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Savarese > Full deck > Flashcards

Full deck Flashcards

1
Q

Cervical superior facet orientation?

A

Backward, upward, medial

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2
Q

Thoracic superior facet orientation?

A

Backward, upward, lateral

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3
Q

Lumbar superior facet orientation?

A

Backward, medial

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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

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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

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6
Q

Isolytic contraction?

A

Muscle contraction against resistance while forcing the muscle to lengthen; operator’s force is more than patient’s force

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7
Q

Concentric contraction?

A

Muscle contraction that results in the approximation of the muscle’s origin and insertion

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8
Q

Eccentric contraction?

A

Lengthening of muscle during contraction due to an external force

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9
Q

Myofascial release?

A

Direct and indirect, active and passive

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10
Q

Counterstrain?

A

Indirect, passive

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11
Q

Facilitated positional release?

A

Indirect, passive

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12
Q

Muscle energy?

A

Direct, active

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13
Q

HVLA?

A

Direct, passive

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14
Q

Cranial?

A

Direct and indirect, passive

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15
Q

Lymphatic treatment?

A

Direct, passive

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16
Q

Chapman’s reflexes?

A

Direct, passive

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17
Q

In type I dysfunction, what motion precedes what?

A

SB precedes rotation (OSR)

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18
Q

In type II dysfunction, what motion precedes what?

A

Rotation precedes SB (TRS)

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19
Q

What is the only subjective component of TART?

A

Tenderness

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20
Q

2 types of isotonic contraction?

A

1) Concentric (shortening)2) Eccentric (lengthening)

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21
Q

Upward mvt of a bicep curl?

A

Concentric contraction

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22
Q

Downward mvt of a bicep curl?

A

Eccentric

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23
Q

Contraction in which tension remains the same?

A

Isotonic

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24
Q

Which vertebra has no spinous process or vertebral body?

A

C1

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25
Q

Which vertebrae have bifid spinoud processes?

A

C2-6

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26
Q

What portion of the cervical vertebrae lies bt the superior and inferior facets?

A

Articular pillars (or lateral masses)

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27
Q

What is located posterior to the cervical transverse processes?

A

Articular pillars

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28
Q

What is used by DO’s to evaluate cervical vertebral motion?

A

Articular pillars

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29
Q

What vertebrae do the vertebral arteries pass thru?

A

C1-6

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30
Q

What do the vertebral arteries pass thru?

A

Foramen transversarium

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31
Q

Where do the scalenes originate?

A

Posterior tubercle of the transverse processes of the cervical vertebrae

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32
Q

Where does the anterior scalene insert?

A

Rib 1

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33
Q

Where does the middle scalene insert?

A

Rib 1

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34
Q

Where does the posterior scalene insert?

A

Rib 2

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35
Q

What are the actions of the scalenes?

A

Sidebend to same side with unilateral contraction, flex with bilateral contraction (also aid in respiration)

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36
Q

Where would you find a scalene tenderpoint in a rib dysfunction?

A

Posterior to clavicle at base of neck

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37
Q

Where does the SCM originate?

A

Mastoid and lateral half of superior nuchal line

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38
Q

Where does the SCM insert?

A

Medial 1/3 of clavicle and sternum

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39
Q

What are the actions of the SCM?

A

With unilateral contraction, will sidebend ipsilaterally and rotate contralaterally; bilateral contraction flexes head

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40
Q

Shortening or restrictions within the SCM results in what?

A

Torticollis

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41
Q

What ligament extends from the sides of the dens to the lateral margins of the foramen magnum?

A

Alar ligament

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42
Q

What ligament attaches to the lateral masses of C1 to hold the dens in place?

A

Transverse ligament of the atlas

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43
Q

What syndromes can weaken the alar and transverse ligaments resulting in AA subluxation?

A

Down’s and RA

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44
Q

What are uncinate processes?

A

Superior lateral projections originating from the posterior lateral rim of the vertebral bodies of C3-7

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45
Q

What is the joint of Luschka (unconvertebral joints)?

A

The articulation of the superior uncinate process and superadjacent vertebrae

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46
Q

What is the most common cause of cervical nerve root pressure?

A

Degeneration of the joints of Luschka plus hypertrophic arthritis of the intervertebral synovial (facet) joints

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47
Q

Where does C8 nerve root exit?

A

Between C7 and T1

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48
Q

What nerve roots make up the brachial plexus?

A

C5-T1

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49
Q

What is the primary motion of the OA?

A

Flexion and extension–50% of flexion/extension of cervical spine occurs at OA

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50
Q

How does sidebending occur at OA?

A

Opposite rotation

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51
Q

What is the primary motion of the AA?

A

Rotation–50% of rotation of cervical spine occurs at AA

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52
Q

What are the mvts of C2-7

A

Sidebending and rotation occur to the same side

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53
Q

Main motions of C2-4?

A

Rotation

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54
Q

Main motions of C5-7?

A

Sidebending

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55
Q

Lateral translation to the right will cause what motion?

A

Left sidebending

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56
Q

What if you feel a deep sulcus on the right at the OA joint?

A

Rotated right, sidebent left

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57
Q

How do you evaluate the AA?

A

Flex cervical spine to 45 degrees to lock out rotation of typical cervical vertebrae

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58
Q

An acute injury to the cervical spine is best treated how?

A

MFR or counterstrain

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59
Q

How does cervical foraminal stenosis present?

A

Neck pain radiating to upper extremity

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60
Q

What are the S/S of cervical foraminal stenosis?

A

Increased pain with neck extension, posiive Spurling’s, paraspinal muscle spasm, posterior and anterior cervical tenderpoints

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61
Q

Which vertebra actually rotates, the atlas or axis?

A

Atlas rotates on axis

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62
Q

Which cervical segment is best assessed by flexing neck to 45 and rotating?

A

C1

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63
Q

T1-3 rule of 3’s?

A

SP is located at level of corresponding TP

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64
Q

T4-6 rule of 3’s?

A

SP is located one-half a sefment below the corresponding TP

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65
Q

T7-9 rule of 3’s?

A

SP is located at level of TP of vertebrae below

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66
Q

Follows same rules as T7-9?

A

T10

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67
Q

Follows same rules as T5-7?

A

T11

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68
Q

Follows same rules as T1-3?

A

T12

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69
Q

Spine of scapula is at what level?

A

T3

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70
Q

Inferior angle of scapula corresponds with what?

A

Spinous process of T7

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71
Q

Sternal notch is at what level?

A

T2

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72
Q

Sternal angle (angle of Louis) attaches to which rib and what level is it?

A

2nd rib, level of T4

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73
Q

What is the main motion of the thoracic spine?

A

Rotation

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74
Q

Upper and middle thoracic spine motion?

A

Rotation > flexion/extension > SB

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75
Q

Lower thoracic spine motion?

A

Flexion/extension > SB > rotation

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76
Q

Primary muscles of respiration?

A

Diaphragm, intercostals

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77
Q

Rib attachments for diaphragm?

A

Ribs 6-12 b/l

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78
Q

Vertebral attachments for diaphragm?

A

L1-3

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79
Q

Anterior attachment for diaphragm?

A

Xiphoid

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80
Q

Action of intercostal muscles?

A

Elevate ribs during inspiration and prevent retractions during inspiration

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81
Q

Secondary muscles of respiration?

A

Scalenes, pec minor, serratus anterior/posteiror, quadratus lumborum, latissimus dorsi

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82
Q

What makes a typical rib typical?

A

Contains Shaft, Head, Angle, Neck, Tubercle (SHANT)

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83
Q

What is the difference bt head and tubercle of rib?

A

Head–articulates with vertebra above and corresponding vertebra; tubercule–articulates with corresponding TP

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84
Q

Typical ribs?

A

3-10

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85
Q

Atypical ribs?

A

1, 2, 11, 12 (ribs with “1” and “2”), sometimes 10

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86
Q

Reason why rib 1 is atypical?

A

Articulates only with T1 and has no angle

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87
Q

Reason why rib 2 is atypical?

A

Has large tuberosity on shaft for serratus anterior

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88
Q

Reason why ribs 11 and 12 are atypical?

A

They articulate only with corresponding vertebrae and lack tubercles

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89
Q

Reason why rib 10 may be atypical?

A

May articulate only with T10

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90
Q

True ribs?

A

1-7 (attach to sternum thru costal cartilages)

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91
Q

False ribs?

A

8-12 (connected by its costal cartilage to the cartilage of the rib superior)

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92
Q

Floating ribs?

A

11, 12

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93
Q

Rib motions?

A

Pump handle, bucket handle, caliper

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94
Q

Move primarily in pump handle?

A

Ribs 1-5

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95
Q

Move primarily in bucket handle?

A

Ribs 6-10

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96
Q

Move primarily in caliper?

A

Ribs 11 and 12

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97
Q

Rib appears to be “held up”, will not move caudad?

A

Inhalation dysfunction

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98
Q

Rib appears “held down”, will not move cephalad?

A

Exhalation dysfunction

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99
Q

Rib elevated anteriorly?

A

Pump handle inhalation dysfunction (depressed anteriorly for exhalation dysfunction)

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100
Q

Rib elevated laterally?

A

Bucket handle inhalation dysfunction (depressed laterally for exhalation dysfunction)

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101
Q

Anterior narrowing of intercostal space above dysfunctional rib?

A

Pump handle inhalation dysfunction (opposite for exhalation dysfunction)

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102
Q

Lateral narrowing of intercostal space above dysfunctional rib?

