Instrumentation Packet Flashcards
Gonstead Quote.
“First, spend all the time necessary to precisely find and correct a patient’s problem. Do not be in a hurry. Check and recheck your x-ray, your palpation, instrumentation and visualization. Second, remember that Chiropractic always works. When it does not seem to examine you application, but do not question the principle. Third, be prepared when demand for chiropractic care increases. Study the spinal column and the nervous system every chance you get. Our future will be our results.”
Name the 5 parts of the Gonstead system
- Visualization
- Instrumentation
- Palpation
- X-ray
- Patient symptoms
Name the 11 aspects of visualization.
- Foot Flare
- Antalgic Position
- Dishing
- Loss of a smooth lateral curve
- Head tilt or rotation
- Pelvic tilt
- Buttocks/gluteals
- Rib humping
- High shoulder
- Shoulder drop
- Scoliosis
What can unilateral “toe out” foot flare be caused by?
- IN ilium
2. PEX tibia
What can bilateral “toe out” foot flare be caused by?
- Base posterior sacrum
2. Knee problems
What can unilateral “toe in” foot flare be caused by?
- EX ilium
- Anterior talus (an inversion sprain)
- Paralysis of the extensor muscles
What would you check for if a patient has antalgic position?
You would first check the lumbar region. If the patient is unable to stand up straight, they may have a base posterior sacrum.
What is dishing?
Flatness in the thoracics is a compensation do to a posterior vertebra below
How can you check for a loss of a smooth lateral thoracic arc?
Laterally flex or bend the patient slowly and look for the loss of a smooth arc
What is typically the cause of a bilateral loss of the lateral thoracic arc?
A segment of the spine is fixed or stacking is present; usually posteriority is the major part of the listing
What is typically the cause of a unilateral loss of the lateral thoracic arc?
The wedge would be the major part of the listing and will be suspected on the side of unilateral loss
How does scoliosis effect the loss of the lateral thoracic arc?
When a scoliosis is present it will make the lateral wedging more difficult to observe.
Which is more common; head tilt or rotation?
Head tilt
Why is rotation less common than head tilt?
Rotation may be caused by overall spinal rotation or by upper cervical rotation.
What happens to the head when there is a posterior rotated atlas?
It causes the head to be raised on that side, due to the shape of the superior articular facets, which results in a higher mastoid on that side.
What happens to a child with an AS occiput?
They might walk on their toes or they might bang their heads in effort to decrease the pressure that is caused by the AS occiput. These children also have a flattened forehead due to banging their heads.
Explain what the PSIS, gluten folds, and the iliac crests look like in a patient with pelvic tilt.
If there is a lower PSIS, there is a lower fluteal fold and a higher iliac crest.
If there is a higher PSIS and glutenl fold, there is a lower iliac crest.
What could cause a lower PSIS, lower fluteal fold and a higher iliac crest on that side?
A PI ilium, an anatomically short leg, or a fallen arch in the foot.
What could cause a higher PSIS, higher fluteal fold, and a lower iliac crest?
May be caused by an AS ilium.
What does a flat buttocks indicate?
May be caused by an IN ilium or a posterior rotated sacrum.
What does a narrow peaked buttocks indicate?
May be caused by an EX ilium or the sacrum may be rotated posterior on the opposite side.
What is rib humping?
Ribs on the patient are more prominent posterior on one side.
What causes a high shoulder?
- Open wedge in the mid thoracic spine on the side of the high shoulder
- PS shoulder
- Scapula that is fixed superiorly
- Sternoclavicular or acromioclavicular subluxation
What could shoulder drop be caused by?
May be caused by paralysis of the trapezius.
How do you determine if scoliosis is structural or non-structural?
Use Adam’s test: have the patient bend at the waist and note if the scoliosis disappears or stays the same
What does it mean if the scoliotic curve disappears?
The curve is mild to moderate or less than 25 degrees
Do moderate scoliotic curves have more of a structural or functional component?
They have more of a functional component and are amendable to conservative management
What muscle changes does rotary scoliosis have?
A rotary scoliosis has a more prominent muscle bundle on the side of the high transverse. Raised muscles may also be evident on the side of handedness.
Should you take a different x-ray if the visualization changes on the patient?
Yes because we now have a different patient.
What are the 7 skin changes to look for when visualizing?
- Skin color
- Varicosities
- Pete Chia
- Brown or white patches
- Blemishes
- Scarring
- Hair changes
What does the skin color look like in an acute condition?
There is redness that may be due to tubbing, increased vascularization, swollen irritated tissues, or cutaneous radiation
How does a skin color change in a parasympathetic dermatomal area? (Occiput to C5 and below L5)
Discoloration or a small red spot in the area
What does the skin color look like in a chronic condition?
Discoloration or a small red spot in a parasympathetic dermatomal area
What are varicosities?
Chronic vascular changes, which are most common in the sympathetic region (especially vp to L5)
What usually accompanies varicosities in the VP region?
Dowgar’s Hump (edema)
What is petechiae?
Broken blood vessels which indicate a possible problem area
What causes brown or white patches along the spine?
Chronic neurological changes in the sympathetic area; they occur either on the left or the right side because they are neurologically specific
What do blemishes indicate?
