Midterm Extra Info Flashcards
CRI rate
10-14 BPM
CRI direction
linear and symmetric
CRI characteristics (RRADS)
Rate, Rhythm, Amplitude, Direction, Strength
Function of dural folds (falx cerebri/cerebelli and tentorium cerebelli) in cranial movement
act as reciprocal tension membranes, springing the cranial bones
storing energy in flexion (stretch) and releasing in extension (rebound)
SBS flexion/inhalation
Sphenoid rotates anteriorly,
Occiput rotates posteriorly
head gets shorter and wider
SBS extension/exhalation
Sphenoid rotates posteriorly,
Occiput rotates anteriorly
head gets longer and narrower
Sacral motion in SBS flexion
counternutation : dural pull, sacral base moves posterior
Sacral motion in SBS extension
nutation : dural release, sacral base moves anterior
*moves towards the nuts
CNs that travel thru the optic canal (1)
Optic
CNs that travel thru the superior orbital fisure (4)
Oculomotor
Trochlear
V1 (opthalamic)
Abducens
CNs that travel thru the foramen rotundum (1)
V2 (maxillary)
CNs that travel thru the foramen ovale (1)
V3 (mandibular)
CNs that travel thru the internal acoustic meatus (2)
Facial
Vestibulocochlear
CNs that travel thru the jugular foramen (3)
Glossopharyngeal
Vagus
Accessory
SBS joint type
synchondrosis of hyaline cartilage
Paired bones in cranial motion (3)
Frontal, Parietals, Temporals
flexion and extension
Paired cranial bone movement in flexion
EXternal rotation in flEXion
flexternal
Paired cranial bone movement in extension
internal rotation
Ethmoid movement in cranial motion
rotates same direction as occiput (vowels move together)
- moves like a gear against the sphenoid
- sphenoid rotates forward in flexion, so ethmoid/occiput rotate backward
Vomer movement in cranial motion
rotates same direction as sphenoid (consonants move together)
*sphenoid rotates forward in flexion, so vomer rotates forward
Doc who invented cranial omm
William Garner Sutherland
Rotation axis of midline bones (occiuput, sphenoid, ethmoid, vomer)
transverse axis (F/E)
Rotation axis of paired bones
saggital axis (IR/ER)
Cranial vault contact
Thumbs: Frontal Index: Greater wing sphenoid Middle: Anterior to ear Ring: Mastoid process Pinky: Occiput Palms: Parietals
Frontal occipital contact
Top hand: thumb and index finger on opposite greater sphenoid wings
Bottom hand cradles occiput
Becker contact
thumbs on greater sphenoid wings
Left Torsion
Saggital axis (opposite)
Air hands: rotate opposite directions w/
Lt index going up, Rt index going down
Right Torsion
Saggital axis (opposite directions)
Air hands: rotate opposite directions w/
Rt index going up, Lt index going down
Right Sidebending Rotation
Saggital axis (same), 2x vertical axes (opposite)
Air hands: spread and scrunch
Rt hand gets wider, Lt hand gets narrower
*named based on wide side
Left Sidebending Rotation
Saggital axis (same), 2x vertical axes (opposite)
Air hands: spread and scrunch
Lt hand gets wider, Rt hand gets narrower
*named based on wide side
Superior Vertical Strain
Parallel transverse axes (same)
Air hands: rotate same direction
Lt and Rt hand rotate forward
*named for base of sphenoid movement
Inferior Vertical Strain
Parallel transverse axes (same)
Air hands: rotate same direction
Lt and Rt hand rotate backward
*named for base of sphenoid movement
Left Lateral Strain
Parallel vertical axes (same)
Air hands: parallelogram
Pinkies shift Lt, Index fingers shift Rt
Right Lateral Strain
Parallel vertical axes (same)
Air hands: parallelogram
Pinkies shift Rt, Index fingers shift Lt
Strain pattern caused by trauma at the temporal bone (DIRECTLY AT THE LEVEL OF THE SBS)
Sidebending rotation strain
Strain pattern caused by trauma at the pterion or asterion (anterior or posterior to the SBS)
Lateral strain
Strain pattern caused by downward force on top of the frontal bone, or upward force at the occiput
Inferior strain
*both would cause the base of the sphenoid to move (relatively) inferiorly
Strain pattern caused by upward force on the mandible, or downward force at the saggital suture (parietal bones)
Superior strain
*both would cause the base of the sphenoid to move (relatively) superiorly
Strain pattern caused by rotational force anterior or posterior to the SBS
Torsion strain
Rotator cuff special tests
empty can, apprehension, drop arm
Shoulder impingement special tests
Neer, painful arc, hawkins
AC joint pathology special test
cross arm
Inhaled rib MET/ART
Push bottom rib down into exhalation
Rib 1-2 Exhaled MET/ART
pt hand on forehead, flex head against force
Rib 1 = ant/mid scalene
Rib 2= post scalene
Rib 3-5 Exhaled MET/ART
pt arm above head and pull down against force
Rib 3-5 = pec minor
Rib 6-8 Exhaled MET/ART
pt cross arm and push elbow towards ceiling
Rib 6-8 = serratus anterior
Rib 9-10 Exhaled MET/ART
pt force elbow behind them
Rib 9-10 = lat dorsi
Rib 11-12 Exhaled MET/ART
pt scrunch back (sidebend), physician push rib up
Rib 11-12 = quad lumb
Spencer Technique
- E
- F
- compression circumduction
- traction circumduction
- Add/ER or Abduction
- IR
- traction inferior glide
AC joint dx
step off = superior clavicle
step on = inferior clavicle
