Midterm Flashcards
What must you do before palpating a patient
Ask for consent
What is the doctor conduct
The professional has a duty to, without exception or reservation, consider the need, health, and well being of the client above the needs or desires of him or herself
What is the definition of palpation
To examine or explore by touching (an organ or area of the body) usually as a diagnostic aid.
What are the three components to palpating
Locating a structure, becoming aware of its characteristics, assessing its quality or condition so you can determine how to treat it
What are the three principles of palpation
Move slowly, avoid using excessive pressure, be present and mindful
What are the tables used in technique class
Zenith tables
What are the two doctor’s stance
Fencer/lunge and toggle/square stance
What is the fencer/ lunge stance
Legs are separated at shoulder width or greater and angled to the torso. Knees are bent, doctor’s back heel is off of the floor. Doctor can easily transfer weight forward and inferior toward his front foot
What is toggle/ square stance
Feet are parallel and aligned in the coronal plane. Maintain a neutral spinal posture by widening the stance and bending at the knees and hips.
Doctor’s stance should include
Contract/ engage abdomen and glutes and shoulders back
What to use when creating stability when palpating deeper structures
Both hands
How to use both hands when trying to increase stability
Place one hand on top of the other and apply pressure with the top hand to direct movement and depth while the bottom hand stays relaxed in order to palpate
What are the landmarks of the C spine
C1 TVP, C6 and C7
Landmarks of T spine
T3 and T7
Lumbar landmarks
L4
Sacrum landmark
S2
What is the last freely movable segment
C6
Vertebral prominence is where
C7
What vertebrae lines up with spine of scapula
T3
What vertebra lines up with the inferior border of scapula
T7
What vertebra lines up with the superior portion of iliac crest
L4
What are the landmarks of the anterior pelvis
ASIS and pubic bone
What are the landmarks of the posterior pelvic bone
PSIS and S2 tubercle
AKA of preload
Take off force
What is preload
Force applied to the body part being adjusted to take out excess slack in tissues and preload the joint to prepare it for an adjustment
AKA of thrust
Peak impulse force
What is thrust
Greatest amount of impulse force that you apply during adjustment
Equation for peak impulse force
Total force- take off force
What is the way FSTT measures speed
Time to peak force
What would occur during a general assessment
History (symptoms, family hx), inspection (symmetry, muscle balancing, redness swelling, temp, scoliosis, moles, scars), palpation
What to find in T spine palpation
Spinous process, interspinous space and TVP
TVP guideline of upper thoracic (T1-T4)
1 SP up and 1 to 1 1/2” lateral
TVP guideline to middle thoracic T5-T8
2 interspinous spaces up and 1-1 1/2” lateral
TVP guidelines lower thoracic T9-T12
1 SP up and 1-1 1/2” lateral
Muscles on the back to palpate
Trapezius, SCM, levator scapula, deltoid, teres major, infraspinatus, rhomboid major, latissimus dorsi
What do you look for in lumbar spine palpation
Spinous process, interspinous space, mammillary process
What to look for in pelvis palpation
Iliac crest, PSIS, S2 tubercle, ischial tuberosity, greater trochanter of femur, SI joint and coccyx
What characteristics of typical C-spine vertebrae
Rectangular body, bifid SP, 3 cervical lips (2 uncinate lateral process and 1 anterior-inferior process), bilateral TVP located anterior to the superior articular process, bilateral Transverse foramina in TVP, bilateral costotransverse grooves on each TVP, triangular shape spinal foramen
Characteristics of atlas
Ring shaped, no body no sp
Characteristics of Axis
No lateral uncinate process, odontological process (dens)
What are the suboccipital muscles
Obliquus capitis superior, obliquus capitis inferior, rectus capitis posterior major, rectus capitis posterior minor
What can you palpate in lumbar spine
Spinous process, interspinous space, mammillary process
What to palpate on pelvis
Iliac crest, PSIS, S2 tubercle, ischial tuberosity, greater trochanter, SI joint, coccyx
What does SOAP stand for
Subjective, objective, assessment and plan
What is covered under subjective portion
Health history intake paperwork, case history
What acronym is used for focused case history
OPQRST
What does OPQRST stand for
Onset, palliative/ provocative, quality, radiating, severity and time
Objective portion is
Based on chiros point of view using outcome assessments
What would be under assessment of SOAP
General assessment, diagnosis, phases of healing, overall prognosis, complicating factors, ADLs
What is under plan of SOAP
Treatment plan and billing
What is under treatment plan
Including treatments, at home care, recommendations, alerts, referrals, plan start and stop date
