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OPP IV: Test 2 > Lect: MSK dysfunction (5), pediatric ortho (5), OPP psych (5), Neurology (5), CP (5) > Flashcards

Lect: MSK dysfunction (5), pediatric ortho (5), OPP psych (5), Neurology (5), CP (5) Flashcards

1
Q

median nerve

A

C5-T1
tingling in the first three fingers
(carpal tunnel signs) - indicates nerve root impingement, rather than peripheral nerve problem

pinch points?

  • thoracic outlet: first rib, clavicle, scalene dysfunction
  • axilla
  • cubital area (pronator teres syndrome)
  • interosseous membrane
  • carpal tunnel
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2
Q

pronator teres syndrome

A

other sites around the elbow - - nerve can run under ligament of struthers

  • thickenend biceps aponeurosis
  • thickened flexor digitorum superficialis

= impingement of median nerve

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3
Q

plantar fasciitis

A

inflamm. and tearing of the heel bone fascia

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4
Q

what can you do w/ OMT to tx CP?

A
  1. address mm. tone (function affects structure)
  2. address proprio input to affect motor output (structure affects fn.)

Goals:

  1. decrease pain
  2. affect proprio input to change posture - limit and prevent contractures
  3. improve functional capabilities
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5
Q

classifications of CP motor function?

A
  1. pyramidal = spastic (results in hemiplegia, diplegia, etc.) = hypertonia, stiff limbs
  2. extrapyramidal = non-spastic / dyskinetic (results in more athetoid, dystonic/ataxic mvmts) = hypotonia, floppy limbs
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6
Q

pyramidal CP

A
  • spastic, hypertonic
  • UMN damage in cortex
  • more common
  • stiff rigid limbs, w/ exagerrated reflexes, jerky mvmt
  • Most often arms and legs affected, but can affect tongue, mouth and larynx, affecting speech, eating, breathing and swallowing
    • Associated pathology: **Hip pathology, scoliosis, limb deformities
  • contractures, hamstring hypertonicity

Spastic CP:

  • spasticity affects posture, and influences cortical mapping
  • joint proprio is altered
  • baseline tone is very tight

biomechanics:
- Impaired down-regulation of the descending modulating pathways of the myotactic reflex d/t cortical damage –> hypertonicity and spasticity and uncoordinated mvmts
- Muscle agonist/antagonist pairs don’t work well together
- Each movement has the potential to activate this reflex due to the imparied down-regulation

Myotatic reflex: stretched mm –> efferent contraction of mm –> causes antagonist mm. to be stretched…. both mm. become hypertonic at same time!

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7
Q

extrapyramidal CP

A

= nonspastic, “floppy kids”, hypotonic (20% of pts.)

  • usually present with generalized hypotonia and increased DTR’s in infancy which then progresses to dyskinesia’s in childhood
  • baseline tone lower than normal, posture impaired
  • may have sensorineural hearing loss, strabismus and nystagmus
  • two types:
    1. ataxic CP (uncoord. mvmt) - damage to cerebellum, tremor, hypotonia, lack of balance
    2. dyskinetic CP (choreaform mvmts) - assoc. w/ damage to BG, has hyper and hypotonia

** see impairemtn in involuntary mvmt: dyskinesas, dystonias, athetosis

  • Mental impairment and seizures are less likely
  • Less likelihood of limb deformities
  • Speech may be affected due to muscle impairment
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8
Q

postural compensation in spastic CP?

A

Muscles most commonly affected? Lower Extremities

  • hamstring hypertonicity –> posterior innom, decreased lumbar lordosis
  • extension of TLJ
  • flattened thoracic kyphosis
  • extended OA
  • altered mechanics of hip –> excessive forces through acetabulum –> increased hip dislocation, fracture or avascular necrosis

** always evaluate new onset pain or changes in function

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9
Q

MET to use w/ CP?

