OMM Flashcards
When AT Still flung the flag vs found American School of Osteopathy
1874 vs 1892 in Kirksville, MO
osteopathic philosophy has 4 principles
body = unit of mind, body, spirit; body = capable of self regulation, self healing, and health maintenance; structure and function = reciprocally interrelated; rational tx = based upon understanding of basic principles above
somatic dysfunction
“Impaired or altered function of related components of the somatic system (body framework) : skeletal, arthroidal, and myofascial structures, and related vascular, lymphatic and neural elements”
TART
tissue texture abnlity, asymmetry in structure (static or dynamic), restriction in ROM (usually around a joint), tenderness (the only subjective finding of the 4)
direct vs indirect techniques
limited ROM on L but fine on R –> passive motion to L; Move the dysfunctional segment towards the (restrictive) barrier- aka engage the barrier (ex: high vel-low amp and muscle energy) vs limited ROM on L but fine on R –> passive motion to R; Move the dysfunctional segment away from the (restrictive) barrier- aka disengage the barrier (ex: counterstrain aka strain-counterstrain, balanced ligmentous tension); indirect takes more time than direct
activating force. intrinsic vs extrinsic corrective forces
Force which is used to correct somatic dysfunction. in/voluntary forces from within the patient that assist in the manipulative treatment process vs Treatment forces external to the patient that may include operator effort, effect of gravity, mechanical tables, etc
goal of OMT?
restore homeostasis by using pt’s structure (anatomy) and function (physio), and using med and surgery in all branches/specialties
barriers w/in nml motion. restrictive barrier?
anatomical - limit of motion imposed by anatomic structure; the limit of passive motion, if you go past it –> dmg tissue vs physiological - limit of active motion; extent pt can move a joint; functional barrier vs elastic - range b/w physiologic and anatomic barrier of motion in which passive ligamentous stretching occurs before tissue dmg. restrictive - functional limit tht abnlly diminishes nml physiologic ROM –> diminishes active ROM –> pt thinks it’d be an anatomic barrier but dr can make it move further via passive test –> pt would have a “new neutral”
acute vs chronic findings
light to firm touch; recent; skin: light, warm, moist, red, hypersympathetic activity; tender, painful; inc muscle tone; nml ROM or dec d/t edema; muscle: boggy, edematous vs light to firm touch; long lasting; skin: cool, pale, dry, vasoconstriction; less tender, dull, achy, paresthesias; dec muscle tone; limited ROM, contractures, ankyloses; muscle: hard, ropy, nonresilient, edema replaced by fibrosis –> affects fascia, muscle movement, ligament
end feel
gradual, observable, increase in tension that can be palpated by the physician as they bring a body part through its passive range of motion
why US?
5x greater resolution than MRI, only imging w/ allowing dynamic exam, no radiation, only imging that allows slice you need, extension of physical exam, used for diagnostics and for intervention purposes
pulse-echo technique
sound creates imgs of structures w/in body: transducer emits brief impulses at fixed rate –> “listens” in-b/w for pulse for returning echoes
why inc # of piezoelectric crystals?
better resolution: crystals generate US waves –> vibrate thru tissue => act as transmitter –> electrical current generates from returning echoes –> img => act as receiver
speed of sound in body. relationship b/w wavelength and freq? resolution and freq? axial (vertical) resolution depends on?
1540 m/s (it’s constant). C = wavelength * freq; wavelength and freq = inversely related. higher freq –> higher res but low wavelength –> waves don’t penetrate deep tissue –> deep structures require low freq. freq
Attenuation
dec sound intensity as it passes thru medium; sum of all tissue effect on a sound wave –> dec its energy before returning to transducer: absorption - loss US energy by conversion to heat, reflection - waves = reflected at tissue boundaries and interfaces, refraction - bending beam when encounters media of diff velocities, scattering -> diffraction - spreading out of US beam –> lessens intensity; lower freq has less attenuation –> passes thru deep tissue
linear probe vs curvilinear probe
smaller wavelength –> higher freq –> less penetration –> best for superficial structures vs larger wavelength –> lower freq –> more penetration –> best for deeper structures
what’s B mode?
gray scale imging
transverse vs longitudinal vs mixed/oblique
structure cut in half by transducer –> structure comes out of pic vs structure runs along same plane as transducer –> see length of structure across the screen v structures shown diagonally in plane of transducer
needle in plane vs out of plane
along length of needle –> see needle across img vs only tip or dot of needle seen
SALS vs LALS vs rotation vs pivot vs tilt/toggle vs heel - toe in
short axis linear slide vs long axis linear slide vs entire probe spins on its center vs one end probe fixed, other spins vs short axis bend vs long axis bend
Knobology
1) set freq: choose highest freq for best (axillar) res that still allows enough penetration to see target; pick correct transducer (curvi/linear). 2) set depth: zoom to see target but not wasted space or too zoomed in. 3) adjust focal points: maximize horizontal res at depth of target (crossbeam (software) and more crystals (hardware) = better), inc to 3 focal pts if possible. 4) adjust gain aka amplification like vol: find best contrast for img to differentiate target, too much gain = bright, too little gain = dark
color doppler vs MSK/power doppler
indicates directional flow w/ blue and red: red = moving towards probe, blue = moving away from probe (DOES NOT ALWAYS MEAN ARTERIAL OR VENOUS) vs not directional, only has red, reads reflection of RBCs in vessels (5x more sensitive than color doppler), less sensitive in anemic ppl
echogenicity and types
capacity of structure to reflect sound waves. hyperechoic - bright img (bone), nml echogenicity aka isoechoic - nml echo img (ligament and tendon), hypoechoic - weak/low signal (muscle, fat), anehoic - no echo signal/dark (air, liquid)
artifacts and categories
any structure in img that doesn’t directly correlate w/ actual tissue. missing structure - they’re present in body but not showing up on img (anisotropy, acoustic shadowing), perceived structure - img shows but structure not actually present (through transmission enhancement, edge-artifact, reverberation)
which structures = sensitive to anisotropy?
