OMM II Final Exam Flashcards by Jesi Whitley

Glossary: A dysfunctional, persistent pattern, in some cases reversible, resulting when homeostatic mechanisms are partially or totally overwhelmed

Decompensation

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Glossary: Systems for classifying and recording the preferred directions of fascial motion throughout the body. Described by Zink and Neidner

Fascial patterns

common compensatory
uncommon compensatory
uncommon fascial

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Glossary: A type of fascial pattern the describes the specific finding of alternating fascial motion preference at transitional regions of the body

Common compensatory pattern

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Glossary: The finding of fascial preferences that do not demonstrate alternating patterns of findings at transitional regions. Because they occur following stress, or trauma, they tend to be symptomatic.

Uncommon fascial pattern

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Glossary: The finding of alternating fascial motion preference in the direction opposite that of the common compensatory pattern

Uncommon compensatory pattern

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Glossary: a forward translation of the body’s center of gravity by bipedal locomotion

Gait

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Glossary: the somatic dysfunction tht maintains a total pattern of dysfunction, including other secondary dysfunctions. The initial or first somatic dysfunction to appear temporarily

Key lesion

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Glossary: a system of diagnosis and treatment that considers the dysfunction to be a continuing inappropriate strain reflex, which is inhibited by applying a position of mild strain in the direction exactly opposite to that reflex. This is accomplished by specific directed positioning about the point of tenderness to achieve the desired therapeutic response

Strain-counterstrain

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Glossary: Provides information regarding the health of the patient. Utilizes the concepts of body unity, self-regulation and structure-function interrrelationships to develop a treatment plan.

Osteopathic Musculoskeletal evaluation

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Glossary: The examination of a patient by an osteopathic practitioner with emphasis on the neuromusculoskeletal system including palpatory diagnosis for somatic dysfunction and viscerosmatic change within the context of total patient care. The exam is concerned with finding somatic dysfunction in all parts of the body (performed in multiple positions to provide static and dynamic evaluation).

Osteopathic structural examination

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Glossary:

With the hand, rotation of the forearm in such a way that the palmar surface turns backward (internal rotation).
With the foot, involves a combination of eversion and abduction movements taking place in the tarsal and metatarsal joints.

Pronation

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Glossary: Prone

lying face down

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Glossary: Posterior displacement of one vertebrae relative to the one immediately below

Retrolisthesis

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Glossary: A short-lived increase CNS response to repeated sensory stimulation that generally follows habituation

Sensitization

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Glossary: posterior displacement of one vertebra relative to the one immediately below

Retrolisthesis

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Glossary: Hypothetically, a short lived (minutes - hours) increase in CNS response to repeated sensory stimulation that generally follows habituation

Sensitization

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Glossary: There are 4 types of somatic dysfunction -

Immediate or short termm impairement or altered function of related components of the body framework. It is characterized in early stages by vasodilation, edema, tenderness, pain, and tissue contraction.

It is diagnosed by Hx and palpatory assessment of TART

Acute

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Glossary: a group curve of thoracic and/or lumbar vertebrae in which freedoms of motion are in neutral with sidebending and rotation OPPOSITE directions with maximum rotation at the apex (towards CONVEXITY of the curve). *Fryette principle

Type I dysfunction

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Glossary: Thoracic or lumbar somatic dysfunction of a single vertebral unit in which the vertebra is significantly flexed or extended with sidebending and rotation in the same direction (rotation towards CONCAVITY of the curve). Fryette prinicple

Type II dysfunction

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Glossary: Stretching injuries of ligamentous tissue

first degree = microtrauma
second degree = partial tear
third degree = complete disruption

Sprain

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Glossary: Small, hypersensitive points in the myofascial tissues of the body thaqt do not have a pattern of pain radiation. These points are a manifestation of somatic dysfunction and are used as diagnostic criteria and for monitoring treatment.

Tenderpoints

*counterstrain; Jones

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Glossary: A congenital anomaly of a vertebra in which it develops characteristics of the adjoining structure or region.

Transitional vertebrae

a. Lumbarization
b. Sacralization

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Glossary: The patient with their back to the examiner, is told to lift first one foot and then the other. The position and movements of the gluteal fold are watched. When standing on the affected limb, the gluteal fold on the sound side falls instead of rising. Seen in poliomyelitis, un-united fracture of the femoral neck, coxa vara, congenital dislocations

Trendelenburg test

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Glossary: A small hypersensitive site that, when stimulated, consistently produces a reflex mechanism that gives rise to referred pain and/or other manifestations in a consistent reference zone thatis consistent from person to person.

