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OMM > OMM IV Exam I Cranial > Flashcards

OMM IV Exam I Cranial Flashcards

1
Q

Concussions: ______ is a brain injury and is defined as a complex patho-physiological process affecting the brain, induced by biomechanical forces.

A

Concussion

*mild, traumatic brain injury

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2
Q

Concussions: Concussion is caused either by a direct blow to the head, face, neck or other on the body with an impulsive force that is transmitted to the head.

True/False - It typically results in rapid onset of short-lived impairment of neurological function that resolves spontaneously.

A

True

  • self-limiting
  • may evolve over minutes to hours

**CT, MRI usually normal

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3
Q

COncussions: Acute clinical symptoms of a concussion reflect a functional disturbance rather than a structural injury. Abnormalities are not usually seen on standard structural neuroimaging.

True/False - Concussions normally result in a graded set of clinical symptoms that may or may not involve loss of consciousness.

A

True

*resolution follows sequential course

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4
Q

Concussions: True/False - No helment in any sports prevents concussion. Furthermore, mouth guards do not help prevent concussion, rather, they help to prevent dental injury

A

True

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5
Q

Concussions: Concussions are due to dysfunction of brain metabolism, not structural injury/damage. Acutely, the _____ works overtime, requiring increased amounts of ATP, and triggering a dramatic jump in glucose metabolism.

A

Na/K+ pump

*hypermetabolism is due to dec. cerebral blood flow *cellular energy crisis

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6
Q

Concussions: True/False - The resulting energy crisis is a likely mechanism for post-concussive vulnerability, making the brain less able to respond adequately to a second injury and potentially leading to longer lasting deficits.

Following the initial period of accelerate glucose utilization, the concussed brain goes into a period of depressed metabolism.

A

True

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7
Q

Concussions: A 21 year old female presents to the clinic accompanied by her coach after being hit on the head during a championship soccer match. Her coach states her athlete has complained of HA, Nausea/Vomiting, and dizziness. You note visual problems/increased sensitivity to light and noise. These are physical signs and symptoms of concussion.

What cognitive signs/symptoms could you expect to see in this patient?

a. “foggy” or slowness
b. difficulty remembering or concentrating
c. confusion
d. repeats questions or answers questions slowly

A

all of the above

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8
Q

Concussions: A 21 year old female presents to the clinic accompanied by her coach after being hit on the head during a championship soccer match. Her coach states her athlete has complained of HA, Nausea/Vomiting, and dizziness.

On PE you note visual problems/increased sensitivity to light and noise. Patient appears confused and answers questions slowly. What are emotional signs/symptoms of concussion?

A

-irritability -sadness -emotional -nervousness/anxiety

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9
Q

Concussions: A 21 year old female presents to the clinic accompanied by her coach after being hit on the head during a championship soccer match. Her coach states her athlete has complained of HA, Nausea/Vomiting, and dizziness. On PE you note visual problems/increased sensitivity to light and noise. Patient appears confused and answers questions slowly. What are sleep-related signs/symptoms of concussion?

A
  • drowsiness
  • sleeping less or more than normal
  • difficulty falling asleep
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10
Q

Concussions: Concussion is a diagnosis of exclusion (start with ABC’s and structural/neurologic exam). On Field or Sideline Evaluations of concussion should include

  1. Medical evaluation
  2. Monitoring or Sending emergently
  3. No RTP on day of injury

Explain

A
  1. Must do full exam! Hx of event
  2. Med eval: ABC’s to rule out structural intracranial lesions
  3. Monitoring –monitor for initial few hours

–emergent release if change in behavior, worsening HA, repeated vomiting, double vision, excessive drowsiness or worsening symptoms

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11
Q

Concussions: Which of the following is a red flag for concussion?

a. neck pain or tenderness
b. double vision
c. weakness/tingling or burning sensations in the arms or legs
d. severe or increasing HA

A

all of the above

  • *seizure or convulsion
  • *loss of consciousness
  • *deteriorating or conscious state
  • *vomiting
  • *restlessness/agitation/combative
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12
Q

Concussions: True/False - It is important to look for observable signs (witness or observed on video) and to perform a memeory assessment (e.g. maddocks questions). A glascow coma scale and cervical spine assessment may also be necessary.

A

True *px who is not lucid or fully conscious, a cervical spine injury should be assumed until proven otherwise

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13
Q

Concussions: Complications of brain injury include

  1. cervical spine injury
  2. skull fracture
  3. intracranial hemorrhage
  4. seizures
  5. post-concussion syndrome
  6. second impact syndrome
  7. chronic traumatic encephalopathy

_______occurs when an athlete sustains a second head injury while symptoms of concussion still persist after an initial injury. Athletes are at increased risk if they return to play while still recovering from an previous head injury.