A

Bucket handle inhalation dysfunction (opposite for exhalation dysfunction)

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103
Q

Superior edge of posterior rib angle is prominent?

A

Pump handle inhalation dysfunction (opposite for exhalation dysfunction)

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104
Q

Lower edge of rib shaft is prominent?

A

Bucket handle inhalation dysfunction

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105
Q

What is the key rib responsible for group inhalation dysfunctions?

A

Lowest rib

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106
Q

What is the key rib responsible for group exhalation dysfunction?

A

Uppermost rib

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107
Q

Where is tx directed for a group dysfunction?

A

Key rib

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108
Q

Reason why lumbar spine is more susceptible to disc herniation?

A

Narrowing of posterior longitudinal ligament

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109
Q

Comparison of posterior longitudinal ligament at L1 and at L4-5?

A

Is 1/2 the width at L4-5 than at L1

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110
Q

Location of where spinal cord terminates?

A

L1-2

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111
Q

Location of where nerve roots exit in lumbar spine?

A

Below corresponding vertebrae, but above the IV disc

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112
Q

Origin of iliopsoas m?

A

T12-L5 vertebral bodies

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113
Q

Insertion of iliopsoas m?

A

Lesser trochanter

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114
Q

Erector spinae mm from lateral to medial?

A

Iliocostalis, Longissimus, Spinalis (I Love Spine)

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115
Q

Level of iliac crest?

A

L4-L5

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116
Q

T10 dermatome at umbilicus is anterior to which IV disc?

A

L3-L4

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117
Q

Most common anomaly in lumbar spine?

A

Facet trophism–predisposes to early degenerative changes

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118
Q

What is facet trophism?

A

Lumbar facet joints are aligned in coronal plane (instead of sagittal)

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119
Q

What is sacralization?

A

TPs of L5 are long and articulate with sacrum–predisposes to early degenerative changes

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120
Q

What is lumbarization?

A

Failure of fusion of S1 with other sacral segements

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121
Q

What is spina bifida?

A

Defect in closure of limina of vertebral segment

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122
Q

3 types of spina bifida?

A

Occulta, meningocele, meningomyelocele

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123
Q

Alignment of lumbar facets?

A

Backward and medial for superior facets

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124
Q

Major motion of lumbar spine?

A

Flexion and extension (small degree of SB, limited rotation)

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125
Q

Sidebending of L5 will cause what sacral motion?

A

Sacral oblique axis will be engaged on same side

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126
Q

Rotation of L5 will cause what sacral motion?

A

Sacrum will rotate toward opposite side

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127
Q

Ferguson’s angle?

A

Lumbosacral angle–formed by intersection of a horizontal line and the line of inclination of the sacrum (25-35 degrees)

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128
Q

98% of disc herniations occur where?

A

Between L4-5 or L5-S1

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129
Q

A herniation bt L4-5 will exert pressure on which nerve root?

A

L5 (the nerve root below)

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130
Q

Positive test seen in disc herniation?

A

Straight leg raising test

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131
Q

What is relatively CI in herniation?

A

HVLA

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132
Q

OMT for herniation?

A

Initially indirect techniques, then gentle direct

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133
Q

Positive test seen in psoas syndrome?

A

Thomas test

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134
Q

Tender point seen in psoas syndrome?

A

Medial to ASIS

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135
Q

Dysfunctions seen in psoas syndrome?

A

Nonneutral dysfunction of L1-2, positive pelvic shift test to contralateral side, sacral dysfunction on an oblique axis, and contralateral piriformis spasm

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136
Q

When do you stretch psoas m in psoas syndrome?

A

Chronic spasms

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137
Q

OMT for psoas syndrome?

A

Counterstrain to anterior iliopsoas tenderpoint followed by ME/HVLA to high lumbar dysfunction

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138
Q

Causes of spinal stenosis?

A

Hypertrophy of facet joints, Ca deposits within ligamentum flavum and posterior longitudinal l, loss of IV disc height

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139
Q

Radiology for spinal stenosis?

A

Osteophytes and decreased IV disc space, foraminal narrowing on oblique views

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140
Q

What is spondylolisthesis?

A

Anterior displacement of one vertebrae in relation to one below due to fractures in the pars interarticularis

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141
Q

Where does spondylolisthesis occur?

A

L4 or L5

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142
Q

What are the neuro deficits in spondylolisthesis?

A

None

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143
Q

What is a positive vertebral step-off sign?

A

Palpating the spinous process there is an obvious forward displacement at the area of listhesis

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144
Q

S/S of spondylolisthesis?

A

Pain with extension-based activities, tight hams b/l, stiff-legged, short stride, waddling gait

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145
Q

Goal of tx for spondylolisthesis?

A

Reduce lumbar lordosis and somatic dysfunction

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146
Q

What is CI in spondylolisthesis?

A

HVLA

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147
Q

Grading for spondylolisthesis?

A

1 = 0-25%; 2 = 25-50%; 3 = 50-75%; 4 = >75%

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148
Q

What is spondylolysis?

A

Defect of pars interarticularis WITHOUT anterior displacement of vertebral body

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149
Q

Radiology for spondylolysis?

A

Scotty dog on oblique view–fracture of pars interarticularis

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150
Q

What is spondylosis?

A

Radiological term for degenerative changes within IV disc and ankylosing of adjacent vertebral bodies

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151
Q

How do you dx spondylolisthesis vs. spondylolysis?

A

Spondylolisthesis = lateral x-ray; sponylolysis = oblique x-ray

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152
Q

Cause of cauda equina syndrome?

A

Massive central disc herniation

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153
Q

S/S of cauda equina syndrome?

A

Saddle anesthesia, decreased DTRs, decreased rectal sphincter tone, loss of bowel/bladder control

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154
Q

Result of delay in surgery for tx cauda equina?

A

Irreversible paralysis

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155
Q

Epidemiology of scoliosis?

A

5% of school-aged children develop it before 15

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156
Q

Percentage of children with actual sxs related to their scoliosis?

A

10%

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157
Q

Female: Male ratio for scoliosis?

A

4:01

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158
Q

Dextroscoliosis?

A

Curve that is SB left = scoliosis to the right

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159
Q

Levoscoliosis?

A

Curve that is SB right = scoliosis to the left

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160
Q

2 types of scoliosis curves?

A

1) Structural curve2) Functional curve

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161
Q

Which curve is fixed and inflexible?

A

Structural

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162
Q

Which curve will NOT correct with sidebending in opposite direction?

A

Structural

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163
Q

Which is assoc with vertebral wedging and shortened ligaments/musccles on concave side?

A

Structural

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164
Q

T/F An uncorrected functional curve may progress to a structural curve?

A

TRUE

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165
Q

When should kids be screened?

A

10-15 years

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166
Q

What is the angle measures the degree of scoliosis?

A

Cobb angle

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167
Q

What is Cobb angle?

A

Draw horizontal line from vertebral bodies of extreme ends of curve; then draw perpendicular lines from these horizontal lines

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168
Q

At what angle is respiratory function compromised?

A

>50

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169
Q

At what angle is cardiac function compromised?

A

>75

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170
Q

What are the causes of scoliosis?

A

Idiopathic, congenital, neuromuscular, acquired

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171
Q

Which type is most often progressive?

A

Congenital

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172
Q

What are Konstancin exercises?

A

A series of specific exercises that has been proven to improve the pt with scoliotic postural decompensation

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173
Q

When is bracing indicated?

A

Moderate scoliosis

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174
Q

When i surgery indicated?

A

Severe scoliosis–if there is resp compromise or if it progresses despite conservative management

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175
Q

3 things that cause short leg?

A

1) Sacral base unleveling2) Vertebral SB and rotation3) Innominate rotation

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176
Q

Most common cause of anatomical short leg?

A

Hip replacement

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177
Q

First ligament to be stressed in short leg?

A

Iliolumbar ligaments, then the SI ligaments

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178
Q

Sacral base unleveling compensation?

A

Sacral base will be lower on short leg side

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179
Q

Innominate compensation?

A

Anterior rotation on short leg side; posterior rotation on long leg side

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180
Q

Lumbar spine compensation?

A

SB away, rotate toward short leg side

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181
Q

Lumbosacral (Ferguson’s) angle compensation?

A

Increased 2-3 degrees

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182
Q

How to quantify differences in heights of femoral head for short leg syndrome?

A

Standing x-ray

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183
Q

When to consider heel lift?

A

Femoral head difference >5mm

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184
Q

When should the full lift be administered?

A

Sudden onset of discrepancy (e.g. fracture, surgery)

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185
Q

What should the final lift height be?

A

1/2 - 3/4 of measured leg length discrpancy

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186
Q

What should the “fragile” pt begin with?

A

1/16” (1.5mm) and increase 1/16” every 2 weeks

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187
Q

What should the “flexible” pt begin with?

A

1/8” (3.2mm) and increase 1/8” every 2 weeks

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188
Q

What is the max height that can be applied to INSIDE the shoe?

A

1/4”

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189
Q

What if >1/4” is needed?

A

Apply to OUTSIDE of shoe

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190
Q

What is maximum heel lift possible?

A

1/2”

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191
Q

How do you prevent pelvis from rotating to opposite side when >1/2” lift is needed?

A

Apply an ipsilateral anterior sole lift extending from heel to toe

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192
Q

Most common cause of scoliosis?

A

Idiopathic

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193
Q

When do the 3 bones of the innominate fuse?

