MIdterm Flashcards
What are the five components of PRM
Inherent mobility of brain and SC, fluctuation of CSF, mobility of intracranial and intraspinal membranes, articulatory mobility of cranial bones, involuntary mobility of sacrum btw ilia
What creates cranial motion
Glial cells
What is the layer palpation used for cranial
Hair, skin, subcutaneous tissue, bone
Can you feel the CRI if a patient holds their breath
Yes
What is the Sutherland fulcrum
Functional name given to straight sinus
What is reciprocal tension membrane aka core link
Meninges and the cord constitute a link btw cranium and the sacrum
What fascia affect the PRM
Pannicular, axial and appendicular, meningeall, visceral
What creates the reciprocal tension membrane
Falx cerebra and cerebellum and tentorium; holds vault and base under constant tension; allows for change in the vault while maintaining constant volume; allows but limits motion
What are the main poles of attachment of the RTM
- anteriorsuperior pole: Crista Galli
- anterior/inferior pole: clinoid process of sphenoid
- lateral pole: mastoid angels of parietals and petrous ridges of temporal bone
- posterior pole: internal occipital protruberance and transverse ridges
What is a suspended automatic shifting fulcrum
Suspended: moves but remains in RTM
Automatic: moves with motion of CRI
Shifting: straight sinus moves up and down
Where is the point of function
Straight sinus - junction of falx and tentoria
What is extension of SBS paired with in terms of breathing
Exhalation; cheekbones prominent; SBS decreased angle
Where does the dura attach that influences sacral motion
Foramen mangnum and posterior body and disc of S2
What is the postural sacral axis
Transverse axis of nutation/counternutation throuh anterior part of S2
What is the pelvic/ileal axis
Functional transverse axis at S3; movement of ilia on sacrum
What axis does movement occur on for the sacrum during PRM
Superior transverse
What contributes to health
Unity, structure/function, and self healing
What are the models of osteopathic treatment
Postural structural, neuro, respiratory circulatory, bioenergy, psychosocial
What does the approach to the patient of osteopaths look like
Structural exam (objective); changing* address the cause and not the effect
What are the midline (unpaired) bones
Sphenoid, occiput, ethmoid, mandible, vomer, frontal
What are the paired bones
- cranial vault: parietal, temporal, squamous temporal, frontal
- facial: inferior nasal concha, lacrimal, maxilla, nasal, palatine, zygoma
What axis do the paired bones usually rotate around
AP axis in the coronal plane
What are the parts of the ethmoid
- horizontal: cribriform plate; includes crista galli
- perpendicular plate
- lateral masses: form orbital plates - medial walls of orbit; forms middle and superior concha
How does the ethmoid move in flexion
Perpendicular plate is rotated by the sphenoid about its transverse axis; crista galli moves superiority and posteriorly
-external rotation: lateral masses expand inferiorly due to pull of external rotation of maxillae
How does the ethmoid move in extension
Crista galli moves inferiorly and anteriorly
-internal rotation
What clinical considerations would you consider for an ethmoid dysfunction
- Sinusitis: lateral masses move into external rotation with widening o ethmoid notch and external rotation of maxillae, opening nasal passage; ER/IR creates pumping acting on ethmoid sinus
- septal deviation
- headache: lymphatic backup -> increased dural tension and vascular effects
What does the vomer articulate with
Sphenoid, ethmoid, septal cartilage, maxillae, palatines
Describe the motion of the vomer in flexion and extension
Flexion: wide flat palate
Extension: narrow, tall palate
*depresses the hard palate with SBS flexion
How do the ethmoid and vomer move during SBS flexion
Ethmoid: same as occiput
Vomer: same as sphenoid
What do the palatines articulate with
Sphenoid, ethmoid, maxilla, vomer, contralateral palatine, inferior concha
How do the palatines move during flexion
Palate flattens; eternally rotates (horizontal plate moves laterally and inferiorly)
What are clinal correlations for dysfunction of palatine
Swallowing/speech difficulties
How do you name a torsion