A

Second impact syndrome

**cerebral swelling, brain herniation, death can occur

**Zack Lystedt Law: premature return to the game

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14
Q

Concussions: True/False - There is no FDA approved treatment for concussion or post-concussion symptoms, however, rest is important (acutely) and no return to sport on same day of injury is required.

A

True

*physical rest: no organized sports, no recess, no PE

*brief rest: 24-48 hours during acute phase

*encourage gradual/progressive return to physical activity (as long as it doesn’t exacerbate symptoms)

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15
Q

Concussions: Congitive rest involves

a. limiting use of mobile devices, TV, noisy environments
b. reduction in school work load, schedule, homework or testing restrictions
c. driving for first 24 hours
d. restriction in organized sports

A

A-C

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16
Q

Concussions: True/False - During the acute phase, both physical and cognitive rest should be recommended, followed by a graded program of exertion prior to medical clearance and RTP (return to play). Activities that require concentration and attention (and could exacerbate symptoms) may delay recovery

A

True

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17
Q

Concussions: As a general principle, OMT should not be used at the game/event or within the first 24 hours. Treatment may be used within the first 24 hours if:

a. symptoms are improving
b. symptoms are mild
c. only one reported symptom (*eg. headache)

A

all of the above

**ideally 24-36 hours after injury

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18
Q

Concussions: Review return to learn and return to play protocol

A

slides 44, 45

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19
Q

Concussions: Concussion symptoms resolve within 2 weeks in 80-90% of cases. In the remainder of cases, persistent symptoms including sleep disturbance, cognitive impairment , HA and emotional symptoms can persist. This is known as post-concussion syndrome. How is post-concussion syndrome treated?

A
  1. Treat symptoms
  2. No meds proven to reduce duration of symptoms
  3. Possibly OMT
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20
Q

Concussions: Which of the following accounts as evidence for use of OMT for concussion symptoms?

a. Headache
b. Dizziness
c. Visual disturbance
d. Depression

A

all of the above *

fatigue, balance

**don’t use in 1st 24 hours

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21
Q

Concussions: With OMT, the primary goal is achieving maximum function over pain relief. What OMT techniques should be avoided in concussion patients? What can be used?

A
  1. AVOID HVLA —of cervical spine (if unstable, symptomatic)
  2. May use OMT to:

–dec. muscle tension (cercial and upper thoracics)

–counterstrain, cranial, indirect techniques –ME if done without pain

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22
Q

Concussions: Increased muscle spasm during OMT indicates the patient’s tolerance has been exceeded. If the patient feels uncomfortable, stop and choose another approach, or wait and try again later.

A

True

Sequence:

–suboccipital release –ME OA, AA

–correct cervicothoracic

–myofascial (trapezius, levator, cervical)

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23
Q

Intro to Cranial: The 5 elements of the primary respiratory mechanism are:

  1. The _______ of the CSF
  2. The inherent _______ of the CNS
  3. The ______ of the intracranial and intra-spinal membranes and function of reciprocal tension membrane (RTM)
  4. The _______ Mobility of the cranial bones
  5. The _______ Mobility of the sacrum between the ilia
A
  1. The Fluctuation of the CSF
  2. The inherent Motility of the CNS
  3. The Mobility of the intracranial and intraspinal membranes and function of reciprocal tension membrane (RTM)
  4. The articular Mobility of the cranial bones
  5. The involuntary Mobility of the sacrum between the ilia

Fluctuation, Motility and 3 Mobility’s

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24
Q

Intro to Cranial: List the Midline bones

A

Sphenoid, Occiput, Vomer and Ethmoid bone

NOTE: Frontal is not midline because it has 2 separate ossification centers

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25
Q

Intro to Cranial: List the Paired Bones

A

Temporal and Parietal

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26
Q

Intro to Cranial: ______ are a site of active bone growth. They are a form of articulation characterized by the presence of a thin layer of fibrous tissue uniting the margins of the contiguous bones.

Sutures persist if there is motion and stress across them, allowing more mechanical resilience in the case of trauma to the head or from chewing forces. What are the suture landmarks?

A

Sutures

Landmarks:

  1. Bregma: coronal + sagittal
  2. Pterion: frontal, parietal, temporal, and sphenoid bones join
  3. Lambda: lambdoid + sagittal
  4. Asterion: parietomastoid suture (post.)
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27
Q

Intro to cranial: Which of the following is true about sutures?

a. active site of bone growth
b. periosteum splits into 2 layers at the suture (outer layer and inner layer/fibrous capsule)
c. forms a strong bond uniting adjacent bones while permitting slight movement
d. enables slow, progressive angulation to take place between the bones as the skull alters in shape during growth

A

all of the above

*allows bending strength and energy absorption (protects brain)

*b/t 2 capsules is central zone containing weak fiber bundles running in all directions, nerves and sinusoidal blood vessels