Trigger point

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Glossary: Somatic dysfunction that arises either from mechanical or neurophysiologic response subsequent to or as a consequence of other etiologies

Secondary somatic dysfunction

Glossary: Transitional vertebrae _____: transitional segment in which the first sacral segment becomes like an additional lumbar vertebra, articulating with the second sacral segment.

Lumbarization

Glossary: Transitional vertebrae . _____: incomplete separation and differentiation of the 5th lumbar vertebrae (L5) such that it takes on characteristics of a sacral vertebrae OR when transverse processes of L5 are large leading to pseudoarthrosis (batwing).

Sacralization

Viscerosomatics: Sympathetic nervous system occurs at T1-L2/3. Explain the effects of the sympathetic nervous system on 1. eyes 2. glands 3. heart 4. lungs 5. GI 6. Bladder 7. Female reproductive 8. Male reproductive 9. Energy

1. Eyes: mydriasis, lens relax 2. dec. gland (nasal/lacrimal) secretion 3. inc. sweating 4. Inc. heart rate/contractility 5. relax bronchial SM 6. Relax GI lumens; contracts sphincters (dec. motility) 7. Relax bladder wall; contracts sphincter 8. Relax cervix; constrict uterine body 9. Ejaculation 10. Stimulates glycogenolysis *Loss = Horner syndrome - ptosis, miosis, loss of sweating

Viscerosomatics: The parasympathetic nervous system arises from CN 3, 7, 9, 10 and S2-S4 (pelvic splanchnics). Which of the following is NOT an action of the parasympathetic system? a. miosis and lens contraction b. nasal, lacrimal, gastric inhibition c. sweating of palms d. decrease heart rate and contractility

Answer: B - nasal, lacrimal, gastric inhibition Actually, promotes secretion Also: - contracts bronchilar SM - contracts GI lumens; dilates sphincter (inc. motility) - NO effect on arterioles - contracts bladder wall; relaxes trigone - erection - constricts cervix; relaxes uterus

Viscerosomatics: The afferent neuron has a cell body located in the ________, and a central process that terminates in the _____ of the spinal cord. This central process terminates on interneurons, which innervate the effector neurons in the gray matter of the spinal cord or brainstem.

a. DRG b. Dorsal Horn *effector neurons terminate on processes outside the CNS

Viscerosomatics: Naming reflexes involves the first component, which is the ________ source and causation, and then the ____ describes the included effect. E.g. = viscerosomatics - arise from viscera affecting the body

First component; Second component

Viscerosomatics: Organ info that leads to somatic change. Afferent stimuli from the viscera travel through the dorsal horn of the spinal cord, synapse on interconnecting neurons, and convey a stimulus to autonomic and somatic efferents resulting in sensory and motor changes in the somatic tissues.

Viscerosomatic reflex

Viscerosomatics: Levels of the spine associated with head and neck

Sympathetic: T1-T4/T5 Parasympathetic: Specific Cranial Nerves

Viscerosomatics: Levels of the spine associated with Upper extremities

Sympathetic: T2-T8 Parasympathetic: none

Viscerosomatics: Levels of the spine associated with the heart

Sympathetic: T1-T5 Parasympathetic: CNX; Occiput; C1-2

Viscerosomatics: Levels of the spine associated with the respiratory tree

Sympathetic: T1/2 - T7 Parasympathetic: CNX; Occiput; C1-2

Viscerosomatics: Levels of the spine associated with the esophagus

Sympathetic: T2-T7 Parasympathetic: - CN X (lower 2/3); - Occiput - C1-C2

Viscerosomatics: Levels of the spine associated with the respiratory tree

Sympathetic: T1/2 - T7 Parasympathetic: CNX; Occiput; C1-2

Viscerosomatics: Levels of the spine associated with Small Intestine

Sympathetic: T8-T11 Parasympathetic: CN X; Occiput; C1-C2

Viscerosomatics: Levels of the spine associated with the Stomach, GB, Liver, Spleen

Sympathetic: T5-T9 Parasympathetic: CN X; Occiput; C1-C2

Viscerosomatics: Levels of the spine associated with Small Intestine

Sympathetic: T8-T11 Parasympathetic: CN X; Occiput; C1-C2

Viscerosomatics: Levels of the spine associated with the pancreas

Sympathetic: T5-T9 (head); T10-T11 (tail) Parasympathetic: CN X; Occiput, C1-C2

Viscerosomatics: Levels of the spine associated with the Colon and Rectum

Sympathetic: T8 to L2 Parasympathetic: - CN X (ascending, transverse) - S2-S4 (descending, sigmoid, rectum)

Viscerosomatics: Levels of the spine associated with the Appendix

Sympathetic: T12 Parasympathetic: Occiput; C1-C2

Viscerosomatics: Levels of the spine associated with the Kidneys and Upper Ureter