A

Isometric - this is what we are taught, same length

Isotonic concentric= Same tone, shorten the muscle (let the patient win)

Isotonic eccentric= Same tone, lengthen the muscle (let the physician win)

Isolytic = Quickly overcoming patient contraction

Reciprocal inhibition = Utilizes the withdrawal and crossed-extensor reflexes therapeutically- Applying MET to one group of mm to affect the antagonist partner (i.e. treat hamstrings to affect Quads, or treat left hams to affect right quads)

** Due to muscle physiology, MET is not the
best choice for kids under 8 years

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10
Q

tx for spastic CP?

A

MET:
Isolytic: slowly and gently break up fibrosis
- Good for adhesions, fibrosis from long term contraction
- Can use directly on hypertonic muscles (gently)

Reciprocal inhibition

  • To decrease tone to hypertonic muscles using muscles that may be under better voluntary control of the patient
  • Hemiplegias, unilateral contractures

MFR, can alwys be used!

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11
Q

postural compensation in nonspastic CP?

A

lock weight-bearing joints –> lock adductors and quds –> anterior pelvic displacement

decreased cervical lordosis, head forward posture - extended dysfunction in OA and shortening of suboccipital muscles may lead to chronic headache and bruxism

Common orthopedic problems:
- Tibial rotations and torsions, persistent femoral anteversion, pes planus, genu valgus

Common complaints
Back pain, knee, hip pain, headache

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12
Q

Tx for non-spastic CP?

A

MET:
- Isotonic eccentric
Use to address the shortened muscles, especially antigravity muscles (adductors, quads, abductors, psoas) – slowly lengthen it like direct MFR

  • Isotonic concentric
    Help to strengthen and improve firing patterns of hypotonic muscles – (like when working out at the gym)
  • Isometric may be used to address joint mechanics and muscle firing patterns of opposing muslce groups

MFR, can alwys be used!

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13
Q

which tx to use w/ all types of CP?

A
  1. MFR ALWAYS!!!
  2. BLT - esp. tibia-fibula and interosseous membrane (lots of proprio info!)
  3. FPR - great for short restrictors (suboccipital muscles, paraspinals)
  4. C/S: used to lengthen and relax tone in long restrictor muscles (psoas, quads, hams)

DONT USE HVLA!!! hypotonic too lax, hypertonic too much guarding

parent at home tx?
Rib raising
Diaphragms
Lymphatic pumps

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14
Q

BLT

A

balanced ligamentous tension/ligamentous articular strain

disengage (compression/decompression), exaggerate (take into dysfunction), balance

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15
Q

articulatory technique

A

direct tx - moves through a restrictive barrier

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16
Q

FPR

A

facilitated positional release - put joint in neutral –> apply compression –> then take to ease

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17
Q

still technique

A
  1. place the dysfunctional tissues into the position of ease
  2. add a force vector through the dysfunctional tissue
  3. then position it into the barrier while maintaining the vector force
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18
Q

support for other medical issues w/ CP?

A
  1. pneumonia
    - maximize O2 and clearance of secretions through: rib tx, thoracic motion, thoracic MFR at sternum
  2. Gastric reflux
    - G tube placed for nutrition
    - reduce relux through encouraging diaphragm motion: thoracic inlet, thoracic, pelvic
    - Cranial base mechanics (vagus nerve comes through here!)
    - Middle cervical spine (C3-5) – important for diaphragm motion! phrenic nerve
    - Middle thoracic spine (T5-9) – viscerosomatic to stomach!
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19
Q

research on CP shows?

A

MFR helps with spasticity

OMT + MFR is better than accupuncture

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20
Q

causes of limping child?

A

0-4 years: think transient toxic synovitis, septic arthritis

4-10 years: TTS, septic arthritis, LCP disease, JIA

10-18 years: slipped capital femoral epiphysis (SCFE), gonococcal arthritis, stress fracture

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21
Q

developmental hip dysplasia:

A
  • more common in females, large birth, oligohydramnios, first born, breech

= -femoral head unstable within acetabulum- may be loose in socket or completely dislocated

sx: asymptomatic or decreased ROM hip; diffificulty w/ diaper change; delayed crawling, standing, walking; gait asymmetry

early detection before 6 mos = best outcome

+ barlow/ortolani test

if not corrected results in mishapen acetabulum in adult + arthritis

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22
Q

SALTR classification - physeal (growth plate) fracture

A 
S: Slip (epiphysis separated from shaft)
A: Above - fracture through metaphysis
L: Lower - fracture through epiphysis
T: Through (epiphysis & metaphysis)
R: Rammed
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23
Q

osteomyelitis

A

Inflammation of bone marrow & adjacent bone ** most often staph **

Age: all

Children: hematogenous spread

Location: metaphysis of long bones

Sx: local inflammation & fever, irritability, lethargy, bone tenderness & dec. ROM

Tx: IV antibiotics (4-6 wks min.)

