OPP 2 EXAM #1 Flashcards
Facilitated segments ONLY occur at
Sympathetics
Convexity to the right equals
left side-bending
Greatest motion in the thoracic spine is
rotation
t motion in the thoracic spine is
extension
Rib 10 can be categorized as
both a typical and atypical rib
Rotatores most likely involved in
Type II somatic dysfunction
Anterior T1-T6 counterstrain tender points are treated with
flexion
Important to treat the thoracoabdominal diaphragm if
flattened (indicates diminished zone of apposition
People with COPD are an example of people with
a flattened diaphragm and diminished zone of apposition
treatment of a flattened diaphragm and diminished zone of apposition
- improves diaphragmatic excursion which improves the pressure gradient between abdominal cavity and thoracic cavity, which helps improve lymphatic flow
- Treatment improves lymphatic flow also by relaxing the tension in the thoracoabdominal diaphragm
Vertebral bodies usually rotated towards the
side of dysfunction
If you have left lower lobe pneumonia, the vertebra will rotate to the
left
If you have gastritis, the vertebrae will rotate to the
left
If you have cholecystitis (gallbladder issues), the vertebrae will rotate to the
right
patient may be obese female, in her 40s, passing flatus after eating meals and the vertebra(e) would rotate to the
right in the area of the gallbladder
Proprioception
The subconscious mechanism involved in the self-regulation of posture and movement through stimuli originating in the receptors imbedded in every joint, tendon, and muscle and combined with info from the vestibular system
somatic dysfunction causes
altered proprioception
Type 1
- Typically applies to a group of vertebrae (more than two)
- Side-bending precedes rotation
Type 2
- Typically applies to a single vertebra
- Rotation precedes side-bending
Rule of 3’s T1-3
spinous processes project posteriorly therefore the tip of the spinous process is in the same plane as the transverse process of that vertebra
-T12
Rule of 3’s T4-6
spinous processes project slightly downward, therefore the tip of the spinous process lies in a plane halfway between that vertebra’s transverse processes and the transverse processes of the vertebra below it
-T11
Rule of 3’s T7-9
spinous processes project moderately downward, therefore the tip of the spinous process is in a plane with the transverse process below it
-T10
Examples of Indirect Techniques
- Counterstrain
- Facilitated Positional Release (FPR)
- Balanced Ligamentous Tension Technique (BLT)
- Functional Technique
FPR
- Body part in NEUTRAL position (flatten the curve/spine)
- COMPRESSION applied to shorten muscle/muscle fibers (some cases may have TRACTION instead)
- Place area into EASE of motion (INDIRECT) for 3-5 seconds
IVC hiatuses
T8
Esophagus hiatuses
T10
Aorta hiatuses
T12
Examples of Direct Techniques
Soft tissue Articulatory Muscle Energy High velocity, low amplitude (HVLA) Springing
Orientation of Superior Facets
BUM
BUL
BM
Orientation of Inferior Facets\
AIL
AIM
AL
Viscero-somatic reflex
gallstones causing tissue texture changes
Somato-visceral reflex
manipulating someone and causing constipation
post ganglionic sympathetic fibers lead to
tissue texture changes such as hypertonicity, moisture, erythema
Sympathetic Pre-ganglionics levels
T5 through L2
Celiac Ganglion (T5-T9) Post-ganglionic to
Distal Esophagus STOMACH (epigastric) Liver GALLBLADDER (cholecystitis) Spleenportions of Pancreas proximal Duodenum (foregut)
Superior Mesenteric Ganglion (T10-T11) Post-ganglionic to
Portions of Pancreas Duodenum Jejunum Ileum Ascending Colon Proximal 2/3 of Transverse Colon (midgut) Adrenals Gonads Kidneys upper ½ Ureter
Inferior Mesenteric Ganglion (T12-L2) Post-ganglionic to
Distal 1/3 Transverse Colon Descending Colon SIGMOID Rectum (hindgut) lower ½ Ureter Bladder Prostate Genitalia
Sympathetic Innervation Greater Splanchnic Nerve (T5-9) synapse
Synapses at the Celiac Ganglion\
Sympathetic Innervation Lesser Splanchnic Nerve (T10-11) synapse
Synapses at the Superior Mesenteric Ganglion
Sympathetic Innervation Least Splanchnic Nerve (T12) and Lumbar Splanchnic Nerve (L1-2) synapse
Synapses at the Inferior Mesenteric Ganglia
Sympathetic Innervation Greater Splanchnic Nerve (T5-9) innervates
Stomach Liver Gall Bladder Pancreas Parts of Duodenum
Sympathetic Innervation Lesser Splanchnic Nerve (T10-11) innervates
Small Intestines
Right Colon
(APPENDIX is found here)
Sympathetic Innervation Least Splanchnic Nerve (T12) and Lumbar Splanchnic Nerve (L1-2) innervates
Left Colon
Pelvic Organs
Sympathetic Innervation: Chapman’s Reflexes Tip of right 12th rib (right and left)
appendicitis
McBurney’s point
what has to be cleared/opened/treated BEFORE ANY other lymphatic treatment)
Thoracic inlet/outlet -Another way of saying this is that you have to open myofascial pathways at the transition zones -Examples include: Anterior cervical fascia release Thoracic inlet myofascial release Pectoral Traction
Flattening of the diaphragm causes
- Stagnation of lymph
- Increased tissue congestion
- Decreased cardiac output
- Associated with increased infection, mortality, prolonged healing time, fibrosis and scarring
Thoracoabdominal Diaphragm Must evaluate neurological influence
Phrenic Nerve/C3, C4, C5
Thoracoabdominal Diaphragm Must evaluate biomechanical influence
Where the thoracoabdominal diaphragm attaches: lower ribs, thoraco-lumbar junction, T10-L3 are examples
COPD: Musculoskeletal Changes
Restricted motion of the diaphragm
- Flattened diaphragm (Diminished Zone of Apposition)
- Decreased lymphatic drainage will occur because rib cage and diaphragm are not moving well
Pump-Handle motion
