Motion And Palpation Flashcards
Standing structural exam
Observes the overall configuration of the body and determines location of most significant anatomic asymmetries/areas of concern (Screening exam)
What landmarks do you assess posteriorly on a standing structural exam?
.Mastoid process, occipital, vertebral prominent, acromion processes, scapulae, spine of scapulae, inferior angle of scapula, iliac crests, PSIS, greater trochanter, lat. and med. malleoli
What position is normally used to palpate back region?
Prone position
How do you find L1?
. Palpate ribs 11-12 w/ fingertips and stretch thumbs medically like you’re touching them together
. Palpate iliac crests to identify L4 and then count up
In lumbar region are transverse processes even with spinous process?
YES
How do you find erector spinae muscles?
Find spinous process of L1 and move thumbs 2 inches laterally
Where are lumbar transverse processes?
Deep to erector spinae muscles
How hard do you press on palpation of lumbar vertebra?
Apply amount of pressure required to blanch the nail of your thumb
As you press anteriorly on the back what force are you applying?
Left rotation for ace to vertebral segment
As you press over left transverse process what force are you giving?
Right rotational force of vertebral segment
How do you find the PSIS?
Place fingertips over iliac crests and drop thumbs medically and inferiorly
How do you find trochanter?
Put thumb over PSIS and rotation your hand down onto their side with thumb still on PSIS
How to assess flexion/extension of thoracic spine?
. Stand behind seated patient where patient’s feet reach floor
. Patient drops chin to chest and slump forwards (flexion)
.Patient sit up straight and look at ceiling (extension)
How to assess side bending of thoracic spine?
. Stand behind seated patient
. Have patient bend at waist right and left (right and left side bending)
how to assess rotation of thoracic spine?
. Stand behind seated patient
. Patient twists to right and look over right shoulder (right rotation)
. Twists left and looks over left shoulder (left rotation)
How to assess flexion/extension of lumbar spine?
. Stand behind standing patient w/ no shoes
. patient stand shoulder-width apart and bend forward at waist to touch toes without bending knees (flexion)
. Patient bends backward at waist to pain-free limitation (extension)
Normal angles for lumbar flexion and exension
. Flexion: 70-90 degrees
. Extension: 30-45 degrees
How to assess sidebending of lumbar spine
. Patient standing bends at waist to right and left by sliding hand down leg in direction of knee
How to assess rotation of lumbar spine
. patient standing twists at waist to right and left
. Not all this rotation is coming from back (hips, thoracic spine, and ribcage also involved)
When to perform soft tissue treatment in general
. When tissue has restricted motion or are mildly tender
. To get diagnostic information
What types of tissue are amendable in soft tissue treatment and which types are not?
. Chronic tissue texture changes (cooler, stringy, ropy) can be amendable
. Acute tissue changes (heat, erythema, spasm, tenderness, swelling) is not as much
What do you want to contact in soft tissue treatment for vertebral regions and how do you do it?
Contact paraspinal muscles in groove between spinous process and the muscle
. Apply firm pressure to muscle mass and pull in lat. direction w/o overstretching skin
How do you avoid overstretching skin?
Move fingers medically a short distance w/o losing contact w/ skin to gather excess skin and then apply deeper pressure and lat. traction on muscle
Guidelines for soft tissue treatment
. Apply and release force slowly
. Never allow muscle to snap back
. Don’t slide fingers over / overstretch skin
. Spread forces out and avoid direct force on bony prominences
. Sensing approach (see how patient and muscles respond and adjust accordingly)
. Stop when muscle relaxes
. Obtain feedback from patient
. Use finger pads and not fingernails
What is m99.03 ST
Lumbar-soft tissue- patient prone
What dysfunction prompts soft tissue of lumbar spine treatment?
Tight/hypertonic lumbar paraspinal musculature
What is objective of lumbar soft tissue treatment?
. Relaxation/softening of lumbar paraspinal musculature
. Increase available spinal motion
Patient and physician position or soft tissue lumbar treatment?
. Patient prone on table w/ head turned toward physician
. Physician standing at side table opp. Tight paraspinal musculature
Procedure of lumbar soft tissue treatment
. Place thumbs in groove between paraspinal musculature and spinal processes on side opp. You
. Apply force slowly anterolaterally (can move medically first to gather excess skin)
. Stop when barrier is reached
. Slowly release and repeat working cephalad to caudad
. Switch sides and repeat
What is M99.02 ST
Thoracic soft tissue patient prone
Dysfunction for soft tissue on thoracic spine treatment?
Tight/hypertonic thoracic paraspinal muscles
Objective of thoracic soft tissue treatment
. Relaxation/softening of thoracic paraspinal musculature
. Increase available spinal motion
Patient and physician position in thoracic soft tissue treatment
. Patient prone with head towards physician side
. Physician standing at opp. Side of tight paraspinal musculature
Thoracic soft tissue treatment procedure
. Place thumbs between groove between paraspinal muscles and spinous process on opp. Side you
. Apply force anterolaterally (can go medial first to collect excess skin)
. Stop when barrier reached
. Slowly release and repeat working cephalad to caudad
What is M99.01 ST
Cervical soft tissue method 1 patient supine
Dysfunction to warrant cervical soft tissue treatment
Cervical soft tissue tension
Objective of cervical soft tissue treatment
. Decrease cervical tissue tension and muscle spasm
. Reduce paraspinal muscle tension and increase spinal motion
Patient and physician position for cervical soft tissue treatment
. Patient supine
. Physician seated or standing at head of table
Procedure for cervical soft tissue treatment
. Place finger pads bilaterally in contact w/ paraspinal muscles
. Start in lower region of neck and work towards head
. Use left hand to roll patient’s head and neck to right to gather soft tissue into right hand
. Move right hand anterolaterally to stretch right paraspinal muscles while rolling head and neck to the left
. Reverse process w/ left hand stretching and right hand rolling patient’s head to the right
What is M99.03 EXER
Lumbar constant rest position exercises
Lumbar constant rest position exercise objective
Relieve muscle pain and tension by allowing muscles of hips, pelvis, and spine to relax
. Provides temp. Relief of aches and pains assoc. w/ hip, pelvis,and spine
Procedure for lumbar constant rest position exercise
. Start in supine position on floor w/ head support on towel
. Drape legs over chair/ottoman
. Height of chair should allow knees and hips to bend at 90 degree angle
. Stretch arms out to sides at shoulder level palms facing ceiling
. Lie in position and let muscles relax (can put ice packs for acute situations)
. Relax for 3-10 minutes
Which 2 DOs allowed COH to use their unlimited licenses until DOs got their full practicing rights in IL?
Dr Craske and Dr Kistner
