head?
Dorsiflex
638
What type of technique is HVLA?
Passive direct
639
Theories of the neurophysiology of HVLA?
1) Forcefully stretching a contracted muscle sends a barrage of afferents to CNS, causes reflex inhibitory signals to the spindles2) Forcefully stretching contracted muscle activates the golgi tendon and reflexively relaxes muscle
640
When is the final force applied?
Relaxation/exhalation phase
641
What is the main indication of HVLA?
Motion loss in somatic dysfunction
642
What are the absolute contraindications?
1) Osteoporosis2) Osteomyelitis (including Pott's)3) Fractures in area of thrust4) Bone mets5) Severe RA6) Down's
643
Why are RA pts at risk?
RA weakens the transverse ligament of the dens, so cervical manipulation may cause AA subluxation
644
Why are Down's pts at risk?
Laxity in transverse ligament of dens may results in AA subluxation with cervical manipulation
645
What are the relative contraindications?
1) Acute whiplash2) Pregnancy3) Post-op conditions4) Herniated nucleus pulposus5) Pt's on anticoagulaion or hemophiliacs6) Vertebral artery ischemia (positive Wallenberg's test)
646
What is the most common MINOR complication?
Soreness or symptom exacerbation
647
What is the most common MAJOR complication overall?
Vertebral artery injury--usually due to cervical rotatory forces with neck in extended position
648
What is the most common MAJOR complication in the low back?
Cauda equina syndrome (very rare)
649
Where is the thrust directed for OA HVLA?
Opposite eye (of rotation)
650
Direction of thrust for cervical rotational technique?
Opposite eye
651
Direction of thrust for cervical sidebending technique?
Opposite shoulder
652
Direction of force for flexed thoracics?
At dysfunctional segment and aimed toward floor
653
Direction of force for extension thoracics?
At vertebrae below dysfunctional segment and thrust is aimed 45 degrees cephalad
654
Direction of force for neutral thoracics?
Aimed toward floor, sidebend away
655
Technique for a purely flexed/extended thoracic lesion?
Use bilateral fulcum (thenar eminence under one TP and flexed MCP under the other TP)
656
Which rib cannot be treated using Kirksville Krunch?
Rib 1
657
Location of thenar eminence when treating ribs using KK?
Posterior rib angle of key rib
658
Pt position for rib 1 inhalation dysfunction HVLA?
Supine, SB toward rotate away
659
Doc's hand placement for rib 1 inhalation dysfunction HVLA?
1st MCP on tubercle of rib 1
660
Direction of thrust for rib 1 inhalation dysfunction?
Posterioanterior and caudad
661
Which vertebrae can be treated with HVLA using the lumbar roll?
T10-L5
662
Arm position when treating type II dysfunction with TP up?
Pull inferior arm down
663
Arm position when treating type II dysfunction with TP down?
Pull inferior arm up
664
Arm position when treating type I dysfunction with TP up?
Pull inferior arm up
665
Arm position when treating type I dysfunction with TP down?
Pull inferior arm down
666
Patient position for lumbar roll?
Lateral recumbent
667
Purpose of pulling inferior arm down when treating with lumbar roll?
Induce sidebending
668
Who find articulatory techniques more acceptable than other vigorous direct techniques?
Post-op pts and elderly
669
Indications?
1) Limited/lost articular motion2) Need to increase frequency or amplitude of motion of body region3) Normalized SNS activity
670
Contraindications?
1) Repeated hyper-rotation of upper cervicals when in extension may damage vertebral artery2) Acutely inflamed joint, such as infection or fracture
671
What is the typical articulatory procedure?
1) Move joint to the restrictive barrier2) Use respiratory cooperation or ME activation to further increase myofascial stretch3) Return to neutral4) Repeat
672
What are 2 common articulatory techniques?
1) Rib raising2) Spencer's
673
What is rib raising useful for?
Those pts who have a resistant or noncompliant chest wall (e.g. viral pneumonia)
674
What is Spencer's useful for?
Adhesive capsulitis
675
What position is the pt in Spencer's?
Lateral recumbent with dysfunction shoulder up
676
Spencer's stage 1?
Stretch tissues and pumping fluids with arm extended
677
Spencer's stage 2?
Shoulder extensioni/flexion with elbow flexed
678
Spencer's stage 3?
Shoulderf flexion/extension with elbow extended
679
Spencer's stage 4?
