Lectures 1, 2, 3, 4, 5, & 6 Flashcards
What did A.T. Still do?
- saw relationship bw structures of musculoskel and function in health and diease
- experimented with manipulation and found better results than with other treatments of his day
- practiced surgery, obstetrics (midwifery), and patient education (moderation and avoidance-alcohol and smoking)
Philosophy of Disease on diease (CLassic)
- disease is the effect of an abnormal anatomic state with subsequent physiologic breakdown and decreased host adaptability.
- decreased host adaptability (process of getting sick)can be influenced further by adverse environmental conditions to cause more disease.
philosopy of disease on symptoms (CLassic)
- symptoms often were due to an artery not feeding blood to an area=decreased function=disease
- BV controled by nerves that can be irritated by incorrectly positioned bones or ligaments
philoophy of disease fluid accumulation (CLassic)
- irritated or improperly fucntioning areas have accumulation of fluid from poor drainage of veins and lymph system
- pathophysiologic processes (DISEASE) is commonly created by accumulation of fluids (congestion/inflammation)
Osteopathic tenets were formed from ____ by ____.
many osteoppathic principles
by kirksville college of osteopath med
4 tenets of osteopathy
1) The body is a unit; the person is a unit of body, mind, and spirit.
2) The body is capable of self-regulation, self-healing, and health maintenance.
3) Structure and function are reciprocally interrelated.
4) Rational treatment is based upon an understanding of the basic principles of body unity, self-regulation, and the interrelationship of structure and function.
Pain in the body affects
thinking
emotions
eventually function
anxiety of the mind and nervousness affects
increased tension in muscles
muscle disease
stomach disease (ulcers)
intestinal disease
Someone who does not feel accepted (spiritual) can end up with …
with huge levels of stress that can lead to ulcers, head aches, chronic pains, etc
Surgery depends on…
the body’s ability to heal its wounds once the ends are approximated and fixed in place
when are atrophied muscles able to re-grow?
when nerves are relieved with OMM, therapies or surgery
Viscerosomatic reflex is and does?
T5-T9 on the left affec tthe function of the stomach
What does C5 do?
innervates and affects the function of the Rhomboids (upper back muscles)
A slightly shorter leg can affect…
(its a myofascial triggerpoint) the knee, low back and head/neck
Rational treatment includes… and IF NOT?
OMM!
If NOT, then tenets1-4 represent regular medicine, which is not irrational but it is then osteopathically incomplete
OMM…
- Restores proper function in the human body by manually treating abnormal structure found in the musculoskeletal system.
- Osteopathic Manual Medicine (OMM) is ONLY ONE of the many ways the osteopathic physician treats patients.
- OMM is among the founding principles of the profession
OMM’s function:
1) OMM is designed to find and relieve Somatic Dysfunctions (SD)
2) A SD is a musculoskeletal restriction in motion that affects the patient’s function.
3) This can only be diagnosed by observation and palpation for asymmetry, tissue texture changes and motion abnormalities.
Somatic dysfunctions classical definition:
Impaired or altered function of related components of the somatic (body framework) system: Skeletal; Arthrodial; Myofascial structures; And their related vascular, lymphatic and neural elements
SD Concept: we need to view the clinical presentation (Illness) as a _____ and not just as a _____.
combination of factors
NOT JUST AS A DISEASE
disease is almost always combined wtih…
a somatic dysfunction in the host
Complete clinical presentation a pt comes in with is…
the disease PLUS the host response to illness (the SD)
anterior vertebral body is for
weight bearing
vertebral arch function
protects the spianl cord
formed by the R and L pedicles and laminae
Vertebral foramen function
space behind the body of the vertebrae
vertebral canal fucntion
houses the spinal cord and meninges
made by the succession of the vertebral foramina in the articulated column
pedicles function
Join the vertebral arch to the vertebral body
laminae fucntion
Two braoad, flat plates of bone which project from the pedicles and unite in the posterior midline
Intervertebral (or Neural) Foramen
Formed by the superior and inferior vertebral notches.
Spinous Process
- Projects posteriorly from the junction of the lalminae
- Function as muscle attachment to provide movement
Transverse Processes
- Project posterolaterally from the junction of the pedicles and laminae
- Function as muscle attachments to provide movement
Articular Processes
- Two superior
- Two inferior
- Also arise from the junctions of the pedicles and laminae, each bearing an articular surface or Facet
- Function to restrict (or guide) movement
- Pars Interarticularis is the portion of bone between the superior and inferior articular processes.
intervertebral disks
- shock absorber of the spine and is made up of two main parts:
1) The Annulus Fibrosus; the outer layer of the disc, which is a fibroelastic mesh made up largely of fibrocartilage.
