OMM COMLEX Flashcards
AT 1 tender point location and treatment
episterna notch midline- or slightly lateral
treatment: flexion
AT 2-6 tender point location and treatment
midline of the sternum at the level of the corresponding rib
treatment: flexion, with minimal fine tuning in side bending or rotation
AT 7 tendering location and treatment
bilateral 1/4 distance from the Xiphoid tip to umbilicus
treatment: FSTRA
AT 8 tender point location and treatment
location: 1/2 distance between the diploid process and umbilicus bilaterally
treatment: FSTRA
AT 9 tenderpoint location and treamtent
3/4 distance from the xiphoid tip and umbilicus
treatment: FSTRA
AT 10 tender point location and treament
1/4 distance from umbilicus to the pubic symphysis ( bilaterally)
treatment: flex sideband ankles towards and rotate torso away
AT 11 tender point location and treatment
1/2 distance from umbilicus and pubic symphisis (biltaerally)
treatment: flex, sideband ankles towards, rotate torso away
AT 12 tender point location and treatment
Apex of the iliac crest at mid axillary line (bilaterally)
treatment: flex, sideband ankles away rotate torso towards
where is L1 located
medial to the ASIS
where is AL1 located
medial to the ASIS
where is AL2 located
medial to the AIIS
where is AL3 located
lateral to the AIIS
where is AL4 located
inferior to the AIIS
where is AL5 located
on the pubic ramps 1cm lateral to the pubic symphysis
what is the straight leg raise used for
to evaluare for lumbar nerve root compression
Straight leg raise is also. known as?
lasegue test
what is the braggard test
a modification of the SLR that applies ankle dorsiflexion- conducted same as SLR but then dorsiflex ankle to reproduce symptoms
positive test is indicative of sciatica
FABER test
aka Patrick test that is used to evaluate for a labral tear, hip impingement.
hip is flexed, ABducted, ER
lumbosacral spring test
tests pathology of the sacrum
pat is prone and the heel of the physicians hand is placed over the lumbosacral junction. The physician will place a gentle rapid downward force with the hand and if not spring is noted than it is positive and the sacral base is posterior
ober test
evaluates for a tight tensor fascia late and ITB
pt. lies on the side that is not affected and the physician will stand behind them and flexes the knee 90 degrees, abducts the hip as far as possible and then slightly extends the hip then you allow the thigh to fall to the table
if the hip remained in the abducted position it is positive and there is a tight ITB
the trendelenburg test
evaluates weak gluten medius muscles
physician is behind patient and has them lift 1 leg off the floor
pelvis drops on the contralateral side there is weakness of the gluteus medius of the weight bearing leg
how do you augment flow
- remove thoracic inlet somatic dysfunction: open the thoracic inlet which is formed by Gibson’s fascia
- rib raising or paraspinal inhibition
- redone the diaphragm
- apply lymphatic pump techniques
thoracic inlet drains what
left arm, left side of the thorax, the abdomen and both legs
head and neck viscera somatic
T1-T4
heart viscerosomatics
T1-T5 on the left
respiratory system viscerosomatics
T2-T7
esophagus viscerosomatics
T2-T8
upper GI viscerosomatics
T5-T9
Middle GI tract viscerosomatics (SMA)
T10-T11
Lower GI tract viscerosomatics
T12-L2
appendix/cecum viscerosomatics
T10-T12
arms viscerosomatics
T2-T8
kidney viscerosomatics
T10-T11
Upper ureters viscerosomatics
T10-T11
lower ureters viscerosomatics
T12-L1
bladder viscerosomatics
T11-L2
gonads viscerosomatics
T10-T11
uterus/cervic viscerosomatics
T10-L2
erectile tissue viscerosomatics
T11-L2
prostate viscerosomaitics
T12-L2
legs viscerosomatics
T11-L2
what makes up the upper GI tract
stomach, liver, gallbladder, spleen, portions of pancreas, duodenum (Celiac)
what makes up the middle GI tract
portions of pancreas, duodenum, jejunum, ileum, ascending colon, proximal 2/3 transverse colon
lower GI tract contents
distal 1/3 transverse colon, descending colon, sigmoid colon, rectum
parasympathetic to ovaries and testes?