1) Circumduction and slight compression with elbow flexed/extended2) Circumduction and traction with elbow extended
680
Spencer's stage 5?
Adduction and external rotation with elbow flexed
681
Spencer's stage 6?
Abduction with internal rotation with arm behind back
682
Spencer's stage 7?
Stretching tissues and pumping fluids with arm extended
683
Spurling's test (compression test) procedure?
Pt seated, doc extends and SB C-spine toward side being tested
684
Positive Spurling's?
Pain radiating into ipsilateral arm due to nerve root compression
685
Wallenberg's test?
Test for vertebral artery insufficiency
686
Positive Wallenberg's test?
Pt complains of dizziness, visual changes, lightheadedness, or nystagmus
687
Wallenberg's procedure?
Pt supine, doc flexes neck, holding for 10 sec, then extends holding for 10 secs, rotation right and left, rotation during flexion, and rotation during extension
688
Thoracic outlet tests?
1) Adson's2) Wright's3) Costoclavicular syndrome test (military posture test)
689
What is being tested in Adson's?
Tight scalenes
690
Adson's test procedure?
Monitor pt's pule, extend shoulder, externally rotated and slightly abducted; pt then takes deep rbeath and turn head TOWARD ipsilateral arm
691
What is being tested in Wright's?
Pectoralis minor muscle at coracoid process
692
Wright's procedure?
Hyperabduct arm above head with some extension while monitoring pulse
693
What is being tested in military posture test?
Clavicle and 1st rib
694
Military posture procedure?
Monitor radial pulse while depressing and extending shoulder
695
Positive test for Adson's, Wright's, and military posture tests?
Severely decreased or absent radial pulse
696
Drop arm test procedure?
Abduct shoulder to 90, then slowly lower arm
697
Positive drop arm test procedure?
Unable to lower arm smoothly, or if arm drops indicating rotator cuff tear
698
Speeds test?
Assess biceps tendon in bicipital groove
699
Speeds test procedure?
Fully extend elbow, flex shoulder and supinate while doc resists shoulder flexion
700
Positive speeds test?
Tenderness in bicipital groove
701
Yergason's test?
Tests stability of biceps tendon in bicipital groove
702
Yergason's test procedure?
Doc supinates as the pt resists
703
Positive Yergason's?
Biceps tendon pops out of bicipital groove
704
Allen's test?
Assesses adequacy of blood supply to hand by radial and ulnar arteries
705
Finkelstein test?
Test for tenosynovitis in abductor pollicis longus and extensor pollicis brevis tendons at the wrist (De Quervain's dz)
706
Reverse Phalen's test (prayer test)?
For dx carpal tunnel--extend wrist while gripping doc's hand
707
Hip drop test?
Evaluate sidebending (lateral flexion) of lumbar spine
708
Normal hip drop?
Lumbar spine SBs to side opposite bent knee, ipsilateral iliac crest drops more than 20-25 degrees
709
Positive hip drop test?
Anything less than a smooth convexity of lumbar spine, or drop of iliac crest
710
Straight leg test (Lasegue's test)?
Evaluation of sciatic nerve compression
711
Braggard's test?
To differentiate bt tight hamstring and sciatic nerve compression, doc dorsiflexes foot
712
Positive Braggard's?
Pain is elicited by dorsiflexion indicating sciatic nerve compression
713
Seated flexion test?
Assess SI motion (sacrum)
714
Standing flexion test?
Assess iliosacral motion (innominates)
715
ASIS compression test?
Determine side of SI dysfunction (esp when standing/seated flexion tests are equivocal)
716
Pelvic side shift test?
Determines if sacrum is in the midline
717
Pelvic side shift test procedure?
With pt standing, doc stabilizes the shoulders with one hand and pushes the pelvis to the opposite side, the hands are then switched to check the other pelvis
718
Positive pelvic side shift test?
Positive on side of freer translation (this indicates that the pelvis is shifted to that side)
719
What does a positive pelvic side shift test usually indicate?
Flexion contracture of psoas (psoas syndrome)--if contracture on right, there will be positive test to the left
720
Trendelenburg test?
Assesses gluteus medius muscle strength
721
Positive Trendelenburg?
Side that drops indicates the opposite gluteus medius is weak
722
Lumbosacral spring test?
Assesses whether or not the sacral base is tilted posterior
723
Backward bending test (the sphinx test)?