- ribs move anterior and superior with inhalation
- rib 1-5
- best palpated at mid-clavicular line
Bucket-Handle motion
- Predominantly ribs 6-10
- Ribs move laterally and increase transverse diameter with inhalation
- Best palpated at mid-axillary line
Inhalation Rib Somatic Dysfunction
Motion toward inhalation is more free
Motion toward exhalation is restricted
Exhalation Rib Somatic Dysfunction
Motion toward exhalation is more free
Motion toward inhalation is restricted
Bottom Rib is key rib in
Inhalation dysfunction
Top Rib is key rib in
Exhalation dysfunction
Exhaled ribs are prominent
posteriorly
Inhaled ribs are prominent
anteriorly
Anterior Rib Counterstrain Points are associated with
Exhalation Rib Somatic Dysfunction
Posterior Rib Counterstrain Points are associated with
Inhalation Rib Somatic Dysfunction
If pain increases when patient inhales
indicates exhalation rib somatic dysfunction
If pain increases when patient exhales
indicates inhalation rib somatic dysfunction
Strain-Counterstrain ribs 1-2
Pain in anterior chest wall
Strain-Counterstrain Ribs 3-6
Pain in lateral chest wall
Tender Point Locations AR1
Below clavicle on 1st chondrosternal articulation associated with pectoralis major and internal intercostal muscles
Tender Point Locations AR2
Superior aspect of 2nd rib in midclavicular line
Tender Point Locations AR3-10
On the dysfunctional rib at the anterior axillary line associated with the serratus anterior (AR3-8) and internal intercostal muscles (AR9-10)
Postisometric Relaxation
- Patient is Instructed to GENTLY Push AWAY From the Barrier
- doctor towards barrier
Reciprocal Inhibition
Patient is Instructed to GENTLY Push TOWARD the Barrier
-patient pushes towards the barrier
Compression fractures causes
Increased kyphosis
-altered mechanics of the thoracic spine and rib cage
Scalene triangle entrapment
- ant/mid scalene
- Brachial plexus, subclavian artery
Costoclavicular space entrapment
- 1st rib, clavicle
- Brachial plexus, subclavian artery and vein
Subcoracoid space entrapment
Overlying ribs under pectoralis minor attachment at coracoid process
Aortic Stenosis
Crescendo decrescendo
Mitral stenosis
crescendo
Aortic regurgitation
decrescendo
Mitral regurgitation
plateau
ventricular septal defect
holosystolic murmur
late systolic murmur
mitral valve prolapse
early diastolic murmur
incompetent semilunar valves
CK-MB vs Cardiac troponin
-both used for diagnosis of acute MI (CK-MB will rise first but less specific than cardiac troponin)
components of the Mini Mental Status Exam
orientation registration attention and calculation recall language
affect
what you as the doctor observe the patients mood to be
-definition: the pattern of observable behaviors which is the expression of a subjectively experienced feeling state (emotion) and is variable over time in response to changing emotional states
mood
what the patient thinks (how they feel)
patient’s ability for Judgment
process of deciding on a course of action given alternatives
patient’s ability for insight
awareness that symptoms or disturbed behaviors are normal or abnormal
Functional status
is the ability to perform tasks and fulfill social roles associated with daily living across a wide range of complexity
Functional assessment from the social history
home life, martial status, relationship status the ability to maintain stable home life and relationships; occupation -> the ability to maintain function in education and employment status; social activities -> clubs, churches, attends events
Six activities of daily living
bathing dressing toileting continence transferring feeding
instrumental activities of daily living
transportation (driving the car) taking medication (managing meds) managing money (finance, accounts, the will)
Egophony
EE sounds like AA
Bronchophony
99 will be louder and clear rather than muffled and indistinct
Fremitus
patients says a 99 and vibrations are felt
-more vibrations = positive test
Stertor
snoring
-partial obstruction of the airways from the nose to the hypopharynx
Coarse inspiratory crackles indicates
the presence of mucus (sputum) in the airways
-Bronchitis
Fine inspiratory crackles
indicating re-expansion of collapsed alveoli or respiratory bronchioles
- Pneumonia
- Atelectasis
Inspiratory strider
Indicates partial obstruction in the airways from the epiglottis until the airways enter the intrathoracic influence
Wheezing
narrowing of the airways
- Asthma
- Foreign body
- Bronchomalacia
- Extra-bronchial compression
Grunting
- Closing the glottis at the middle of expiration to increase the airway positive end expiratory pressure
- attempts to prevent collapse of the alveoli at the end of expiration
Finger Clubbing
-Caused by endothelial platelet-derived growth factor
Happens in:
1. Destructive lung disease (Cystic Fibrosis)
2. Cyanotic congenital heart disease
3. Ulcerative colitis
4. Crohn’s disease
5. Can be familial
Respiratory syncytial virus (RSV)
is a common, and very contagious, virus that infects the respiratory tract. For most babies, the infection causes nothing more than a cold, but for a small percentage, infection with RSV can lead to serious problems such as bronchiolitis, which is inflammation of the small airways of the lungs, or pneumonia, which can become life threatening. Symptoms include coughing and a runny nose, which usually lasts for 1-2 weeks
Pertussis
paroxysmal cough with a “whoop” at the end
Newborn respiratory distress
the most common etiology is transient tachypnea; this is triggered by excessive lung fluid, and symptoms usually resolve spontaneously. Can occur in premature infants as a result of surfactant deficiency and underdeveloped lung anatomy