24
Q

septic arthritis

A

Infection with the joint space

Intense synovitis is the result of the inflammatory response

Sx: monoarticular, erythema, swelling, pain, dec. ROM
- Knee most common

** in age 10-18 think gonococcal arthritis!

  • tx w/ Abs
25
Q

transient toxic synovitis

A

Sx: “irritable hip syndrome”: acute hip pain, dec. ROM

Hip in flexion/abduction & ext. rotation

  • self limited - 5-7 days; NSAIDs
26
Q

Legg-Calve-Perthes disease (LCP)

A

idiopathic osteonecrosis of the femoral head

Age 4-10 years

Lack of blood flow to femoral head=necrosis

  • Bone collapses—flattens
  • Blood supply returns after several months
  • New bone replaces old

Boy>girls–4:1
Typically thin, active boys

Sx: slight limp, pain in knee, aching thigh or groin, limited ROM, leg length discrepancy, antalgic gait

Tx: meds/reduce activity to dec. pain (children under 6); splinting or surgery to keep hip stable

27
Q

Slipped capital femoral epiphysis (SCFE)

A

Noninflammatory condition; femoral head displaced from femoral neck

Initially bilateral 20-40%, if unilateral, the other side slips in 30-60%

Age: 10-14 years

**Typically overweight boys: shear stress

Association with endocrine disorders, 1° hypothyroid and HGH deficiency

Sx: insidious, sudden onset, complaint of pain in hip and limp

Tx: surgical stabilization

28
Q

Juvenile idiopathic arthritis (JIA)

A

Chronic joint pain for min. of 6 wks & age onset

29
Q

OSD - Osgood schlatter Disease

A

AKA:
= Tibial Tuberosity Avulsion
= Osteochondritis of tibial tubercle
- Apophysitis of tibial tubercle at the insertion of the patellar tendon

20% b/l, occurs in 20% of all young atheltes d/t Repetitive, tensile forces on developing tibial tubercle.

presentation:
- Pain over tibial tubercle with activity, especially eccentric contraction of quadriceps.
- Tenderness and swelling over tubercle.
- lots of sports

= inflammation of the patellar ligament at the tibial tuberosity. It is characterized by a painful lump just below the knee and is most often seen in young adolescents. Risk factors include overuse (especially in sports involving running, jumping and quick changes of direction) and adolescent growth spurts.

Clinical presentation:

  • Age 9-14 y/o very active in sports w/ rapid growth spurt
  • Clinical diagnosis
  • complete avoidance of activity is NOT recommended, inactivity can decondition the area- playing with pain is permited!!!
30
Q

Ober’s Test

A

Tests ITB - lay on side - bring leg into extension and external rotation, then adduct

31
Q

FPR release for fibula

A

fibula is gently disengaged from the tibia by bringing the fibular head anteriorly and laterally, while at the same time bringing the lateral malleolus posterior and medially

compression through the long axis of the fibula is introduced to activate tissue motion

fibula is gently rocked in a ‘see-saw’ fashion, with the fulcrum of motion approximately mid-shaft. The motion is generally restricted at first and will become more pronounced as the tissue motion becomes freer.

32
Q

growth centers appear?