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28
Q

Intro to cranial: _____ is the thin membrane which encloses and adhere to the brain and spinal cord

A

pia mater

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29
Q

Intro to cranial: ______ is a gauzy, web like reticulum pervading all the spaces it occupies with a sponge like structure containing CSF

A

arachnoid mater

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30
Q

Intro to cranial: _____ is a tough, bluish-white membrane that is the outermost layer of the CNS. It has one continuous membrane (though often describes as having cranial and spinal portions)

A

Dura mater

-external layer: periosteum (internal and external surfaces)

–Internal layer: meningeal layer

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31
Q

Intro to cranial: The internal (meningeal) layer of the Dura mater surrounds the brain and comes together in 2 layers to form the

  1. Falx cerebri
  2. Tentorium cerebelli
  3. Falx cerebelli

THe _____ arises from the straight sinus, attaches to the frontals, parietals, occiput, and crista galli of the ethmoid bone.

A

falx cerebri

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32
Q

Intro to cranial: The intradural venous sinuses are formed via spaces/areas. These sinuses are:

  1. Superior/Inferior sagittal sinus
  2. Straight sinus
  3. Transverse sinus
  4. Sigmoid sinus
  5. Occipital sinus

True/False - Venous sinus drainage technique exerts its effects through dural attachments to sutures.

A

True

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33
Q

Intro to cranial: The internal (meningeal) layer of the Dura mater surrounds the brain and comes together in 2 layers to form the

  1. Falx cerebri
  2. Tentorium cerebelli
  3. Falx cerebelli

The ______ has two halves which originate at the straight sinus and attach to the occiput, temporals and sphenoid bone

A

tentorium cerebelli

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34
Q

Intro to cranial: The internal (meningeal) layer of the Dura mater surrounds the brain and comes together in 2 layers to form the

  1. Falx cerebri
  2. Tentorium cerebelli
  3. Falx cerebelli

The falx cerebelli arises inferior to the tentorium and is continuous with the spinal _____ layer. It attaches to the occiput and formen magnum

A

dural layer

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35
Q

Intro to cranial: The dura mater extends down the spinal canal with firm attachment around the _______, to the posterior aspect of the dens and body of C3, and to the posterior aspect of the body of S2 (corelink)

A

foramen magnum

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36
Q

Intro to cranial: Dural structures maintain consistent tension across the system. This is known as

A

Reciprocal tension membrane

*tentorium cerebelli, falx cerebri, falx cerebelli

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37
Q

Intro to cranial: The involuntary mobility of the sacrum between the ilia occurs via the _______. The sacrum moves in response to the SBS via the dural attachments at the forman magnum and S2 (_____)

A

Core Link

*At S2 = axis of nutational movement

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38
Q

Intro to cranial: During flexion, what happens to the:

  1. Greater Wing of Sphenoid
  2. SBS
  3. Core Link
  4. Sacral Base
A
  1. Greater wing of sphenoid flexes forward
  2. SBS rises
  3. Inc. Tension on Core Link
  4. Sacral Base – Superior and Post. (Counternutates)
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39
Q

Intro to cranial: What happens to the during extension:

  1. Greater Wing of Sphenoid
  2. SBS
  3. Core Link
  4. Sacral Base
A
  1. Greater wing of sphenoid extends upwards
  2. SBS drops
  3. Release Tension on Core Link
  4. Sacral Base – Anterior and Inferior (Nutates)
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40
Q

Intro to Cranial: There are 2 phases of Cranial Motion: Inhalation and Exhalation. Explain what happens to the following during Cranial Inhalation:

  1. Midline bones
  2. Paired bones
  3. Sacrum
  4. A-P diameter of the head
  5. Transverse diameter
A
  1. Midline bones: Cranial Flexion
  2. Paired bones: Externally rotate
  3. Sacrum: Counternutates
  4. AP diameter: Decreases (solid line - consistent volume)
  5. Widened Transverse diameter
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41
Q

Intro to Cranial: There are 2 phases of Cranial Motion: Inhalation and Exhalation. Explain what happens to the:

  1. Midline bones
  2. Paired bones
  3. Sacrum
  4. A-P diameter of the head
  5. Transverse diameter during Cranial Exhalation
A
  1. Midline bones: Cranial Extension
  2. Paired bones: Internally rotate
  3. Sacrum: Nutates
  4. AP diameter: Increases
  5. Narrowed Transverse diameter
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42
Q

Intro to Cranial: The CSF is produced chiefly by the choroid plexus. It acts as a support and buffer for the central nervous system and is vital to its metabolism.

  1. _______ occurs via hydrostatic forces at choroid plexuses and the arachnoid granulation.
  2. _______ occurs as a back and forth movement of the fluid (like the tide in the ocean) contributes to this process
A
  1. Circulation
  2. Fluctuation

–CSF moves in response to arterial pulse and respiration

–PRM also causes fluctuation

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43
Q

Intro to cranial: The inherent motility of the CNS is a subtle, slow, pulse-wavelike movement.

