Lecture Exam 1 Flashcards
1
Q
tenet 1
A
the body is a unit
2
Q
tenet 2
A
the body possesses self-regulatory mechanisms
3
Q
tenet 3
A
structure and function are reciprocally interrelated
4
Q
tenet 4
A
rational therapy is based upon an understanding of body unity, self-regulatory mechanisms, and the interrelationship of structure and function
5
Q
somatic dysfunction definition
A
impaired or altered function of related components of the somatic (bodywork) system
6
Q
somatic system structures
A
skeletal, arthrodial, myofascial (SAM)
7
Q
somatic system elements
A
vascular, lymphatic, neural (VLAN)
8
Q
how do you diagnose somatic dysfunction?
A
TART
9
Q
first T in TART
A
tissue texture abnormalities
10
Q
A in TART
A
asymmetry (static or active)
11
Q
R in TART
A
restriction of motion
12
Q
second T in TART
A
tenderness
13
Q
how do you name somatic dysfunction?
A
direction in which motion is freer
14
Q
acute somatic dysfunction
A
impairment or altered function of related components of the body framework system
15
Q
acute somatic dysfunction characteristics
A
pain, erythema, relative warmth, increased moisture/bogginess, vasodilation, edema, tenderness, tissue contraction
16
Q
chronic somatic dysfunction
A
impairment or altered function of long-standing duration of related components of the body framework system
17
Q
chronic somatic dysfunction characteristics
A
itching, paresthesia, palpable sense of tissue dryness, coolness, tissue contracture, fibrosis tenderness, pallor
18
Q
contracture definition
A
abnormal, sometimes permanent, contraction of a muscle
19
Q
acute tissue texture abnormality words
A
erythema, hot, boggy, edema, spasm, tissue contraction
20
Q
chronic tissue texture abnormality words
A
pale/blanching, cool, ropey, stringy, scar, doughy
21
Q
how do you treat somatic dysfunction?
A
osteopathic manipulative treatment (OMT)
22
Q
OMT
A
therapeutic application of manually guided forces to improve physiology function and/or support homeostasis that has been altered by somatic dysfunction
23
Q
which is greater, AROM or PROM
A
PROM
24
Q
active range of motion (AROM)
A
patient does the moving
25
passive range of motion (PROM)
doctor does the moving
26
physiologic barrier
limit of active motion
27
anatomic barrier
limit imposed by anatomic structure
28
elastic range
range between the physiologic and anatomic barrier (end of passive motion)
29
restrictive barrier
functional limit that abnormally diminishes the normal physiologic range
30
levels of evidence: A
randomized clinical trials (RCTs), systematic reviews, meta-analyses of RCTs
31
levels of evidence: B
case-control or cohort studies, retrospective studies, certain uncontrolled studies
32
levels of evidence: C
consensus statements, expert guidelines, usual practice, opinion
33
OMT contraindications
no somatic dysfunction, patient does not consent, inappropriate clinical situation
34
post-OMT symptoms
rare adverse symptoms
35
avoiding post-OMT symptoms
proper H&P, appropriate techniques, appropriate application of technique, hydration and rest
36
post-OMT soreness is similar to
post-exercise soreness
37
three body types
mesomorphic, ectomorphic, endomorphic
38
mesomorphic
muscular or sturdy body build, middle ranges of ROM, relative prominence of structures developed from the embryonic mesoderm
39
mesomorph example
Harrison Ford, 6'1" 180lbs
40
ectomorphic
thin body build, higher ranges of ROM, relative prominence of structures developed from the embryonic ectoderm
41
ectomorph example
Scottie Pippen, 6'8" 228lbs
42
endomorphic
heavy body build, lower ranges of ROM, relative prominence of structures developed from embryonic endoderm
43
endomorph example
Howard Taft, 6'0" 335lbs
44
color words
pale, erythema, jaundice, cyanosis, necrosis
45
pallor may indicate
anemia
46
erythema may indicate
inflammation
47
jaundice may indicate
cirrhosis
48
cyanosis may indicate
poor oxygenation, coldness
49
notable skin findings
lesions, scars, tattoos, piercings
50
skin lesion ABCDE
asymmetry, border, color, diameter, evolution
51
skin lesion asymmetry
a line in the middle would not create matching halves
52
skin lesion border
irregular, wavy, jagged border clearly defined against surrounding skin
53
skin lesion color
uneven color, light brown to black
54
skin lesion diameter
>6mm
55
skin lesion evolution
rapid evolution of size (width), color or thickness
56
what factors create asymmetry?