A

20 years old

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194
Q

Anterior portion of 1st segment (S1)?

A

Sacral promontory

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195
Q

Sacral base?

A

Top (most cephalad) part

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196
Q

In somatic dysfunctions, what can be recorded as shallow (posterior) or deep (anterior)?

A

Sacral base or sacral sulci

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197
Q

How can you record the sacral ILA’s?

A

Shallow (posterior), deep (anterior), superior or inferior

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198
Q

The SI joint is an inverted “L” joint with 2 arms converging anteriorly. Where do these arms join?

A

S2

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199
Q

2 types of pelvic ligaments/

A

True and accessory

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200
Q

True pelvic ligaments?

A

Anterior, posterior and interosseous SI ligaments

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201
Q

Accessory pelvic ligaments?

A

Sacrotuberous, sacrospinous, iliolumbar ligaments

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202
Q

What ligament divides the greater and lesser sciatic foramen?

A

Sacrospinous ligament

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203
Q

Which ligament is the 1st to become painful in lumbosacral decompensation?

A

Iliolumbar ligament

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204
Q

Types of pelvic muscles?

A

Primary and secondary

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205
Q

Primary pelvic muscles?

A

Make up pelvic diaphragm–levator ani, coccygeus

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206
Q

Secondary pelvic muscles?

A

Iliopsoas, obturator internus, piriformis

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207
Q

Origin/insertion of piriformis?

A

ILA, greater trochanter

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208
Q

Action of piriformis?

A

Ext rot, extend thigh, abducts thigh with hip flexed

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209
Q

Innervation of piriformis?

A

S1 and S2 nerve roots

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210
Q

What are S/S of sciatica due to hypertonic piriformis?

A

Pain from buttock radiating down thigh but not past knee

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211
Q

Axis upon innominates rotate?

A

Inferior transverse axis (S4)

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212
Q

4 types of sacral motion?

A

1) Dynamic motion2) Respiratory motion3) Inherent (craniosacral) motion4) Postural motion

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213
Q

Location of transverse axis for resp and inherent motion of sacrum?

A

S2 (superior transverse axis)

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214
Q

Craniosacral flexion induces what sacral motion?

A

Counternutates (rotates posterior)

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215
Q

Craniosacral extension induces what sacral motion?

A

Nutation (rotates anterior)

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216
Q

Axis during dynamic sacral motion (walking)?

A

Oblique axes

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217
Q

Axis during postural motion?

A

Middle transverse axis (S3)

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218
Q

When L5 is SB, what sacral axis is engaged and where?

A

Oblique axis on the same side as side bending

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219
Q

When L5 is rotated, the sacrum rotates which way?

A

Opposite on an oblique axis

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220
Q

Where is the seated flexion test positive in sacral SD?

A

Opposite the oblique axis

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221
Q

B/l sacral flexion or extension move around what sacral axis?

A

Middle transverse

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222
Q

What is a common sacral dysfunction in the postpartum patient?

A

B/l sacral flexion

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223
Q

What axis does the sacrum rotate in a sacral margin posterior SD?

A

Mid-vertical or parasagittal

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224
Q

What is treated first, L5 or sacrum?

A

L5

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225
Q

Joints of the shoulder/

A

Scapulothoracic (pseudo-joint), AC joint, glenohumeral, SC joint

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226
Q

Primary flexor?

A

Deltoid (anterior portion)

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227
Q

Primary extensors?

A

Lat dorsi, teres major, deltoid (posterior portion)

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228
Q

Primary external rotators?

A

Infraspinatus, teres minor

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229
Q

Subclavian artery passes bt which 2 muscles?

A

Anterior and middle scalenes–contracture of these muscles affects arterial supply but not venous drainage

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230
Q

When does subclavian a become axillary a?

A

Lateral border of 1st rib

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231
Q

1st major branch of brachial a?

A

Profunda brachial a–accompanies radial n in its posterior course of radial groove

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232
Q

What becomes the deep palmar arterial arch?

A

Radial a

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233
Q

Tx technique to relieve lymph congestion of UE?

A

1) Open thoracic inlet2) Redome diaphragm3) Posterior axillary fold technique

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234
Q

Degrees of motion during arm abduction?

A

120 degrees due to glenohumeral motion, 60 degree due to scapulothoracic motion

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235
Q

Most common somatic dysfunction of shoulder?

A

Restriction in internal and external rotation

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236
Q

Least common somatic dysfunction of shoulder?

A

Restriction in extension

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237
Q

Most common somatic dysfunction of SC joint?

A

Clavicle anterior and superior on sternum

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238
Q

“Step-off” seen at the AC joint?

A

Superior and lateral clavicle on acromion

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239
Q

Pathogenesis of supraspinatus tendinitis?

A

Continuous impingement of greater tuberosity against acromion as arm is flexed and internally rotated

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240
Q

“Painful arc”?

A

Pain exacerbated by abduction from 60-120 degrees in supraspinatus tendinitis

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241
Q

Aggravating factors in bicipital tenosynovitis?

A

Elbow flexion or supination

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242
Q

Location of pain in rotator cuff tear?

A

Tenderness just below tip of acromion

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243
Q

Etiology of frozen shoulder?

A

Prolonged immobility of shoulder

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244
Q

Most common shoulder dislocation?

A

Anterior and inferior–affects axillary n

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245
Q

Most common brachial plexus injury?

A

Erb-Duchenne’s palsy

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246
Q

What is paralyzed in Erb-Duchenne’s?

A

Abduction, external rotation, flexion, supination

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247
Q

Crutch palsy?

A

Radial n

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248
Q

Saturday night palsy?

A

Compression of radial n against humerus as arm is draped over back of chair

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249
Q

Most common cause of injury to radial n?

A

Humeral fracture

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250
Q

Most commonly affected nerve injured in UE due to direct trauma?

A

Radial n

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251
Q

Erb-Duchenne’s?

A

Upper trunk (C5-6)

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252
Q

Pathogenesis of winging of scapula?

A

Weakness of anterior serratus due to long thoracic n injury

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253
Q

When is pain elicited in frozen shoulder?

A

End of ROM

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254
Q

Motions most often affected in adhesive capsulitis?

A

Abduction, internal and external rotation (extension is preserved)

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255
Q

Most commonly affected rotator cuff muscle?

A

Supraspinatus

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256
Q

Pathogenesis of bicipital tenosynovitis?

A

Inflammation of tendon and its sheath of long head of biceps

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257
Q

Site of pain in supraspinatus tendinitis?

A

Tip of acromion

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258
Q

Sites of compression of nv bundle in thoracic outlet syndrome?

A

1) Bt anterior and middle scalenes2) Bt clavicle and 1st rib3) Bt pectoralis minor and upper ribs

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259
Q

Most common somatic dysfunction of AC joint?

A

Clavicle superior and lateral on acromion

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260
Q

Motion of clavicle during internal/external rotation?

A

Around transverse axis

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261
Q

Second most common somatic dysfunction of shoulder?

A

Restriction in abduction

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262
Q

For every 3 degrees of abduction…

A

Glenohumeral joint moves 2 degrees and the scapulothoracic joint moves 1 degree

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263
Q

Nerve roots of brachial plexus?

A

C5-T1

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264
Q

What becomes the superficial palmar arterial arch?

A

Ulnar a (Ulnar is Up in the palm)

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265
Q

Where does brachial a divide into ulnar and radial aa?

A

Under bicipital aponeurosis

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266
Q

When does the axillary a become the brachial a?

A

Inferior border of teres minor

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267
Q

Subclavian vein passes where?

A

Anterior to anterior scalene

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268
Q

Primary internal rotator?

A

Subscapularis

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269
Q

Primary adductors?

A

Pec major, lat dorsi

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270
Q

Primary abductor?

A

Deltoid (middle portion)

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271
Q

Rotator cuff muscles?

A

Supraspinatus, Infraspinatus, teres minor, Subscapularis (SItS)

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272
Q

Bones making up the shoulder?

A

Clavicle, scapula, humerus

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273
Q

Only muscle of thenar eminence NOT innervated by median n?

A

Adductor pollicis brevis (ulnar n)

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274
Q

Innervation of lumbricals?

A

1st-2nd innervated by median n; 3rd-4th innervated by ulnar n

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275
Q

What attaches to the DIPs?

A

Flexor digitorum profundus

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276
Q

What attaches to PIPs?

A

Flexor digitorum superficialis

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277
Q

Carrying angle?

A

Intersection of 1) longitudinal axis of humerus and 2) line from distal radial-ulnar joint passing thru proximal radial-ulnar joint

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278
Q

CA for men?

A

5 degrees

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279
Q

CA for women?

A

10-12 degrees

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280
Q

CA >15 degrees?

A

Cubitus valgus OR abducation of ulna in SD

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281
Q

CA

A

Cubitus varus OR adduction of ulna in SD

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282
Q

An increase in CA causes what wrist motion?

A

Adduction of wrist

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283
Q

A decreased in CA causes what wrist motion?

A

Abduction of wrist

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284
Q

What motions occur with adduction of ulna?

A

Lateral glide of olecranon, radius is pulled proximally resulting in abduction of wrist

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285
Q

What motions occur with abduction of ulna?

A

Medial glide of olecranon, radius is pushed distally resulting in adduction of wrist

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286
Q

Radial head motion?

A

Anterior with supination; posterior with pronation

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287
Q

Location of reference when naming ulna motion?

A

Distal ulna

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288
Q

Common cause of posterior radial head?