Sympathetic: T9 - T11 Parasympathetic: CN X; Occiput; C1-C2

Viscerosomatics: Levels of the spine associated with the Lower ureter and Bladder

Sympathetic: T11 - L2 Parasympathetic: S2-S4

Viscerosomatics: Levels of the spine associated with the Gonads

Sympathetic: T9 - T11 Parasympathetic: CN X

Viscerosomatics: Levels of the spine associated with the Uterus

Sympathetic: T10 - L2 Parasympathetic: S2-S4

Viscerosomatics: Levels of the spine associated with the Prostate

Sympathetic: L1-L2 Parasympathetic: S2-S4

Viscerosomatics: Levels of the spine associated with the lower extremities

Sympathetic: T11 - L2 Parasympathetic: S2-S4

Viscerosomatics: Organs before the ligament of Treitz (divides duodenum and jejunum) have what sympathetic innervation?

T5 - T9 *liver, stomach, gallbladder, etc.

Viscerosomatics: All organs above the diaphragm have what parasympathetic innervation?

Vagus nerve

Viscerosomatics: Ovaries and Testes are innervated by

Vagus (gonads are VAluable) Others: Pelvic splanchnic

Viscerosomatics: Somatic irritant that causes visceral changes. It is elicited by stimulation of somatic tissue and manifests as an alteration in ANS function.

Somatovisceral reflex

Viscerosomatics: The maintenance of a pool of spinal neurons in a state of lowered threshold for activation (less afferent stimulation needed to trigger impulse)

Facilitation *less stimulation for the same effect; inc. sensitivity

Viscerosomatics: Diagnosis of Viscerosomatic reflex requires 2 or more adjacent spinal segments that show evidens of somatic dysfunction. TART can help ID. What are common TART findings for acute? chronic?

Acute: edema, boggy, heat, sweat chronic: ropey, cool, firm, tension * intensity may be = to severity of visceral path

Viscerosomatics: When should you have a higher index of suspicion for viscerosomatic dysfunction?

When resistant to OMM Tx | treated dysfunction returns w/ a rubbery end feel

Viscerosomatics: _______ can be applied to normalize vagal tone

OAD

Viscerosomatics: _______ can be applied to normalize sympathetic tone

Correcting somatic dysfunction from T1-L3

Viscerosomatics: _______ can be applied to increase sympathetic tone

rib raising

Viscerosomatics: _______ can be applied to decrease sympathetic tone

Inhibotry pressure to thoracolumbar paraspinals

Viscerosomatics: _______ can be applied to normalize parasympathetic tone

sacral rocking

Models: Focuses on posture, gait and joint motion. Treatment would involve OMT to restore balanced posture and improved motion.

Structural/Biomechanical model ex: patient w/ short leg; sports injury; trauma

Models: Focuses on musculoskeletal interaction with the respiratory and circulatory systems. This may include effects of the musculoskeletal system on arteries, veins, and lymph

Respiratory-circulatory model *assess rib cage mobility; diaphragm and its attachments

Models: Focuses on the musculoskeletal interaction with the nervous system: 1. Somatic (soft tissues, muscles, joints) 2. Autonomic (visceral) - -sudomotor, pilomotor, tissue texture, visceral changes

Neurological model ex: patient with nerve entrapment, chronic cough ex: arm pain during heart attack

Models: Focuses on metabolic processes, homeostasis and energy balance. It also emphasizes enhancing the body's self-healing mechanisms and MS system's impact on energy expenditure.

Metabolic-energetic model *patient who eats poorly - poor muscle tone; feeding issues in infants

Models: Focuses on various behavioral and psychosocial factors influencing patient health. Somatic factors may be involved in stressful conditions (pain/fear) due to inc. sympathetic output.

Behavioral model *stress management, emotional health, etc.

Spinal Mechanics: When the spine is in neutral, sidebending to one side occurs with rotation to the ________ side.

Opposite side Type I * groups (>2 segments) * long restrictors (erector spinae, quadratus)

Spinal mechanics: When the spine is flexed or extended (non-neutral), sidebending to one side will occur with rotation to the ______ side

Same - Type II mechanics - Facets control motion - Segmental short muscles - One vertebral segment is restricted -- worse in flexion or extension

Spinal mechanics: A flexed dysfunction indicates that the restriction occurs in _______

extension *asymmetry looks worse in extension

Spinal mechanics: Type II flexed dysfunction indicates that one side is held open. Which way does the spine sidebend and rotate?

AWAY from the open side

Spinal mechanics: Type II Extended dysfunction indicates that one side is held closed. Which way does the spine sidebend and rotate?

TOWARDS the closed side *asymmetry seen in Flexion (restricted in flexion)

Spinal mechanics: A prominent spinous process may indicate?