bone deformity, joint deformity, kyphoscoliosis, postural, sacral base unleveling, somatic dysfunction
57
anterior view head landmarks
eye level, ear level, ear prominence, nose and nares symmetry
58
anterior view upper extremities landmarks
acromion height, angles of clavicles, carriage of arms, finger tip length compared to iliac crests
59
anterior view lower extremities landmarks
patellar alignment, medial and lateral malleoli
60
anterior view trunk landmarks
angle of rib cage, umbilicus
61
anterior view pelvis landmarks
crest of ilium, greater trochanter levels
62
posterior view above the pelvis landmarks
carriage of head, scapular spine, scapula angle, medial scapular border, arm carriage, spinous process alignment or deviation from midline
63
posterior view pelvis and lower extremity landmarks
iliac crest heights, PSIS, greater trochanter, gluteal line, popliteal line and space, Achilles tendon, medial and lateral malleoli
64
lateral view plumb line landmarks
external auditory canal, acromion process, greater trochanter, anterior medial malleolus
65
lateral view spinal curvatures
cervical and lumbar lordosis, thoracic kyphosis
66
plane
flat surface on which a straight line joining any two points on it would wholly lie
67
axis
straight line around which on object rotates
68
coronal/frontal/lateral
bisects the body into front and back halves
69
sagittal/antero-posterior
bisects the body into right and left halves
70
horizontal/transverse
divides the body into superior and inferior halves
71
what motions occur in the saggital/antero-posterior plane
flexion/extension
72
what motions occur in the frontal/coronal plane
sidebending, abduction/adduction
73
what motions occur in the horizontal/transverse plane
rotation
74
three types of joints
fibrous, cartilaginous, synovial
75
fibrous joint example
skull articulations
76
cartilaginous joint example
discs between vertebrae
77
six types of synovial joints
pivot, ball and socket, hinge, condyloid, plane, saddle
78
pivot joint example
between C1 and C2 vertebrae
79
ball and socket joint example
hip joint
80
hinge joint example
elbow
81
condyloid joint example
between radius and carpal bones of wrist
82
plane joint example
between tarsal bones
83
saddle joint example
between trapezium carpal bone and first metacarpal bone
84
three components of ROM
direction, range, quality
85
components of ROM: direction
flexion/extension, sidebending, rotation
86
components of ROM: range
actual measurements in degrees
87
components of ROM: quality
smooth (normal), ratcheting, restricted, exhibiting resistance to the motion induced
88
ratcheting ROM may indicate
Parkinson's disease
89
restricted ROM may indicate
contracture or somatic dysfunction
90
exhibiting resistance to the motion induced ROM may indicate
cerebral palsy
91
words used to describe end feel ROM
elastic, abrupt, hard, empty, crisp
92
elastic end feel ROM
like a rubber band
93
abrupt end feel ROM
OA or hinge joint
94
hard end feel ROM
somatic dysfunction
95
empty end feel ROM
stops due to voluntary guarding
96
crisp end feel ROM
involuntary muscle guarding (pinched nerve)
97
loss of motion in somatic dysfunction results in
shift of midline of active ROM
98
types of flexibility
static, dynamic
99
flexibility
ROM in a joint or group of joints or the ability to move joints effectively through a complete ROM
100
static flexibility
maximal ROM a joint can achieve with an externally applied force
101
dynamic flexibility
ROM an athlete can produce and speed at which he/she can produce it
102
stiffness
reduced ROM of a joint or group of joints
103
functional unit of spine
two vertebrae, their associated disc, neurovascular, and other soft tissue
104
what part of the spine exhibits greatest motion
cervical spine
105
concept of coupled motion
consistent association of a motion along or about one axis, with another motion about or along a second axis (the principle motion cannot be produced without the associated motion occurring as well)
106
linkage
relationship of joint mechanics with surrounding structures
107
how to diagnose Ehler-Danlos syndrome
2 major Brighton criteria, 1 major plus 2 minor, 4 minor, 2 minor plus first degree family history
