OMM Flashcards
HPI complaints for thoracic spine: joint vs muscular vs skel vs neuro vs injury. how to tx?
uni/bil, swelling/red, stiff/dec ROM vs achy/sharp, atrophy, loss ctrl/paralysis vs deformity, gait, pain w/ movement, pressure sensation vs uni/bil, numb/tingly, weak, HA vs pop, tear, snap, direct trauma. PRICE-H, NSAIDs, muscle relaxers, manual, OMT/PT
special considerations for peds vs preg vs elderly
fine/motor develop, obese, sports, spurts vs gest age, injuries in prev preg vs prev falls, meds, bone screen, poor vision, change in ease movement, nocturnal sxs
PE inspection for posture vs skin vs muscle vs resp
kyphosis/lordosis, symm vs swelling, red, mass vs symm, hyper/atrophy, fasc, spasm vs rate/amp, location (abd)
PE palpation for skin, muscle, bone, joints. spinous process?
TART; swelling, crepitus, fluctuance/effusion. common for chronic pain but if severe –> infxn, fx, arthritis
PE: ROM for thoracic
R > SB > F > E; rotation better in lower thoracic b/c closer to lumbar anatomy
sclerotome vs myotome vs radicular pain
nerves at tendon, lig, facets on bone –> dull, achy, diffuse pain vs nerves at myofascial tissue planes around muscle –> dull, achy, diffuse, crampy, tight pain vs nerve root compression –> sharp shooting pain, paresthesia, dec DTR
schuermann dz sxs vs dx vs tx
congen wedge thoracic vertebra –> rigid kyphosis, worse w/ flex vs standing lat radiographs showing ant wedging > 5 in 3 consecutive vertebrae vs conservative (strength, stretch, oral analgesics, brace), surg if kyphosis > 60degrees
scolio types: congenital vs neuromuscular vs syndromic vs idio
hemivertebrae, bars, blocks vs CP, Spina bifida, Muscular dystrophies vs Marfan’s, NF-1, Ehlers-Danlos vs Infantile, Juvenile, Adolescent
idio adolescent scolio sxs vs dx vs tx
back pain vs skel maturity (5 = completely fused), Cobb angle; thorac > 2x major > thoracolumbar > lumbar vs conservative (heat, OMT/PT), observation for curves <25/skel immature or curves <50/skel mature, brace for >25/skel immtaure, surg >50
atypical adolescent schuermann’s sxs vs dx vs tx
thoracolumbar jxn pain worse w/ physical activity, long standing/rest vs 3 successive vertebrae w/ >/=10% wedging + schmorl nodes (nucleus pulposus hern) vs OMT/PT
mobility vs stability of joints: nml vs dysfxn
multiplane motion, stiff/injured vs single motion, unstable
postural/static vs phasic/movement system
prone to hyperactivity –> shortening, not susceptible to fatigue b/c using low lvl tone all the time vs prone to inhibition –> lengthening/weakening, susceptible to fatigue b/c shorter bursts of activity w/ rest in b/w
upper cross syndrome sxs vs tx
Muscle imbalance around head/shoulder –> ant head carriage, kyphosis. weak scalene, longus coli -> mid/low trap, rhomboids; tight up trap, lev scap, suboccipital -> pecs vs stretch tight muscles to strengthen, OMT/PT, wet/dry needling, acupuncture
lower cross syndrome sxs vs tx
Muscle imbalance about the pelvis –> Low back/hip pain, Patellofemoral dysfunction, Ant pelvic tilt, lumbar lordosis. weak rectus/transversus abdominis, obliques -> glut; tight erector spinae, quad lumborum -> iliopsoas, rectus femoris, TFL vs same w/ upper cross
mechanical vs nonmechanical fx
vertebral, rib –> localized pain, severe w/ movement; from chronic steroids, elderly, ankylosing spondylitis vs pain in T spine d/t 2ndary causes: tumors/mets (PB KTL), HNP, infxn
trigger point vs tender point. can trigger points be txed w/ counterstrain?