A

Falling on pronated forearm

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289
Q

Common cause of anterior radial head?

A

Falling backward on supinated forearm

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290
Q

Gold standard dx for carpul tunnel?

A

EMG

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291
Q

Swan neck deformity?

A

Flexion contracture of MCP and DIP, extension contracture of PIP

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292
Q

Boutonniere deformity?

A

Extension contracture of MCP and DIP, flexion contracture of PIP

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293
Q

Cause of swan neck?

A

Contracture of intrinsic mm of hand

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294
Q

Cause of boutonniere?

A

Rupture of hood o extensor tendon at PIP

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295
Q

Primary hip extensor?

A

Gluteus maximus

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296
Q

Primary hip flexor?

A

Iliopsoas

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297
Q

Primary knee extensor?

A

Quadriceps

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298
Q

Primary knee flexors?

A

Semimembranosus and semitendinosus

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299
Q

4 ligaments that make up femoroacetabular joint?

A

1) Iliofemoral2) Ischiofemoral3) Pubofemoral4) Capitis femoris

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300
Q

What ligament attaches the head of the femur to the acetabular fossa?

A

Capitis femoris

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301
Q

What are the minor motions of the hip?

A

Anterior and posterior glide

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302
Q

What motion occurs with anterior glide of the head of the femur?

A

External rotation

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303
Q

What motion occurs with posterior glide of the head of the femur?

A

Internal rotation

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304
Q

Etiologies of hip external rotation SD?

A

Piriformis or iliopsoas spasm

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305
Q

Etiologies of hip internal rotation SD?

A

Spasm of internal rotators

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306
Q

3 joints that make up the knee?

A

1) Tibiofemoral 2) Patellofemoral3) Tibiofibular

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307
Q

What is the largest joint in the body?

A

Tibiofemoral

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308
Q

What is the origin and insertion of the ACL?

A

Originates at posterior aspect of femur, attaches to anterior aspect of tibia

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309
Q

Origin and insertion of the PCL?

A

Originates at anterior aspect of femur and inserts on posterior aspect of tibia

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310
Q

Which ligament articulates with the medial meniscus and helps prevent valgus stress at the knee?

A

Medial collateral ligament

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311
Q

Attachments of the lateral collateral ligament?

A

Femur and fibula

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312
Q

Mvt of the tibiofibular joint occurs with what motions of the foot?

A

Pronation and supination

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313
Q

What motion occurs when the fibular head glides anteriorly?

A

Pronation

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314
Q

What motion occurs when the fibular head glides posteriorly?

A

Supination

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315
Q

Pronation motions?

A

Dorsiflexion, eversion, abduction

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316
Q

Supination motions?

A

Plantarflexion, inversion, adduction

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317
Q

Pronation of foot causes what fibular motion?

A

Causes talus to push distal fibula posteriorly allowing anterior glide proximally

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318
Q

Supination of the foot causes what fibular motion?

A

Causes anterior talofibular ligament to pull distal fibula anteriorly, and allows proximal fibula to glide posteriorly

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319
Q

Femoral nerve roots?

320
Q

Sciatic nerve roots?

321
Q

Femoral n innervations?

A

Quads, iliacus, sartorius and pectineus

322
Q

Which foramen does the sciatic n pass thru?

A

Greater sciatic foramen

323
Q

85% of population, the sciatic n will be in what relation to piriformis?

A

Inferior to piriformis

324
Q

Innervation of short head of biceps femoris?

A

Peroneal division of sciatic n

325
Q

Angulation of head of the femur?

A

Normally 120-135 degrees

326
Q

Coxa vara?

A

Angulation of femur

327
Q

Coxa valga?

A

Angulation of femur >135

328
Q

Q angle?

A

Formed by intersection of a line from ASIS thru middle of patella, and a line from tibial tubercle thru middle of patella

329
Q

Normal Q angle?

A

10-12 degrees

330
Q

Genu valgum?

A

Increased Q angle (knocked-kneed)

331
Q

Genu varum?

A

Decreased Q angle (bow-legged)

332
Q

What ligament prevents hyperextension of knee?

333
Q

Posterior fibular head foot positions?

A

Talus internally rotated causing foot to invert and plantarflex

334
Q

Anterior fibular head foot positions?

A

Talus externally rotated causing foot to evert and dorsiflex

335
Q

What nerve lies directly posterior to the proximal fibular head?

A

Common peroneal nerve (injured in posterior fibular head SD)

336
Q

Pathophysiology of patello-femoral syndrome?

A

Imbalance of musculature of quads (strong vastus lateralis and weak vastus medialis) causing patella to deviate laterally due to larger Q angle

337
Q

S/S of patello-femoral syndrome?

A

Deep knee pain esp when climbing stairs, atrophy of vastus medialis, patellar crepitus

338
Q

Lower leg compartments?

A

Anterior, lateral, deep posterior, superficial posterior

339
Q

Which compartment is most commonly affected in compartment syndrome?

340
Q

S/S of compartment syndrome (anterior)?

A

Tibialis anterior m is head and tender to palpation, pulse are present, stretching muscle causes extreme pain

341
Q

O’Donahue’s triad (terrible triad)?

A

ACL, MCL, medial meniscus

342
Q

Portion of talus that artciulates with ankle mortise?

A

Trochlea of talus

343
Q

Which ankle motion is more stable, plantarflexion or dorsiflexion?

A

Dorsiflexion–bc talus is wider anteriorly

344
Q

Talocrural joint (tibiotalar joint)?

A

Hinge joint bt talus and medial malleolus, and lateral melleolus

345
Q

Main motions of talocrural joint?

A

Plantarflexion and dorsiflexion

346
Q

What motion occurs with anterior glide of talus?

A

Plantarflexion

347
Q

What motion occurs with posterior glide of talus?

A

Dorsiflexion

348
Q

80% of ankle sprains occur in plantarflexion or dorsiflexion?

A

Plantarflexion (due to stability of ankle in dorsiflexion)

349
Q

What joint allows internal/external rotation of leg while foot is fixed?

A

Subtalar joint (talocalcaneal joint)

350
Q

Arches of foot?

A

Longitudinal and transverse

351
Q

Medial longitudinal arch?

A

Talus, navicular, cuneiforms, 1-3 metatarsals

352
Q

Lateral longitudinal arch?

A

Calcaneus, cuboid, 4-5 metatarsals

353
Q

Tranverse arch?

A

Navicular, cuneiforms, cuboid

354
Q

Where do most SDs occur in foot?

A

Transverse arch–often seen in long distance runners

355
Q

Lateral stabilizers of ankle?

A

ATF, calcaneofibular, posterior talofibular

356
Q

Most common injured ankle ligament?

357
Q

Type I ankle sprain?

358
Q

Type II ankle sprain?

A

ATF and calcaneofibular

359
Q

Type III ankle sprain?

A

ALL 3 lateral ligaments

360
Q

Excessive pronation usually results in what injury?

A

Fracture of medial malleolus (rather than pure ligamentous injury)

361
Q

Spring ligament?

A

Calcaneonavicular ligament–strengthens medial longitudinal arch

362
Q

Attachments of plantar aponeurosis?

A

Calcaneus and phalanges

363
Q

What is the primary respiratory mechanism (PRM)?

A

CNS + CSF + dural membranes + cranial bones + sacrum

364
Q

What do the brain and spinal cord do during exhalation phase of PRM?

A

Lengthen and thins

365
Q

What do the brain and spinal cord do during inhalation phase of PRM?

A

Shortens and thickens

366
Q

What is normal cranial rhythmic impulse (CRI)?

367
Q

What decreases CRI?

A

Stress, depression, chronic fatigue and chronic infections

368
Q

What increases CRI?

A

Vigorous exercise, systemic fever, following OMT to the craniosacral mechanism

369
Q

What forms the falx cerebri and tentorium cerebelli?

A

Dura mater

370
Q

Where does the dura attach?

A

Foramen magnum, C2, C3, S2

371
Q

The dura is elastic or inelastic?

A

Inelastic–when the dura moves, the cranial bones move

372
Q

What is the reciprocal tension membrane (RTM)?

A

Mvt of meninges cause cranial motion–called an automatic, shifting, suspension fulcrum

373
Q

Where does the dura attach to the sacrum?

A

POSTERIOR superior aspect of S2 (this is where the superior transverse axis runs that allows sacral motion)

374
Q

What is the sphenobasilar synchondrosis (SBS)?

A

Articulation of sphenoid with occiput

375
Q

Motions of SBS?

A

Flexion and extension

376
Q

IRE of ERF?

A

Internal rotation of paired bones occur with extension of midline bones; external rotation occurs with flexion

377
Q

What are the midline bones?

A

Sphenoid, occiput, ethmoid, vomer

378
Q

What causes counternutation?

A

SBS flexion

379
Q

Bert head?

A

Flexion (widen head and decrease AP diameter)

380
Q

Ernie head?

A

Extension (narrow head and increase AP diameter)

381
Q

What causes nutation?

A

SBS extension

382
Q

What are the 5 elements of the PRM?

A

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
Q

Axis/plane of motion in torsion?

A

AP axis, coronal plane

384
Q

Torsion motions?

A

Sphenoid rotates one direction about AP axis, occiput rotation in opposite direction

385
Q

How are torsion SDs named?

A

Named for greater wing of sphenoid that is more superior

386
Q

Axes of motion in SB/rotation?

A

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
Q

SB/rotation motions?

A

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
Q

Sidebending to left will cause what rotation?