  1. It is a ______ cycle, with a rhythmic nature.
  2. The entire CNS _____ and thickens (coils) during one phase and legnthens and thins during the other phase.
A
  1. Biphasic cycle
  2. Shortens and thickens during one phase
  3. Lengthens and thins during other phase

*rhythm: 10-14 cycles per minute (Cranial Rhythmic pulse)

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44
Q

Intro to cranial: The CSF flows through the CNS creating an interchange throughout the body. This describes

A

Fluctuation of the CSF

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45
Q

Intro to cranial: The CNS moves in a slow, biphasic cycle at a rhythm of 10-14 cycles per minute called the Cranial Rhytmic impulse (CRI). This is best described as

A

The inherent motility of the CNS

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46
Q

Intro to Cranial: The spinal and cranial dura responds to the inherent motion of the CNS and fluctuation of the CSF and moves through a biphasic cycle, influencing the cranium and sacrum. This best fits

A

The mobility of the intracranial and intraspinal membranes and function of RTM

47
Q

Intro to Cranial: The beveled articular surfaces of the sphenoid bone are like the “gills of a fish”. This led Dr. Sutherland to find the articular mobility for a primary mechanism by observing the _____ of the cranial bones

A

sutures

48
Q

Intro to Cranial: The dura attaches to the swacrum on the posterior aspect of S2, causing the axis of rotation during carniosacral motion to occur through the vertebral body. This describes

A

Involuntary mobility of the sacrum between the ilia

49
Q

Intro to Cranial: CSF + CNS (CRI) + Dural Membranes (RTM) + sacrum + Cranial bones =

A

PRM

50
Q

OCMM II: The primary respiratory mechanism is palpable throughout the body and occurs in two alternating phases:

  1. Inhalation (______ phase): flexion of the midline bones
  2. Exhalation (____ phase): extension of the midline bones. It occurs rhythmically, 10-14 cycles/min and is similar to thoracic respiration.
A
  1. Inhalation - expansive phase
  2. Exhalation - receding phase
51
Q

OCMM II: Inhalation (swelling) results in Flexion of the greater wing of the sphenoid. The SBS rises, and the AP diameter shortens. What happens to the paired bones?

A

External rotation *widened transverse diameter NOTE: posterior motion of sacral base (counternutation)

52
Q

OCMM II: Exhalation (receding) results in Extension of the greater wings of the sphenoid. The SBS drops and the A-P diameter increases/lengthens. What happens to the paired bones? Sacral base?

A
  1. Paired bones - internally rotate –narrow transverse diameter 2. Sacral base –nutation (anterior motion)
53
Q

OCMMII: Flexion/Extension involves the midline bones (occiput, sphenoid, ethmoid and sacrum). Flexion is part of ______ with slight elevation of the SBS junction, and the greater wings of the sphenoid flex down.

A

Inhalation *greater wings flex down *SBS elevates (Ernie head)

54
Q

OCMMII: Flexion/Extension involves the midline bones (occiput, sphenoid, ethmoid and sacrum). Extension is part of ______. It involves drop of the SBS junction, while the greater wings of the sphenoid extend upward.

A

Exhalation *NOTE: both extension and flexion rotate around transverse axes

55
Q

OCMMII: In flexion, the sphenoid rotates anteriorly around a _______ axis through the body (level of floor of sella turcica).

A

Transverse axis

*greater wings move forward (lateral and inferior)

*pterygoid processes move posterior (lateral)

NOTE: Flexion (wings flap down)

56
Q

OCMM II: The occiput has 4 parts at birth:

  1. Condylar parts fuse with the _____ between ages 3-5.
  2. Condylar parts and basilar parts fuse at age 7-8
A
  1. Squama
57
Q

OCMM II: The motion of the occiput is primarily Flexion/Extension. In flexion and extension, the occiput rotates around a transverse axis that is directly above the foramen magnum.

  1. In flexion, the squamous part moves _______
  2. In extension, the squamous part moves
A
  1. posterior
  2. anterior
58
Q

OCMM II: Motion of the temporal bones is primarily External and Internal Rotation. They rotate around an axis that runs through the jugular surface to the petrous apex. The squama flare _____ with external rotation (mastoids medial and anterior)

A

Out

**external and internal rotation

59
Q

OCMM II: THe parietal bones are paired bones that play a role in internal and external rotation. They have only one part (squama). The inferior surface moves ______ around an axis, connecting the anterior and posterior bevel changes (coronal and lambdoid sutures)

A

Laterally

  1. External rotation –inferior part rises (like beetle wings)
  2. Internal rotation (inferior part drops and moves medially)
60
Q

OCMM II: The frontal bones are paired bones at birth that function in internal and external rotation. In adults, they acts as paired bones because of the metopic suture.