A possible problem area
What does scarring indicate?
If nerve damage has occurred, healing may be haphazard
Where are potential areas for increased hair growth?
Over the sacrum and over abnormalities like spina bifida
Where are potential areas for decreased hair?
Over a subluxated area
In the area of C2-L5, what causes subluxation?
The nucleus is compressed by a misaligned vertebral body and exerts pressure on the annulus. The annular fibers are stretched beyond their normal capacity by the nucleus and are torn or damaged. The ensuing inflammatory reaction fills the disc with edematous fluid causing it to swell. The resulting protrusion of the disc into the neural canal of the IVF causes compression of the neural structures creating nerve pressure. AKA subluxation is disorder of the disc
What causes subluxations in the upper cervical and sacroiliac regions?
Subluxations are the result of damages to the interarticular ligaments, which swell and produce nerve pressure.
How is nerve pressure detected by an instrument?
Compression of the nerve causes an inflammatory reaction, which alters the metabolic rate and therefore the metabolic heat of the nerve. The heat radiates from the inflamed nerve root will produce a temperature change that is detectable on the skin surface.
What does the dual probe instrument consist of ?
- A micro voltmeter
2. One thermocouple on each side
What side does the needle of the voltmeter go to when ran along the spine?
The needle deflects to the side of the nerve that is warmer
What happens to the voltmeter when the thermocouple is directly over the involved nerve?
The needle will be at its maximum point of deflection, which is called the peak of the break
What are heat swings?
Muscle imbalances and vasomotor reflexes that create slight variations in skin surface temperature, causing the needle to deflect in a gradual and moderate way
What are examples of skin conditions that can cause unilateral localized temperature changes?
- Burns
- Contusions
- Sweating reflexes
- Inflammatory skin lesions
Besides detecting the exact location of subluxation, the dual probe instrument serves what other purposes?
- It indicates the intensity of nerve pressure
- It indicates patient progress
- It indicates when a subluxation is corrected
Can you use instrumentation to detect acute vs. chronic breaks?
No
What happens to the disc when there is a bilateral temperature alteration?
The disc protrudes straight posterior instead of posterolateral and causes pressure on the spinal cord itself
How do you detect spinal cord pressure?
The instrument should be cambered (tilted) so that the nerve of the vertebra above is compares to that of the vertebra below. This will cause the pointer to peak at the level of cord pressure
What levels can cord pressure occur at?
Any level of the spinal cord
What levels are more commonly affected by cord pressure?
The upper cervical region due to the atlas
What level should the instrument be placed on most of the time?
High
What is the width of the probes from occiput to T9?
As wide as possible.
What is the width of the probes from T10 to sacrum?
The probes should be places closer together.
At what angle should the doctor hold the instrument to the spine?
90 degrees
In your first glide, what bone do you begin and end with?
T5 to occiput
In your second glide, what bone do you begin and end with?
C6 to sacrum
What is the speed for the upward glide?
3 sec/segment
What is the speed for the downward glide?
2sec/segment
When gliding upward and you find a break, where should you mark it?
At the inferior edge of the probe
When gliding downward and you find a break, where should you mark it?
At the superior edge of the probe
What are the 10 errors of instrumentation?
- Gliding too fast
- Uneven pressure of the thermocouples
- Too light of pressure on skin
- Too wide a convergence of terminals in the cervicals causing air leaks
- Not repeating the glide to bring out the deflection and reduce the ambient temperature
- Not marking the break at its peak
- Varying the glide speed
- Misinterpreting skin lesions as subluxation deflections
- Not keeping the terminals centered along the spine
- Marking the recession instead of the peak of the break
Where would you mark a break in the range of C2-T3?
The reading is below the involved segment
Where would you mark a break at T4?
The break should be level with the spinous
Where would you mark a break in the range of T5-T9?
The break will be in the interspinous space above the involved vertebra
Where would you mark a break in the range of T10-T12?
The break will be level with the spinous
Where would you mark a break in the range of L1-L5?
The break will be located at the lower 1/4 of spinous
Where would you mark a break at the SI joint?
The break will occur anywhere between the inferior and superior border of the articulations
Name the 8 skin changes you can feel with static palpation.
- Contour changes
- Spongy edema
- Pitting edema
- Tone
- Texture
- Temperature
- High transverse process
- Tenderness
Where does spongy edema occur?
- Where the nerve exits the spine, except at L5 due to the wide transverses.
- In the thoracic’s, it may be present under the spinous
- Center of the sacrum
What is pitting edema?
A collagen breakdown of the skin due to inadequate nerve supply.
Is pitting edema the result of an acute or chronic problem?
Chronic
What does the texture of a problem area feel like?
Smooth and silky
What does the skin over the spinous feel like in a problem area?
Sticky
What is the most sensitive part of the hand?
Thenar
Why do the thoracic’s often feel warmer?
Because they are in the area of the heart
What does a high transverse process indicate?
The side of body rotation
When does a patient feel tenderness?
Pain will be present when pushing the spinous toward the side of laterality
What do taut and tight fibers typically indicate?
A possible compensation
What do lax fibers typically indicate?
A possible subluxation