2) The Nucleus Pulposus; a gel-like substance inside the ring of the annulus fibrosus, made up of mucopolysaccharides.—> This is an avascular tissue.
T11 and T12 act like
act like lumbar vertebrae because they are not attached anteriorly to the thoracic cage through the ribs
have floating ribs
Functional nubering of the thoracic and lumbar spine
- TEN thoracic
- 7 LUMBAR (BC T11 and T12 are LIKE LUMBAR
Two major types of curves in the spine:
1) Kyphotic Curve: where the concavity of the spinal curve is anterior
The thoracic and sacral curves are normal kyphotic curves.
2) Lordotic Curves: where the concavity of the spinal curve is posterior.
The cervical and lumbar curves are normal lordotic curves.
Kyphosis and Lordosis
“-OSIS” ending?
NOT normal curves - Exaggerated curves
“-osis” is a word element meaning disease; morbid state; poor healing; degeneration
In this case it means: abnormal increase.
scoliosis
- Always abnormal
- Lateral curvature of the spine
- The functional impairment caused by scoliosis depends on the degree of curvature
Thoracic kyphossi due to:
-Degenerative disc disease (as in old age)
Osteoporosis, from anterior compression (or wedge) fractures: Dowager’s hump is when a thoracic kyphosis is caused by osteoporosis.
Postural: Flexed Somatic Dysfunctions in the thoracic spine
Dowager’s hump
when a thoracic kyphosis is caused by osteoporosis.
Lumbar lordosis
- Abnormal increase in the lumbar lordotic curve
- Characterized by an anterior rotation of the pelvis at the hip joints producing an abnormal increase in the lumbar curvature.
- The sacral base (or top of the sacrum) tilts forward.
- associated with weak trunk musculature
Pregnant women have what kind of curve?
lordosis
Lordotic and Kyphotic curves are
NORMAL - The term is defined normal
dont need to say Normal lordotic curve
four functions of the spine
1) Provide support for ligaments, muscles, and tendons that attach to the spinal column.
2) Provides protection for the CNS: spinal cord and the meninges.
3) Weight bearing: Spine is very, very durable and bears the weight of the whole body and head.
4) Cushioning Effect
sagittal plane divides body into
R and L halves
What movement occurs within the sagittal plane?
flexion/extension within
What movement occurs within the coronal plane?
side bending
Also: The thoracic spine articulations face in the coronal spine.
What movement occurs within the horizontal plane?
rotations
four motions of the spine
1) Flexion: Straight forward bending (sagittal plane)
2) Extension: Straight backward bending (sagittal plane)
3) Side bending: lateral bending (coronal plane); Sidebent side is the concave side
4) Rotation: movement around a vertical axis (transverse plane); Anterior aspect of the body points to direction of rotation
Flexion loads the
Flexion stretches the
Loads the anterior elements (vertebral body, discs)
Stretches the posterior elements and posterior muscles.
Extension loads the
Extension stretches the
Loads the posterior elements (facets, pars interarticularis)
Stretches the anterior elements and muscles.
Sidebending loads
Sidebending opens
Sidebending stretches
Loads the facets on one side, closing the neuroforaminal canal
Opens the facets on the other side
Stretches elements and muscles on the opposite side
naming rotations by using
the ant superior surface of the vertebrae
Functional Vertebral Unit
- Vertebral Unit: Two adjacent vertebrae with their associated intervertebral disk, arthrodial, ligamentous, muscular, vascular, lymphatic and neural elements.
- The motion of one vertebra is not described as if it moved in space all by itself; it is described as it moves in relation to the vertebra below.
- So the side-bent vertebra is the one on top of the one below.
- This applies for rotation, flexion/extension, etc.
typical cervical vertebrae are
C3-C6
Typical Cervical Vertebrae Characteristics:
- Saddle shape, small bodies; these have the smallest bodies of the spine.
- Spinous processes are bifid (divide at the tip) allowing for more muscle attachments.
- There are holes or foramen in the transverse processes for the vertebral artery and veins to pass through.
The vertebral arteries pass through the transverse foramen of vertebrae
C1-C6
characteristics of C7
- C7 has a long non-bifid spinous process
- vertebral artery does not pass through the transverse foramina
- C7 also has the longest transverse processes of the cervical spine
C1 characteristics
- Atlas, is an atypical vertebra –> no body.