vagus
the rest of the parasympathetics are normal
above diagram vagus
below diaphragm: pelvic splanchinuc
what are the three types of soft tissue techniques
longitudinal: long axis stretching (axial traction)
perpendicular: kneeding (rhythmic perpendicular stretching )
direct inhibition: sustained pressure
in a scoliotic curve the vertebra deviating farthest from the midline is known as
apical vertebra (curve apex)
the _ barrier is engaged in direct techniques
restrictive
during exhalation the sacrum moves
nutation ( flexion)
during inhalation the sacrum moves
counternutation ( extension)
this decreases the lordotic curve
respiratory motion of the sacrum occurs around
the superior transverse axis at level S2
most common dysfunction of the sacrum in post parts patients is
bilateral sacral flexion
articulatory techniques are
low velocity with moderate to high amplitude
carried through its full ROM to increase mobility
primarily direct but can be modified to be indirect
articulatory techniques are contraindicated in?
acute strains or sprains
gall bladder chapman point
6th intercostal space at the mid clavicular line on the right
steps of direct myofascial release
Palpate down to the layer of the fascia.
Position the fascia to the restrictive barrier.
Hold the tissue at the restrictive barrier for 30 seconds until a release or fascial “creep” is felt.
Recheck to determine if tissue compliance and quality have improved.
treatment of carpal tunnel syndrome
mfr of the transverse carpal ligament
standing flexion test is used for
innominate dysfunctions
seated flexion test is used for
sacrum dysfunctions
yergason test
specialty test for biceps tendinopathy or instability
physician holds compression against the tendon of the long head of the biceps brachia in the bicipital groove and asks patient to supinate their forearm and flex there elbow against resistance (positive is if there is a snap_
long head the biceps tenderpoint location and treatment
over the biceps tendon
patient is supine, supinate the arm and flex the arm to 90 at the shoulder and flex the alone
tenderpoint of the acromioclavicular joint and the treatment
behind the anterior surface of the distal clavicle
treat: patient is prone and adduct the arm across the back with applied traction
tenderpoint for the supraspinatus location and treatment
location: supraspinatus fossa
treatment: pt is supine and the patients arm is flexed and abducted to 120 degrees then the humerus is externally rotated
latissimus dorsi tenderpoint location and treatment
location: deep in the axilla on the medial surface of the humerus
treatment: patient is supine and holding the arm posteriorly over the side of the table towards the ground with internal rotation and traction
tenderpoint for the subscapularis location and treatment
location: on the anterior surface of the scapula
treatment: patient is supine, hold the arm and pull it toward the ground and internally rotate
asending colon chapman point
right lateral thigh (middle 3/5)
HVLA on the cervical spine presents concerns for damage to the _ system
vertebrobasilar ssytem
when treating the cervical spine with HVLA you should avoid what positions
hyperextension and excessive rotation
AC1 mandible tenderpoint location and treatment
posterior aspect of the ascending ramps of the mandible at the earlobe level
AC1 mandible tenderpoint location and treatment
posterior aspect of the ascending ramus of the mandible at the earlobe level
AC1 mandible tenderpoint location and treatment
posterior aspect of the ascending ramus of the mandible at the earlobe level
rotate away
AC1 transverse process tenderpont location and treatment
lateral aspect of C1 transverse process hallway between mastoid process and ramus of manidble
rotate away
AC2-AC6 tenderpoint locations and treatments
anterior lateral aspect of tubercles of corresponding vertebrae transverse process
flex to the level of segment and side bend and rotate away (FSARA)
AC7 tenderpoint location and treatment