Superior sphenoid wing
What axis is involved in a torsion
AP (rotate in opp direction)
What axes are involved in lateral strains
2 vertical axes; sphenoid and occiput spin in same direction
How do you name a lateral strain
Direction of the translation of the basisphenoid (ie: left would be sphenoid base to left and occipital base to right)
How do you name sidebending rotation
Flexed side (convex side)
How do you test for SBS compression
Lift lateral angles of frontal bone anteriorly with the thumbs while stabilizing the lateral angles of the occiput posteriorly with the hands in vault hold
What does the parietal bone articulate with
Occiput, frontal, sphenoid temporal, opposite parietal
Which bone is the only one that connects all 4 fontanelles
Parietal
Where is the origin of the temporalis m
Lower temporal ridge
What happens to the Pterion asteroid and squamous sutures during flexion
Move laterally
What happens to the Sagittal suture during flexion
Ones inferiorly
What are the signs and sx of parietal bone dysfunction
- cranial synostosis: premature closure of sutures
- head pain: Om and asterion - tension HA pterion - temporal
- giant cell arteritis
- head, face and tooth pain (temporal)
What does the squamous portion of the temporal bone obtain
Zygomatic process
What does the petrous portion of the temporal bone contain
Otovestibular organ, eustahian tube exit, border of foramen lacerum (lacrimmation), attachment of tentorium, internal carotid, styloid process, jugular foramen
What does the temporal bone in a newborn skull lack
Mastoid process
What does internal rotation of the temporal bone abuse
High pitched tinnitus
What happens during external and internal rotation of the temporal bones
External: squamous portion moves laterally, mastoid process moves medially
Internal: squamous moves medially; zygomatic process more prominent;
What drives temporal bone motion
Occiput through Om
What are the signs and sx of temporal bone SD
- Tmj pain
- head pain
- neck pain: Scm
- dizziness, ear infections swallowing and chewing; Bell’s palsy
How does the frontal bone move
External: lateral side moves anterior/lateral and slightly inferior; glabella moves posteriorly
What are the signs and sx of frontal bone SD
- head pain from diminished cSF flow due to increased dural tension at cribriform plate: coronal suture: tension headaches ; pterion: temporal
- sinusitis
- double vision
- anosmia
- frontalis m
What does bicoronal synostosis cause
Bracycephaly; restriction of growth of the anterior fossa resulting in wider skul
What does unicoronal synostosis cause
Anterior plagioephaly; head flat on effected side and ear forward; c shape or facial twist (base of nose drawn towards affected side and tip of nose pointed away)
Where is the Eustachian tube most likely to get blocked
At the cranial base where the sphenoid and temporal bones meet
Where is the exit of the eustahian tube
Junction of petrous portion of temporal and sphenoid
How can you treat otitis media
Temporal rocking …… or give them fucking antibiotics
Which arteries cause the most headaches
Anterior and idle erebral and intracranial portion of internal carotid
Which veins have a dural envelope
Superior and inferior Sagittarius sinus, straight sinus, transverse sinus
Where does the trigem go out
superior orbital fissure (also 3 4 6) Foramen rotunda and Oale
Where are the foramen oale and rotunda located
Sphenoid bone
Where is the trigem ganglion
Temporal bone
Where does the tentorium erebelli attach
Petrous portion of temporal bone
What are some benefits that research has shown of cranial
Shorter IU stay; easier to fall asleep (neuro) *used in post trauma
What help you pout
Depressor labii inferior
What does the leator Anguli orisdo
Snarl
What does risorius do
Approiates lips and draws lips and lateral corners lateral - grimace
What trauma an cause TJ
Direct whiplash third olar extraction intubation * if direct blow with losed outh - posterior capsule injury
What an be some auses of tj
Opensatory changes - short leg syndrome scoliosis *work oral habits sports developmental ab ood disorders
What an cause intraapsular TJ
Infection RA OA gout artiular dis displacement
What are risk factors for TJ
Neck trauma female hormone