108
major Brighton criteria
Beighton score of >4, arthralgias for longer than 3 months in 4 or more joints
109
minor Brighton criteria
Beighton score of 1-3, arthralgias <3 months in 1-3 joints, dislocation or subluxation in more than 1 joint, back pain >3 months, 3 or more soft tissue lesions, marfanoid habitus, skin striae, drooping eyelids, varicose veins, mitral valve prolapse
110
marfanoid habitus ratios
arm span to height >1.03, upper segment to lower segment <0.89
111
Ehler-Danlos treatment
physical therapy (joint stabilization), medications to control pain (non-narcotic), surgery to repair joints as needed
112
skeletal dysfunction
hard end point
113
skeletal dysfunction examples
OA, RA, somatic dysfunction
114
arthrodial dysfunction
hard end point
115
arthrodial dysfunction examples
OA, RA, somatic dysfunction
116
myofascial dysfunction
tight, elastic end point
117
myofascial dysfunction examples
scar tissue, somatic dysfunction
118
vascular dysfunction
empty end feel
119
vascular dysfunction examples
PVD, thoracic outlet syndrome, somatic dysfunction
120
lymphatic dysfunction
empty or boggy end feel
121
lymphatic dysfunction examples
lymphedema, visceral dysfunction (CHF), acute injury (sprained ankle), somatic dysfunction
122
neural dysfunction
crisp or empty end feel
123
neural dysfunction examples
herniated disc, thoracic outlet syndrome, somatic dysfunction
124
L spine flexion angles
40-90
125
L spine flexion landmarks
S1 to vertical C7
126
L spine sidebending angles
15-30
127
L spine sidebending landmarks
S1 to vertical C7
128
L spine extension angles
20-45
129
L spine extension landmarks
S1 to vertical C7
130
L spine rotation angles
3-18
131
L spine rotation landmarks
center of head to acromion, ASIS
132
elbow flexion angles
140-150
133
elbow flexion landmarks
lateral epicondyle to acromion, radial styloid
134
elbow extension angles
0 to -5
135
elbow extension landmarks
lateral epicondyle to acromion, radial syloid
136
elbow pronation angles
90
137
elbow pronation landmarks
axis lateral to ulnar styloid to dorsal distal radium, parallel to humerus
138
elbow supination angles
90
139
elbow supination landmarks
axis medial to ulnar styloid to ventral distal radius, parallel to humerus
140
wrist flexion angles
80-90
141
wrist flexion landmarks
lateral wrist to ulna, 5th metacarpal
142
wrist extension angles
70
143
wrist extension landmarks
lateral wrist to ulna, 5th metacarpal
144
wrist adduction/ulnar deviation angles
30-40
145
wrist adduction/ulnar deviation landmarks
mid wrist to lateral epicondyle, 3rd metacarpal
146
wrist abduction/radial deviation angles
20-30
147
wrist abduction/radial deviation landmarks
mid wrist to lateral epicondyle, 3rd metacarpal
148
knee flexion angles
145-150
149
knee flexion landmarks
lateral epicondyle of knee to greater trochanter, lateral malleolus
150
knee extension angles
0
151
knee extension landmarks
lateral epicondyle of knee to greater trochanter, lateral malleolus
152
ankle dorsiflexion angles
15-20
153
ankle dorsiflexion landmarks
lateral malleolus of ankle to fibular head, 5th metatarsal
154
ankle plantarflexion angles
50-65
155
ankle plantarflexion landmarks
lateral malleolus to fibular head, 5th metatarsal
156
ankle inversion angles
20
157
ankle inversion landmarks
posterior ankle to midline of leg, midline of calcaneus
158
ankle eversion angles
10-20
159
ankle eversion landmarks
posterior ankle to midline of leg, midline of calcaneus
160
list the 11 body systems
HEENT, CV, respiratory, GI, GU, MSK, endocrine, integumentary, nervous, immune, psychiatric
161
list the 5 osteopathic models
biomechanical, neurologic, respiratory/circulatory, metabolic/energetic/immune, behavioral (biopsychosocial)
162
biomechanical model systems
MSK, integumentary
163
components of the musculoskeletal system
muscles, bones, tendons/ligaments, fascia
164
neurologic model systems
nervous
165
components of the nervous system
brain and spinal cord
166
components of the spinal cord
musculoskeletal and autonomic
167
components of the autonomic nervous system
parasympathetic and sympathetic
168