The axis of external/internal rotation occurs from the _________ through the center of the orbital plate.

A

Frontal eminence

*ER/IR keys off of lateral aspects of frontal bones

61
Q

OCMM II: 1. External motion of the frontal bones results in the lateral part moving _____ 2. Internal motion of the frontal bones results in the lateral part moving _____

A
  1. Out
  2. In
62
Q

OCMM II: The sacrum moves in concert with the occiput, responding to pull of dural membranes which are attached to the foramen magnum at the cervical spine and S2 (core link). True/False: Cranial flexion results in counternutation (posterior), while cranial extension results in nutation (anterior) of the sacral base

A

True

Flex: Counter

Extend: Nut

63
Q

OCMM II: Torsions and Sidebending/Rotation are considered physiologic strains (they don’t interfere with normal flexion and extension.

In SBS torsions, the Axis is ___1__, and the sphenoid and occiput rotate in ___2__ direction. It is named for the ___3_____ sphenoid wing.

A
  1. AP axis
  2. Opposite directions
  3. High sphenoid wing Occiput: counterclockwise Sphenoid: clockwise
64
Q

OCMM II: Torsions and Sidebending/Rotation are considered physiologic strains (they don’t interfere with normal flexion and extension.

In SBS torsions, the Axis is ___1__, and the sphenoid and occiput rotate in ___2__ direction. It is named for the ___3_____ sphenoid wing.

A
  1. AP axis
  2. Opposite directions
  3. High sphenoid wing Occiput: counterclockwise Sphenoid: clockwise

Due to: Dental trauma (chipping left upper tooth = left torsion)

65
Q

OCMM II: In a ______ torsion, the sphenoid rotates to the right, and the occiput rotates to the left (counterclockwise). The left index finger feels more anteriosuperior, while the right will feel posteroinferiorly rotated (vault hold).

A

Left torsion *left side more anterosuperior (sphenoid wing) *sphenoid rotates counterclockwise (right); occiput rotates clockwise (left) NOTE: Remember anatomical R and L

66
Q

OCMM II: In a right torsion, the sphenoid rotates to the _______ and the occiput rotates to the _____. Using the vault hold, the left index finger will feel more inferior, and the right will feel more superior.

A

Sphenoid rotates left (clockwise)

Occiput rotates right (counterclockwise)

****NOTE: remember, it is anatomical R and L

67
Q

OCMM II: To perform the vault hold, position hands on either side of the cranium. List the locations of the:

  1. Index finger
  2. Middle finger
  3. Ring finger
  4. Little fingers
  5. Thumbs
A
  1. Index finger: Greater wing of sphenoid
  2. Middle finger: Temporal bone (ant. to ear)
  3. Ring finger: Temporal bone (behind ear)
  4. Little fingers: Occiput
  5. Thumbs: gently rest over superior-parietal part of cranium

*palpate the cranial motion through the respiratory cycle

68
Q

OCMMII: Sidebending rotations have a total of 3 axes (2 parallel vertical axes and 1 AP). Thus, 2 separate motions of the SBS occur simultaneously.

  1. Sidebending occurs in _____ directions on the 2 vertical axes (through the body of the sphenoid and the center of the foramen magnum).
  2. The Occiput and sphenoid rotate in the ______ direction around the AP axis
A
  1. SB in opposite directions
  2. Same direction (AP axis)

–same as torsions

–rotate toward convexity creating SB

**Name by side of convexity/fuller side

69
Q

OCMM II: A _____ SB and rotation is created when the sphenoid and occiput are closer on the left side. In a vault hold, the right fingers spread (convex) and move caudad while the left fingers narrow and move cephalad.

A

RIght SB and rotation

*convex = anatomical right side

*sphenoid and occiput fold toward left side

*wing of sphenoid inferior on the right side

NOTE: Remember anatomical left and right!!

70
Q

OCMM II: A _____ SB and rotation is created when the sphenoid and occiput are closer on the right side. In a vault hold, the left fingers spread (convex) and move caudad while the right fingers narrow and move cephalad.

A

Left SB and rotation

*left side = convex, inferior

*right side = concave

71
Q

OCMM II: What is a common cause of a Right sidebending strains?

A

Getting hit in the head at the level of the SBS on the LEFT

72
Q

OCMM II: Non-physiologic strains affect normal flexion/extension and cause more symptoms. These include:

  1. Vertical
  2. Lateral
  3. Compression

Vertical strains are Superior/Inferior strains that occur along _____ transverse axes. In vertical strains, the sphenoid and occiput rotate in the _____ direction(s).