A

Sphenoid and occiput will rotate so that they are inferior on the left

389
Q

Sidebending causes the SBS to deviate which way?

A

Right SB causes deviation of SBS to right and vice versa

390
Q

Extension causes what motion of SBS?

A

SBS will move caudad

391
Q

Flexion causes what motion of SBS?

A

SBS will move cephalad

392
Q

What is vertical strain?

A

When sphenoid deviates cephalad or caudad in relation to the occiput

393
Q

Axes of motion in vertical strain?

A

One tranverse axis thru center of sphenoid, other transverse axis just superior to occiput

394
Q

What is lateral strain?

A

Sphenoid deviates laterally in relation to occiput

395
Q

Axes of motion in lateral strain?

A

One vertical axis thru center of sphenoid, one vertical axis thru foramen magnum

396
Q

Compression?

A

When sphenoid and occiput are pushed together causing decreased amplitude of flexion and extension

397
Q

Cause of compression?

A

Trauma to back of head–if severe enough can obliterate CRI

398
Q

Site of vagal SD?

A

OA, AA, C2 dysfunction

399
Q

Cause of poor suckling in newborn?

A

Condylar compression (CN XII) and dysfunctions of CN IX and X at jugular foramen

400
Q

What drains 85-90% of blood from cranium?

A

Venous sinuses

401
Q

What drains 5% of blood from cranium?

A

Facial veins and external jugular

402
Q

Venous sinus technique?

A

Directly spreads apart sutures of cranium that overly occipital, transverse and sagittal sinuses

403
Q

Purpose of CV4 bulb decompression?

A

Increase amplitude of CRI

404
Q

CV4 technique?

A

1st resist flexion phase and encourage extension phase until a “still point” is reached, then allow restoration of flexion/extension to occur

405
Q

What is CV4 good for?

A

Fluid homeostasis and induce uterine contraction in post-date gravid women

406
Q

Purpose of vault hold?

A

Address strains of SBS

407
Q

Vault hold finger placement?

A

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
Q

Purpose of V spread?

A

To separate restricted or impacted sutures and can be applied to any suture

409
Q

Purpose of lift technique?

A

Frontal and parietal lifts are used to aid in balance of membranous tension

410
Q

Absolute contraindications?

A

Acute intracranial bleeds or increased ICP, skull fracture

411
Q

Relative contraindications?

A

Pts with known hx of seizures or dystonia, traumatic brain injury

412
Q

Miosis?

A

CN III –> ciliary ganglion –> pupils

413
Q

Tears and nasal secretions?

A

CN VII –> sphenopalatine ganglion –> lacrimal and nasal glands

414
Q

Salivation via submandibular and sublingual glands?

A

CN VII –> submandibular ganglion –> submandibular and sublingual glands

415
Q

Salivation via parotids?

A

CN IX –> otic ganglion –> parotids

416
Q

Vagus to GU system?

A

Kidney and UPPER ureter

417
Q

Vagus to repro system?

A

Ovaries and testes

418
Q

Vagus to GI system?

A

Everything above 1/2 transverse colon

419
Q

Pelvic splanchnic to GU system?

A

LOWER ureter and bladder

420
Q

Pelvic splanchnic to repro system?

A

Uterus, prostate and genitalia

421
Q

Pelvic splanchnic to GI system?

A

Descending colon, sigmoid and rectum

422
Q

Head and neck?

423
Q

Heart?

424
Q

Respiratory system?

425
Q

Esophagus?

426
Q

Anything before ligament of Treitz?

427
Q

Spleen?

428
Q

Anything after ligament of Treitz and before the splenic flexure?

429
Q

Anything after splenic flexure?

430
Q

Greater splanchnic nerve and celiac ganglion?

431
Q

Lesser splanchnic nerve and superior mesenteric ganglion?

432
Q

Least splanchnic nerve and inferior mesenteric ganglion?

433
Q

Appendix?

434
Q

Kidneys?

435
Q

Adrenal medulla?

436
Q

Upper ureters?

437
Q

Lower ureters?

438
Q

Bladder?

439
Q

Gonads?

440
Q

Uterus and cervix?

441
Q

Erectile tissue of penis and clitorus?

442
Q

Prostate?

443
Q

Arms?

444
Q

Legs?

445
Q

Ganglion to kidneys?

A

Superior mesenteric

446
Q

Ganglion to upper ureters?

A

Superior mesenteric

447
Q

Ganglion to lower ureters?

A

Inferior mesenteric

448
Q

Entire GI tract?

449
Q

L3-L5?

450
Q

How would you describe anterior chapman’s points?

A

Smooth, firm, discretely palpable nodules approx 2-3mm in diameter

451
Q

Where are anterior chapman’s points located?

A

Within deep fascia or on periosteum of bone

452
Q

Where are posterior chapmna’s points located?

A

Bt spinous and transverse processes

453
Q

How would you describe posterior chapman’s points?

A

Rubbery, similar to tissues texture changes assoc with classic viscero-somatic reflexes

454
Q

What will gentle pressure on a chapman’s point elicit?

A

Sharp, nonradiating, exquisitely distressing pain

455
Q

What are chapman’s points?

A

Somatic manifestations of a visceral dysfunction

456
Q

Anterior appendix?

A

Tip of right 12th rib

457
Q

Posterior appendix?

A

Transverse process of T11

458
Q

The presence of which particular reflex helps to direct the DDx more toward acute appendicitis?

A

Posterior appendix chapman’s point

459
Q

Anterior adrenal?

A

2” superior and 1” lateral to umbilicus

460
Q

Posterior andrenals?

A

Bt spinous and transverse processes of T11 and T12

461
Q

Anterior kidneys?

A

1” superior and 1” lateral to umbilicus

462
Q

Posterior kidney?

A

Bt spinous and transverse processes of T12 and L1

463
Q

Bladder?

A

Periumbilical region

464
Q

Colon?

A

Lateral thigh within the IT band from greater trochanter to just above knee

465
Q

Cecum?

A

Right proximal femur

466
Q

Hepatic flexure?

A

Right distal femur

467
Q

Sigmoid colon?

A

Left proximal femur

468
Q

Splenic flexure?

A

Left distal femur

469
Q

What is a trigger point?

A

May refer pain when pressed

470
Q

What is a tender point?

A

DOES NOT refer pain when pressed

471
Q

Where will trigger points of the SCM refer pain?

A

Ipsilateral occipital and temporal regions

472
Q

What trigger point is assoc with supraventricular tachycardias?

A

Right pectoralis muscle bt 5th and 6th ribs near the sternum

473
Q

What do trigger points represent?

A

Somatic manifestations of a viscero-somatic, somato-visceral or somato-somatic reflex

474
Q

Methods are used to eliminate trigger points?

A

Neurological or vascular methods

475
Q

How do you treat myofascial trigger points?

A

Spray and stretch using vapocoolant spray, injection with local anesthetic

476
Q

What are tenderpoints used for?

A

Diagnostic criteria and as a treatment monitor for counterstrain

477
Q

What type of technique is MFR?

A

Direct or indirect, active or passive

478
Q

Applying traction along the long axis of muscle?

A

Direct technique

479
Q

Applying compression along the long axis of muscle?

A

Indirect technique

480
Q

What is the MFR procedure?

A

1) Palpate restriction2) Apply compression or traction3) Add twisting or transverse forces4) Use enhancers5) Await release

481
Q

What are the 2 goals of MFR?

A

1) Restore functional balance2) Improve lymphatic flow

482
Q

What is the most important diaphragm?

483
Q

What are the 4 diaphragms?

A

1) Tentorium cerebelli2) Thoracic inlet3) Abdominal diaphragm4) Pelvic diaphragm

484
Q

According to Zink, what are the 4 compensatory curves of the spine?

A

1) OA junction2) Cervicothoracic junction3) Thoracolumbar junction4) Lumbosacral junction

485
Q

According to Zink, what is the Common Compensatory Pattern?

A

In 80% of healthy people, OA is rotated left, cervicothoracic is right, thoracolumbar is left, and lumbosacral is right

486
Q

When performing indirect MFR, which barrier is engaged?

487
Q

What are contraindications for MFR?

A

Malignancy, aneurysm, acute RA, febrile state, healing fracture, osteoporosis, open wounds

488
Q

3 purposes of rib raising?

A

1) Decrease SNS activity2) Improve lymphatic return3) Encourage max inhalation and provokes a more effective negative pressure

489
Q

Indications for rib raising?

A

Visceral dysfunction, decreased rib excursion, lymphatic congestion, fever, paraspinal m spasm

490
Q

Contraindications for rib raising?

A

Spinal/rib fracture, recent spinal surgery

491
Q

Effect of rib raising on SNS activity?

A

Initial increase in SNS activity, followed by inhibited SNS activity

492
Q

What can be used to reduce incidence of ileus in post-op patients?

A

Rib raising, soft tissue paraspinal inhibition

493
Q

How can lumbar paraspinal inhibition produce the same effects as rib raising?

A

Bc upper lumbar (L1-2) SNS ganglia is continuous with that of thoracic paraspinal ganglia

494
Q

Purpose of celiac, SM, and IM ganglia releases?

A

Decrease SNS activity

495
Q

Indications for GI ganglia releases?

A

GI dysfunction, pelvic dysfunction

496
Q

Contraindications for GI ganglia releases?

A

Aortic aneurysm, open surgical wound

497
Q

Purpose of treating Chapman’s points?