A

Iliac Crest: 11-14 years (completes at 20 years)

Ischial Tuberosity: 13-15 yrs (completes 16-18 years)

Gr. Troch: 4-6 yrs (completes 16-17 years)

Femoral Head: 4 mos (ends 16-19 years)

Tibial Plateau: Birth (ends 16-19 years)

33
Q

intoeing

A

= metatarsus adductus

OMT: tx
tightness in the medial fascia and adductors of the foot
Torsion of the first and second metatarsals and inversion rotation of the first cuneiform
Everted calcaneus
Lateral longitudinal arch flattened
Posterior fibular head

34
Q

pes planus

A

= flat foot

”functionally” - when great
toe is passively extended
the median arch will lift up - this is normal to have a functional pes planus (common in 2-3 y/o)

rigid pes planus -while in a rigid flat foot it will remain flattened - never normal

OMT- Pes planus results
in compensatory
internal
rotation of tibia
during loading (bad for OSD)
35
Q

OMT w/ OSD?

A

OMT:
- often see posterior rotations and lateral flares that can cause increased tensile forces across patella

  • Anterior rotations
    alter tone in
    knee flexors and may
    influence knee rotation
  • tibia rotates laterally w/ knee extension - If the tibia can not externally/internally rotate with knee flexion and extension tensile forces are increased.
- Need to consider 
knee flexors
which can limit tibial 
accommodation
of femur
  • Hypertonicity of the
    Sartorius may cause
    External tibial rotation
- Shortened biceps femoris (hamstrings)
 Medially:
 Can limit external rotation 
of tibia during knee extension
Laterally:
Can limit internal rotation 
Of tibia during knee flexion
36
Q

injury seen in epidural hematoma?

A

think blow to temporal bone –> injury to middle meningeal and left lateral displacement

37
Q

4 tenets

A
  1. human being is dynamic
  2. body possesses self-regulatory mechanisms that are self-healing
  3. structure and function are interrelated
  4. rational tx based on above principles
38
Q

SD in psychiatry?

A

In general: many have dysfunction at C2 and T4-6, along w/ altered CRI (cranial rhthmic impulse)

schizophrenia = occipital

manic depresssive = SBS compression

Involutional dementia = frontosphenoid

OMM in psychiatry? look at autonomics, cranial strain patterns

  • C2, T4-6
  • NO HVLA
  • NO tx >24 hrs after ECT
39
Q

increased cortisol

A

can occur d/t stress –> if elevated for long enough can result in damage to hippocampal formation –> memory loss (ex. of body affecting the mind)

40
Q

difft. types of stretching?

A

static: held position
dynamic: move through a challenging range - more beneficial

passive stretching: using outside assistance to help acheive a stretch

active stretching: actively contracting the mm. in opposition to one being stretched

41
Q

toe lifts

A

Good for forefoot pronation or pes planus, plantar fasciitis, lower extremity dysfunction
Strengthens intrinsic muscles of the foot
Stand with neutral pelvic rotation (tail tucked) and neutral position of femur on tibia (knees soft)
Lift heels off floor 1 inch keeping all 10 toes on the floor
Hold for up to 30 seconds
Toes that lift up indicate specific muscle dysfunction

42
Q

pigeon pose

A

= active stretch for piriformis

Flex hip and knee and place leg in front of you

Extend other leg behind

Increase stretch on piriformis by dropping torso onto forearms

43
Q

dynamic hamstring stretch?

A
  • Bend hips to 90 degrees and flex knees

Keep pelvis in anterior tilt

Extend knees and push ischial tuberosities up to the ceiling

44
Q

active psoas stretch?

A

Start by kneeling on floor with one leg flexed at knee.
Invert foot on floor. Keep torso erect with neutral pelvic
rotation. Contract gluteus maximi muscles and
advance into lunge. Hold for 30 seconds.

Psoas mm:
- Type I muscle fibers have the largest cross-sectional area over Type II fibers
- Fiber types differ in level of the muscle with Type I mostly in the cephalad portion starting from L1 to L4
- Therefore, more postural and stabilizes the lumbar spine, controls disc space anterolaterally
- Type II fibers are more predominant in the caudal portion of the muscle
Therefore, more dynamic as main flexor of the hip

45
Q

reciprocal innervation

A

Joint flexes, flexor contracts, extensor lengthens
Joint extends, flexor lengthens, extensor contracts
Occurs ipsilaterally & contralaterally
Ipsilateral flexor contracts, contralateral flexor lengthens

46
Q

alpha motor neuron

A

Control of muscle length by muscle spindle
Stretching muscle causes spindle to discharge more = muscle is lengthening
Contracting muscle causes spindle to be silent = muscle is shortening