- It has a very small spinous process.
- The occipital bone rests on the ring of C1.
- This shape allows for flexion and extension.
- (occiput and C1) = joint.
C2 characteristics
- Axis; atypical vertebra.
- The dens/odontoid process is a modified body; this provides the function of rotation.
- The dens and odontoid bones form the “NO” joint.
- Over 50% of rotation occurs in this joint.
thoracic spine
- KEY THING: has facets for rib articulation- on vertebral bodies and transverse process of thoracic vertebrae
- bodies =heart shaped and long slender spinous process
- articulations of intervertebral facets are facing in coronal plane
lumbar spine
- large kidney shaped bodies
- LARGEST BODIES AND INTERVERTEBRAL DISKS
- articulations of intervertebral facets are facing in sagittal plane
sacrum
- wedge shaped (triangular)
- bw spine and ilia
- 4 foramina on each side - for nerves to exit through
ant longitudinal ligament
Main function :
Prevents hyperextension of the spine
-STRONGER THAN POSTERIOR LONG LIG
post longitudinal ligament
- This ligament covers the posterior aspect of the vertebral bodies and intervertebral discs from the body of the axis (C2) to the sacrum
- Function: prevents hyperflexion
- most freqwuent area for disc herniation
erector spinae
illiocostalis
longisimus
spinales
Palpation is
of using the hands to uncover and receive information without disrupting tissue.
active motion
movement by pateint
passive motion
movement by physician while pt remains relaxed
Need what for proper OMM
- practiced palpaton
- knowledge of ANATMOY (KNOWING NORMAL)
The osteopathic structural exam is used to… by…
WHen is it done?
to be done after medical history and physical exam
find somatic dysfunction in any part of the body
by havin ght epateint in multiple positions to provide static and dynamic eval
OBSERVE, PALPATE, ASK ABOUT PAIN
static eval
NO MOVEMENT - assess for: Abnormal position (side-to-side comparison) Bony or soft tissue abnormalities Tenderness Temperature
dynamic eval
phys induces movement or asks the pt to mvoe something (ACTIVE AND PASSIVE)
assess for:
Restricted range of motion (ROM)
Pain – if present ask “Where is the pain?”
Crepitus (a feeling of grinding that may or may not be audible)
Joint popping or clicking (may or may not be audible)
Proper Osteopathic structural exam and manual medicine treatment are dependent upon
Palpation: static, motion (passive & active)
visual inspection
communication with the patient
knowledge of normal structure
knowledge of abnormal structure and how it affects function
knowledge of disease
3 cardinal steps in in every proper Dx and Tx with OMM
1) Diagnosis of the specific structure (SD).
2) Treatment of the specific SD.
3) Rechecking of the specific SD just treated to determine the effectiveness of the treatment.
ALL DEPENDS ON PALPATION
Process of Palpation: Description (way to remember describe)
T.A.R.T.
T=tissue texture abnormality (TTA)
A=Asymmetry (side to side difference),
R=restriction of motion
T=Tenderness (not pain)
Pains chronic/acute
acute=severe cutting or sharp
chronic=dull achy with paresthesias
skin changes acute/chronic
acute=warm moist red enflamed
chronic=cool, pale
vasculature acute/chronic
acute=vasodilation inflammation edema
chronic=constricted due to sympathetics
sympathetic activity acute/chronic
acute=increased (vasodilation)
chronic=local vasoconstriction due to hypersympathetic tone
musculature acute/chronic
acute=inc muscle tone
chronic=decreased muscle tone
mobility chronic/acute
acute=range of motion normal but qualit yis sluggish
chronic=ROM is diminished but quality of remaining movemnet is normal
soft tissues acute/chronic
acute=boody edema, acute congestion, fluids from vascular leakage, chemical reaction i nthe tissues
chronic=congestion, cloughy, stringy fibrotic, increased resistance to penetration, contracted, contractured
achexa acute/chronic
acute=moist skin, no trophic changes
chronic=scaly dry skin, pimples, follicullitis, altered pigmentation
vaisceral acute chronic
acute=minimal somatovisceral reflect effects
chronic=common somatovisceral reflex effects
dorsum of the foot is the
top of the foot
dorsum of the hand is the
back of the hand
lumbar puncture b/w
4th and 5th lumbar
iliac crests
level of L4