Flexed vertebra *opposite if less prominent spinous process

Cervical vertebrae: If a patient's OA is worse in flexion, but gets better in extension, and is more restricted on the right side, what is the diagnosis?

ESRRL **Dx via palpation of suboccipital region

With diagnosis of AA rotated right, the spinous process of C1 is shifted toward the

Left

A patient whose AA is more restricted to the left would be diagnosed with what dysfunction?

AA rotated right *Dx by flexing 45 degrees

C2-C4 segments primarily function in _____, while C5-C7 segments primarily function in ______

1. C2-C4 = rotation | 2. C5 - C7 = sidebending

Reciprocal inhibition involves placement of the dysfunctional segment into the barrier, and then the patient pushes _______ the barrier, while the physician ______.

INTO, resists *standard ME, patient pushes away

Lower Extremity I: Tests for FLexion, Abduction, External rotation, and extension. Used to distinguish site of pain. Considered positive if painful.

FABERe (Patrick's test) Pain: - contalateral = SI joint - Groin = hip joint

Lower Extremity I: Evaluates Iliopsoas tightness. The patient is situated supine at the edge of the table, while the Dr. flexes one knee to the patient's chest to flatten lumbar. Positive test is either increased lumbar lordosis, or if the patient's leg rises off the table.

Thomas test

Lower Extremity I: The psoas muscle originates on the sides of the lumbar vertebrae and inserts onto the lesser trochanter. It is innervated by L2-L4. What is its action with the origin fixed? with the insertion fixed?

1. Fixed origin - -flex hip joint - -some ext. rotation/abduction of hip 2. Fixed insertion - -bilaterally: increase lumbar lordosis - -unilaterally: sidebending (same side)

Lower extremity: Psoas muscle may demonstrate referred pain patters. Sites of referred pain include _______ thoracic to SI region, and _______ buttock between the thigh and the groin.

Ipsilateral thoracic to SI region | Upper buttock b/t thigh and groin

Lower extremity I: What are the features of Psoas syndrome on the right side w/ regard to 1. Thomas test 2. Lumbar sidebending 3. Location of sacral dysfunction 4. Pelvic side shift

1. + Thomas on Rt. 2. Lumbar sidebending toward tight psoas 3. Sacral dysfunction (oblique axis) -- usually same side as lumbar sidebending 4. Pelvic side shift - Left

Lower extremity I: Test characterized by Lateral deviation of the pelvis to the right or left of midline when the patient is standing. It is performed when the patient is standing, with the physician behind the patient stabilizing the right shoulder. THe pelvis is pushed towards the right and then left side. A positive test is the side w/ freer translation.

Pelvic side shift test

Lower extremity I: Psoas syndrome on the right, will cause a positive pelvic side shift to the ____1___. Psoas syndrome on the left will cause positive PSS test to the ____2__.

1. left 2. right *+ syndrome = compression of psoas = shifts body in opposite direction