A

Decrease SNS tone to assoc visceral tissues

498
Q

Superior cervical paraspinal ganglia?

499
Q

Middle cervical paraspinal ganglia?

500
Q

Inferior cervical paraspinal ganglia?

501
Q

Purpose of cranial manipulation?

A

Improve PNS function in head structures innervated by CN III, VII, IX, X

502
Q

How to reach sphenopalatine ganglion?

A

Manual finger pressure intraorally

503
Q

Purpose of sphenopalatine ganglion technique?

A

Enhance PNS activity to encourage thin watery secretions

504
Q

Indications for sphenopalatine ganglion technique?

A

Thick nasal secretions

505
Q

Purpose of condylar decompression?

A

Help free PNS responses to structures innervated by CN IX and X by freeing passage thru jugular foramen (i.e. occipito-mastoid suture)

506
Q

What can condylar compression cause?

A

Suckling difficulties in newborns

507
Q

Vagus nerve treatment?

A

OA, AA, or C2 joint treatment

508
Q

Purpose of sacral somatic dysfunction treatment?

A

1) Decrease hyperPNS tone in left colon and pelvis2) Reduce labor pain caused by cervical dilation

509
Q

Indications for sacral SD treatment?

A

Dysmenorrhea, labor pain from cervical dilation, constipation

510
Q

Contraindications for sacral SD treatment?

A

Local infections or incisions

511
Q

Which lobe of the lung does NOT drain into the right (minor) duct?

A

Left upper lobe

512
Q

What drains into the right (minor) duct?

A

Right UE, right hemicranium, heart and lobes of lung (except left upper lobe)

513
Q

Where does the right (minor) duct drain into?

A

Right brachiocephalic vein OR junction of right IJV and subclavian vein

514
Q

Where does the left (major) duct drain into?

A

Junction of left IJV and subclavian veins

515
Q

Where does the thoracic duct traverse?

A

Sibson’s fascia of the thoracic inlet up to the level of C7 before turning around and empyting into the left (major) duct

516
Q

Where does the right (minor) duct traverse?

A

Only traverses the thoracic inlet once

517
Q

Infection of the right toe would drain where?

A

Left (major) lymphatic duct

518
Q

What drains directly into the thoracic duct and bypasses LNs?

A

1) Thyroid2) Esophagus3) Coronary and triangular ligaments of liver

519
Q

What has prelymphatics?

A

Superficial skin, deep portions of peripheral nerves, endomysium, and bones (Haversion canals)

520
Q

2/3 of lymphatic fluid is produced where?

A

Liver and intestines

521
Q

What is the de facto lymph of the CNS?

522
Q

What level is the cisterna chyli?

523
Q

Where does the thoracic duct cross the diaphragm?

A

Aortic hiatus (T12)

524
Q

When is the lymphatic system developed in utero?

A

By the 3rd month

525
Q

What has more valves, lymphatics or veins?

A

Lymphatics–semilunar

526
Q

What has “flap valves”?

A

Terminal lymphatic capillaries–allows fluid to enter

527
Q

How does interstitial fluid enter the terminal lymphatic vessels?

A

Micropinocytosis

528
Q

What is the lymphatic return to the heart in a day?

A

Entire volume of serum of body

529
Q

How much extracellular fluid is carried from interstitium to the blood per day?

A

10-20% or 3 liters

530
Q

What do the intestinal lymphatics absorb?

A

Long chain fatty acids, chylomicrons, and cholesterol

531
Q

What are the main cells found in lymph?

A

Lymphocytes

532
Q

What is the innervation of lymphatics?

A

SNS (just like vasculature)

533
Q

What does SNS stimulation do the lymphatics?

A

Initially causes increased peristalsis, long term hyperSNS tone decreases overall mvt of lymph

534
Q

What is the SNS control to the lymphatic duct?

A

Intercostal nerves

535
Q

What innervates the cisterna chyli?

536
Q

What is interstitial fluid pressure and flow rate?

A

-6.3mmHg, rate of 120cc/hr

537
Q

What if interstitial pressure increases (closer to 0mmHg)?

A

Increased absorption into lymphatics

538
Q

What happens if pressure gets above 0mmHg?

A

Lymphatics collapse–decrease in lymphatic drainage

539
Q

What factors increase interstitial pressure above 0mmHg?

A

1) Systemic HTN2) Cirrhosis (decreased plasma protein synthesis)3) Hypoalbuminemia assoc with starvation4) Toxins such as rattlesnake poisoning

540
Q

What kind of technique is CS?

A

Passive indirect

541
Q

What is a tenderpoint?

A

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
Q

How do you determine a tenderpoint is clinically significant?

A

Compare to same spot on other side

543
Q

Where should you start tx if there are multiple tenderpoints?

A

Tx the most tender area first

544
Q

Where do you place the pt?

A

Into position of comfort/ease by shortening the muscle

545
Q

After fine tuning the tx position with small arcs of motion, how much pain should be reduced?

546
Q

What is a maverick point?

A

Tenderpoints that do not improve with fine tuning

547
Q

How do you tx maverick points?

A

Place the pt in a position opposite of what would be used typically

548
Q

How long must the position be maintained?

A

90 secs–time takes for proprioceptive firing to decrease

549
Q

How much tenderness should remain after tx?

A

75-100% better

550
Q

Anterior cervical TP location?

A

Anterior to or on most lateral aspect of lateral masses

551
Q

Tx position for anterior cervical TP?

A

SB and rotate head away form side of TP

552
Q

Anterior cervical maverick point (anterior 7th cervical) location?

A

2-3cm lateral to medial end of clavical at lateral attachment of SCM

553
Q

Anterior cervical MP tx position?

A

Flex, SB toward and rotate away from side of TP

554
Q

Posterior cervical TP location?

A

Tip of SP or on lateral side of SP

555
Q

Posterior cervical TP tx position?

A

Extend, SB (slightly), and rotate away

556
Q

Posterior cervical MP/inion (posterior 1st cervical) location?

A

At inion (posterior occipital protuberance) or just below

557
Q

Posterio cervical MP inion tx position?

A

Marked flexion

558
Q

Anterior thoracic TPs location?

A

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
Q

Anterior thoracic TPs tx position?

A

Flex thorax and add small amount of SB and rotation away

560
Q

Posterior thoracic TPs location?

A

Either side of SP or on TP

561
Q

Posterior thoracic TPs tx position?

A

Extend, rotate away and SB slightly away

562
Q

Anterior rib TPs are assoc with what rib position?

A

Depressed ribs (exhalation dysfunction)

563
Q

Posterior rib TPs are assoc with what rib position?

A

Elevated ribs (inhalation dysfunction)

564
Q

How long must rib tx positions be held?

A

120 secs–allows pt extra time to relax

565
Q

Anterior rib 1 TP location?

A

Just below medial end of clavicle

566
Q

Anterior rib 2 TP location?

A

6-8cm lateral to sternum on rib 2

567
Q

Anterior ribs 3-6 TP locations?

A

Along mid-axillary line on corresponding rib

568
Q

Anterior rib tx position for ribs 1 and 2?

A

Flex head, SB and rotate towards

569
Q

Anterior rib tx position for ribs 3-6?

A

SB and rotate thorax toward, encourage slight flexion

570
Q

Posterior rib TP location?

A

Angle of corresponding rib

571
Q

Posterior rib TP tx position?

A

Tx with minimal flexion, SB and rotate away

572
Q

Anterior lumbar TP L1 location?

A

Just medial to ASIS

573
Q

Anterior lumbar TP L2-4 location?

A

On the AIIIS

574
Q

Anterior lumbar TP L5 location?

A

1cm lateral to pubic symphisis on superior ramus

575
Q

Anterior lumbar TP tx position?

A

Most treated with pt supine, knees and hips flexed and markedly rotated away

576
Q

Posterior lumbar TP location?

A

Either side of SP or on TP; L3-4 may be on iliac crest; L5 may be on PSIS

577
Q

Posterior lumbar TP tx position?

A

Most treated with pt prone, extended and SB away (rotation may be towards or away)

578
Q

Posterior lumbar MPs (lower pole 5th lumbar) location?

A

Inferior to PSIS as much as 1 cm

579
Q

Posterior lumbar MP tx position?

A

Pt prone, hip and knee flexed, leg internally rotated and adducted

580
Q

Iliacus TP location?

A

~7cm medial to ASIS

581
Q

Iliacus tx position?

A

Pt supine with hip flexed and externally rotated

582
Q

Piriformis TP location?

A

In the piriformis m 7cm medial to and slightly superior to greater trochanter

583
Q

Piriformis TP tx position?

A

Pt prone, hip and knee flexed, thigh abducted and externally rotated

584
Q

What percentage of TPs are maverick?

585
Q

What region is assoc with the greatest number of MPs?

A

Cervical spine

586
Q

What type of technique to FPR?

A

Indirect myofascial release

587
Q

What are the basic steps of FPR?

A

1) Straighten AP curvature2) Apply compression3) Shorten muscle by placing into position of ease

588
Q

How long must the position be held?

589
Q

What can FPR be used to treat?

A

Superficial mm, deep intervertebral mm to influence vertebral motion

590
Q

Purpose of straightening AP curvature?

A

Decrease kyphosis (thoracic spine) or lordosis (cervical or lumbar spine)

591
Q

Where must the head be when treating cervical spine?

A

Off the table

592
Q

What kind of technique is ME?

A

Active direct or active indirect (rarely)

593
Q

Where does the physician initially place the pt for ME?