Are there genetic risks for TJ
No
When should you do radiographs for TJ
R/o tooth problems *ri
What hoe eerises an you do for TJ
Pads of fingers over hin open outh and push against fingers as you inhale; exhale and lose outh
What is the teporalis self treatment
Hot packs for 15-20 in; stretch with pinky finger pad placed firmly behind hairline and rest of the fingers in hair around ears apply traction up while opening and losing outh
What has poorer prognosis with TJ
Psychiatri factors; prolonged use of opiates beno alcohol
What is a facilitated segment
SD; *two hallmarks - lower threshold and hypersensitiiity
What would indicate parasympathetic dysfunction
On suture restriction; OA AA SD; sacrum
How an you balance the ANS
see-\/ 4 technique; regional: rib raising paraspinal inhibition; ab ollateral ganglion; type II SD of spine; suboipital inhibition; sphenopallatine ganglia release; sacral inhibition and rocking; SI gap
What deceases sympathetic activity
RIb raising; paraspinal inhibition; ganglia inhibition; type II SD
What will normalize parasympathetic tone
Suboipital release; sphenopalatine release sacral inhibition and rocking; SI gap; BLT
What did the Hearts of rabbits with T3 and atlas SD look like
Abnormal Olor to tissue; abundant fibrils; edema; hemorrhagic areas
What should you look at for head pain
Head neck upper thorax upper ribs UE sacrum posture leg strength
What auses head pain of anterior 2/3 s posterior 1/3
Anterior: trigem; posterior: lesser oipital (1-3) and recurrent branches of 9 and 10
What tension HA PE findings will you see
Periranial tenderness; neck tenderness; neuro normal
What is the neuro treatment of tension HA
-analgesics
What is the etaboli treatment for tension HA
Sleep hygiene hormonal influences hydration
What treatment is ost effective for tension HA
FR
What are the risk factors for migraine
Analgesia overuse; multiple sclerosis
What is the ost frequent ause of neck -headache
2-3 facet
What is neck tongue syndrome
Rapid head turning auses subluxation of posterior AA joint and 2 spinal root kopression; neck pain occipital pain ipsilaterall tongue sensory symptoms
What OT should you not do for neck ha
HLA
What are the eraperitonial organs (no mesentery)
Retro: descending and horizontal duodenum; pancreas; ascending and descending kolon; see-u; upper 2/3 rektu infra: lower 1/3 rektu
What does iseral pain feel like
Irritation spasm; poorly localized; ague; deep burning; sweating; N; pallor
What does Soatik pain feel like
Well localized; asymmetric ; sharp; aggravated
What is the percutaneous reflex of orley
Direct transfer of inflammatory irritation from isera to peritoneu; not reflex through iseral afferent reflex; ie: appendicitis - peritonitis
What is the sympathetic part of ANS in GI system
-thoracic splanchnic n - seliak and superior mesenteric ganglion; lumbar splanchnic- inferior mesenteric
What levels do each of theganglion have
See-Liak: T5-9; superior: T10-11; Inf: T12-L2
What does the left agus n innerate
Greater urature of stomach
How does the pelvic diaphragm go
During inhalation - inferiorly
What nodes do diff parts of the abdomen drain
See Liak: stomach duodenu and spleen and liver; superior: jejunum ileum ascending and transverse olon; inferior: desneindg and sigmoid rectum
What are some antiinflaatory foods
Olive oil tomatoes nuts spinach kale salon blueberries and oranges
When do you stop OT in Gi patient
-relaxation of soft tissues; altered Autonomic tone; peripheral asodilation (increased skin temp/redness/swelling); increase in HR or resp rate; urgent to use restroom
What is the diff btw sacral rocking and inhibition
Rocking increases parasympathetic tone; inhibition dereases it
What are the kontraindikations to mesenteric release
AAA; open surgical wound
Describe olon release
-sigmoid: on anteroedial side of left pel Bri with fore directed toward RUQ; descending: L posterolateral flank with medially directed fore; transverse: inferior to costal margin with inferior directed force; ascending: right posterolateral flank with a edially directed fore
What are the indications for si release
Indigestion delayed gastri eptying holestasis
When would you not perfor SI release
Peritonitis splenomegaly recent ag surgery