Lower Extremity: Psoas syndrome is treated by OMT, but follows LIPLSIP. What must be treated before the Psoas muscle?

``` Lower extremity Innominate shears Pubic shears Lumbar Sacrum Innominate rotation/flares Psoas ```

Lower extremity 1: Tests Flexion, Adduction, and Internal rotation. 1. Hip flexed to 60 2. Knee flexed 60-90 Dr. adducts and internally rotates the hp while applying downard pressure to the knee. Positive test is that which reproduces SCIATIC-LIKE symptoms.

FAIR test

Lower extremity: The piriformis muscle originates on the anterior surface of S2-S4. It inserts into the superior medial aspect of the greater trochanter. It is innervated by S1-S2. What are its actions when the hip is extended? hip flexed?

extended: external rotation of the thigh | flexed 90 degrees: abduction of the thigh

Lower extremity: Counterstrain and myofascial techniques can be applied to piriformis dysfunctions. For counterstrain, where is the tenderpoint located and what is the treatment position?

Tenderpoint: middle of piriformis muscle Tx: F abd (captain morgan stance)

Lower extremity: _______ Tests IT band (ITB) tightness and flexibility at the knee. The test is positive if unable to drop below the horizontal level.

Ober's test *leg is flexed, abducted and hyperextended

Lower extremity I: A tight IT band can lead to irritation of the ______ _____ and ____ ____, resulting in inflammation of trochanteric bursa and pain at the distal knee

greater trochanter and tibial tubercle

Lower extremity: Which of the following is an effective treatment for IT band tightness? a. NSAIDS, Ice b. Counterstrain c. Therapeutic postures

All of the above *Counterstrain Tx: f abduction

Lower extremity I: _______ assesses the stability of the hip abductors (gluteus medius) on stance leg. A positive test is where the pelvis dips to the opposite side when standing on the weak leg.

Trendelenburg's sign

Lower extremity I: True/False: Gluteus medius strain/weakness can be associated with referred pain to the ilium (posterior crest), sacrum, and buttocks (posterolateral).

True

Lower extremity I: Treatment for gluteus medius weakness involves strengthening exercises and counterstrain. Counterstrain is at the PL3 tenderpoint location. How is it treated?

E Abd er *patient prone with hip/thigh extended and abducted

Lower Ext. II: The knee is a large synovial modified hinge joint w/ 3 main articulations: 1. patellofemoral 2. tibiofemoral 3. tibiofibular What is the primary motion of the knee?

Flexion and Extension | 8-12 degrees rotation

Lower Ext. II: The ______ glides superiorly as the knee extends. It acts as a guide for the quadriceps. Imbalance of muscle can lead to its abnormal movement.

Patella

Lower Ex. II: The wuadriceps provide anterior support to the lower extremity via tendon and patella. The hamstrings on the other hand, provide posterior support. What structures provide lateral and medial support to the lower extremity?

Lateral: IT band and biceps femoris Medial: muscle tendons and pes anserinus (gracilis, semitendinosus and membranosus)

Lower Ext II: 1. _____: knock knee (inc. Q angle) 2. ____: bowleg (dec. Q angle) 3. _____: normal in kids

1. Genu valgum 2. Genu varus 3. genu varum -- straight ---valgum

Lower Ext. II: X-rays may be performed if certain knee rules/criteria are met. These rules are: 1. Ottawa knee rule 2. Pittsburgh rule This rule is associated with a fall or blunt trauma. It occurs in ages < 12 or older than 50 and applies when the patient is unable to bear weight in the ER.

Pittsburgh rule

Lower Ext. II: X-rays may be performed if certain knee rules/criteria are met. These rules are: 1. Ottawa knee rule 2. Pittsburgh rule This rule is associated w/ patients > 55y/o who complain of isolated patellar tenderness or fibular head tenderness. Other criteria include inability to flex past 90o and inability to bear weight immediately.

Ottawa knee rule

Lower Ext. II: This is a test that assesses swelling. It is positive if: 1. fluid is present 2. patella elevates with compression 3. patella hits femur when pushed down 4. patella rebounds when released

Ballottement

Lower Ext II: This is a test that assesses swelling of the lower ext. It is positive if a bulge occurs on the opposite side (indicates moderate increase in fluid within the knee)

Bulge test

Lower Ext II: The knee depends on ligaments for stability and guidance for motion. The ______ restricts anterior motion of the tibia, while the ______ restricts its posteior motion.

1. ACL - restricts anterior motion - -ant. drawer, Lachmans 2. PCL - restricts posterior motion

Lower Ext II: The anterior cruciate ligament restricts anterior motion of the tibia. There are two tests that may be performed to determine damage to the ACL: 1. anterior drawer test 2. Lachman's test The _________ is positive if there is anterior displacement indicating an ACL tear. Accuracy of this test may be affected by PCL injury and protective spasms.

Anterior drawer

Lower Ext II:Lower Ext II: The anterior cruciate ligament restricts anterior motion of the tibia. There are two tests that may be performed to determine damage to the ACL: 1. Anterior drawer test 2. Lachman's test This test is preferred due to its increased accuracy/specificity. It is positive if there is anterior displacement.

Lachman's test