A

Directly into the barrier

594
Q

What is isometric contraction?

A

Distance bt origin and insertion of muscle remais the same as the muscle contracts (but internal CT will stretch)

595
Q

What does this isometric contraction cause the golgi tendon to do?

A

Change tension and causes reflex relaxation of agonist muscle fibers allowing the doc to further engage the barrier

596
Q

What is reciprocal inhibition?

A

When antagonist muscles contract, the agonist muscles will reflexively relax

597
Q

How can reciprocal inhibition be done?

A

Directly or indirectly

598
Q

How would you tx a biceps m spasm using direct reciprocal inhibition?

A

Extend elbow to restrictive barrier, have pt contract triceps against resistance

599
Q

How would you tx a biceps in spasm using indirect reciprocal inhibition?

A

Fully flex elbow (away from restrictive barrier), have pt contract triceps against resistance

600
Q

What is teh oculocephalogyric reflex?

A

Uses EOM contraction to reflexively effect the cervical and truncal musculature

601
Q

What is the crossed extensor reflex?

A

When reflex occurs, the flexors in withdrawing limb contract and extensors relax, while in the other limb the opposite occurs

602
Q

How long is ME maintained?

603
Q

How many times is ME repeated?

604
Q

What is more important, localization of force or intensity of force?

A

Localization

605
Q

What barriers must be engaged during ME?

A

The restrictive barrier in ALL planes of motion

606
Q

When is ME contraindicated?

A

Post-surgical pts and intensive care pts

607
Q

Tx position for pump handle inhalation dysfunction?

A

Flex pts forward while supine

608
Q

Tx position for bucket handle inhalation dysfunction?

A

SB towards while supine

609
Q

Initial tx position for exhalation dysfunctions?

A

Pt places forearm on affected side across forehead with palm up

610
Q

Where does pt monitor exhalation dysfunctions during tx?

A

Posteriorly at rib angle

611
Q

Isometric contraction for rib 1?

A

Pt raises head directly toward ceiling

612
Q

Isometric contraction for rib2?

A

Pt turns head 30 degrees away from dysfunctional side and lift head toward ceiling

613
Q

Isometric contraction for ribs 3-5?

A

Pt pushes elbow of affected side toward opposite ASIS

614
Q

Isometric contraction for ribs 6-9?

A

Pt pushes arm anterior

615
Q

Isometric contraction for ribs 10-12?

A

Pt adducts arm

616
Q

Rib 1 muscles being tx?

A

Anterior and middle scalenes

617
Q

Rib 2 muscle being tx?

A

Posterior scalene

618
Q

Ribs 3-5 muscle being tx?

A

Pectoralis minor

619
Q

Ribs 6-9 muscle being tx?

A

Serratus anterior

620
Q

Ribs 10-11 muscle being tx?

621
Q

Rib 12 muscle being tx?

A

Quadratus lumborum

622
Q

Unilateral sacral flexion?

A

Place hypothenar eminence on pt’s ipsilateral ILA, push anterior on ILA during inhalation; resit any posterior mvt during exhalation

623
Q

Unilateral sacral extension?

A

Place hypothenar eminence on ipsilateal sacral sulcus, push anterior and caudad on superior sulcus during exhalation; resist anterior superior mvt during inhalaiton

624
Q

Forward sacral torsion pt position?

A

Lateral sims position (face down, axis side down) with flexed legs off table

625
Q

Forward sacral torsion pt activating force?

A

Lifting legs toward ceiling against equal counterforce

626
Q

Backward sacral torsion pt position?

A

Lateral recumbent with face up, axis side down, legs off table

627
Q

Backward sacral torsion pt activating force?

A

Lifting legs toward ceiling against equal counterforce

628
Q

Anterior innominate position?

A

Flex hip and knee into barrier

629
Q

Posterior innominate position?

A

Drop hip and leg off table inducing extension

630
Q

Pt position for superior pubic shear?

A

Drop ipsilateral leg off table and abduct until resistance is felt, stabilize opposite ASIS

631
Q

Pt activating force for superior pubic shear?

A

Bring ipsilateral knee to opposite ASIS (flexion and adduction)

632
Q

Pt position for inferior pubic shear?

A

Flex and abduct pt’s ipsilateral hip and knee until resistance is felt, stabilize pt’s opposite ASIS

633
Q

Pt activating force for inferior pubic shear?

A

Push ipsilateral knee to opposite foot (extension and adduction)

634
Q

Pt position for anterior fibular head?

A

Pt prone, knee flexed, hand on lateral side of foot cupping ankle, plantarflex and invert foot, externally rotate tibia

635
Q

Pt activating force for anterior fibular head?

636
Q

Pt position for posterior fibular head?

A

Pt prone, knee flexed, hand on lateral side of foot cupping ankle, plantarflex and invert foot, internally rotate tibia

637
Q

Pt activating force for posterior fibular head?

638
Q

What type of technique is HVLA?

A

Passive direct

639
Q

Theories of the neurophysiology of HVLA?

A

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
Q

When is the final force applied?

A

Relaxation/exhalation phase

641
Q

What is the main indication of HVLA?

A

Motion loss in somatic dysfunction

642
Q

What are the absolute contraindications?

A

1) Osteoporosis2) Osteomyelitis (including Pott’s)3) Fractures in area of thrust4) Bone mets5) Severe RA6) Down’s

643
Q

Why are RA pts at risk?

A

RA weakens the transverse ligament of the dens, so cervical manipulation may cause AA subluxation

644
Q

Why are Down’s pts at risk?

A

Laxity in transverse ligament of dens may results in AA subluxation with cervical manipulation

645
Q

What are the relative contraindications?

A

1) Acute whiplash2) Pregnancy3) Post-op conditions4) Herniated nucleus pulposus5) Pt’s on anticoagulaion or hemophiliacs6) Vertebral artery ischemia (positive Wallenberg’s test)

646
Q

What is the most common MINOR complication?

A

Soreness or symptom exacerbation

647
Q

What is the most common MAJOR complication overall?

A

Vertebral artery injury–usually due to cervical rotatory forces with neck in extended position

648
Q

What is the most common MAJOR complication in the low back?

A

Cauda equina syndrome (very rare)

649
Q

Where is the thrust directed for OA HVLA?

A

Opposite eye (of rotation)

650
Q

Direction of thrust for cervical rotational technique?

A

Opposite eye

651
Q

Direction of thrust for cervical sidebending technique?

A

Opposite shoulder

652
Q

Direction of force for flexed thoracics?

A

At dysfunctional segment and aimed toward floor

653
Q

Direction of force for extension thoracics?

A

At vertebrae below dysfunctional segment and thrust is aimed 45 degrees cephalad

654
Q

Direction of force for neutral thoracics?

A

Aimed toward floor, sidebend away

655
Q

Technique for a purely flexed/extended thoracic lesion?

A

Use bilateral fulcum (thenar eminence under one TP and flexed MCP under the other TP)

656
Q

Which rib cannot be treated using Kirksville Krunch?

657
Q

Location of thenar eminence when treating ribs using KK?

A

Posterior rib angle of key rib

658
Q

Pt position for rib 1 inhalation dysfunction HVLA?

A

Supine, SB toward rotate away

659
Q

Doc’s hand placement for rib 1 inhalation dysfunction HVLA?

A

1st MCP on tubercle of rib 1

660
Q

Direction of thrust for rib 1 inhalation dysfunction?

A

Posterioanterior and caudad

661
Q

Which vertebrae can be treated with HVLA using the lumbar roll?

662
Q

Arm position when treating type II dysfunction with TP up?

A

Pull inferior arm down

663
Q

Arm position when treating type II dysfunction with TP down?

A

Pull inferior arm up

664
Q

Arm position when treating type I dysfunction with TP up?

A

Pull inferior arm up

665
Q

Arm position when treating type I dysfunction with TP down?

A

Pull inferior arm down

666
Q

Patient position for lumbar roll?

A

Lateral recumbent

667
Q

Purpose of pulling inferior arm down when treating with lumbar roll?

A

Induce sidebending

668
Q

Who find articulatory techniques more acceptable than other vigorous direct techniques?

A

Post-op pts and elderly

669
Q

Indications?

A

1) Limited/lost articular motion2) Need to increase frequency or amplitude of motion of body region3) Normalized SNS activity

670
Q

Contraindications?

A

1) Repeated hyper-rotation of upper cervicals when in extension may damage vertebral artery2) Acutely inflamed joint, such as infection or fracture

671
Q

What is the typical articulatory procedure?

A

1) Move joint to the restrictive barrier2) Use respiratory cooperation or ME activation to further increase myofascial stretch3) Return to neutral4) Repeat

672
Q

What are 2 common articulatory techniques?

A

1) Rib raising2) Spencer’s

673
Q

What is rib raising useful for?

A

Those pts who have a resistant or noncompliant chest wall (e.g. viral pneumonia)

674
Q

What is Spencer’s useful for?

A

Adhesive capsulitis

675
Q

What position is the pt in Spencer’s?

A

Lateral recumbent with dysfunction shoulder up

676
Q

Spencer’s stage 1?

A

Stretch tissues and pumping fluids with arm extended

677
Q

Spencer’s stage 2?

A

Shoulder extensioni/flexion with elbow flexed

678
Q

Spencer’s stage 3?

A

Shoulderf flexion/extension with elbow extended

679
Q

Spencer’s stage 4?

A

1) Circumduction and slight compression with elbow flexed/extended2) Circumduction and traction with elbow extended

680
Q

Spencer’s stage 5?