characteristic pain pattern, only in muscle, taut, twitch, dermographia over skin vs no characteristic pain pattern, muscle/tendon/lig/fascia, no taut/twitch/dermographia. yes
counterstrain tx seq
- do H&P, TART
- tenderness scale = 10/10, put pt in max comfort & hold for 90 sec
- chk q 30s for tenderness & readjust
- slow return back to nml, pt still passive
- aim for <3/10
absolute vs relative contraindic of counterstrain
fx, lig tear, life threatening exac, pt request vs cardiac event, DVT, gravely ill, neuro condition, joint replacement, OA, RA, preg, Down syndrome
what are Maverick points? how to tx mult tender points?
when counterstrain points = not in reg motion when F/E, S/R like C4. tx most tender first vs tx middle first
atypical vs typical cervical vertebrae. atypical vs typical cervical joints. how are spinal nerves named?
C1, C2 vs C3-C7. C0 on C1, C1 on C2 vs C2-C7 w/ C7 on T1 (C7). above associated vertebral bodies
does atlas have vertebral body? how does it move about C2? do cervicals follow Fryette’s principles? know how OA/AA does rot/sidebend too
no. rotates around C2 d/t cruciform/transverse lig. no: C1 = type 1-like, 50% does F/E at OA (C2-7 does rest); C2 = only 50% rotation at AA w/ transverse lig (C3-7 does rest); C3-C7 = type 2-like
know cervical landmarks
C1: b/w mastoid process and mandible
C2: between mastoid process and angle of mandible (level with SP)
C3: hyoid
C4: slightly above thyroid cartilage notch
C5: slightly below thyroid cartilage notch
C6: first cricoid ring of trachea and carotid tubercle
C7: vertebral prominens
how far can PROM go in sagittal vs coronal vs transverse plane
50 degrees chin to chest, 60 degrees directly looking at ceiling vs 45 degrees ear to shoulder vs 80 degrees head turn to shoulder
what is pos for spurling’s test? Lhermette’s sign = sx of what?
radicular pain on ipsi head rotation & compression. myelitis, MS, B12 defic, disc hern, Chiari, tumor
how to do OA vs AA dx
like nml, name type 1-like vs cup fingers on occiput and fingers on AA –> fully flex head –> rotate –> find dysfxn
joints of Luschka
▪ Unciform joints, synovial joints
▪ Assist in maintaining stability
▪ Act as a guide rail for F/E
▪ Limits translatory motion, subluxation sideways
how to find typical C3-C7 articular pillars
Superior Facet of above vertebrae + Inferior Facet of below vertebrae, 2-3cm posterolat from spinous process; OPEN = forward bending or sidebending away, CLOSE = backward bending or sidebending towards
how to chk for rotation vs sidebending when pt is supine during dx
force ventrally on L lat mass –> rotate R, on R lat mass –> rotate L vs R to L –> sidebend R, L to R –> sidebend L
OA somatic dysfxn: flexion sd vs extension sd. how are OA asymm compensated?
post condyles on C1, space b/w occiput & C1 = deeper, chin tucking in vs ant condyles on C1, space b/w occiput & C1 = shallower, chin tucking out. suboccipital muscles, OA = last thing to compensate for gravity/posture
prevention of cerebrovasc dz: HTN, wt vs smoking, DM vs dyslipidemia
leading risk of ischemic & hem stroke, inc risk 2x vs 2x ischemic/3x subarach hem, 2-3x inc vs 5-17x stroke
causes of CN1 impairment vs how to test CN1?