Golgi tendon organ responds to stretch and contraction & initiates inhibitory reflex arc to prevent overloading the muscle

47
Q

dynamic psoas stretch

A

sumo wrestler exercise

Stand with feet 18” apart
Flex knees and hips
Round spine, particularly lumbars
Use glut max to push pubes anteriorly
Keeping pubes anterior, extend knees, hips
Straighten spine by rotating at hip joints
Keep lordotic curve minimal
Repeat 3 more times
48
Q

dynamic psoas stretch

A

sumo wrestler exercise

Stand with feet 18” apart
Flex knees and hips
Round spine, particularly lumbars
Use glut max to push pubes anteriorly
Keeping pubes anterior, extend knees, hips
Straighten spine by rotating at hip joints
Keep lordotic curve minimal
Repeat 3 more times
49
Q

what leads to mm. dysfunction?

A

Postural/tonic muscles become facilitated, hypertonic, shortened]

  • hip: psoas, piriformis, rectus femoris and adductors are tight
  • shoulder: levator scapula, upper traps, pecs

Dynamic/phasic muscles become inhibited, hypotonic, weak

  • hip: glut med and max get weak
  • shoulder: supra and infraspinatus, lower traps, deltoid, rhomboids are weak
50
Q

lower crossed syndrome

A

Weak gluteus maximus and tight hip flexors
Weak abdominals and short lumbar erector spinae
Weak gluteus medius and minimus and short tensor fascia latae and quadratus lumborum
Anterior pelvic tilt and increased lumbar lordosis
Hypermobility in the lowest lumbar levels

    • weak abs and gluts
    • right thoraco-lumbar extensors, iliopsoas and rectus femoris (quads)

** results from anteriorly rotated pelvis + tight erector spinae –> tight iliopsoas/rectus femoris and weak abs

tx: strengthen glut max and med, lengthen iliopsoas/rectus femoris, engage abs, cause pelvis to tilt more neutral

51
Q

upper crossed syndrome

A
    • weak deep cervical flexors, weak lower traps and serratus anterior
    • right upper traps, levator scapulae, tight pectoralis and SCM
52
Q

what leads to mm. dysfunction?

A

Postural/tonic muscles become facilitated, hypertonic, shortened]

  • hip: psoas, piriformis, rectus femoris and adductors are tight
  • shoulder: levator scapula, upper traps, pecs

Dynamic/phasic muscles become inhibited, hypotonic, weak

  • hip: glut med and max get weak
  • shoulder: supra and infraspinatus, lower traps, deltoid, rhomboids are weak
  • Trigger points, pain and tendonitis develop in muscles that tend to be weak and inhibited.

Tears and ruptures develop in muscles that tend to tightness.

53
Q

upper crossed syndrome

A
    • weak deep cervical flexors, longus coli, weak lower traps and serratus anterior
    • right upper traps, levator scapulae, tight pectoralis and SCM
  • forward head posture
  • Straightening of the lower cervical lordosis.
  • Extension of the upper cervical spine.
  • Increased kyphosis of the cervico-thoracic junction.
  • Internal rotation of the shoulder girdles.
54
Q

MET of upper traps/ SCM? strengthening of lower traps?

A
  • MET is performed by holding the head like a football and taking it to the feather edge of rotation toward and sidebending away from the shoulder. Hold the first rib and clavicle down during the MET maneuver.

Sit with pelvis in neutral
Contract lower traps
If weak, strengthen by holding arms with elbows at your side, palms up.
Contract lower traps.
Pull Theraband taut by moving fists away.
Maintain contraction while releasing tension on the Theraband.
Repeat 5 more times.

55
Q

latissimus dorsi stretch?

A

This is essentially the prayer pose. Can advance to
sitting on heels and placing arms on floor for a
greater stretch.

56
Q

longus coli strengthening

A

deep neck flexors thats inhibited but substituion of SCM and scalenes

strengthening: Tuck chin to throat as far as possible. Hold for 10 seconds and repeat 3-5 times. Work up to holding tuck for 30 seconds.

OPP IV: Test 2 (2 decks)

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