denser tissue = more sensitive to anisotropy; ligaments (most dense) > tendons > muscle > nerves (least dense)
how does osteo med help US?
DO learns to palpate joint movement and later tx w/ OMM; US helps DOs visualize that joint movement
anisotropy vs acoustic shadowing vs through transmission enhancement vs edge artifact vs reverberation artifact
when transducer hits fibrillar structure, fibrillar structure reflects waves away from transducer –> no returning echo => hypoechoic; anisotropic effect = dependent on angle of US beam to target (happens 3-8 degrees) vs when sound hits high attenuating tissue (bone/calcification) –> everything underneath = anechoic vs liquid filled structures attenuate less sound compared to surrounding oft tissue –> region below liquid makes brighter echoes than adjacent tissue not below liquid vs aka Ring down artifact, US beam reflects mult times b/w smooth/flat objects –> linear reflective echoes deep to structure (you see long linear shadows), occurs w/ bone and metal vs when US beam encounters 2 strong parallel reflectors –> transducer interpret returning echo as “reverberation”
vital signs
bp, HR, RR, temp
can US waves penetrate bone?
nope –> attenuation
axial skel
skull, vertebrae (sacrum, coccyx), ribs, hyoid (bone that helps with swallowing), ossicles, sternum
fxns and divisions of cervical spine
support and stability of head, encompasses spinal cord and vertebral artery; mobility > stability: precise control of head position and mobility –> essential for nml fxn of special senses. superior: upper cervical complex (UCC) - occiput, C1/atlas (doesn’t possess spinous process or vertebral body), C2/axis (has dens/odontoid process); has atypical motion - rotate head to L –> sidebend to R; inferior: C3?-C7, bifid spinous processes, typical motion
what causes Hangman’s fx?
fx in C1-C2, hyperextension
OA joint vs AA joint vs facet/zygapophysial joint
2 articulations: occipital condyles (convex) - superior articular facets of atlas (concave) –> flexion/extension = major motion, sidebending and rotation = minor motion vs dens/odontoid process of axis serves as pivot point –> rotation = major motion vs 1 superior facet with 1 inferior facet
cervical vertebrae supporting structures
lateral part of C1-C6 have transverse foramen –> vertebral artery - supplies occipital lobe, brainstem, cerebellum; at C1, arteries make several R angle turns before entering skull; posterior muscles = continuous from cervical spine to sacrum that are divided into superficial/intermediate/deep
fxn and divisions of thoracic spine
motion of ribs and vertebrae, breathing, posture, locomotion, head and neck control, stabilization of extremities, long palpated SP. upper T1-4: sympathetic innervation to head and neck, middle T5-9: upper abd viscera (liver, stomach, pancreas, spleen, gallbladder, duodenum), lower T10-12: rest of sm intestines, kidneys, ureters, gonads, R colon. know rule of 3’s (palpating tips of spinous process to corresponding transverse process). less flexion and sidebending motion
fxn of lumbar spine
body support; dorsal lumbar muscles bound to dorsal lumbar vertebrae that are divided into superficial/deep and medial/lateral; flexion, extension, sidebending motion
vertebral facet orientation. c vs t vs l
described by superior facet vertebra. superior facets = BUM –> flexion/extension, sidebending, rotation (lat flex/rot = same direction) vs superior facets = BUL –> less flexion, sidebending vs superior facets = BM –> flexion/extension, sidebending, rotation (side/rot = same or opposite directions)
Fryette’s Principles
doesn’t exist in cervical spine; Type I: when sidebending a group of typical vertebrae –> rotation of entire GROUP = towards convex/opposite side, engages vertebral bodies; Type II: when rotating a SINGLE vertebra –> sidebending of vertebra = towards same side, engages facets
manubriosternal joint vs xiphisternal joint vs sacrococcygeal joint
manubrium and sternal body articulation vs sternal body and xiphoid process articulation vs sacral apex and coccyx articulation
rib motion: pump handle motion vs bucket handle motion vs pincer type motion
R1-5, true ribs attach to sternal by costal cartilage, rib shaft = pump handle, vertebral column = pivot point, costal cage moves superiorly and anteriorly vs R6-10, false ribs move round fxnal pivots posteriorly and anteriorly, shafts move laterally and superiorly during inhalation, costal cage inc in transverse diameter vs R11-12, don’t attach to sternum or chondral mass, open/close in posterior-anterior direction
articular pillars aka?
lateral masses
4 ways to classify somatic dysfunction?
duration, etiology, motion, location