also assess ER/IR
Tx w/ circulatory sweep or ER/IR MET
SC joint dx (clavicular head)
shrug = abduction = inferior/caudal movement
lowered shoulders = adduction = superior/cephalad movement
shoulder protraction = flexion = posterior movement
shoulder retraction = extension = anterior movement
Sacral Diagnosis
bend, spring, sphinx, respiratory
SEATED forward bend test to lateralize
+ Lumbar spring test = resistance to springing = E sacrum
+ Backward bend test = worsened assymetry = E sacrum
Respiratory motion = E on Inhale, F on exhale
Sacral torsion bases/ILAs
Same movement on same side
Opposite movement on opposite side
i.e. L base posterior L ILA posterior R base anterior R ILA anterior
PA
PA
Sacral unilateral flexion bases/ILAs
Opposite movement on same side
Same movement on opposite side
i.e. L base posterior L ILA anterior R base anterior R ILA posterior
PA
AP
Radial Head movement
Radial head moves posterior with pronation
anterior with supination
Fibular head movement
Fibular head moves posterior with plantarflexion (also inversion)
moves anterior with dorsiflexion
Viscerosomatic Levels:
Head/Neck/Upper esophagus
T1-5
Viscerosomatic Levels:
Heart
T1-6
Viscerosomatic Levels:
Lungs
T1-7
Viscerosomatic Levels:
Upper GI
T5-10
Viscerosomatic Levels:
SI and Ascending colon
T9-11
Viscerosomatic Levels:
Ascending/Transverse colon
T10-11
Viscerosomatic Levels:
Descending/Sigmoid colon/rectum
T12-L2
Viscerosomatic Levels:
Adrenals
T5-10
Viscerosomatic Levels:
GU and Ureters
T10-L2
Viscerosomatic Levels:
Upper extremities
T2-7
Viscerosomatic Levels:
Lower Extremities
T11-12
Cranial technique that increases CRI amplitude
CV4
CV4 tx
thenar eminences on the occiput
encourage extension of occiput (anterior rotation)
hold still point
HA dx?
Bilateral tight/achy/band-like pain that radiates from cervical region
Due to trauma, strain, sedentary life, TRIGGR POINT
Tension HA (most common)
Smoking cessation helps reduce number of what type of HA?
Tension HA
HA dx?
Unilateral throbbing/burning pain
May have aura, N, photo/phonophobia
Triggered by stress, hormones, sleep dist, etc
Migraine
Tx for medication rebound HA (most commonly due to use of chronic pain meds)
discontinue med
Tx for tension HA
biofeedback, NSAIDs
Tx for Migraines
biofeedback, triptans, propalolol
Tx for Cluster HA
Triptans, Oxygen
ADC VANDALISM for inpatient admission
Admit to Dx Condition Vitals Allergies Nursing instructions Diet Activity Labs IV fluids Special instructions Medication/Monitoring
How to avoid anchoring bias
dont get hooked on first thing heard from referring physician, do HPI and PE yourself
How to document assessment
order of importance
TMJ BLT worse while opening
compress mandible and push laterally to point of ease
TMJ BLT worse while closing
open mandible and push laterally to point of ease
Masseter CS
pt relax jaw, translate TOWARD tenderpoint
Medial pterygoid CS
TP on medial part of angle of mandible
translate AWAT from tenderpoint
Temporalis/masseter/medial pterygoid MET for lateral deviation
RB is opposite of side of deviation, pt force toward side of deviation
*i.e. left deviation = cant go right = right sided RB
doc force right, pt force left
Temporalis/masseter/medial pterygoid MET for S curve deviation
depress jaw to engage RB, have pt try to close
*these muscles close the jaw, so direct barrier will be found with opening jaw
Lateral pterygoid/digastrics/mylohyid/geniohyoid MET for S curve deviation
close jaw to engage RB, have pt try to open
*these muscles open the jaw, so direct barrier will be found with closing jaw
Diagnostic criteria for FMS
Diffuse pain + >3 months + no other explanation
Tx for FMS
amytriptyline, gabatentin, cyclobenzaprine, tramadol, duloxetine, milnacipran, cannabinoids, Vitamin D (only if low)
exercise, proper sleep
OMT (mainly indirect txs)
Categories of nerve injuries
focal damage to myelin fibers, sheath remains intact
1 degree (neuropraxia)
Categories of nerve injuries
injury to axon itself with myelin remaining intact
2nd degree (axonotmesis)
Categories of nerve injuries
disruption of axon + endoneurium
3rd degree neurotemesis
Categories of nerve injuries
disruption of axon + endoneurium + perineurium
4th degree neurotemesis
Categories of nerve injuries
disruption of axon + endoneurium + perineurium + epineurium
5th degree neurotemesis
Peripheral nerve damage
broken proximal humerus, triceps dysfuntion, decreased sensation over dorsum of hand
radial nerve damage/entrapment
Peripheral nerve damage
repetitive hand motions at job, nighttime numbness of digits 1-3
median nerve entrapment (carpal tunnel)
other medial n compressions can cause medial forarm pain and weak pronation
Peripheral nerve damage
parasthesia to 4th and 5th digits
ulnar nerve entrapment/damage
Peripheral nerve damage
pain in proximal lateral leg, foot drop with slapping gait
fibular n compression
Peripheral nerve damage
pain over dorsum of foot with extensor digitorum weakness
deep fibular nerve (anterior tarsal tunnel syndrome)
Peripheral nerve damage
plantar foot weakness and decreased sensation
posterior tibial nerve (tarsal tunnel syndrome)