A

Adduction and external rotation with elbow flexed

681
Q

Spencer’s stage 6?

A

Abduction with internal rotation with arm behind back

682
Q

Spencer’s stage 7?

A

Stretching tissues and pumping fluids with arm extended

683
Q

Spurling’s test (compression test) procedure?

A

Pt seated, doc extends and SB C-spine toward side being tested

684
Q

Positive Spurling’s?

A

Pain radiating into ipsilateral arm due to nerve root compression

685
Q

Wallenberg’s test?

A

Test for vertebral artery insufficiency

686
Q

Positive Wallenberg’s test?

A

Pt complains of dizziness, visual changes, lightheadedness, or nystagmus

687
Q

Wallenberg’s procedure?

A

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
Q

Thoracic outlet tests?

A

1) Adson’s2) Wright’s3) Costoclavicular syndrome test (military posture test)

689
Q

What is being tested in Adson’s?

A

Tight scalenes

690
Q

Adson’s test procedure?

A

Monitor pt’s pule, extend shoulder, externally rotated and slightly abducted; pt then takes deep rbeath and turn head TOWARD ipsilateral arm

691
Q

What is being tested in Wright’s?

A

Pectoralis minor muscle at coracoid process

692
Q

Wright’s procedure?

A

Hyperabduct arm above head with some extension while monitoring pulse

693
Q

What is being tested in military posture test?

A

Clavicle and 1st rib

694
Q

Military posture procedure?

A

Monitor radial pulse while depressing and extending shoulder

695
Q

Positive test for Adson’s, Wright’s, and military posture tests?

A

Severely decreased or absent radial pulse

696
Q

Drop arm test procedure?

A

Abduct shoulder to 90, then slowly lower arm

697
Q

Positive drop arm test procedure?

A

Unable to lower arm smoothly, or if arm drops indicating rotator cuff tear

698
Q

Speeds test?

A

Assess biceps tendon in bicipital groove

699
Q

Speeds test procedure?

A

Fully extend elbow, flex shoulder and supinate while doc resists shoulder flexion

700
Q

Positive speeds test?

A

Tenderness in bicipital groove

701
Q

Yergason’s test?

A

Tests stability of biceps tendon in bicipital groove

702
Q

Yergason’s test procedure?

A

Doc supinates as the pt resists

703
Q

Positive Yergason’s?

A

Biceps tendon pops out of bicipital groove

704
Q

Allen’s test?

A

Assesses adequacy of blood supply to hand by radial and ulnar arteries

705
Q

Finkelstein test?

A

Test for tenosynovitis in abductor pollicis longus and extensor pollicis brevis tendons at the wrist (De Quervain’s dz)

706
Q

Reverse Phalen’s test (prayer test)?

A

For dx carpal tunnel–extend wrist while gripping doc’s hand

707
Q

Hip drop test?

A

Evaluate sidebending (lateral flexion) of lumbar spine

708
Q

Normal hip drop?

A

Lumbar spine SBs to side opposite bent knee, ipsilateral iliac crest drops more than 20-25 degrees

709
Q

Positive hip drop test?

A

Anything less than a smooth convexity of lumbar spine, or drop of iliac crest

710
Q

Straight leg test (Lasegue’s test)?

A

Evaluation of sciatic nerve compression

711
Q

Braggard’s test?

A

To differentiate bt tight hamstring and sciatic nerve compression, doc dorsiflexes foot

712
Q

Positive Braggard’s?

A

Pain is elicited by dorsiflexion indicating sciatic nerve compression

713
Q

Seated flexion test?

A

Assess SI motion (sacrum)

714
Q

Standing flexion test?

A

Assess iliosacral motion (innominates)

715
Q

ASIS compression test?

A

Determine side of SI dysfunction (esp when standing/seated flexion tests are equivocal)

716
Q

Pelvic side shift test?

A

Determines if sacrum is in the midline

717
Q

Pelvic side shift test procedure?

A

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
Q

Positive pelvic side shift test?

A

Positive on side of freer translation (this indicates that the pelvis is shifted to that side)

719
Q

What does a positive pelvic side shift test usually indicate?

A

Flexion contracture of psoas (psoas syndrome)–if contracture on right, there will be positive test to the left

720
Q

Trendelenburg test?

A

Assesses gluteus medius muscle strength

721
Q

Positive Trendelenburg?

A

Side that drops indicates the opposite gluteus medius is weak

722
Q

Lumbosacral spring test?

A

Assesses whether or not the sacral base is tilted posterior

723
Q

Backward bending test (the sphinx test)?

A

Determines if sacral base moved posterior or anterior

724
Q

Ober’s test?

A

Detects tight tensor fascia lata and IT band

725
Q

Patrick’s test?

A

FABER–assess SI and hip joint pathology (esp osteoarthritis)

726
Q

Thomas test?

A

Assess flexion contracture of hip, usually iliopsoas

727
Q

Bounce home test?

A

Tests problem with full knee extension, usually due to meniscal tears or joint effusions

728
Q

Apley’s compression?

A

Assess meniscus injury

729
Q

Apley’s distraction?

A

Assess collateral ligament injury

730
Q

McMurray’s test?

A

Detects tears in posterior aspect of menisci

731
Q

McMurray’s for medial meniscus?

A

Flex hip/knee, palpate medial joint line, tibia is then externally rotated and a valgus stress is applied while slowly extending knee

732
Q

McMurray’s for lateral meniscus?

A

Flex hip/knee, internally rotate tibia and a varus stress is applied while slowly extending knee

733
Q

How to test for chondromalacia patellae?

A

Patellar grind test

734
Q

Anterior drawer test of ankle?

A

Assess medial and lateral ligaments of ankle, mainly the ATF ligament

735
Q

Positive seated or standing flexion tests?

A

Positive on side of superior PSIS

736
Q

Myocardium?

737
Q

Esophagus?

738
Q

Thyroid?

739
Q

Bronchi?

740
Q

Upper lung?

741
Q

Lower lung?

742
Q

Liver?

A

5th and 6th ICS R

743
Q

Stomach (hyperacidity)?

744
Q

Gallbladder?

745
Q

Pancreas?

746
Q

Spleen?

747
Q

Appendix?

A

Tip of 12th rib R

748
Q

Adrenals?

A

1in lateral 2in superior to umbilicus

749
Q

Kidneys?

A

1in lateral 1in superior to umbilicus

750
Q

Bladder?

A

Peri-umbilical area

751
Q

Urethra?

A

Superior pubic ramus, 2cm lateral to symphysis

752
Q

Prostate?

A

Outer femur (along posterior IT band) bilateral

753
Q

Pylorus?

A

Center of sternum

754
Q

Celiac ganglion?

A

Just below xiphoid process

755
Q

Superior mesenteric ganglion?

A

Bt points for celiac and inferior mesenteric ganglion

756
Q

Inferior mesenteric ganglion?

A

Just above umbilicus

757
Q

Stomach (peristalsis)?

758
Q

Small intestine?

A

8-10th ICS

759
Q

Tonsils?

760
Q

Middle ear (otitis media)?

A

1st rib and clavicals, lateral to where they cross the 1st ribs

761
Q

Eyes?

A

Surgical neck of humerus

762
Q

1st rib?

A

1) Middle ear2) Sinuses

763
Q

Tongue?

764
Q

Uterus?

A

Superior edge of inferior pubic ramus

765
Q

Broad ligament?

A

Outer femur along posterior IT band

766
Q

Ovaries?

A

Superior pubic ramus, 2cm lateral to symphysis

767
Q

Intestine (peristalsis)?

A

Few inches above greater trochanter

768
Q

Myocardium?

A

T2-3 lamina of TP

769
Q

Esophagus?

A

T2-3 lamina of TP

770
Q

Thyroid?

A

T2-3 lamina of TP

771
Q

Bronchi?

A

T2 lamina of TP

772
Q

Upper lung?

A

T3 lamina of TP

773
Q

Lower lung?

A

T4 lamina of TP

774
Q

Liver?

A

T5-6 lamina of TP R

775
Q

Stomach acid?

776
Q

Stomach peristalsis?

777
Q

Gallbladder?

A

T6 lamina of TP R

778
Q

Pancreas?

A

T7 lamina of TP R

779
Q

Spleen?

A

T7 lamina of TP L

780
Q

Appendix?

A

T11 lamina R

781
Q

Adrenals?

A

T11-12 could be unilateral

782
Q

Kidneys?

A

T12-L1 lamina of TP bilateral

783
Q

Bladder?

A

L2 upper edge of TP bilateral

784
Q

Urethra?

A

L2 TP bilateral

785
Q

Prostate?

A

Lateral sacral base bilateral

786
Q

Ear?

A

C1 posterior lateral pillar

787
Q

Pylorus?

A

T9 lamina of TP right

788
Q

Uterus?

A

Lateral sacral base bilateral

789
Q

Broad ligament?

A

Lateral sacral base bilateral

790
Q

Vagina?

A

Lateral sacral base bilateral and upper inner edge of thigh

791
Q

Ovaries?

A

T10-11 lamina of TP bilateral

792
Q

Large intestine?

A

Right triangle - lateral edge of TP of L2-4, bottom edge is L4 to iliac crest

793
Q

Pharynx, tongue, larynx, sinuses, arms?

794
Q

Nasal sinuses?

A

Bottom edge of C1 pillar

795
Q

Peristalsis (intestine)?

Savarese (32 decks)

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