nasal obstruction, foreign body, intracranial lesion vs close eyes & one nostril –> introduce smell; don’t do noxious smells –> activate pain fibers CN5
CN2 fundoscopic exam
look at both retinas with an ophthalmoscope; Optic discs: Point of entry of optic nerve, Retinal vasculature & abnlities
CN2 visual acuity test: far vision vs near vision
snellen chart, 20 ft away, distance from chart/distance avg eye can read line) vs rosenbaum chart, 14”/arm’s distance
visual field test: confrontational testing. how to test extraocular movements?
pt covers 1 eye fixed on dr’s nose, dr holds how many fingers in sup temp/nasal & inf temp/nasal quadrants. follow finger in 6 cardinal direction
pupillary light rxn CN2 (sensory) & CN 3 (motor) test. accommodation vs convergence
beam of light shining into one retina causes pupillary constriction in that eye (DIRECT RESPONSE) and in the contralateral eye (CONSENUAL RESPONSE). inc convexity lens for near objects vs bil MR muscle activation
CN3 vs CN4 vs CN6 GSE
levator palpebrae sup muscle vs eye adducts –> depression, eye abducts –> intorsion vs LR to abduct
Horner’s syndrome = interruption of what pathway?
oculosympathetic pathway –> anhidrosis, ptosis, constricted pupil. lung mass can push up pathway
Marcus Gunn. cause? vs Argyll Robertson pupil. cause?
no ipsi direct pupil constriction, but contralat consensual does. lesion in optic n, eye, retina vs no ipsi pupil constriction but ipsi accommodation. syphilis
how to test for CN5 sens vs motor vs corneal reflex
Qtip or pin at forehead, cheek, jaw bil –> see if same or diff both sides vs pt clenches teeth –> feel bulging muscle bellies vs hold eyebrow & head –> pt looks L –> cotton wisp on R cornea –> bil eyelid closure reflex
CN7 facial n tests. describe facial droop
-raise eyebrows
-close eyes tight and doctor tries to pen up eye against resistance
-puff out cheeks and resist
-bare teeth, smile
* Upper Motor Neuron Lesion –> Contralat lower face weakness, Spares contralateral forehead, CVA
* Lower Motor Neuron Lesion –> Total ipsi face paralysis, Bells Palsy
CN8 vestibular/hearing: FINGER RUB TEST. know the hearing pathways, air & bone condux
pt eyes closed –> Examiner rub fingers together near 1 ear at a time –> pt raises hand on side where rubbing occurred
rinne conductive hearing loss test
compare AC to BC. 512 Hz tuning fork –> mastoid –> pt tells when they can’t hear anymore –> external acoustic meatus; pos if can hear at meatus after mastoid –> AC > BC, neg if can’t –> BC > AC –> conductive hearing loss
Weber test conductive or sensorineural loss
512 Hz tuning fork middle forehead –> hearing in mid or lat. nml if mid; abnl if lat: unilat conductive loss for sound on affected side, unilat sensorineural loss for sound on unaffected side
palate eval vs gag reflex vs CN11 strength test
say ah –> palate up, uvula midline, post pharynx medial vs qtip in –> palate up, pharynx constrict. CN9 = sensory, CN10 = motor vs pt rotates head –> dr pulls lat chin for pt to resist; pt shrugs shoulders up –> dr bring them down on AC joint
CN12 innervates what? how does dev happen? impairment causes?
intrinsic tongue muscles. tongue pushes toward abnl side. UMN cortex, LMN CN12 lesion, tongue muscle lesion, neuromuscular jxn
articulation testing of CN 7/10/12. impairment causes?