cranial nerves and segments associated with parasympathetic autonomic nervous system
cranial nerves III, VII, IX, X
| sacrum S2-4
169
segments associated with sympathetic autonomic nervous system
T1-L2
170
respiratory/circulatory model systems
cardiovascular (includes lymphatic), respiratory, HEENT, GU
171
metabolic/energetic/immune model systems
GI, lymph organs, endocrine
172
list the lymph organs
spleen, liver, thymus, tonsils, appendix, lymph nodes
173
components of the endocrine system
hypothalamus-pituitary-adrenal axis
174
behavioral (biopsychosocial) model systems
psychiatry
175
biomechanical model generally refers to
how the body responds to gravity
176
behavioral (biopsychosocial) model generally refers to
behaviors that influence health and health decisions
177
environmental stressors that can disrupt homeostasis
trauma, infection, nutrition, social
178
each of the 5 osteopathic models may be influenced by what system to improve homeostasis
MSK
179
viscoelastic material
any material that deforms according to rate of loading and deformity
180
stress
the force that attempts to deform a connective tissue structure
181
strain
the percentage of deformation of connective tissue
182
hysteresis
energy that is lost in the connective tissue system between loading and unloading
183
how to lengthen connective tissue
stretching into plastic deformational range
184
creep
connective tissue under a sustained, constant load (below failure threshold), will elongate (deform) in response to the load
185
bind
palpable restriction of connective tissue mobility
186
ease
the direction in which the connective tissue may be moved most easily during deformational stretching (palpated as a sense of "looseness")
187
fascial continuity
fascial restriction in one area of the body will create connective tissue restrictions (pulls) at a distance away from the site of the initial restriction
188
tight-loose relationship
for every tightness, there is a three-dimensionally related looseness, commonly in the exact opposite direction from the tightness
189
Newton's third law
when two bodies interact, the force exerted by one is equal in magnitude and opposite in direction to the forces exerted by the other
190
Hooke's law
the strain (deformation) placed on an elastic body is in proportion to the stress (force) placed upon it
191
Wolff's law
bone will develop according to the under stressed placed upon it (this concept extends to fascia too)
192
Sherrington's law (of reciprocal innervation)
when a muscle (agonist) receives a nerve impulse to contract, its antagonists simultaneously receive an impulse to relax
193
restrictive barrier from somatic dysfunction reduces what
both AROM and PROM
194
direct OMT
go towards and eventually through the restrictive barrier
195
indirect OMT
go away from the restrictive barrier
196
soft tissue OMT
direct, a system of diagnosis and treatment directed toward tissues other than skeletal or arthrodial elements
197
myofascial release (MFR) OMT
direct or indirect, a form of myofascial treatment that engages continual palpatory feedback to achieve release of myofascial tissues
198
integrated neuromusculoskeletal release (INR) OMT
direct or indirect, treatment system in which combined procedures are designed to stretch and reflexively release patterned soft tissue and joint related restrictions
199
structures and elements targeted by soft tissue OMT
muscular and fascial structures, neural and vascular elements
200
soft tissue OMT techniques
perpendicular, longitudinal, inhibitory
201
direct MFR (dMFR)
identify restrictive barrier in the myofascial tissues then engage the restrictive barrier with a loaded, constant, directional force until the tissue releases and motion is restored
202
indirect MFR (iMFR)
tissue position of ease is identified then engaged with direct pressure, guiding the tissues along the line of least resistance until free movement of all tissues is achieved
203
fascia definition
complete system with blood supply, fluid, drainage (largest organ system in the body) composed of irregularly arranged fibrous elements of varying density
204
fascia functions
mobility and stability of MSK system, tissue protection and healing, sensory