A
  1. 2 transverse axes
  2. Same direction

**shearing of sphenoid base

**named by position of sphenoid base

73
Q

OCMM II: What is a common cause of a superior vertical strain? Inferior?

A
  1. Trauma from below/anterior to SBS

–post to transverse axis of sphenoid

e. g. uppercut punch
2. Fall onto feet or buttocks

–force transmitted to condyles

–standing up into cabinet door (hitting anterior SBS)

–posterior to transverse axis of sphenoid)

*trauma from above down or below up; anterior to or posterior to axes of rotation

74
Q

OCMM II: In a(n) ______ vertical strain, the sphenoid and occiput rotate anteriorly, while the sphenoid base is higher at the SBS compared to occiput.

A

Superior vertical strain (shear)

75
Q

OCMMII: Lateral strains occur as either a Right or Left strain. They occur on 2 vertical axes, with the sphenoid and occiput rotating in the same direction. This creates a shearing of the sphenoid base to the left or the right of the basoocciput.

How are these strains named?

A

Based on the position of the sphenoid base

76
Q

OCMMII: In a _______ lateral strain, the base of the sphenoid shears to the right, while the greater wing of the sphenoid and the occiput goes to the left.

In the vault hold, it forms a parallelogram with the index finger shifting left and the little finger shifting right.

A

Right lateral strain

77
Q

OCMMII: In a _____ lateral strain, the base of the sphenoid shears left, while the greater wing and the occiput move to the right

A

Left lateral strain

78
Q

OCMM II: Lateral strains are most often due to trauma from left to right and anterior to the SBS (left lateral strain). It may also be due to right to left trauma, and/or trauma posterior to the SBS (right lateral strain).

What type of strain would getting hit by a baseball on the left side of the temple (anterior to axis of motion) cause?

A

Left lateral strain

*base of sphenoid moves left

*wing and occiput move right

79
Q

OCMMII: SBS compression impairs physiologic motion and may present with compensatory patterns. It often occurs with a “bowling ball head” and severe headaches.

True/False - Compression may occur from pressure or trauma to either the front or the back of the head (circumferential compression that exceeds resislency of tissues). This results in the sphenoid and occiput being forced together

A

True

*concussions, birth trauma

80
Q

Cranial Applications: Latching difficulties in newborns may be associated with the birthing process. This may cause changes in the structural relationships between the bones, dura and fascia.

Birthing can cause changes to the 3-D structural relationships of the jugular foramen. What are examples?

A
  1. Impact CN 9-11 = latching problems

*CN 9 most important in latching and sucking

*OMM targets OA and condyles, other cranial and submandibular muscles

81
Q

Cranial Applications: Suckling involves coordination of the following nerves:

  1. Trigeminal
  2. Facial
  3. Glossopharyngeal
  4. Vagus
  5. Hypoglossal

Explain their actions in suckling

A
  1. Trigeminal
    * –mastication
  2. Facial
    * –purse lips
  3. CN 9
    * –sensation, taste, motion of larynx and pharynx
  4. Vagus
    * –motor innervation of soft palate, pharynx, larynx, esophagus
  5. Hypoglossal
    * –motor of tongue
82
Q

Cranial applications: The cranial base and sacrum are are inlets and outlets of critical nerves, arteries and veins.

The jugular foramen is a site through which multiple structures (nerves, vessels) pass. List the structures that pass through it

A
  1. jugular vein
  2. CN 9, 10, 11
83
Q

Cranial applications: Consequences of perinatal somatic dysfunction can be acute (immediate post-natal) or can occur within the first 6 months of development.

What are examples of each?

A

1. Immediate post-natal

  • Hypoventilation
  • Irritability
  • Poor suck
  • Reflux
  1. First 6 months
  • Colic, Reflux
  • Torticollis
  • Plagiocephaly
  • Early onset ear infections
84
Q

Cranial Application: The fetal skull is vulnerable to intra-osseous dysfunction due to its structural anatomy. The occiput is split into 4 parts, temporal into 3 parts and sphenoid into 3 parts.

The structure of the OA contributes to stability during labor, because the convex occiput fits into the concave atlas. What is another structure that helps maintain the structure of the skull?

A

Stability of dural membranes (RTM)

*veins within dural folds

85
Q

Counterstrain: Explain How to treat the following cervical counterstrain points:

  1. AC1
  2. AC7
  3. AC8
  4. Typical Anterior Cervical points
A
  • AC1
    • On the posterior aspect of the ascending ramus of mandible
    • Neck RA
  • AC7
    • On the posterior-superior surface of the clavicle at the clavicular attachment of the SCM
    • Neck F STRA
  • AC8
    • On the medial head of the clavicle at the sternal attachment of the SCM
    • Neck F SARA
  • Typical Anterior Cervical Points
    • Neck F SARA
86
Q

COunterstrain: Explain How to treat the following cervical points:

  1. PC1 inion
  2. PC3
  3. Typical posterior cervical points
A

PC1 inion

–On the inferior nuchal line, just lateral to the inion

–Neck F

PC3

–On the inferior or infero-lateral aspect/tip of the spinous process of C2

–Neck F SaRa

Typical posterior cervical points

–Neck E SARA

87
Q

Cranial Application: List the sites of the following dural attachments (to the skull)

  1. Anterior attachment
  2. Posterior attachment
  3. Lateral attachmen
A
  1. Crista galli
  2. Internal protuberance and transverese ridges
  3. Petrous parts of temporal bones, posterior clinoid processes of sphenoid
88
Q

Cranial applications: Which of the following is an anatomical change of the skull associated with age?

a. At 1 y/o, the skull doubles in size, temporals fuse, mandible ossifies and OA patterns set
b. At 3 y/o, metopic closing and maxillae heighten
c. At 3 y/o the bevels are evident and the cranial base is adult size
d. At 1 y/o the parts of the occiput and atlas fuse (still flexible)

A

A and B

6 y/o: bevels evident, cranial base adult size

7-9: parts of occiput + atlas fuse

12 y/0: inc. facial development

25 y/o: SBS “fuses”

89
Q

Cranial application: True/False - Normally, newborns should display symmetric structure and function (e.g. no hand preferencing before 1 y/o). Flexion tone + extensor reflexes gradually changes to flexible, stabilized extension (upright) and voluntary control of motion.

A

True

Rostral: caudal development

Medial: lateral development

Gross: fine motor control

90
Q

Cranial Applications: Colic is a predictable, inconsolable crying episode that lasts > 3 hours/day, for > 3 days/week for 3 weeks or more. It occurs in otherwise healthy babies, and has an undefined etiology (GI discomfort/distension/gas). GI targeted therapies (e.g. simethicone) are often helpful, along with OMT.

True/False - Condylar and OA restrictions are often found in these babies. Improvement of these restrictions is associated with improved symptoms.

A

True

*vagal dysfunction at jugular foramen (impairs gut regulation)

*head/neck pain

*target diaphragm and thoracics too

91
Q

Cranial applications: Infantile reflux is an issue that may present with newborns. Interventions may include

  1. dec. amount of feeding
  2. burping frequently
  3. keeping baby upright after feeds
  4. changing formula (breastfeeding patients, monitoring whether certain foods that mom eats makes baby’s GERD worse)
  5. Zantac

OMM is also helpful with regard to correcting the condylar and OA restrictions. Thoracolumbar and diaphragm restrictions can be targeted as well.

A

True

*dysfunction of vagus at jugular foramen is key

92
Q
A
93
Q

Headache: Which of the following is a headache red flag?

a. sudden onset of first severe HA (thunderclap)
b. worst HA of life (e.g. thunderclap)
c. late onset (after 30y/o) of new HA
d. HA associated with fever, rash, or stiff neck

A

all of the above

*progressively worsening

*HA w/ neuro signs or aura

*HA w/ altered mental status

*HA w/ exertion, sexual activity, coughing or sneezing

94
Q

A patient presents with complaints of a unilateral, pulsatile headache lasting 4-72 hours. She says the pain ranges from moderate to severe in intensity, and is aggravated by physical activity (e.g. walking). During these headaches, she often has either nausea w/ vomiting or photphobia and phonophobia.

You suspect

A

Migraine without aura

*at leastr 5 attackes (unilateral, pulsatile, up to 72 hrs, disabling intensity)

*4/5 intensity = migraine

95
Q

Headaches: True/False - Migraines with auras may involve visual, sensory, motor or speech changes. Examples included parallel zigzag lines, ipsilateral arm or periorbital numbness or tingling, mild dysphagia, and/or vertigo.

Symptoms must be fully reversible!!

A

True

96
Q

Headaches: A patient presents with complaints of frequent “migraines.” When asked about her symptoms, she exhibits minimal neurological symptoms and no neurological signs. Her headaches are often episodic (happening every now and then).

She reports her HA lasts for 30 minutes, 7 days with at least 2 of the following:

  1. Pressing or tightening (non-pulsating), “band” like tension
  2. Mild-moderate intensity of HA
  3. Bilateral
  4. No aggravation by routine physical activity

She also denies nausea/vomiting. You suspect

A

Tension Headache

*due to muscle tension

One of the following:

*no nausea or vomiting

*may have photophobia, or phonophobia or neither

97
Q

A patient presents with complaints of severe, unilateral orbital (or supraorbital pain) that lasts 15-180 minutes. He admits that he has at least 5 attacks, and his headache is often associated with at least one of the following ipsilateral signs:

  • -conjunctival injection
  • -lacrimation
  • -miosis, ptosis
  • -eye edema
  • -forehead/facial sweating
  • -restlessness/agitation

He reports frequency being every other day to 8x daily. You suspect

A

Cluster (Trigeminal) HA

*may be seasonal (e.g. always during a specific season) or throughout the year

98
Q

Headaches: Primary headaches are migraines, tension and cluster/trigeminal.

