OMM 1 Flashcards
TMJ dysfunction symptoms
pain, clicking when mouth is open or closed, HA, sinus congestion, dizziness, facial pain, tinnitus, hoarseness, ear pain
Digastric and suprahyoid
depresses mandible
Depression/opening of the jaw ->
depresses mandible
Unilateral contraction of pterygoids
contralateral deviation and anterior
Contralateral pterygoids
draw articular disc anteriorly to facilitate opening
Direct blow to a closed mouth or WHIPLASH
posterior capsule injury
Malocclusion Class 2
overbite
Malocclusion Class 3
underbite
Upper molar extraction
temporal bone compressed into occiput
Lower molar extraction
temporal bone compressed into TMJ -> strained sphenomandibular joint -> sphenoid pulled inferiorly and contralaterally
Internal rotation of temporal bone
anterior lateral movement of mandible
External rotation of temporal bone
posterior and medial movement of mandible
Mandible deviates away from _______ rotated mandible
internally
Mandible deviates toward ______ rotated mandible
externally
Stylomandibular ligament
attaches temporal to mandible
Short leg ->
unleveling of occiput -> temporal and TMJ dysfunction
Flexion head
external rotation of paired bones (wide, flat)
Extension head
internal rotation of paired bones (long, narrow)
CNV1 may be affected by dysfunction of
Dysfunction of temporal bone
CNV2 may be affected by dysfunction of
temporals, sphenoid, maxillae and mandible
CNV3 may be affected by dysfunction of
sphenoid bone
CNV1 dysfunction may affect what
ethmoid sinus
Tic doulourex
CNV2 dysfunction
Trigeminal neuralgia
CNV3 dysfunction
External carotid may be affected by dysfunction of
temporal, occipital, sphenoid
Internal carotid may be affected by dysfunction of
cervical dysfunction C6-C2
Internal jugular may be affected by dysfunction of
temporal
Lymphatics to head may be affected by dysfunction of
upper thoracic spine, upper ribs (1-4), and clavicle
External carotid dysfunction may cause
weakness and altered sensation on opposite side
Internal carotid dysfunction may cause
vision abnormalities, and dizziness
Internal jugular dysfunction may cause
head congestion
Which n passes through the pterygopalatine fossa
CNV2
Abducens n lies under the
petrosphenoidal ligament
Entrapment of CN VI can lead to
strabismus and diplopia or sixth nerve palsy
Abducens n may be affected by dysfunction of
Sphenoid or temporal dysfunction
Bell’s Palsy
dysfunction of temporal bone impinging on facial n
parasympathetics to the eye are carried by
CNIII
parasympathetics to the lacrimal gland and nasopharyngeal mucosa are carried by
CNVII
CNVII parasympathetic hyperactivity ->
thin, watery secretions, excessive tear production
Somatic dysfunction at T1-T4 may cause
photophobia, tinnitus and unsteadiness, vasoconstriction
Hearing decrease and vertigo may result from dysfunction of __________ impinging on CN8
sphenoid, occiput and temporal bones
HEENT Chapman’s Reflex Points - anterior
clavicle to 2nd rib
HEENT Chapman’s Reflex Points - posterior
suboccipital musculature, intertransverse spaces C1-C2
All facial bones except mandible are driven by
sphenoid
Referred sinus pain follows
trigeminal
CNV1 innervates all sinuses except
Maxillary (CNV2)
Otitis Media may be caused by ______________ of the temporal bone
internal rotation
secretory to submandibular, sublingual and lacrimals
CNVII
Parasympathetic n carried by CNVII
Greater Petrosal
Parasympathetics carried by glossopharyngeal synapse ____________ and innervate
otic ganglion; parotid gland
Sympathetics to the head are carried via
T1-T4 -> sphenopalatine ganglion
Vertigo may result from dysfunction of
temporal bone
Internal rotation of the temporal bone
closes off the ET; high pitched ringing
Treating sinusitis with OMT
inhibitory trigeminal stimulation over CNV1 and CNV2
relaxing medial pterygoid muscle, allows
tensor veli palatine to open ET
out pouching of respiratory diverticulum
d22
bifurcation into R/L bronchial buds
d27
branching into lobes, 3 on R, 2 on L
5w
branching into tertiary buds, 16w (terminal bronchial buds) -> 300-700 million sacs in mature lung, 20-70 million sacs
16w
Rib lesions are common with
extended Type II dysfunctions
Diaphragm and quadratus lumborum attach to which ribs
11-12
Inhalation ribs
up in front, down in back
Structural Rib Dysfunction
Not related to breathing, rather a disturbance due to rib motion and biomechanical restrictions of the thoracic spine