Lower Ext II: The posterior cruciate ligament restricts posterior motion of the tibia. Damage most commonly occurs from trauma. There are two tests that may be performed to determine damage to the PCL: 1. Posterior Drawer test 2. SAG sign With this test, the patient is supine with knee flexed to 90 degrees. The foot is externally rotated, but stabilized. It is a positive test if there is Posterior displacement of the tibia (indicating tear)

Posterior drawer test

Lower Ext II: The posterior cruciate ligament restricts posterior motion of the tibia. Damage most commonly occurs from trauma. There are two tests that may be performed to determine damage to the PCL: 1. Posterior Drawer test 2. SAG sign The SAG sign involves the patient being supine while the doctor examines the patient from the ____ aspect looking for posterior displacement of the tibia.

lateral aspect

Lower Ext II: The varus and valgus stress tests assess the medial and lateral collateral ligaments. Both should be performed with the leg abducted and with knees at 0 (stabilize) and 30 (assess laxity) degrees of flexion. 1. ______: checks the medial collateral ligament 2. _____: checks the lateral collateral ligament.

1. Valgus - -positive if absent at end point - -O degrees: PCL and MCL tears - -30 degrees flexion: only MCL 2. Varus - -positive if absent end point - -0 degrees: LCL, PCL, ACL, lateral meniscus capsule - -30 degrees flexion: LCL, cruciate ligaments, popliteus

Lower Ext. II: The )______ is another test that may be used to assess leg pain. The test is positive if increased pain after the knee is flexed to 90o and the foot is pulled up while applying internal and external rotation.

apley distraction

Lower Ext. II: This test assesses for Meniscal tears. 1. External rotation and valgus stress tests are applied for the medial meniscus 2. Internal rotation and varus stress tests are applied for the lateral meniscus. A test is positive if there is a thus, click, or pain

McMurray Test

Lower Ext. II: The ______ test involves flexing the knee to 90 degrees with the patient prone. To test, compression down through the heel is applied, while internally and externally rotating the tibia. A positive test is pain or decreased motion

Apley compression

Lower Ext II: ______ tests the patellar articulatory surface for possible chondromalacia that may occur from PFS. It is positive if it recreates pain.

Patellar grind test *weak vastus medialis obliquus = patella will track laterally

Lower Ext. II: ______ tests ITB tightness and flexibility at the knee. A positive test is indicated if the leg is unable to aDDuct past the horizontal level, indicating IT band tightness.

Ober's test

Lower Ext. II: Hallmarks of this syndrome include 1. anterior knee pain 2. overuse injury 3. pain with squatting and patellar tenderness

Patellofemoral syndrome

Lower Ext. II: Hallmarks of this syndrome include: 1. Lateral knee pain 2. Pain just prior to foot strike 3. Positive Ober and Noble compression test

Iliotibial band syndrome

Lower Ext. II: Ankle motion involves 20o dorsiflexion, 50 degrees plantarflexion, and inversion and eversion occur where the talus meets the calcaneus at the subtalar joint. The ankle joint has no intrinsic muscles, instead the ligaments and tendons provide structural support. What ligaments provide lateral stability of the ankle?

1. ATF: anterior talofibular 2. calcaneofibular 3. PTF: posterior talofibular

Lower Ext. II: The ankle joint has no intrinsic muscles, instead the ligaments and tendons provide structural support. What ligaments provide medial stability of the ankle?

deltoid, spring, medial talocalcaneal

Lower Ext II: What test is used to test lateral stability of the ankle joint? What test is used to check Anterior talofibular (ATF) stability?

Lateral stability: Inversion stress test | ATF stability: Anterior drawer test

Lower Ext. II: The following describes what dysfunction? 1. torn ligament due to inversion 2. MC anterior talofibular 3. X-ray based on Ottawa rules 4. Ligaments take up to 6 mos

Lateral ankle sprain

Lower Ext: II: The ottowa ankle rules for fracture are used to determine if an X-ray is necessary for a lateral ankle sprain. Which of the following is NOT a component of the ottawa ankle rules? a. tenderness of posterior tip of lateral malleoli b. tenderness of posterior tip of medial malleoli c. tenderness of navicular bone d. tenderness of base of the 4th metatarsal e. can't bear weight immediately and in the ER

Answer: D - tenderness at base of 4th **tenderness at the base of the 5th metatarsal

Lower Ext. II: True/False: The anterior drawer can test for Anterior talofibular ligament strain. One hand would be placed on the leg, while the other hand translates the talus anteriorly from the mortise. The test is positive if excessive translation movement

True

Lower Ext. II: tests lateral ankle injury. One hand holds the leg, while the other hand inverts/supinates the foot. Positive if excessive tilting movement

Inversion stress test

Lower Ext. II: Classification of ankle sprain. 1. ________: partial tear of a ligament 2. _______: incomplete tear of a ligament with moderate functional impairement 3. _______: complete tear and loss of integrity of a ligament

1. Grade I 2. Grade II 3. Grade III *most grade I and II's can ben treated with price and OMM

Lower Ext II: What must always be checked in a patient with ahistory of lateral ankle sprains?

Fibular head

Lower Ext II: The following describes the motions of the fibular head 1. The proximal fibular head will move Posterior when the lower leg is __1___ rotated and ___2___. (also seen with supination)