“pah, pah pah” –> labial sounds (CNVII)
“cah, cah, cah” –> pharyngeal sounds (CNX)
“tah, tah, tah” –> tongue sounds (CNXII).
motor cortex, BG, cerebellum; articulation muscles, neuromuscular jxns; periph or central CN 5/7/9/10/12
muscle stretch reflex/DTR pathway. C5 vs C6 vs C7 vs L4 vs S1 tendon reflex
tap tendon in partially stretched muscle –> special sensory fibers –> sensory impulse to periph n to spinal cord –> ant horn cells –> neuromuscular jxn –> muscle ctx to complete reflex. biceps vs brachioradialis vs triceps vs patellar vs achilles
C5 structures for shoulder abdux vs elbow flex
delt, axillary n, post cord, post division, mid trunk vs biceps, brachialis, lat cord, ant division, sup trunk
C6 wrist ex vs C7 elbow ex vs C8 grip structures
extensor carpi radialis longus/brevis, radial n, post cord, post division vs triceps, radial n, post cord, post trunk vs flex digitorum superficialis/profundus, median & ulnar n
T1 finger abdux vs L2 hip flex vs L3 knee ex structures
doral intereossei, ulnar n, med cord, ant division, inf trunk vs iliospoas, femoral n vs quads, fem n
L4 ankle dorsiflex vs L5 great toe dorsiflex vs S1 plantarflex
ant tibialis, deep fib n vs extensor hallucis longus, deep fib n vs gastroc/sol, tibial n
where to test C2 vs C3 vs C4 vs C5 vs C6 vs C7 vs C8 vs T1 vs T2 sensation?
1cm lat to inion vs supraclavicular fossa vs sup AC joint vs radial antecubital fossa vs dorsal prox thumb vs dorsal prox mid finger vs dorsal prox pinky vs ulnar antecubital fossa vs apex axilla
where to test L1 vs L2 vs L3 vs L4 vs L5 vs S1 vs S2 vs S3 vs S4/5 sensation?
b/w T12 & L2 vs anteromed thigh vs med epicondyle vs med malleolus vs dorsal foot vs lat calcaneus vs popliteal fossa vs ischial tuberosity vs perianal
primary sensory eval: vib vs proprio
128 Hz tuning fork on heel of hand –> bring to distal joint (finger/toe) –> pt closes eyes and says when vib stops; if abnl, proceeds to finger/toe > knee/elbow > hip/shoulder vs grab pt’s toe/thumb and tell them which is up/down –> pt closes eyes and dr moves up/down –> pt reports direction; if abnl proceed joints like in vib
discriminatory exam: stereognosis vs graphesthesia vs 2 pt discrim vs localization vs extinction
ID object by sensation (eyes closed) vs ID number drawn on hand eyes closed vs feeling 2 points w/ smallest distance possible <5mm on finger pads vs replicate point on body that was palpated eyes closed vs feel simult touch on both sides of body; abnl if pt only feels one side
coordination requires what 4 systems?
Motor system (strength)
Cerebellar system (rhythmic movement and steady posture)
Vestibular system (balance and coordinating eye/head/body movements)
Sensory system (position sense)
appendicular vs truncal ataxia
defect in cerebellar hemis –> axial & prox limb weakness vs defect in cerebellar vermis –> falling on ipsi side
coordination: rapid alternating movements: UE vs UE finger vs LE toe
hands on thighs vs tap index & thumb vs toe tapping; abnl if slow or clumsy
coordination: point to point
finger to nose: abnl if dysmetria, ataxia, tremor
heel to shin: abnl if dysmetria, ataxia, intention tremor
Romberg: lose bal when closing eyes 30-60s
Brudzinski vs Kernig test
both test for mengingeal, nerve root, dural irritation. 1. Patient actively flexes head onto the chest; POSITIVE = pain in the neck or spine vs 1. Patient actively raises leg –> If pain in neck or spine occurs, patient flexes knee; POSTIVE = pain disappears when flexing knee
extension & rotation of occiput can occlude what artery?
opposite vertebral a
describe lig in cervical context
narrow elastic support for head, ctrls great ROM and protects spinal cord/nerves; become primary support when muscles = fatigued
know the muscle groups for fl, ex, rot, sb for head/neck
OMM peer tutor study guide, pg 28
mechanical neck pain pattern. assoc w? ddx? exam findings?