Determines if sacral base moved posterior or anterior
724
Ober's test?
Detects tight tensor fascia lata and IT band
725
Patrick's test?
FABER--assess SI and hip joint pathology (esp osteoarthritis)
726
Thomas test?
Assess flexion contracture of hip, usually iliopsoas
727
Bounce home test?
Tests problem with full knee extension, usually due to meniscal tears or joint effusions
728
Apley's compression?
Assess meniscus injury
729
Apley's distraction?
Assess collateral ligament injury
730
McMurray's test?
Detects tears in posterior aspect of menisci
731
McMurray's for medial meniscus?
Flex hip/knee, palpate medial joint line, tibia is then externally rotated and a valgus stress is applied while slowly extending knee
732
McMurray's for lateral meniscus?
Flex hip/knee, internally rotate tibia and a varus stress is applied while slowly extending knee
733
How to test for chondromalacia patellae?
Patellar grind test
734
Anterior drawer test of ankle?
Assess medial and lateral ligaments of ankle, mainly the ATF ligament
735
Positive seated or standing flexion tests?
Positive on side of superior PSIS
736
Myocardium?
2nd ICS
737
Esophagus?
2nd ICS
738
Thyroid?
2nd ICS
739
Bronchi?
2nd ICS
740
Upper lung?
3rd ICS
741
Lower lung?
4th ICS
742
Liver?
5th and 6th ICS R
743
Stomach (hyperacidity)?
5th ICS L
744
Gallbladder?
6th ICS R
745
Pancreas?
7th ICS R
746
Spleen?
7th ICS L
747
Appendix?
Tip of 12th rib R
748
Adrenals?
1in lateral 2in superior to umbilicus
749
Kidneys?
1in lateral 1in superior to umbilicus
750
Bladder?
Peri-umbilical area
751
Urethra?
Superior pubic ramus, 2cm lateral to symphysis
752
Prostate?
Outer femur (along posterior IT band) bilateral
753
Pylorus?
Center of sternum
754
Celiac ganglion?
Just below xiphoid process
755
Superior mesenteric ganglion?
Bt points for celiac and inferior mesenteric ganglion
756
Inferior mesenteric ganglion?
Just above umbilicus
757
Stomach (peristalsis)?
6th ICS L
758
Small intestine?
8-10th ICS
759
Tonsils?
1st ICS
760
Middle ear (otitis media)?
1st rib and clavicals, lateral to where they cross the 1st ribs
761
Eyes?
Surgical neck of humerus
762
1st rib?
1) Middle ear2) Sinuses
763
Tongue?
2nd rib
764
Uterus?
Superior edge of inferior pubic ramus
765
Broad ligament?
Outer femur along posterior IT band
766
Ovaries?
Superior pubic ramus, 2cm lateral to symphysis
767
Intestine (peristalsis)?
Few inches above greater trochanter
768
Myocardium?
T2-3 lamina of TP
769
Esophagus?
T2-3 lamina of TP
770
Thyroid?
T2-3 lamina of TP
771
Bronchi?
T2 lamina of TP
772
Upper lung?
T3 lamina of TP
773
Lower lung?
T4 lamina of TP
774
Liver?
T5-6 lamina of TP R
775
Stomach acid?
T5 L
776
Stomach peristalsis?
T6 L
777
Gallbladder?
T6 lamina of TP R
778
Pancreas?
T7 lamina of TP R
779
Spleen?
T7 lamina of TP L
780
Appendix?
T11 lamina R
781
Adrenals?
T11-12 could be unilateral
782
Kidneys?
T12-L1 lamina of TP bilateral
783
Bladder?
L2 upper edge of TP bilateral
784
Urethra?
L2 TP bilateral
785
Prostate?
Lateral sacral base bilateral
786
Ear?
C1 posterior lateral pillar
787
Pylorus?
T9 lamina of TP right
788
Uterus?
Lateral sacral base bilateral
789
Broad ligament?
Lateral sacral base bilateral
790
Vagina?
Lateral sacral base bilateral and upper inner edge of thigh
791
Ovaries?
T10-11 lamina of TP bilateral
792
Large intestine?
Right triangle - lateral edge of TP of L2-4, bottom edge is L4 to iliac crest
793
Pharynx, tongue, larynx, sinuses, arms?
C2
794
Nasal sinuses?
Bottom edge of C1 pillar
795
Peristalsis (intestine)?
Rib 11