1. INTernally 2. PLANTARflexed *seen with pronation; PIP

Lower Ext II: The following describes the motions of the fibular head 1. The proximal fibular head will move Anterior when the lower leg is __1___ rotated and ___2___. (also seen with supination)

1. Externally rotated 2. DORSIflexed *seen with pronation, DEA

Lower Ext. II: Tibiotalar dysfunction can cause 1. _____: impingement at ant. or post. talus 2. _____: subtalar joint instability from excessive pronation compresses and inflames the soft tissue of the sinus tarsi 3. _____: achilles fat pad herniation

1. Bone spurs 2. Sinus tarsi syndrome 3. Piezogenic papullae

Lower Ext II: ______ is characterised by inflammation of the growth plate at the Achilles tendon. The tendon is at risk for injury due to inability to stretch to match the growth. It is MC seen in young children and young athletes.

Servers disease

Lower Ext II: This test is used to rule out rupture of the Achilles tendon. The patient lies prone while the examiner gently squeezes his/her calf muscles with their palm. If the Achilles tendon is intact, plantarflexion occurs at the ankle.

Thompson test + = minimal or NO ankle motion (achilles rupture)

Lower Ext II: Micro-injuries from repetitive motion and stress that affect the proximal attachment of the plantar aponeurosis to the calcaneus.

Plantar fasciitis *Tx: Injections, Surgery, Shock wave, proper foot wear, Stretches, OMM, NSAIDs

Lower Ext. II: The foot has three arches: 1. _______: higher and more mobile. It is located between the metatarsals and the calcaneous 2. ______: low with limited mobility (weight bearing). It transmits weight and thrust to the ground. 3. ______: located behind the metatarsal heads. The peroneus longus helps to maintain the arch

1. Medial longitudinal arch 2. Lateral " " 3. Transverse arch

Lower Ext. II: A 26 year old hockey player presents with burning neuropathic foot pain that is poorly localized over the heel and plantar aspect of the foot. You suspect compression of the posterior tibial nerve. What is this syndrome? How is it treated?

Tarsal tunner syndrome Tx: rest, shoes, immobilize, orthotics, injections, meds

Still: Still technique uses a combination of direct and indirect techniques. The starting point is indirect (position of ease), then a force vector is applied and maintained throughout. The dysfunctional segment is then carried through a ___1___ (path of least resistance) toward the __2___ restrictive barrier.

1. motion arc | 2. toward the bind-tight

Still: Why do we start Still at a position of ease? a. disarms the neurological protective mechanisms b. relaxes the myofascial components c. maintains the force vector directly

Answer - A and B

Still: ______ describes axial compression/traction (< 5lbs). It plays a role in re-patterning the neuro-fascial vascular complex in a normalizing direction. It frees the tissue from restriction.

Force vector

Still: Has a passive role in treatment. It monitors the segment/joint/muscle and provides feedback on the vector force, initial positioning, release.

Sensing hand

Still: Sets initial position of tissue, provides force vector, articulates through motion path

operating hand

Still: The following are the steps of Still technique 1. determines ease/where it is found 2. move it and its surrounding tissues into position of ______ 3. exaggerate position of ease 4. introduce vector of force

2. ease 4. 5 lbs 5. arc

Still: Which of the following is an indication for Still technique? a. articular somatic dysfunction (w/ intersegmental motion restriction) b. myofascial somatic dysfunction (w/ muscle hypertonicity or fascial bind c. limitations in other treatments d. communication difficulty

all of the above

Still: Why use still instead of muscle energy? a. indirect, so less likely to reproduce symptoms during setup b. longer treatment duration c. quicker d. relaxation does not require patient feedback

A, C, D *shorter treatment duration

Still: What are contraindications to Still technique? a. severe loss of intersegmental motion due to spondylosis, osteoarthritis, or RA b. moderate to severe joint instability in the area to be treated c. acute strain or sprain if tissues may be further compromised by the motion introduced in the technique

All of the above

AGR: What are the general characteristics of musculoskeletal pain? a. tenderness to palpation of muscle/fascia b. discomfort with movement c. referred pain to other areas d. swelling, congestion, acute inflammation

all of the above

AGR: structural relationship principle in which structural shape is guaranteed by the finitely closed, comprehensively continuous, tensional behaviors of the system and not by the discontinuous and exclusively local compressional member behaviors.

Tensegrity * bones = struts/rods * muscles, tendons, fascia: wires

AGR: Look for the area of greatest restriction by a ________ screen (articulatory screen of the spine, standing or seated flexion tests)

Motion screen

AGR: True/False: Spinal articulate motion should be performed w/ slow and deliberate motions, and should be evaluated for end feel of motions. Ultimately, the physician should be able to determine the ease of motion through the area.

True

AGR: Thoracics, spine and rib cage are intimately related. How do you distinguish rib from vertebral dysfunction?

Ribs: lateral restriction --spring laterally to test Vertebral: facets restricted

AGR: True/False: Upper extremity dysfunction is related to thoracic motion restriction. It is usually unilateral