205
fascia is not
tendons, ligaments, aponeurosis
206
fascial connective tissue layers are mostly composed of
collagen and elastin fibers contained in an amorphous matrix of hydrated proteoglycans
207
fascial proportion of ECM and cells
95% ECM, 5% cells
208
list the four layers of fascia
pannicular fascia (panniculus), axial and appendicular fascia (investing layer), meningeal fascia, visceral fascia
209
pannicular fascia (panniculus)
outermost layer, derived from somatic mesenchyme, surrounds entire body with exception of the orifices
210
outer layer of panniculus
adipose tissue
211
inner layer of panniculus
membranous and adherent
212
axial and appendicular fascia (investing layer)
internal to the pannicular layer, fused to the panniculus, surrounds all of the muscles, the periosteum of bone, and peritendon of tendons
213
endomysium
part of investing layer, forms a continuous lattice connecting all the muscle fibers in the fascicle
214
compartment syndrome
swelling of muscles causing compression of nerves and blood vessels
215
meningeal fascia
surrounds the nervous system, includes the dura
216
visceral fascia
surrounds the body cavities (pleural, pericardial, and peritoneum)
217
transition zone associated with tendorium cerebelli
OA, C1, C2
218
transition zone associated with thoracic inlet
C7, T1
219
transition zone associated with thoracolumbar diaphragm
T12, L1
220
transition zone associated with pelvic diaphragm
L5, sacrum
221
cells located in fascia responsible for contraction
myofibroblasts
222
cells located in fascia responsible for healing
macrophages, mast cells
223
types of neurons in fascia
cutaneous high-threshold mechanoreceptors, stretch receptors, C fibers, piezoelectric
224
stretch receptor function
proprioception
225
C fiber function
pain: mechanical, thermal, chemical
226
C fiber description
unmyelinated, small diameter, low conduction velocity
227
piezoelectric neuron function
generate electric charge in response to mechanical stress
228
soft tissue OMT indications
diagnostic (TART), feedback about tissue response to OMT, improve local and systemic immune response, relaxation, enhance circulation to local myofascial structures, tonic stimulation
229
soft tissue OMT relative contraindications
direct techniques on acute injuries, prone pressure techniques in thoracostal region on severe osteoporosis
230
soft tissue OMT absolute contraindications
fracture, dislocation, neurologic entrapment syndromes, serious vascular compromise, local malignancy, local infection, bleeding disorders, lack of consent
231
MFR/INR OMT indications
somatic dysfunction (almost all soft tissue or joint restrictions), consider indirect MFR when HVLA is contraindicated, when counterstain may be difficult secondary to patient inability to relax
232
MFR/INR OMT relative contraindications
infection of soft tissue or bone, fracture, dislocation, metastatic disease, soft tissue injuries, post op patient with wound dehiscence, rheumatologic condition involving instability of C spine, DVT or anticoagulation therapy
233
MFR/INR OMT absolute contraindications
absence of somatic dysfunction, lack of consent
234
the most absolute contraindication
lack of consent
235
tissue texture abnormalities (acute versus chronic) soft tissue OMT Tx goals
1) stretch and increase the elasticity of shortened myofascial structures to return symmetry
2) improve local tissue nutrition, oxygenation, and removal of metabolic wastes to normalize tissue texture
236
asymmetry of muscles (hypertonic muscles/muscle spasm) soft tissue OMT Tx goals
return symmetry and normalize tone
237
tenderness (myofascial restrictions) soft tissue OMT Tx goals
release fascia
238
restricted (abnormal neurologic activity) soft tissue OMT Tx goals
1) normalized neurologic activity (pain, guarding, and proprioception)
2) improve abnormal somato-somatic and somato-visceral reflexes
239
soft tissue OMT initial application of force
gentle and of low amplitude, applied rhythmically 1 or 2 seconds of stretch followed by similar time of release of stretch
240
soft tissue OMT secondary applications of force
rate remains the same but amplitude increases that are tolerable to patient