posterosuperior surface of the clavicleat clavicular attachment of the SCM
Flex STRA
AC8 tenderpoint location and treatment
superior medical end of the clavicle at sternal attachment of SCM
FSARA
CV4
compression of the 4th ventricle is decompressed
it is used to enhance the CRI in depressed people
technique: resistance to eh flexion phase and encouragement of the extension phase until cessation of the CSF is palpated at the still point
contraindications to the CV4 technique
acute intracranial hemorrhage, increased ICP, acute skull fracture, seizures
petrissage
soft tissue technique that involves kneading and skin rolling to compress the underlying musculature
v spread technique
release peripheral suture
venous sinus technique
retires optimal intracranial blood flow used for sinus headaches
pancreas chapman point posterior and anterior
anterior: 7th intercostal space on the right
posterior: T7 on the right
(epigastric pain that is relieved by bending forward, N/V, ecchymotic discoloration of the flank)
Posterior Sacrum 1 tenderpoint location
at each sacral sulcus
posterior sacrum 2-4 tenderpoint location
midline on the sacrum at the corresponding level
posterior sacrum 5 tenderpoint location
medial and superior to the inferior lateral angle on each side
high ilium flare out tenderpoint location
lateral aspect of ILA
high ilium sacroiliac tenderpoint location
on the ilium 2-3 cm lateral from the PSIS
lower pole L5 tenderpoint
immediately inferior to the PSIS
upper pole L5 tenderpoint location
superior medial surface of the PSIS
during the flexion phase of the primary respiratory mechanism there is _ of the midline cranial bones, _ rotation of the paired cranial bones, the sacral base moves _ and there is a _ anterior posterior diameter of the cranium
flexion
external rotation
posteriorly
decreased
when you have a linked rib and thoracic SD it is best to direct your first treatment toward the?
thoracic segment
AT1 tenderpoint location and treatment
suprasternal notch and treat with flexion and slight side bending/rotation
AT 2 tenderpoint location
angle of Louis (manubriosternal junction)
posterior rib 1 tenderpoint location and treatment
posterior superior aspect of rib 1 lateral to the costotransverse articulation
pt seated, sideband away, rotate towards and slightly extend
posterior rib 2-10 location and treatment
posterior superior angle of corresponding rib
pt seated side bend and rotate away and flex (FSARA)
counterstain for anterior rib 1 tenderpoint
patient is supine you flex sideband toward and rotate away
counterstain for anterior ribs 3-10
pt seated flex side bend toward and rotate away
HVLA contraindications
osteomyelitis, metastasis, severe osteoporosis, infection, joint replacement, down syndrome, veterbrobasilar insufficiency
chapman point for the larynx
second rib (same as larynx and tongue)
treatment for the high ilium flare out
extend and adduct
posterior lumbar 3 or 4 counterstain treatment
extend, abduct and IR
upper pole L5 counterstain treatment
adducted hip and externally rotate
lower pole L5 counterstain treatment
hip flexed, adducted and internally rotated
Primary respiratory motion is comprised of what 5 things
- fluctuation of CSF
- Inherent motion of the brain and spinal cord
- articular mobility of the cranial bones
- tension of the dura
- motion of the sacrum between the ill
attachments of dura
C2,C3, foramen magnum, sacrum (s2)
midline cranial bones
SOVE
sphenoid, occiput, vomer, ethmoid
flexion of the cranial
SBS:
sacrum:
paired bones:
AP diameter:
SBS goes cephalad
sacrum: counternutates
inhalation
paired bones ER
AP diameter shortens
physiologic cranial sacral motion
F/E
torsions
Sidebending rotation
nonphysiological cranial motions
vertical strain
lateral strain
compression
torsions
1 AP axis
greater wing of sphenoid
sphenoid and occiput rotate oppositely
sidebending/rotation
2 vertical axis
1 AP axis
named for the convexity of side bending
same in AP
opposite in vertical axis
vertical strain
2 transverse axis
base of sphenoid
same direction