key ribs are often
structural ribs
Functional Thoracic Inlet
vertebral units of T1-4, ribs 1 and 2 plus their costo-cartilage, and the manubrium
Anatomic Thoracic Inlet
manubrium, rib 1, body of T1
Chronic Obstructive Lung Disease
chronically contracted diaphragm, overuse syndrome of accessory muscles
Accessory Muscles: Forced inhalation
scalenes, SCM, serratus anterior, external intercostals
Accessory Muscles: Forced exhalation
rectus abdominus and internal intercostals
asthma reflex
T2 left
linking of airway
Normal epithelium is ciliated columnar with mucus secreting goblet cells
___________ influence is dominant in normal functioning lung
parasympathetic (watery mucus)
While asthma is “obstructive”, there may be a component of
restrictive lung disease
Restrictive lung disease limits
the amount of air that can get in and out of the lung
Obstructive lung disease limits
the rate of airflow out of the lung
COPD
chronic bronchitis AND/OR emphysema + airway hyperreactivity
antitrypsin
inhibits lung elastase and prevents lung destruction and emphysema/COPD
COPD findings
hyperinflation/barrel chest, hyperresonance, sd in right upper thoracics
FEV1 >80% FEV1 50-80% FEV1 30-50% FEV1
stage 1 stage 2 stage 3 stage4
Chronic bronchitis
long-term exposure to irritant (smoking), productive cough
Emphysema
abnormal permanent entrapment of air - enlarged alveolar sacs
Obstructive Lung Disease
air is trapped in lung, maximum inhalation (barrel chest), forced expiration (no IRV, FVC
blue bloater
COPD - Chronic hypoxemia leads to erythrocytosis, pulmonary hypertension, and eventually right ventricular failure
restrictive lung disease
A stiff thoracic cage results, increased respiratory effort
Order of treatment of thoracic cage
Treat the spinal segment first, then any structural rib, then any respiratory dysfunction.
key area of lymphatic obstruction
fascia
Anterior and middle scalenes attach to
rib 1
Posterior scalene attaches to
rib 2
Diaphragm: 3 apertures levels
vena cava (T8), esophagus (T10), aorta (T 12)
lRT Parasympathetics
OA, AA, C2, suboccipital
Earl Miller
1923 - developed lymphatic pump technique
Thoracic pump is more effective if the chest cage is
compliant
A.T. Still Research Institute established
1913
Louisa Burns D.O., a pioneer in osteopathic research, joined AT Still research institute
1914
research grants from the AOA to Osteopathic institutions
1939
Frank Chapman
Neurolymphatic reflexes in 1920
“Lymphatic Reflexes: A Specific Method of Osteopathic Diagnosis and Treatment” published in
1929 by Chapman
Charles Owens, D.O.
pelvic-thyroid-adrenal syndrome” (PTA
Paul Kimberly, D.O.
FAAO re-introduced Chapman’s reflexes in the KCOM curriculum in the late 70’s
Ward E. Perrin
1943 grad from CCOM, CCOM faculty
first recipient of the AOA’s Bureau of Research Gutensohn/Denslow Award in 1984
Dr. Kelso
William Garner Sutherland, D.O
1939 Cranial
Floyd Peckham, DO
1921 grad CCOM - helped keep CCOM afloat financially
Denslow
1941-1943: spinal reflex research
HEENT parasympathetics (VS)
occiput, C1, C2
HEENT sympathetics (VS)
T1-T5
The input from both visceral and somatic structures end on common
interneurons
Lawrence Jones
1955 tender points
Upper cervical left side dysfunction may cause
AV node effects (PNS) –> impaired conduction and dropped ventricular contractions
Upper cervical right side dysfunction may cause
SA node effects (PNS) –> Bradycardia
Upper thoracic right side dysfunction may cause
SA node effects (SNS) –> tachycardia
Upper thoracic left side dysfunction may cause
AV node effects (SNS) –> premature ventricular contractions
Cardiac Rhythm
T1-T2
Myocardium
T1-T5 (L > R)
Posterior wall MI
T5
Bronchomotor
T1-T3 (b/l or ipsilateral)
Lung
T1-T4 (b/l or ipsilateral)
Esophagus
T2-T6 R
Gastric
T4-T10 L
Upper RT
T1-T5
Oropharynx
T1-T2
Thyroid
C4-C6, T2
Ventricular involvement
C8-T3L
Atrial involvement
T4-T6L
Anterior infarct
T2-T3L
Inferior infarct
T3-T5L, C2
HTN Linkage Pattern
C6, T2ESR-R & Left Inhalation Rib 2 T6FSR-L & Right Exhalation Rib 6
Underlying CAD
Type I curve convex Right
Anterior Adrenal CP
2-2.5” above & 1” lateral to umbilicus
Posterior Adrenal CP
b/w T11-T12 b/w SP and TP
Anterior Kidney CP
1” above & 1” lateral to umbilicus
Posterior Kidney CP
b/w T12-L1 b/w SP and TP
MI Anterior CP
2nd ICS near sternum
MI Posterior CP
b/w T2-T3 b/w SP and TP