241
soft tissue OMT parallel traction (stretch)
increase distance between origin and insertion parallel with muscle fibers
242
soft tissue OMT perpendicular traction (knead)
repetitive pushing of tissue perpendicular to muscle fibers
243
soft tissue OMT inhibition
push and hold perpendicular to the fibers at the musculotendinous part of the hypertonic muscle, hold until relaxation of the tissue
244
MFR OMT thoracolumbar release
1) diagnose restrictions in three planes
| 2) treat myofascial restriction by taking tissues direct or indirect barrier
245
MFR OMT types of activating forces
inherent forces, respiratory cooperation, patient cooperation, physician-guided, springing/vibration
246
MFR OMT inherent force for activation
using the body's primary respiratory mechanism (PRM)
247
MFR OMT respiratory cooperation for activation
refers to a physician directed, patient performed, inhalation or exhalation or a holding of a breath to assist with the manipulative intervention
248
MFR OMT patient cooperation for activation
patient is asked to move in specific directions to aid in mobilizing specific areas of restriction
249
MFR OMT treatment endpoint
when three dimensional release is palpated, continuous application of activating forces no longer produce change, recheck tissue
250
MFR OMT three dimensional release is palpated as
warmth, softening, increased compliance/ROM
251
MFR OMT physician-guided force for activation
after engaging a barrier or point of ease, physician sequentially guides the tissue or joint through various positions until path of dysfunction is retraced and released
252
MFR OMT springing/vibration force for activation
place hands on a dysfunction, apply variable degrees of pressure and/or frequency of force causing springing in the structure which activates release of the tissues
253
MFR OMT respiratory force for activation may be used in four ways
full cycle of respiratory effort, particular phase of respiration, breath holding, coughing or sneezing
254
MFR OMT respiratory force for activation: full cycle of respiratory effort
applied as a fascial/articulatory activating force
255
MFR OMT respiratory force for activation: particular phase of respiration
used to enhance the position of the area being treated
256
MFR OMT respiratory force for activation: breath holding
hold breath until "air hunger" to trigger a generalized relaxation
257
MFR OMT respiratory force for activation: coughing or sniffing
produces a respiratory impulse to assist in the release of restrictions
258
INR OMT release enhancing maneuvers (REMs)
breath holding, prone and supine simulated swimming, R/L cervical rotation, isometric limb and neck movements, patient evoked movement from cranial nerves (eye, tongue, jaw, oropharynx)
259
INR OMT goal of breath holding as REM
alter both intrathoracic and intrabdominal pressure using costodiaphragmatic, shoulder girdle, lumbopelvic interactions
260
structuring a patient visit
create a welcoming environment, speak the language, communicate, understand your goals, examine respectfully, make plans together, allow patient to teach about culture
261
violence screening questions are to be done in 1:1 setting and include
1) have you ever been hurt physically or sexually
2) are you currently being hurt physically or sexually
3) have you ever experienced violence or abuse
4) have you ever been sexually assaulted/raped
262
trauma-informed care (TIC)
adoption of principles and practices that promote a culture of safety, empowerment, and healing
263
adverse childhood experience study (ACES)
determined there to be 10 types of childhood trauma
264
ACES personal trauma
physical abuse, verbal abuse, sexual abuse, physical neglect, emotional neglect
265
ACES trauma related to other family members
alcoholic parent, mother who is victim of domestic violence, family member in jail, family member diagnosed with mental illness, disappearance of parent through divorce, death or abandonment
266
approach to post-trauma patients
safety, trustworthiness and transparence, peer support, collaboration and mutuality, empowerment, cultural/historical/gender issues