aching pain in cervical paraspinal muscles, stiff in neck/shoulders +/- HA up to 6 wks. poor posture, sleep, stress. fibromyalgia, torticollis, somatic dysfxn. dec ROM, pain w/ movement, no neuro deficit
whiplash. how long is chronic? what must be excluded before making dx? exam findings?
paracervical pain/stiff d/t neck hyperfl/ex like in rear end collisions; +/- occipital HA, fatigue, dizzy. >6mo. causes of cervical cord compression like fx, hern, head injury. dec ROM, paracervical tenderness, perceived weakness
cervical radiculopathy. causes? exam findings?
paresthesia in neck + 1 arm. hern disc, spondylosis, dysfxn of C-spine, nerve root probs, tumor, syrinx, MS. C7 –> weak triceps, finger flex; C6 –> weak biceps, brachioradialis, elbow ex
cervical myelopathy. ddx? exam findings?
when cervical disc compresses on spinal cord –> neck pain, paresthesia in U/LE, incont, clumsy hands, walk/gait. cervical spondylosis (abnl wear/tear in cartilage), cervical stenosis from osteophytes, disc hern. UMN sxs, gait, +/- Lhermette
know how to fix ant tenderpoints C1-C8
OMM peer tutor study guide, pg 10
foraminal vs cervical nucleus pulposus hern
unilat dermatomal –> around a rib vs pain LE, numb/weak, inc DTRs
osteomyelitis spread vs micro vs sxs vs risk factors
hematogenous, contig, direct inoc vs s. aureus, strep, p. aeruginosa vs insidious & progressive localized pain vs DM, immunocompromised
spinal epidural abscess spread vs micro vs sxs vs risk factors
hematogenous, contig = direct inoc vs s. aureus, strep, gram neg bacilli, pyogenic staph vs triad: fever, back pain, neuro deficits vs bacteremia from IVDU, intravasc devices, dental abscess
CN5 sensory vs motor
pain/temp/, vib/proprio for face, mouth, ant 2/3, nasal sinuses, meninges vs tensor tympani & mastication muscles
hypo vs hyperactive reflexes causes
ant horn d/o, myopathies vs pyramidal, electrolyte abnlities, hyperthyroid
thoracic costal facets has 3 parts:
2 demifacets on vertebral body (for typicals only), 1 demifacet on transverse process
primary vs secondary mm for inhalation? for exhalation?
diaphragm, scalene, external intercostal vs SCM, upper trap, serratus. lung recoil, diaphragm vs internal intercostal, abd, serratus
sympathetic chain ganglia located on what bone? sympathetic nervous system involved in what reflexes?
ant rib heads. somatovisceral, viscerosomatic
chapman’s reflex. what is a pos Chapman reflex? acute vs chronic characteristics
viscerosomatic; reflex points presenting predictable ant/post fascial tissue texture abnlities reflecting visceral dysfxns. both ant/post point present. tender, nonradiating vs less/non tender
parts of thoracic inlet
T1-4, R1-2, manubrium; scapula, 1st rib, clavicle, neurovasc bundle
know rule of three’s. what’s coupled motion? Law 3 of Fryette’s?
Lec 2, slide 19. principal motion can’t occur w/o secondary motion (ex: rotation & sidebending). motion in 1 plane dec –> motion in all other planes dec if motion alrdy occurred
direct vs indirect OMM tx examples
soft tissue, ME, myofascial release vs bal lig tension, counterstrain, myofascial release
motor exam: bulk vs tone vs strength & reflexes
hyper/atrophy, fasciculation, spasm vs nml = sm sensation, inc = rigid/spastic, dec = flaccid, limp vs you know the scale
CN9 vs 10 for muscles, parasympathetics, sens, taste, chemo/baro
stylopharyngeus. parotid. post 1/3, ex ac, mid ear, pharynx. post 1/3. carotid vs ph/larynx, ex ac, meninges. heart, lungs, GI. pharynx, epiglottis. aortic arch