True

AGR: Thoracics, spine and rib cage are intimately related. How do you distinguish thoracic dysfunction ?

a. central -- spine b. lateral -- ribs c. unilateral; T2-7 --upper extremity

AGR: When would you suspect sacral dysfunction as the AGR?

1. + seated flexion | 2. AGR at L/S junction

AGR: When would you suspect lower extremity?

1. + standing flexion test (PSIS) 2. unilateral lumbar motion restriction 3. general motion worse when standing

AGR: When would you suspect lumbar dysfunction? What must you differentiate lumbar dysfunction from?

1. upper-mid: lumbar 2. L5-S1 -- pelvis (+ seated forward bending) 3. differentiate from LE dysfunction (unilateral w/ positive standing forward bending)

AGR: AGR should be chosen when a. beginning treatment b. finding the most restricted part c. making specific diagnosis

all of the above

AGR: How do I decide which therapy to use? a. character of tissue changes and motion b. history c. mix of the previous two

All of the above Tissue changes -- tenderness, swelling, etc. History -- symptoms, previous Tx

AGR: Considering the character (end feel) of the barrier can help you determine the type of treatment. What types of Tx are recommended when: 1. pain/tenderness predominates 2. muscle spasm/hypertonicity 3. swelling (boggy)

1. strain/counterstrain 2. muscle energy 3. soft tissue/ME, counterstrain

Gait: Total mass of the body can be concentrated at one point: the midline and anterior to the S2 vertebrae. This is termed

Center of Gravity

Gait: True/False: Each person't COG may vary slightly, and it is the point to which the combined mass of the entire body appears to be concewntrated

True

Gait: When a person makes contact with a surface, the ________ is the area beneath the person where every single point of contact is made to that surface

Base of Support

Gait: Line of Gravity (LOG) within the Base of Support (BOS) produces ______, while LOG outside of BOS produces ______.

stability, instability

Gait: 1. 1 stride = ____ steps 2. 1 gait cycle = ____ stride 3. _____ = number of steps per unit of time or distance

1. 1 stride = 2 steps 2. 1 gait cycle = 1 stride 3. Cadence

Gait: The following are components of what phase of the gait cycle? 1. initital contact 2. loading response 3. midstance 4. terminal stance 5. pre-swing

Stance phase

Gait: The following are components of what phase of the gait cycle? 1. Initital 2. Mid 3. Terminal

Swing phase *In My Teapot

Gait: What are the 4 joints with the most movement during walking?

1. hip 2. knee 3. ankle 4. big toe

Gait: True/False: Energy efficiency aims to minimize vertical and horizontal displacement of the COG

True * rhythm - side to side * path: sinusoidal

Gait: Muscles that actively shorten, that generate a force, and that cause acceleration describes what type of muscle contraction?

Concentric *stability, propulsion

Gait: muscles that actively elongate in response to a greater opposing force describe what type of contraction?

Eccentric contraction *deceleration, shock absorption

Gait: List the 6 determinates of gait 1. pelvic rotation 2. ____ tilt 3. knee flexion in ____ position 4. foot/ankle mechanisms 5. knee mechanisms 6. ______ displacement of the pelvis

2. pelvic tilt 3. knee flexion in stance position 6. lateral displacement of pelvis

Gait: Transverse or horizontal plane movement (forward or backward). Influenced by stride length

pelvic rotation *affects hip flexion and extension

Gait: Anterior or posterior tilt in the Sagittal plane. Hip drop on swinging side with lateral shift over stance foot

Pelvic tilt

Gait: True/False: The knee is flexed 15o with loading response to aid in shock absorption and to control COG

true

Gait: 1. ______: dorsiflexion of the foot, abduction and eversion of the ankle 2. _____: plantarflexion, adduction and inversion

1. Pronation | 2. Supination

Gait: True/False: Lateral displacement of the pelvis is due to weight transfer from foot to foot. Frontal plane displacement is influenced by strength and function of the gluteus medius, upper gluteus maximus, tensor fascia lata

True 1. Glut medius: heel strike to toe off 2. upper gluteus maximus: heel strike to heel off 3. tensor fascia lata: substitutes weak gluteal muscles

Gait: List the steps in Gait 1. _______: initial contact (double support) 2. _______: foot flat (single support) 3. Midstance (single support) 4. _______ stance (heel off) 5. Pre-swing (toe off) 6. Initial and Mid-swing 7. Terminal swing

1. Heel strike 2. Loading response 3. Midstance 4. Terminal stance 5. Preswing 6. Initial and Mid-swing 7. Terminal swing Double support: Initial contact, Pre-swing

Gait: What happens with dysfunctional gluteus medius?

Body shifts towards the weak side

Gait: What happens with dysfunctional gluteus maximus?

Hyperextension of pelvis and trunk -- compensates

Gait: Initial contact, the calcaneous makes contact with the ground from an inverted position, with the foot in ____

supination

Gait: In loading response, the foot starts to ______ (from a supinated position) allowing for shock absorption and adaptation to the ground

pronate

Gait: During mid-stance, the foot should be slightly _____

pronated

Gait: During terminal stance, the foot begins to re-______, to provide stability of the foot

re-supinate

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OMM II Final Exam Flashcards

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