What are phases of healing
Subacute, acute, chronic and preventative
What would be under health history intake of subjective portion
Demographics including employment, problem area, medications, supplements, allergies, ROS, personal medical hx, family medical hx, smoking hx, social hx, and occupation/recreational hx
Posture definition
Intrinsic mechanisms of the human body that counteract gravity
What are the three components of postural input
Vestibulocochlear system, visual system and somatosensory system
The vestibulocochlear system has what two systems
Cochlear and vestibular
What is cochlear
Hearing
What is vestibular
Our awareness of head orientation with respect to gravity and the head’s changes in velocity and direction
Visual system consists of
Visual proprioception
What is visual proprioception
Where our bodies are in space, eyes stay even
What is the somatosensory system
Signals located in the joints, muscles, skin all provide input to the higher centers of the nervous system
What is ideal posture
Aligns the body segments so that the torques and stresses generated by gravity are minimized at each point in the China
Two components of ideal posture
Least internal expenditure of energy to maintain and forces of gravity neutralized by counter forces
Each persons posture is unique to their gravitational environment given their unique combination of
Physical, muscular and soft tissue characteristics
Action of sagittal plane
Flexion and extension
Action frontal or coronal
Addiction and abduction
Action of transverse
Rotation
From a lateral examination of ideal line of gravity/plumb line
Mastoid process or tragus of ear, just anterior to the shoulder joint, just posterior to the hip joint, just anterior to the knee joint, just anterior to the ankle joint (lateral malleolus)
Ideal upright posture demonstrates functionally by showing what on lateral examination
S shaped curve, head balanced on the neck, only one set of lateral structures (cheek bone, shoulders, knees)
Posterior or anterior view of ideal line of gravity/ plumb line
Midline of the skull, EOP, ears, shoulder (all borders even), spinous process, rib cage, iliac crest, gluteal crease, midway between knees,midway between ankles, feet arches and position
What curves are present at birth
Kyposis, thoracic and sacral
What curves form from birth to three months
Cervical lordosis
What curve should appear when baby able to start sitting, standing and walking
Lumbar lordosis
When does the adult form of both spinal curve and foot arches form
6 years of age
What occurs to the aging spine
Decreased cervical lordosis, flattened lumbar lordosis, lowered longitudinal arches in their foot, increased body sway
What are some common postural deviations
Scoliosis, hyperkyphosis, anterior head carriage, hyperlordosis, sway back and flat back
What is sway back
Anterior pelvic shift, increased lumbar lordosis, increased thoracic kyphosis, forward head, possible knees locked in extension
What posture requires the least amount of active muscle work depending on ligaments for structure, not muscles
Sway back
What is flat back
Posterior tile in pelvis, decreased lumbar lordosis
What is scoliosis
Any lateral deviation of the spine from the midsagittal plane
What are the two types of scoliosis
Structural and functional
What is structural scoliosis
When the lateral deviation is fixed and does not correct during lateral bending
What is functional scoliosis
Compensatory, postural and transient. Reversible of the abnormal curvature with various positions and movement
How to set up for Adams sign
Patient standing, examiner observes for scoliosis standing, then has patient flex forward to touch their toes and observes for rib humping/ scoliosis
What is a positive Adams sig
Abnormal rib hump on one side
What can cause postural changes in childhood
Frequent illness (four or more/year), low physical activity, puberty rapid growth due to imbalance of bone growth and the development of the supporting and controlling soft tissue associated
What can cause postural changes in adulthood
Maintaining fixed position, hormone related changes, temporary changes such as pregnancy or pain or pathological processes
What is maintaining a fixed position
Mechanism of postural changes: loading of the spine and discs, ischemia of certain muscles
What disorders that may alter posture and gait
Pain or discomfort, muscle weakness or imbalance, limitation of joint motion, in coordination of movement (neuro condition), changes or deformities in bone or soft tissue
What is the patient placement to look for posture
Assume a relaxed stance with feet separated approximately 3 inches, look straight ahead, arms handing loose at the side, gown and shorts, no footwear
If patient has orthotics, how to place patient for posture check
With and without shoes