True/False - Secondary headaches are often due to secondary causes including trauma, vascular disorders or infections. These tend to occur in close associateion with the other disorder, and often resolve within 3 months after treatment or spontaneous remission of the causative disorder

A

True

99
Q

Headaches: A patient presents with complaints of HA. She reports episodes of varying intensity or duration, with moderate, non-excurciating pain. She reports her pain often starts at the neck and spreads to the oculo-frontal temporal areas.

Other symptoms may include N/V, dizziness, photophobia, phonophobia, blurred vision in IL eye, and autonomic signs/symptoms. You suspect

A

Cervicogenic headache

*caused by neck issues

*may have cervicogenic vertigo: improper input to proprioceptive neck muscles

*similar to some post-concussion symptoms

100
Q

Headaches: Interventional Dx is impractical to do for everybody with neck pain and HA, however, it may be done, and may involve nerve blocks under fluoroscopy to determine what structures are causing pain.

What are the most common sites?

A

AA, C2-C3 (70% of cases) and C3-C4

**DD - migraines (neck pain and muscle tension)

**reduced ROM indicative of cervicogenic HA (dec. arterial/venous flow; trigger points)

101
Q

Headaches: The literature suggest 2 or 3 nerves as the causative agents of cervical HA. List them

A
  1. Greater occipital (C2)
  2. Lesser occipital *and greater auricular)
  3. C3 dorsal ramus
102
Q

Headaches: A patient presents with complaints of paroxysmal jabbing pain in the distribution of the greater of lesser occipital nerves. Sometimes this pain is accompanied by diminished sensation or dysesthesia in the affected area. She reports it commonly presents with tenderness over the affected area.

You suspect

A

Occipital neuralgia

*DD occipital referral pain from AA or upper cervical facet/tender trigger points in neck

NOTE: excision of greater occipital can help - only for 244 days

103
Q

Headaches: Cervical somatic dysfunction can refer pain to the head via the trigeminal pathway. The trigeminal nerve innervates cranial and fascial structures such as cerebral blood vessels and dura mater.

Afferent nerves from these joints converge with the trigeminal _____ within the spinal cord. The pain signals from the neck can be referred through the trigeminal pathway to the same field in the thalamus as the head and face.

A

trigeminal nucleus caudalis

*brain interprets as HA pain (instead of referred neck pain)

*pathophys of migrains (intracranial and extracranial nociceptive input)

104
Q

Headaches: A patient presents with a unilateral HA that he describes as brief, electric shock-like pains. They are abrupt in onset and termination, and limited to the distribution of one or more divisions of the trigeminal nerve.

The pain is commonly evoked by trivial stimuli including washing, shaving, brusshing teeth (trigger factors) and frequently occurs spontaneously.

A

Trigeminal neuralgia

105
Q

Headaches: What are contraindications to treating HA?

a. possibility of non-benign etiology (e.g. tumor, stroke)
b. acute fractures to skull or cervical vertebrae
c. acute trauma to head or neck without completed workup or established diagnosis
d. HVLA in CT disorders

A

all of the above

106
Q

Headaches: Areas to Treat for Headaches include:

  1. Upper thoracics (sterunum, clavicle, upper thoracics)
  2. Sympathetics for head and neck (T1-4)
  3. Cervical vertebrae (C2-3), cervical musculature and occipital muscles (OA)
  4. Fascial restrictions of circulation (Venous sinus drainage)
A
107
Q

Cranial: Describe the Finger placement for the FrontoOccipital Hold

A
108
Q

Cranial: Describe the finger placement for the Becker HOld

A

Thumbs on temporal mastoids or on squama

109
Q

Cranial: Review Treatments:

  1. CV4 compression (and clinical indication)
  2. V-spread
  3. Frontal Lift
A
110
Q

Cranial: Review Treatments

  1. Parietal Lift
A
  1. Parietal lift

–motion of the parietal bones =

–gental lifting traction in cephalad direction

111
Q

Cranial: Review the Steps for Venous Sinus Release

A
  1. OA decompression - until release
  2. Confluence of sinuses

–tips of middle fingers at inion

  1. Occipital sinus

–fingers on midline of occiput

  1. Condylar decompression
  2. Transverse/straight sinus

–tips of little fingers together at inion; fingers along superior nuchal line

–thumb at sagittal suture

  1. Superior sagittal sinus

–finger pads either side of metopic suture

–bregma to nasion

112
Q

Cranial: Review Glossary Terms (Rachel’s flashcards)

A
113
Q

Cranial: Review Paper Models

A

OMM (11 decks)

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